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Pubblicazioni recenti - cardiac failure
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Deficiency of HTR4 and ADRB1 caused by SARS-CoV-2 spike may partially explain multiple COVID-19 related syndromes including depression, cognitive impairment, loss of appetite, heart failure, and hypertension.
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Machine Learning for Diastology and Heart Failure With Preserved Ejection Fraction: Hype or Hope?
J Am Soc Echocardiogr2022 Dec;35(12):1256-1258. doi: 10.1016/j.echo.2022.10.003.
Lam Carolyn S P, Ho Jennifer E,
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Xinyang Tablet attenuates chronic hypoxia-induced right ventricular remodeling via inhibiting cardiomyocytes apoptosis.
Chin Med2022 Dec;17(1):134. doi: 10.1186/s13020-022-00689-2.
Gao An-Ran, Li Shuo, Tan Xiao-Cui, Huang Ting, Dong Hua-Jin, Xue Rui, Li Jing-Cao, Zhang Yang, Zhang You-Zhi, Wang Xiao,
Abstract
BACKGROUND:
Hypoxia-induced pulmonary hypertension (HPH) is one of the fatal pathologies developed under hypobaric hypoxia and eventually leads to right ventricular (RV) remodeling and RV failure. Clinically, the mortality rate of RV failure caused by HPH is high and lacks effective drugs. Xinyang Tablet (XYT), a traditional Chinese medicine exhibits significant efficacy in the treatment of congestive heart failure and cardiac dysfunction. However, the effects of XYT on chronic hypoxia-induced RV failure are not clear.
METHODS:
The content of XYT was analyzed by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS). Sprague-Dawley (SD) rats were housed in a hypobaric chamber (equal to the parameter in altitude 5500 m) for 21 days to obtain the RV remodeling model. Electrocardiogram (ECG) and hemodynamic parameters were measured by iWorx Acquisition & Analysis System. Pathological morphological changes in the RV and pulmonary vessels were observed by H&E staining and Masson's trichrome staining. Myocardial apoptosis was tested by TUNEL assay. Protein expression levels of TNF-?, IL-6, Bax, Bcl-2, and caspase-3 in the RV and H9c2 cells were detected by western blot. Meanwhile, H9c2 cells were induced by CoCl to establish a hypoxia injury model to verify the protective effect and mechanisms of XYT. A CCK-8 assay was performed to determine the viability of H9c2 cells. CoCl-induced apoptosis was detected by Annexin-FITC/PI flow cytometry and Hoechst 33,258 staining.
RESULTS:
XYT remarkably improved RV hemodynamic disorder and ECG parameters. XYT attenuated hypoxia-induced pathological injury in RV and pulmonary vessels. We also observed that XYT treatment decreased the expression levels of TNF-?, IL-6, Bax/Bcl-2 ratio, and the numbers of myocardial apoptosis in RV. In H9c2 myocardial hypoxia model, XYT protected H9c2 cells against Cobalt chloride (CoCl)-induced apoptosis. We also found that XYT could antagonize CoCl-induced apoptosis through upregulating Bcl-2, inhibiting Bax and caspase-3 expression.
CONCLUSIONS:
We concluded that XYT improved hypoxia-induced RV remodeling and protected against cardiac injury by inhibiting apoptosis pathway in vivo and vitro models, which may be a promising therapeutic strategy for clinical management of hypoxia-induced cardiac injury.
© 2022. The Author(s).
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Incremental prognostic value of global longitudinal strain to the coronary microvascular resistances in Takotsubo patients.
Int J Cardiovasc Imaging2022 Dec;():. doi: 10.1007/s10554-022-02767-w.
Sans-Roselló Jordi, Fernández-Peregrina Estefanía, Duran-Cambra Albert, Carreras-Mora Jose, Sionis Alessandro, Álvarez-García Jesús, Garcia-Garcia Hector M,
Abstract
BACKGROUND:
Global longitudinal strain (GLS) allows an accurate assessment of left ventricular function with prognostic value. We aimed to evaluate whether the assessment of GLS in the acute phase of Takotsubo syndrome (TTS) provides incremental prognostic value to the degree of impaired microvascular resistance (MR) in TTS patients at 1-year follow-up.
METHODS:
We recruited patients admitted for TTS who underwent cardiac angiography and echocardiography from January 2017 to June 2020. Left anterior descending coronary artery non-hyperaemic angiography-derived index of microcirculatory resistance (LAD NH-IMRangio) was calculated. NT-proBNP, high-sensitive cardiac troponin T (hs-cTnT), left ventricular ejection fraction (LVEF) and GLS were measured at admission. Major adverse cardiac events (MACE) were defined as the composite of cardiovascular death, repeat hospitalizations for heart failure (HF) and acute myocardial infarctions.
RESULTS:
67 patients had both GLS and NH-IMRangio available and were included in the study. Median age was 75.2 years and 88% were women. Rate of MACE at 1-year was 13.4%. Kaplan-Meier curves showed higher rates of MACE at 1-year in patients with both higher LAD NH-IMRangio and GLS values compared with those with higher LAD NH-IMRangio and lower GLS values (33.3% vs. 11.1%; p?=?0.049). NT-proBNP levels at admission and the recovery of LVEF were correlated with GLS values while MR and hs-cTnT were not.
CONCLUSION:
GLS provides incremental prognostic value to the degree of impaired MR in TTS patients. The combination of a poorer GLS with a higher degree of impaired MR was associated with a higher rate of MACE in these patients.
© 2022. The Author(s), under exclusive licence to Springer Nature B.V.
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Prognostic value of left ventricular global constructive work in patients with cardiac amyloidosis.
Int J Cardiovasc Imaging2022 Dec;():. doi: 10.1007/s10554-022-02762-1.
Geers Jolien, Luchian Maria-Luiza, Motoc Andreea, De Winter Jari, Roosens Bram, Bjerke Maria, Van Eeckhaut Ann, Wittens Mandy M J, Demeester Simke, Forsyth Ramses, de Ravel Thomy, Bissay Véronique, Schots Rik, Verbrugge Frederik H, Weytjens Caroline, Weets Ilse, Cosyns Bernard, Droogmans Steven,
Abstract
PURPOSE:
The aim of the present study was to evaluate the role of ejection fraction (EF), left ventricular (LV) global longitudinal strain (LVGLS) and global constructive work (GCW) as prognostic variables in patients with cardiac amyloidosis (CA).
METHODS:
CA patients were retrospectively identified between 2015 and 2021 at a tertiary care hospital. Comprehensive clinical, biochemical, and imaging evaluation including two-dimensional (2D) echocardiography with myocardial work (MW) analysis was performed. A clinical combined endpoint was defined as all-cause mortality and heart failure readmission.
RESULTS:
70 patients were followed for 16 (7-37) months and 37 (52.9%) reached the combined endpoint. Patient with versus without clinical events had a significantly lower LVEF (40.71% vs. 48.01%, p?=?0.039), LVGLS (-9.26 vs. -11.32, p?=?0.034) and GCW (1034.47mmHg% vs. 1424.86mmHg%, p?=?0.011). Multivariable analysis showed that LVEF ( odds ratio (OR): 0.904; 95% confidence interval (CI): 0.839-0.973, p?=?0.007), LVGLS ( OR: 0.620; 95% CI: 0.415-0.926, p?=?0.020) and GCW ( OR: 0.995; 95% CI: 0.990-0.999, p?=?0.016) were significant predictors of outcome, but the model including GCW had the best discriminative ability to predict the combined endpoint (C-index?=?0.888). A GCW less than 1443mmHg% was able to predict the clinical endpoint with a sensitivity of 94% and a specificity of 64% (Area under the curve (AUC): 0.771 (95% CI: 0.581-0.961; p?=?0.005)).
CONCLUSION:
In CA patients, GCW may be of additional prognostic value to LVEF and GLS in predicting heart failure hospitalization and all-cause mortality.
© 2022. The Author(s), under exclusive licence to Springer Nature B.V.
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A fully-automated paper ECG digitisation algorithm using deep learning.
Sci Rep2022 Dec;12(1):20963. doi: 10.1038/s41598-022-25284-1.
Wu Huiyi, Patel Kiran Haresh Kumar, Li Xinyang, Zhang Bowen, Galazis Christoforos, Bajaj Nikesh, Sau Arunashis, Shi Xili, Sun Lin, Tao Yanda, Al-Qaysi Harith, Tarusan Lawrence, Yasmin Najira, Grewal Natasha, Kapoor Gaurika, Waks Jonathan W, Kramer Daniel B, Peters Nicholas S, Ng Fu Siong,
Abstract
There is increasing focus on applying deep learning methods to electrocardiograms (ECGs), with recent studies showing that neural networks (NNs) can predict future heart failure or atrial fibrillation from the ECG alone. However, large numbers of ECGs are needed to train NNs, and many ECGs are currently only in paper format, which are not suitable for NN training. We developed a fully-automated online ECG digitisation tool to convert scanned paper ECGs into digital signals. Using automated horizontal and vertical anchor point detection, the algorithm automatically segments the ECG image into separate images for the 12 leads and a dynamical morphological algorithm is then applied to extract the signal of interest. We then validated the performance of the algorithm on 515 digital ECGs, of which 45 were printed, scanned and redigitised. The automated digitisation tool achieved 99.0% correlation between the digitised signals and the ground truth ECG (n = 515 standard 3-by-4 ECGs) after excluding ECGs with overlap of lead signals. Without exclusion, the performance of average correlation was from 90 to 97% across the leads on all 3-by-4 ECGs. There was a 97% correlation for 12-by-1 and 3-by-1 ECG formats after excluding ECGs with overlap of lead signals. Without exclusion, the average correlation of some leads in 12-by-1 ECGs was 60-70% and the average correlation of 3-by-1 ECGs achieved 80-90%. ECGs that were printed, scanned, and redigitised, our tool achieved 96% correlation with the original signals. We have developed and validated a fully-automated, user-friendly, online ECG digitisation tool. Unlike other available tools, this does not require any manual segmentation of ECG signals. Our tool can facilitate the rapid and automated digitisation of large repositories of paper ECGs to allow them to be used for deep learning projects.
© 2022. The Author(s).
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Efficacy of empagliflozin in heart failure with preserved versus mid-range ejection fraction: a pre-specified analysis of EMPEROR-Preserved.
Nat Med2022 Dec;():. doi: 10.1038/s41591-022-02041-5.
Anker Stefan D, Butler Javed, Usman Muhammad Shariq, Filippatos Gerasimos, Ferreira João Pedro, Bocchi Edimar, Böhm Michael, Rocca Hans Pieter Brunner-La, Choi Dong-Ju, Chopra Vijay, Chuquiure Eduardo, Giannetti Nadia, Gomez-Mesa Juan Esteban, Janssens Stefan, Januzzi James L, González-Juanatey José R, Merkely Bela, Nicholls Stephen J, Perrone Sergio V, Piña Ileana L, Ponikowski Piotr, Senni Michele, Sim David, Spinar Jindrich, Squire Iain, Taddei Stefano, Tsutsui Hiroyuki, Verma Subodh, Vinereanu Dragos, Zhang Jian, Iwata Tomoko, Schnee Janet M, Brueckmann Martina, Pocock Stuart J, Zannad Faiez,
Abstract
The EMPEROR-Preserved trial showed that the sodium-glucose co-transporter 2 inhibitor empagliflozin significantly reduces the risk of cardiovascular death or hospitalization for heart failure (HHF) in heart failure patients with left ventricular ejection fraction (LVEF) ?>?40%. Here, we report the results of a pre-specified analysis that separately evaluates these patients stratified by LVEF: preserved (??50%) (n?=?4,005; 66.9%) or mid-range (41-49%). In patients with LVEF ???50%, empagliflozin reduced the risk of cardiovascular death or HHF (the primary endpoint) by 17% versus placebo (hazard ratio (HR) 0.83; 95% confidence interval (CI): 0.71-0.98, P?=?0.024). For the key secondary endpoint, the HR for total HHF was 0.83 (95%CI: 0.66-1.04, P?=?0.11). For patients with an LVEF of 41-49%, the HR for empagliflozin versus placebo was 0.71 (95%CI: 0.57-0.88, P?=?0.002) for the primary outcome (P?=?0.27), and 0.57 (95%CI: 0.42-0.79, P?0.001) for total HHF (P?=?0.06). These results, together with those from the EMPEROR-Reduced trial in patients with LVEF?40%, support the use of empagliflozin across the full spectrum of LVEF in heart failure.
© 2022. The Author(s).
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Targeting endogenous kidney regeneration using anti-IL11 therapy in acute and chronic models of kidney disease.
Nat Commun2022 Dec;13(1):7497. doi: 10.1038/s41467-022-35306-1.
Widjaja Anissa A, Viswanathan Sivakumar, Shekeran Shamini G, Adami Eleonora, Lim Wei-Wen, Chothani Sonia, Tan Jessie, Goh Joyce Wei Ting, Chen Hui Mei, Lim Sze Yun, Boustany-Kari Carine M, Hawkins Julie, Petretto Enrico, Hübner Norbert, Schafer Sebastian, Coffman Thomas M, Cook Stuart A,
Abstract
The kidney has large regenerative capacity, but this is compromised when kidney damage is excessive and renal tubular epithelial cells (TECs) undergo SNAI1-driven growth arrest. Here we investigate the role of IL11 in TECs, kidney injury and renal repair. IL11 stimulation of TECs induces ERK- and p90RSK-mediated GSK3? inactivation, SNAI1 upregulation and pro-inflammatory gene expression. Mice with acute kidney injury upregulate IL11 in TECs leading to SNAI1 expression and kidney dysfunction, which is not seen in Il11 deleted mice or in mice administered a neutralizing IL11 antibody in either preemptive or treatment modes. In acute kidney injury, anti-TGF? reduces renal fibrosis but exacerbates inflammation and tubule damage whereas anti-IL11 reduces all pathologies. Mice with TEC-specific deletion of Il11ra1 have reduced pathogenic signaling and are protected from renal injury-induced inflammation, fibrosis, and failure. In a model of chronic kidney disease, anti-IL11 therapy promotes TEC proliferation and parenchymal regeneration, reverses fibroinflammation and restores renal mass and function. These data highlight IL11-induced mesenchymal transition of injured TECs as an important renal pathology and suggest IL11 as a therapeutic target for restoring stalled endogenous regeneration in the diseased kidney.
© 2022. The Author(s).
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Chronic obstructive pulmonary disease features in patients visiting primary respiratory clinic and tertiary hospital in Japan.
Respir Investig2022 Dec;():. doi: S2212-5345(22)00152-6.
Terada Kunihiko, Tanabe Naoya, Shiraishi Yusuke, Hamakawa Yoko, Shima Hiroshi, Maetani Tomoki, Terada Satoru, Sato Susumu, Kanezaki Masashi, Hirai Toyohiro,
Abstract
Pulmonologists in primary care clinics are positioned between those in tertiary hospitals and general practitioners in clinics and are anticipated to promote hospital-clinic collaboration for patients with chronic obstructive pulmonary disease (COPD). However, the clinical features of patients in primary respiratory clinics are unclear. This multicenter study cross-sectionally compared the characteristics of patients with COPD in a respiratory clinic (n = 69) with those in a university hospital (n = 124). More patients visited the clinic for symptom relief without a referral, whereas more visited the hospital for consultation of abnormal spirometry/computed tomography (CT). The patients in the clinic showed female predilection, higher prevalence of current smokers, severe dyspnea, and concomitant heart failure, and higher CT-measured cross-sectional area ratio of pectoralis muscle to adjacent subcutaneous adipose tissue compared to those in the hospital (all p
Copyright © 2022 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.
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Outcomes in Diabetic patients treated with SGLT2-Inhibitors with Acute Myocardial Infarction undergoing PCI: The SGLT2-I AMI PROTECT Registry.
Pharmacol Res2022 Dec;():106597. doi: 10.1016/j.phrs.2022.106597.
Paolisso Pasquale, Bergamaschi Luca, Gragnano Felice, Gallinoro Emanuele, Cesaro Arturo, Sardu Celestino, Mileva Niya, Foà Alberto, Armillotta Matteo, Sansonetti Angelo, Amicone Sara, Impellizzeri Andrea, Esposito Giuseppe, Nuccia Morici, Andrea Oreglia Jacopo, Casella Gianni, Mauro Ciro, Vassilev Dobrin, Galie Nazzareno, Santulli Gaetano, Marfella Raffaele, Calabrò Paolo, Pizzi Carmine, Barbato Emanuele,
Abstract
AIMS:
To investigate in-hospital and long-term prognosis in T2DM patients presenting with acute myocardial infarction (AMI) treated with SGLT2-I versus other oral anti-diabetic agents (non-SGLT2-I users).
METHODS:
In this multicenter international registry all consecutive diabetic AMI patients undergoing percutaneous coronary intervention between 2018 and 2021 were enrolled and, based on the admission anti-diabetic therapy, divided into SGLT-I users versus non-SGLT2-I users. The primary endpoint was defined as a composite of cardiovascular death, recurrent AMI, and hospitalization for HF (MACE). Secondary outcomes included i) in-hospital cardiovascular death, recurrent AMI, occurrence of arrhythmias, and contrast-induced acute kidney injury (CI-AKI); ii) long-term cardiovascular mortality, recurrent AMI, heart failure (HF) hospitalization.
RESULTS:
The study population consisted of 646 AMI patients (with or without ST-segment elevation): 111 SGLT2-I users and 535 non-SGLT-I users. The use of SGLT2-I was associated with a significantly lower in-hospital cardiovascular death, arrhythmic burden, and occurrence of CI-AKI (all p
CONCLUSIONS:
In T2DM AMI patients, the use of SGLT2-I was associated with a lower risk of adverse cardiovascular outcomes during index hospitalization and long-term follow-up. Our findings provide new insights into the cardioprotective effects of SGLT2-I in the setting of AMI.
REGISTRATION:
data are part of the observational international registry: SGLT2-I AMI PROTECT.
CLINICALTRIALS:
gov Identifier: NCT05261867.
Copyright © 2022. Published by Elsevier Ltd.
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Prognostic Impact of Indeterminate Diastolic Function in Patients with Functionally Insignificant Coronary Stenosis.
J Am Soc Echocardiogr2022 Dec;():. doi: S0894-7317(22)00637-X.
Chung Yu Jin, Choi Ki Hong, Lee Seung Hun, Shin Doosup, Hong David, Park Sugeon, Joh Hyun Sung, Kim Hyun Kuk, Ha Sang Jin, Park Taek Kyu, Yang Jeong Hoon, Song Young Bin, Hahn Joo-Yong, Choi Seung-Hyuk, Gwon Hyeon-Cheol, Lee Joo Myung,
Abstract
BACKGROUND:
Cardiac diastolic dysfunction is an independent predictor of mortality, regardless of LV systolic function. However, the current guidelines that define cardiac diastolic dysfunction may underrate the clinical implications of those with indeterminate diastolic function.
OBJECTIVES:
We sought to evaluate the prognostic implications of indeterminate diastolic function on echocardiography and its association with coronary microvascular dysfunction (CMD).
METHODS:
A total of 330 patients without LV systolic dysfunction and significant epicardial coronary stenosis (fractional flow reserve>0.80) were analyzed from a prospective registry. Cardiac diastolic dysfunction was defined according to two algorithms depending on the presence of myocardial disease. First, the presence of myocardial disease and evidence of elevated LV filling pressure indicated diastolic dysfunction. Second, diastolic function in those without myocardial disease was defined using echocardiographic parameters (E/e', e' velocity, tricuspid regurgitation velocity, and left atrial volume index). Patients who did not meet half of the available criteria were classified as having indeterminate diastolic function. CMD was defined as coronary flow reserve
RESULTS:
Coronary flow reserve was lower in patients with indeterminate diastolic function compared with those with no diastolic dysfunction (3.5±1.6 vs. 3.2±1.6, P=0.002). The prevalence of CMD was also higher in patients with indeterminate diastolic function than those with no diastolic dysfunction (10.6% vs. 4.9%, P14) were independent predictors for cardiovascular death or admission for heart failure in patients with indeterminate diastolic function.
CONCLUSION:
Patients with indeterminate diastolic function on echocardiogram showed higher risk of cardiovascular death or admission for heart failure than those with no diastolic dysfunction. Presence of CMD and elevated LV filling pressure were independent predictors for cardiovascular death or admission for heart failure among patients with indeterminate diastolic function.
Copyright © 2022. Published by Elsevier Inc.
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Higher Work of Breathing during Exercise in Heart Failure with Preserved Ejection Fraction.
Chest2022 Dec;():. doi: S0012-3692(22)04209-X.
Villarraga Nicolas, Warner Brit, Bruhn Eric J, Hammer Shane M, Bissen Thomas G, Olson Thomas P, Smith Joshua R,
Abstract
BACKGROUND:
It is unknown if pulmonary alterations in heart failure with preserved ejection fraction (HFpEF) impacts respiratory mechanics during exercise.
RESEARCH QUESTION:
Are the operating lung volumes, work of breathing (Wb), and power of breathing (Pb) abnormal in HFpEF patients during exercise?
STUDY DESIGN AND METHODS:
HFpEF (n=8; age: 71 (66-80) yrs) and controls (n=9; age: 68 (64-74) yrs) performed incremental cycling to volitional exhaustion. Esophageal pressure, end-expiratory and inspiratory lung volumes (EELV and EILV), and ventilatory variables were compared at similar absolute (30 and 50 L/min) and relative (45%, 70%, and 100%peak) ventilations (V) during exercise.
RESULTS:
During exercise, EELV were not different between HFpEF and controls (all, p>0.13). EILV were lower in HFpEF than controls at 45% and 70%Vpeak (all, p
INTERPRETATION:
These data demonstrate the HFpEF syndrome is associated with pulmonary alterations eliciting a greater Pb during exercise due to greater inspiratory and expiratory resistive Pb.
Copyright © 2022. Published by Elsevier Inc.
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Heart Failure is Associated with Early Medical and Surgery-related Complications Following THA: A Propensity-Scored Analysis.
J Arthroplasty2022 Dec;():. doi: S0883-5403(22)01031-2.
Sequeira Sean B, Boucher Henry R,
Abstract
INTRODUCTION:
There is a paucity of literature that examines how heart failure (HF) impacts surgery-related complications following total hip arthroplasty (THA). We hypothesized that patients who had HF will be at increased risk of early medical- and surgery-related complications following THA.
METHODS:
Patients who had HF and underwent primary THA between 2010 and 2019 were identified using a large national insurance database. Ninety-day incidence of various medical complications, surgery-related complications, and hospital utilizations were evaluated for patients who did and did not have HF, as well as subgroup analyses on patients who were prescribed mortality-benefitting medications for HF one year prior to THA. Propensity score matching resulted in 34,000 HF patients who underwent primary THA and 340,000 matching patients.
RESULTS:
The HF cohort was associated with a higher 90-day incidence of pulmonary embolism (PE), deep vein thrombosis (DVT), transfusion, pneumonia, cerebrovascular accident (CVA), myocardial infarction (MI), sepsis, acute post hemorrhagic anemia, acute renal failure, and urinary tract infection, as well as one year risk of revision THA, periprosthetic joint infection, aseptic loosening, and dislocation compared to controls. The HF cohort was associated with a higher 90-day incidence of emergency department (ED) visits, readmissions, lengths of stay, and one-year costs of care. The medication cohort was at decreased risk of PE, DVT, CVA, return to ED, readmission and MI within 90 days of surgery, and one-year risk of revision THA and aseptic loosening.
DISCUSSION:
These findings may help to better risk stratify patients who have HF and are scheduled to undergo THA, as well as call for additional surveillance of these patients in the immediate and early postoperative period. This study also helps surgeons and internists understand how chronic medications used to treat HF can impact medical- and surgery-related outcomes following THA.
Copyright © 2022. Published by Elsevier Inc.
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dATP elevation induces myocardial metabolic remodeling to support improved cardiac function.
J Mol Cell Cardiol2022 Dec;():. doi: S0022-2828(22)00570-3.
Mhatre Ketaki N, Murray Jason D, Flint Galina, McMillen Timothy S, Weber Gerhard, Shakeri Majid, Tu An-Yue, Steczina Sonette, Weiss Robert, Marcinek David J, Murry Charles E, Raftery Daniel, Tian Rong, Moussavi-Harami Farid, Regnier Michael,
Abstract
Hallmark features of systolic heart failure are reduced contractility and impaired metabolic flexibility of the myocardium. Cardiomyocytes (CMs) with elevated deoxy ATP (dATP) via overexpression of ribonucleotide reductase (RNR) enzyme robustly improve contractility. However, the effect of dATP elevation on cardiac metabolism is unknown. Here, we developed proteolysis-resistant versions of RNR and demonstrate that elevation of dATP/ATP to ~1% in CMs in a transgenic mouse (TgRRB) resulted in robust improvement of cardiac function. Pharmacological approaches showed that CMs with elevated dATP have greater basal respiratory rates by shifting myosin states to more active forms, independent of its isoform, in relaxed CMs. Targeted metabolomic profiling revealed a significant reprogramming towards oxidative phosphorylation in TgRRB-CMs. Higher cristae density and activity in the mitochondria of TgRRB-CMs improved respiratory capacity. Our results revealed a critical property of dATP to modulate myosin states to enhance contractility and induce metabolic flexibility to support improved function in CMs.
Copyright © 2022. Published by Elsevier Ltd.
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The optimization of guideline-directed medical therapy during hospitalization among patients with heart failure with reduced ejection fraction in daily clinical practice.
Cardiology2022 Dec;():. doi: 10.1159/000528505.
Bánfi-Bacsárdi Fanni, Muk Balázs, Pilecky David, Duray Gábor Zoltán, Kiss Róbert Gábor, Nyolczas Noémi,
Abstract
INTRODUCTION:
Hospitalization due to heart failure (HF) progression is associated with poor prognosis. This highlights the role of the implementation of guideline-directed medical therapy (GDMT) in improving the morbidity and mortality of patients with heart failure with reduced ejection fraction (HFrEF). There is limited data about the intrahospital applicability of GDMT in real-world circumstances. We aimed to assess retrospectively the use of cornerstone GDMT including RASi (ACEI/ARB/ARNI), ?B, MRA, and SGLT2i treatment in a consecutive real-world HFrEF patient population admitted with signs and symptoms of heart failure to the HF unit of a Hungarian tertiary cardiac centre between 2019 and 2021. The independent predictors of therapy optimization and the applicability of new HFrEF medication (ARNI, SGLT2i, vericiguat) were also investigated.
METHODS:
Statistical comparison of admission and discharge medication was accomplished with Fisher's exact test. The independent predictors of the introduction of triple therapy (RASi+?B+MRA) were analyzed using univariate and multivariate logistic regression. The proportion of patients eligible for vericiguat based on the inclusion and exclusion criteria of the VICTORIA trial was also investigated, as well as the number of patients suitable for ARNI and SGLT2i, taking into account the contraindications of application contained in the ESC 2021 HF Guidelines.
RESULTS:
238 patients were included. During hospitalization, the use of RASi (69% vs. 89%) (ACEI/ARBs (58% vs. 70%), ARNI (10% vs. 19%)), ?Bs (69% vs. 85%), and MRAs (61% vs. 95%) increased significantly (p
CONCLUSION:
High rates of application of disease-modifying drugs are achievable among hospitalized HFrEF patients in severe clinical condition, thus awareness of the need for the initiation of the former must be raised.
S. Karger AG, Basel.
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Time Trend in Incidence of Sudden Cardiac Death After Percutaneous Coronary Intervention from 2009 to 2017 (from the Japanese Multicenter Registry).
Am J Cardiol2022 Dec;188():44-51. doi: 10.1016/j.amjcard.2022.11.019.
Nakamaru Ryo, Shiraishi Yasuyuki, Niimi Nozomi, Ueda Ikuko, Ikemura Nobuhiro, Suzuki Masahiro, Noma Shigetaka, Inohara Taku, Numasawa Yohei, Fukuda Keiichi, Kohsaka Shun,
Abstract
The advances in the integrated management of patients with coronary artery disease undergoing percutaneous coronary intervention (PCI) have reduced subsequent cardiovascular events. Nonetheless, sudden cardiac death (SCD) remains a major concern. Therefore, we aimed to investigate the time trend in SCD incidence after PCI and to identify the clinical factors contributing to SCD. From a prospective, multicenter cohort registry in Japan, 8,723 consecutive patients with coronary artery disease undergoing PCI between 2009 and 2017 were included. We evaluated the SCD incidence 2 years after PCI; all death events were adjudicated, and SCD was defined as unexpected death without a noncardiovascular cause in a previously stable patient within 24 hours from the onset. The Fine and Gray method was used to identify the factors associated with SCD. Overall, the mean age of the patients was 68.3 ± 11.3 years, and 1,173 patients (13.4%) had heart failure (HF). During the study period, the use of second-generation drug-eluting stents increased. The 2-year cumulative incidence of all-cause mortality and SCD was 4.29% and 0.45%, respectively. All-cause mortality remained stable during the study period (p for trend = 0.98), whereas the crude incidence of SCD tended to decrease over the study period (p for trend = 0.052). HF was the strongest predictor associated with the risk of SCD (crude incidence [vs non-HF] 2.13% vs 0.19%; p
Copyright © 2022 Elsevier Inc. All rights reserved.
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In acute decompensated HF, adding acetazolamide to IV loop diuretics reduced congestion at 3 d.
Ann Intern Med2022 Dec;():. doi: 10.7326/J22-0095.
Bavishi Chirag,
Abstract
Mullens W, Dauw J, Martens P, et al. N Engl J Med. 2022;387:1185-95. 36027559.
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Changes in the Characteristics and Outcomes of COVID-19 Patients from the Early Pandemic to the Delta Variant Epidemic: A Nationwide Population-based Study.
Emerg Microbes Infect2022 Dec;():1-40. doi: 10.1080/22221751.2022.2155250.
Miyashita Koichi, Hozumi Hironao, Furuhashi Kazuki, Nakatani Eiji, Inoue Yusuke, Yasui Hideki, Karayama Masato, Suzuki Yuzo, Fujisawa Tomoyuki, Enomoto Noriyuki, Inui Naoki, Ojima Toshiyuki, Suda Takafumi,
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed because of virus mutations, vaccine dissemination, treatment development and policies, among other factors. These factors have a dynamic and complex effect on the characteristics and outcomes of patients. Therefore, there is an urgent need to understand those changes and update the evidence. We used a large-scale real-world data set of 937,758 patients with COVID-19 from a nationwide claims database that included outpatients and inpatients in Japan to investigate the changes in their characteristics, outcomes and risk factors for severity/mortality from the early pandemic to the delta variant-predominant waves. The severity of COVID-19 was defined according to the modified World Health Organization clinical-progression ordinal scale. With changing waves, mean patient age decreased, and proportion of patients with comorbidities decreased. The incidences of "severe COVID-19 or death (i.e. ?severe COVID-19)" and "death" markedly declined (5.0% and 2.9%, wild-type-predominant; 4.6% and 2.2%, alpha variant-predominant and 1.4% and 0.4%, delta variant-predominant waves, respectively). Across the wave shift, risk factors for ?severe COVID-19 and death, including older age, male, malignancy, congestive heart failure and chronic obstructive pulmonary disease, were largely consistent. The significance of some factors, such as liver disease, varied as per the wave. This study, one of the largest population-based studies on COVID-19, showed that patient characteristics and outcomes changed during the waves. Risk factors for severity/mortality were similar across all waves, but some factors were inconsistent. These data suggest that the clinical status of COVID-19 will change further with the coming epidemic wave.
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Percutaneous Pulmonary Artery Cannulation to Treat Acute Secondary Right Heart Failure While on Veno-venous Extracorporeal Membrane Oxygenation.
ASAIO J2022 Dec;68(12):1483-1489. doi: 10.1097/MAT.0000000000001692.
Ivins-O'Keefe Kelly M, Cahill Michael S, Mielke Arthur R, Sobieszczyk Michal J, Sams Valerie G, Mason Phillip E, Read Matthew D,
Abstract
Right heart failure (RHF) is a common, yet difficult to manage, complication of severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation (ECMO) that is associated with increased mortality. Reports of the use of percutaneous mechanical circulatory support devices for concurrent right heart and respiratory failure are limited. This series describes the percutaneous cannulation of the pulmonary artery for conversion from veno-venous to veno-pulmonary artery return ECMO in 21 patients who developed secondary RHF. All patients cannulated between May 2019 and September 2021 were included. Either a 19 or 21 French venous cannula was placed percutaneously into the pulmonary artery via the internal jugular or subclavian vein, providing a total of 821 days of support (median 23 [4-71] days per patient) with flows up to 6?L/min. Five patients underwent cannulation at the bedside, with the remainder performed in the cardiac catheterization laboratory. Pulmonary artery cannulation occurred after 12 [8.5-23.5] days of ECMO support. Vasoactive infusion requirements decreased significantly within 24 hours of pulmonary artery cannula placement (p = 0.0004). Nonetheless, 75% of these patients expired after a median of 12 [4-63] days of support, with three patients found to have had significant pericardial effusions peri-arrest. This cannulation technique may be an effective alternative to veno-arterial ECMO cannulation or the placement of a dual-lumen cannula for the treatment of RHF.
Copyright © ASAIO 2022.
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Concomitant tricuspid valve repair in left ventricular assist device implantation may increase the risk for temporary right ventricular support but does not impact overall outcomes.
Eur J Cardiothorac Surg2022 Dec;():. doi: ezac555.
Mihalj Maks, Jezovnik Mateja K, Benk Julia, Heg Dik, Podstatzky-Lichtenstein Teresa, Beyersdorf Friedhelm, Radovancevic Rajko, Gregoric Igor D, Hunziker Lukas, Siepe Matthias, Reineke David,
Abstract
OBJECTIVES:
Tricuspid valve repair in left ventricular assist device implantation continues to pose a challenge and may impact the occurrence of early and late right heart failure. We investigated the effects of concomitant tricuspid repair on clinical outcomes.
METHODS:
A retrospective, multicentre study enrolled adult patients who received continuous-flow left ventricular assist devices between 2005 and 2017 and compared those who received concomitant tricuspid valve repair to those who did not. Primary outcomes were early right heart failure necessitating temporary ventricular assist devices and right heart failure-related rehospitalizations requiring inotropic or diuretic treatment.
RESULTS:
Out of 526 patients who underwent left ventricular assist device implantation, 110 (21%) received a concomitant tricuspid valve repair. Those patients were sicker, and most had moderate or severe tricuspid regurgitation. A significantly higher incidence of temporary right ventricular assist devices was observed in the group with concomitant tricuspid valve repair (18% vs 11%, P?=?0.049), with a significantly elevated risk for temporary right heart assist device (sHR 1.68 [95% CI 1.04-2.72], P?=?0.037). After adjusting for confounders, no significant differences were found in the incidence of and risk for most clinical outcomes, including right heart failure-related rehospitalizations (P?=?0.891) and death (P?=?0.563).
CONCLUSIONS:
Concomitant tricuspid valve repair, when deemed necessary in left ventricular assist device implantation, may increase the risk of early right heart failure requiring a temporary right ventricular assist device but does not impact the incidence or risk of death or rehospitalizations due to late right heart failure.
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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