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Pubblicazioni recenti - cardiac failure
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Predictive value of lower extremity color doppler ultrasonography before knee arthroplasty on a postoperative cardiovascular event.
Knee2021 Jan;28():266-272. doi: S0968-0160(20)30410-5.
Alt?nayak Harun, Balta Orhan,
Abstract
BACKGROUND:
The study intended to determine the presence of lower limb arterial calcification (LLAC) in lower extremity color Doppler ultrasonography (CDUS) before primary total knee arthroplasty (TKA) and its relation with cardiovascular events (CVE) during knee arthroplasty and the postoperative period, as well as to investigate its effect on surgical risk estimation.
METHODS:
We designed this study as a retrospective cohort study. The study comprised 467 patients who met the inclusion criteria and had surgery for a primary gonarthrosis diagnosis between January 2005 and December 2015 were included. In the study group, patients with arterial calcification in the lower extremity CDUS were included; however, those reported not to have it were included in the control group. The research data were obtained from preoperative anesthesia records and patient medical records.
RESULTS:
72% of the sample had preoperative cardiovascular comorbidity. There was no difference between the groups in terms of comorbidities, except for congestive heart failure (CHF) and peripheral artery disease (PAD). The groups did not differ in terms of ASA scores, either. Both pre- and post-operative CVEs, i.e., ischemic heart disease, dysrhythmia, and CHF, were statistically high in the study group. In terms of postoperative mortality, there was no statistical difference between the groups.
CONCLUSION:
The study demonstrates that the presence of LLAC in CDUS is associated with increased risk of perioperative cardiovascular events (CVEs). Ultrasonographic detection of LLAC may give some idea the surgeon about the requirement for additional preoperative cardiac examinations.
Copyright © 2020 Elsevier B.V. All rights reserved.
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Real-time exercise reduces impaired cardiac function in breast cancer patients undergoing chemotherapy: a randomized controlled trial.
Ann Phys Rehabil Med2021 Jan;():101485. doi: S1877-0657(21)00003-8.
Chung Wei-Pang, Yang Hsin-Lun, Hsu Ya-Ting, Hung Ching-Hsia, Liu Ping-Yen, Liu Yen-Wen, Chan Shih-Hung, Tsai Kun-Ling,
Abstract
BACKGROUND:
Previous studies have reported that chemotherapy results in substantial long-term risk of heart failure. Exercise ameliorates exercise responses and exercise tolerance in patients receiving chemotherapy. The cardioprotective effect of real-time exercise in breast cancer is still unclear.
OBJECTIVES:
The aim of the present study was to determine the effect of real-time moderate-to-high-intensity exercise training in women with breast cancer undergoing chemotherapy and to follow up on parameters of cardiac function and exercise capacity at different times. We hypothesized that early moderate-to-high-intensity exercise training has beneficial effects on cardiac function in women with breast cancer undergoing chemotherapy.
METHODS:
This was a randomized controlled study that included 32 women randomly allocated into the control or exercise group. Exercise began with the first cycle of chemotherapy, and the training program was maintained during chemotherapy with 2 to 3 sessions per week for 3 months. Patients were instructed to perform moderate-to-high-intensity training with aerobic and resistance training. Outcome measurements were echocardiography and cardiopulmonary exercise test. The primary outcome was the change in left ventricle ejection fraction (LVEF). The secondary outcome was peak oxygen consumption (peak VO).
RESULTS:
The control group showed lower cardiac systolic function than the exercise group [mean (SD) LVEF 62% (2) and 70% (5), p < 0.05], reduced cardiac diastolic function, and cardiac hypertrophy at 3, 6 and 12 months after chemotherapy. At 6 months after chemotherapy, the exercise group exhibited relatively higher exercise capacity than controls [mean (SD) VO 12.1 (2.2) and 13.6 (2.2) mL/kg/min, p < 0.05]. The main effect size of the study based on echocardiography outcomes was 0.25 (95% confidence interval 0.23 to 0.27), a medium effect size.
CONCLUSIONS:
Moderate-to-high-intensity exercise training in breast cancer patients undergoing chemotherapy may prevent impaired cardiac function.
Copyright © 2021 Elsevier Masson SAS. All rights reserved.
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Acute heart failure due to dilated cardiomyopathy exacerbated by systemic parechovirus-A1 infection in an infant.
Int J Infect Dis2021 Jan;():. doi: S1201-9712(21)00031-X.
Maki Shun, Aizawa Yuta, Ito Yuki, Suda Masashi, Saitoh Akihiko,
Abstract
Parechovirus-A1 (PeV-A1) often causes mild respiratory or gastrointestinal disease. Herein we report a case of acute heart failure due to dilated cardiomyopathy (DCM) exacerbated by acute PeV-A1 infection in a 10-month-old infant. He presented to our hospital with acute respiratory distress and compensated shock. Echocardiogram showed a dilated left ventricle and severe mitral regurgitation, consistent with DCM. PeV-A1 infection was confirmed by 1) positive PCR for PeV-A in multiple anatomical sites including blood, stool, and throat swab samples, 2) genetic sequence of viral protein, and 3) an increase in paired serum PeV-A1-specific neutralizing antibody titers. A few, scattered case reports in infants and young children also indicate the association between myocarditis and/or DCM and PeV-A1 infection. In conclusion, PeV-A1 infection could be associated with exacerbation of myocardial diseases in infants and young children; thus PeV-A1 needs to be evaluated as a viral cause of such condition.
Copyright © 2021. Published by Elsevier Ltd.
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Bending Primordial Trajectories Away From Heart Failure.
J Am Soc Echocardiogr -
A Novel Approach to Medical Management of Heart Failure with Reduced Ejection Fraction.
Can J Cardiol2021 Jan;():. doi: S0828-282X(21)00046-5.
Miller Robert Jh, Howlett Jonathan G, Fine Nowell M,
Abstract
The advent of newly available medical therapies for HFrEF has resulted in many potential therapeutic combinations, increasing treatment complexity. Publication of expert consensus guidelines and initiative aimed to improve treatment implementation have emphasized sequential, stepwise initiation and titration of medical therapy, which is labour intensive. Data taken from heart failure registries shows suboptimal use of medications, prolonged titration time and consequently little change in dose intensity, all of which, indicate therapeutic inertia. Recently published evidence indicates that four medication classes (1. renin-angiotensin-neprilysin inhibitors, 2. beta-blockers, 3. mineralocorticoid antagonists and 4. sodium-glucose cotransporter inhibitors), which we refer to as Foundational Therapy, confer rapid and robust reduction in both morbidity and mortality in most patients with HFrEF, and that they work in additive fashion. Additional morbidity and/or mortality may be observed following addition of several Personalized Therapies in specific subgroups of patients. In this review, we discuss mechanisms of action of these therapies and propose a framework for their implementation based on several principles. These include the critical importance of rapid initiation of all 4 Foundational Therapies followed by their titration to target doses, emphasis on multiple simultaneous drug changes with each patient encounter, attention to patient-specific factors in choice of medication class, leveraging inpatient care, use of the entire health care team and alternative (i.e. virtual visits) modes of care. We have incorporated these principles into a 'Cluster Scheme' designed to facilitate timely and optimal medical treatment for patients with HFrEF.
Copyright © 2021. Published by Elsevier Inc.
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African American-Caucasian American Differences in Aortic Valve Replacement in Patients with Severe Aortic Stenosis: Racial Differences in AVR.
Am Heart J2021 Jan;():. doi: S0002-8703(21)00009-0.
Yankey George S, Jackson Larry R, Marts Colin, Chiswell Karen, Wu Angie, Ugowe Francis, Wilson Jimica, Vemulapalli Sreekanth, Samad Zainab, Thomas Kevin L,
Abstract
BACKGROUND:
Among patients with severe aortic stenosis (AS), there are limited data on aortic valve replacement (AVR), reasons for non-receipt and mortality by race.
METHODS:
Utilizing the Duke Echocardiography Laboratory Database, we analyzed data from 110,711 patients who underwent echocardiography at Duke University Medical Center between 1999-2013. We identified 1,111 patients with severe AS who met ?1 of 3 criteria for AVR: ejection fraction ?50%, diagnosis of heart failure, or need for coronary artery bypass surgery. Logistic regression models were used to assess the association between race, AVR and 1-year mortality. Chi-squared testing was used to assess potential racial differences in reasons for AVR non-receipt.
RESULTS:
Among the 1,111 patients (143 AA and 968 CA) eligible for AVR, AA were more often women, had more diabetes, renal insufficiency, aortic regurgitation and left ventricular hypertrophy. CA were more often smokers, had more ischemic heart disease, hyperlipidemia and higher median income levels. There were no racial differences in surgical risk utilizing logistic euroSCORES. Relative to CA, AA had lower rates of AVR (aOR 0.46, 95% CI 0.3-0.71, p<0.001) yet similar 1-year mortality (aHR 0.81, 95% CI 0.57-1.17, p=0.262). There were no significant differences in reasons for AVR non-receipt.
CONCLUSION:
Among patients with severe AS eligible for AVR, AA patients were less likely to undergo AVR. Despite racial differences in AVR, there were no significant differences in mortality within 1-year or reasons for AVR non-receipt.
Copyright © 2021. Published by Elsevier Inc.
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Electrocardiographic features and their echocardiographic correlates in peripartum cardiomyopathy: results from the ESC EORP PPCM registry.
ESC Heart Fail2021 Jan;():. doi: 10.1002/ehf2.13172.
Mbakwem Amam C, Bauersachs Johann, Viljoen Charle, Hoevelmann Julian, van der Meer Peter, Petrie Mark C, Mebazaa Alexandre, Goland Sorel, Karaye Kamilu, Laroche Cécile, Sliwa Karen, ,
Abstract
AIMS:
In peripartum cardiomyopathy (PPCM), electrocardiography (ECG) and its relationship to echocardiography have not yet been investigated in large multi-centre and multi-ethnic studies. We aimed to identify ECG abnormalities associated with PPCM, including regional and ethnic differences, and their correlation with echocardiographic features.
METHODS AND RESULTS:
We studied 411 patients from the EURObservational PPCM registry. Baseline demographic, clinical, and echocardiographic data were collected. ECGs were analysed for rate, rhythm, QRS width and morphology, and QTc interval. The median age was 31 [interquartile range (IQR) 26-35] years. The ECG was abnormal in > 95% of PPCM patients. Sinus tachycardia (heart rate > 100 b.p.m.) was common (51%), but atrial fibrillation was rare (2.27%). Median QRS width was 82 ms [IQR 80-97]. Left bundle branch block (LBBB) was reported in 9.30%. Left ventricular (LV) hypertrophy (LVH), as per ECG criteria, was more prevalent amongst Africans (59.62%) and Asians (23.17%) than Caucasians (7.63%, P < 0.001) but did not correlate with LVH on echocardiography. Median LV end-diastolic diameter (LVEDD) was 60 mm [IQR 55-65] and LV ejection fraction (LVEF) 32.5% [IQR 25-39], with no significant regional or ethnic differences. Sinus tachycardia was associated with an LVEF < 35% (OR 1.85 [95% CI 1.20-2.85], P = 0.006). ECG features that predicted an LVEDD > 55 mm included a QRS complex > 120 ms (OR 11.32 [95% CI 1.52-84.84], P = 0.018), LBBB (OR 4.35 [95% CI 1.30-14.53], P = 0.017), and LVH (OR 2.03 [95% CI 1.13-3.64], P = 0.017).
CONCLUSIONS:
PPCM patients often have ECG abnormalities. Sinus tachycardia predicted poor systolic function, whereas wide QRS, LBBB, and LVH were associated with LV dilatation.
© 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Clinical outcomes and costs associated with procalcitonin utilization in hospitalized patients with pneumonia, heart failure, viral respiratory infection, or chronic obstructive pulmonary disease.
Intern Emerg Med2021 Jan;():. doi: 10.1007/s11739-020-02618-3.
Johnson Stacy Aric, Rupp Austin Bernard, Rupp Kirsten Leigh, Reddy Santosh,
Abstract
Lower respiratory tract infections (LRTIs) due to bacterial pneumonia are common among hospitalized patients and are frequently treated with antibiotics. Viral illnesses and exacerbations of heart failure or COPD may present with symptoms mimicking a LRTI, resulting in unnecessary antibiotic utilization. Procalcitonin testing may be useful in these clinical scenarios. We attempted to assess the utility of procalcitonin testing versus not testing, and positive versus negative results among hospitalized patients with suspected LRTI. We performed a retrospective cohort study using multivariable analysis comparing clinical outcomes of patients with and without procalcitonin testing. Patients were 18 years or older, hospitalized for pneumonia, heart failure, COPD, or a viral respiratory illness between October 2014 and October 2015 (n = 2353). All patients received at least one dose of antibiotics. Major outcomes were duration of antibiotic therapy, length of hospital stay, C. difficile testing and infections, and normalized total direct costs. Procalcitonin testing occurred in 14.0% of patients and pneumonia (70.6%) was the most common diagnosis. After covariate adjustments, mean length of stay (5.61 vs. 6.67 days, p < 0.001) and duration of antibiotics (3.95 vs. 4.47 days, p < 0.001) were shorter among tested patients. Fewer 30-day readmissions (OR 0.62, 95% CI 0.40-0.95) were observed, and total direct healthcare costs were 34% lower (0.66, 95% CI 0.58-0.74) among tested patients. Negative procalcitonin results were associated with further reductions in some outcomes. In conclusion, procalcitonin testing among hospitalized patients with suspected LRTI is associated with reductions in antibiotic duration, length of stay, 30-day readmission, and healthcare costs.
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McConnell's sign assessed by point-of-care cardiac ultrasound associated with in-hospital mortality of COVID-19 patients with respiratory failure.
J Echocardiogr2021 Jan;():. doi: 10.1007/s12574-020-00507-4.
Doi Shunichi, Izumo Masaki, Shiokawa Noriko, Teramoto Kanako, Ishibashi Yuki, Higuma Takumi, Fujitani Shigeki, Akashi Yoshihiro J,
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Studies of Molecular Mechanisms Underlying Cardioprotective Action of the ALM-802 Compound.
Bull Exp Biol Med2021 Jan;():. doi: 10.1007/s10517-021-05058-x.
Kozhevnikova L M, Barchukov V V, Semenova N P, Vititnova M B, Kryzhanovskii S A,
Abstract
The mechanisms underlying cardioprotective activity of compound ALM-802 were studied in experiments on rats with chronic post-infarction heart failure. Real-time PCR showed that compound ALM-802 (daily intraperitoneal injections in a dose of 2 mg/kg for 28 days starting from day 91 after myocardial infarction modeling) restored the expression of genes encoding ?1- (p=0.00001) and ?2-adrenoreceptors (p=0.01) and type 2 ryanodine receptors (p=0.008) in the myocardium that was reduced in control animals. These effects can serve as the basis for the ability of the compound to reduce the intensity of remodeling and increase the inotropic function of the left heart ventricle shown earlier in this model.
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Effects of Zoniporide and BMA-1321 Compound on the Rate of Oxygen Absorption by Cardiomyocyte Mitochondria in Rats with Experimental Chronic Heart Failure.
Bull Exp Biol Med2021 Jan;():. doi: 10.1007/s10517-021-05059-w.
Spasov A A, Gurova N A, Popova T A, Perfilova V N, Vishnevskaya V V, Kustova M V, Ovsyankina N V, Ozerov A A,
Abstract
Uncoupling of respiration and ATP production by myocardial mitochondria was observed in rats with chronic isoproterenol intoxication (L-isoproterenol subcutaneously, 1 mg/kg, for 10 days) in comparison with controls (injected with the solvent). Inhibitors of NHE-1 zoniporide (1 mg/kg intraperitoneally, 13 days) and BMA-1321 compound (0.92 mg/kg intraperitoneally, 13 days) improved the mitochondrial function in rats with isoproterenol-induced cardiac failure: respiratory control coefficients increased, more so for the respiratory chain complex II, the main source of ROS in heart failure. The effect of BMA-1321 was more manifest (53%; p<0.05) in comparison with zoniporide (35%; p<0.05).
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The multiple faces of autoimmune/immune-mediated myocarditis in children: a biopsy-proven case series treated with immunosuppressive therapy.
ESC Heart Fail2021 Jan;():. doi: 10.1002/ehf2.13163.
Marcolongo Renzo, Rizzo Stefania, Cerutti Alessia, Reffo Elena, Castaldi Biagio, Baritussio Anna, Basso Cristina, Di Salvo Giovanni, Caforio Alida L P,
Abstract
The role of immunosuppressive therapy (IT) in paediatric autoimmune/immune-mediated myocarditis remains poorly defined. To explore its role, we present a series of three consecutive paediatric patients with biopsy-proven, virus negative, autoimmune/immune-mediated myocarditis, with distinct clinical and pathological features, who have been successfully treated with IT, a 14-year-old boy with Loeffler's fibroblastic parietal endomyocarditis, a 6-year-old child with celiac disease with chronic active lymphocytic myocarditis, and a 13-year-old boy with long-standing heart failure and active lymphocytic myocarditis. Patients started IT and entered follow-up between July 2017 and September 2019; the first patient completed IT. IT was associated with a substantial and sustained recovery of cardiac function in our patients, regardless of their heterogeneous clinical and pathological features. Combination IT was well tolerated and enabled tapering and weaning off steroids.
© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Melatonin Alleviates Cardiac Dysfunction Via Increasing Sirt1-Mediated Beclin-1 Deacetylation and Autophagy During Sepsis.
Inflammation2021 Jan;():. doi: 10.1007/s10753-021-01413-2.
Pi Qiang-Zhong, Wang Xiao-Wen, Jian Zhao-Lei, Chen Dan, Zhang Cheng, Wu Qing-Chen,
Abstract
Cardiac dysfunction is a major cause leading to multiple organ failure in sepsis. Beclin-1-dependent autophagy has been evidenced to exert protective effects on hearts in sepsis. However, the mechanisms on how Beclin-1 and autophagy are regulated remains enigmatic. To explore the detailed mechanisms controlling Beclin-1-dependent autophagy in septic heart and whether melatonin could protect against sepsis via regulating cardiac autophagy, adult Sprague-Dawley (SD) rats were subjected to cecal ligation and puncture (CLP) to induce sepsis. Rats were intraperitoneally administrated with 30 mg/kg melatonin within 5-min post-CLP surgery. Our data showed that sepsis induced Becline-1 acetylation and inhibited autophagy in hearts, resulting in impaired cardiac function. However, melatonin treatment facilitated Beclin-1 deacetylation and increased autophagy in septic hearts, thus improved cardiac function. Moreover, melatonin increased the expression and activity of Sirtuin 1 (Sirt1), and inhibition of Sirt1 abolished the protective effects of melatonin on Beclin-1 deacetylation and cardiac function. In conclusion, increased Beclin-1 acetylation was involved in impaired autophagy in septic hearts, while melatonin contributed to Beclin-1 deacetylation via Sirt1, leading to improved autophagy and cardiac function in sepsis. Our study sheds light on the important role of Beclin-1 acetylation in regulating autophagy in sepsis and suggests that melatonin is a potential candidate drug for the treatment of sepsis.
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Practical recommendations for the diagnosis and management of transthyretin cardiac amyloidosis.
Heart Fail Rev2021 Jan;():. doi: 10.1007/s10741-020-10062-w.
Bistola Vasiliki, Parissis John, Foukarakis Emmanouil, Valsamaki Pipitsa N, Anastasakis Aris, Koutsis Georgios, Efthimiadis Georgios, Kastritis Efstathios,
Abstract
Cardiac amyloidosis (CA) is an infiltrative restrictive cardiomyopathy caused by accumulation in the heart interstitium of amyloid fibrils formed by misfolded proteins. Most common CA types are light chain amyloidosis (AL) caused by monoclonal immunoglobulin light chains and transthyretin amyloidosis (ATTR) caused by either mutated or wild-type transthyretin aggregates. Previously considered a rare disease, CA is increasingly recognized among patients who may be misdiagnosed as undifferentiated heart failure with preserved ejection fraction (HFPEF), paradoxical low-flow/low-gradient aortic stenosis, or otherwise unexplained left ventricular hypertrophy. Progress in diagnosis has been due to the refinement of cardiac echocardiographic techniques (speckle tracking imaging) and magnetic resonance (T1 mapping) and mostly due to the advent of bone scintigraphy that has enabled noninvasive diagnosis of ATTR, limiting the need for endomyocardial biopsy. Importantly, proper management of CA starts from early recognition of suspected cases among high prevalence populations, followed by advanced diagnostic evaluation to confirm diagnosis and typing, preferentially in experienced amyloidosis centers. Differentiating ATTR from other types of amyloidosis, especially AL, is critical. Emerging targeted ATTR therapies offer the potential to improve outcomes of these patients previously treated only palliatively.
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Possible diverse contribution of coronary risk factors to left ventricular systolic and diastolic cavity sizes.
Sci Rep2021 Jan;11(1):1570. doi: 10.1038/s41598-021-81341-1.
Suzuki Kenichiro, Inoue Yasunori, Ogawa Kazuo, Nagoshi Tomohisa, Minai Kosuke, Ogawa Takayuki, Kawai Makoto, Yoshimura Michihiro,
Abstract
It is generally believed that risk factors damage the coronary arteries, cause myocardial ischemia, and consequently change the shape of the heart. On the other hand, each of the risk factors may also have a negative effect on the heart. However, it is very difficult to examine the effects of each of these risk factors independently. Therefore, it is necessary to select an appropriate statistical method and apply it efficiently. In this study, the effects of coronary risk factors on left ventricular size and cardiac function were investigated using structure equation modeling (SEM), and were shown as Bayesian SEM-based frequency polygons using selected two-dimensional contours. This study showed that each risk factor directly affected the shape of the heart. Because vascular risk and heart failure risk are likely to evolve at the same time, managing risk factors is very important in reducing the heart failure pandemic.
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PMCA4 inhibition does not affect cardiac remodelling following myocardial infarction, but may reduce susceptibility to arrhythmia.
Sci Rep2021 Jan;11(1):1518. doi: 10.1038/s41598-021-81170-2.
Stafford Nicholas, Zi Min, Baudoin Florence, Mohamed Tamer M A, Prehar Sukhpal, De Giorgio Daria, Cartwright Elizabeth J, Latini Roberto, Neyses Ludwig, Oceandy Delvac,
Abstract
Ischaemic heart disease is the world's leading cause of mortality. Survival rates from acute myocardial infarction (MI) have improved in recent years; however, this has led to an increase in the prevalence of heart failure (HF) due to chronic remodelling of the infarcted myocardium, for which treatment options remain poor. We have previously shown that inhibition of isoform 4 of the plasma membrane calcium ATPase (PMCA4) prevents chronic remodelling and HF development during pressure overload, through fibroblast mediated Wnt signalling modulation. Given that Wnt signalling also plays a prominent role during remodelling of the infarcted heart, this study investigated the effect of genetic and functional loss of PMCA4 on cardiac outcomes following MI. Neither genetic deletion nor pharmacological inhibition of PMCA4 affected chronic remodelling of the post-MI myocardium. This was the case when PMCA4 was deleted globally, or specifically from cardiomyocytes or fibroblasts. PMCA4-ablated hearts were however less prone to acute arrhythmic events, which may offer a slight survival benefit. Overall, this study demonstrates that PMCA4 inhibition does not affect chronic outcomes following MI.
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Instantaneous wave-free ratio guided multivessel revascularisation during percutaneous coronary intervention for acute myocardial infarction: study protocol of the randomised controlled iMODERN trial.
BMJ Open2021 Jan;11(1):e044035. doi: 10.1136/bmjopen-2020-044035.
Beijnink Casper W H, Thim Troels, van der Heijden Dirk Jan, Klem Igor, Al-Lamee Rasha, Vos Jacqueline L, Koop Yvonne, Dijkgraaf Marcel G W, Beijk Marcel A M, Kim Raymond J, Davies Justin, Raposo Luis, Baptista Sérgio B, Escaned Javier, Piek Jan J, Maeng Michael, van Royen Niels, Nijveldt Robin,
Abstract
INTRODUCTION:
Recent randomised clinical trials showed benefit of non-culprit lesion revascularisation in ST-elevation myocardial infarction (STEMI) patients. However, it remains unclear whether revascularisation should be performed at the index procedure or at a later stage.
METHODS AND ANALYSIS:
The instantaneous wave-free ratio (iFR) Guided Multivessel Revascularisation During Percutaneous Coronary Intervention for Acute Myocardial Infarction trial is a multicentre, randomised controlled prospective open-label trial with blinded evaluation of endpoints. After successful primary percutaneous coronary intervention (PCI), eligible STEMI patients with residual non-culprit lesions are randomised, to instantaneous wave-free ratio guided treatment of non-culprit lesions during the index procedure versus deferred cardiac MR-guided management within 4 days to 6 weeks. The primary endpoint of the study is the combined occurrence of all-cause death, recurrent myocardial infarction and hospitalisation for heart failure at 12 months follow-up. Clinical follow-up includes questionnaires at 3 months and outpatient visits at 6 months and 12 months after primary PCI. Furthermore, a cost-effectiveness analysis will be performed.
ETHICS AND DISSEMINATION:
Permission to conduct this trial has been granted by the Medical Ethical Committee of the Amsterdam University Medical Centres (loc. VUmc, ID NL60107.029.16). The primary results of this trial will be shared in a main article and subgroup analyses or spin-off studies will be shared in secondary papers.
TRIAL REGISTRATION NUMBER:
NCT03298659.
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Use of Hydroxychloroquine And Risk of Heart Failure in Patients With Rheumatoid Arthritis.
J Rheumatol2021 Jan;():. doi: jrheum.201180.
Sorour Ahmed A, Kurmann Reto D, Shahin Youssef E, Crowson Cynthia S, Achenbach Sara J, Mankad Rekha, Myasoedova Elena,
Abstract
OBJECTIVE:
To examine the relationship between the use of Hydroxychloroquine (HCQ) and risk of developing Heart Failure (HF) in Rheumatoid Arthritis (RA).
METHODS:
In this nested case-control study, cases were Olmsted county, Minnesota residents with incident RA (based on 1987 ACR criteria) from 1980-2013 who developed HF after RA incidence. Each case was matched on year of birth, sex and year of RA incidence with an RA control who did not develop HF. Data on HCQ use including start and stop dates and dose changes was reviewed, and used to calculate HCQ duration and cumulative dose. Age-adjusted logistic regression models were used to examine the association between HCQ and HF.
RESULTS:
The study identified 143 RA cases diagnosed with HF (mean age 65.8, 62% females) and 143 non-HF RA controls (mean age 64.5, 62% female). HCQ cumulative dose was not associated with HF (Odds Ratio [OR]: 0.96 per 100g increase in cumulative dose, 95% confidence interval [95% CI]: 0.90-1.03). Likewise, no association was found for patients with a cumulative dose ?300g (OR 0.92, 95% CI 0.41-2.08). The HCQ duration of intake in years prior to index was not associated with HF (OR 0.98, 95% CI 0.91-1.05).
CONCLUSION:
Use of HCQ was not associated with development of HF in patients with RA in this study. Further studies are needed to understand the impact of higher doses of HCQ on development of HF in RA.
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Erectile Dysfunction and Cardiovascular Risk in Men with Rheumatoid Arthritis: A Population- Based Cohort Study.
J Rheumatol2021 Jan;():. doi: jrheum.201226.
Wilton Katelynn M, Achenbach Sara J, Davis John M, Myasoedova Elena, Matteson Eric L, Crowson Cynthia S,
Abstract
OBJECTIVE:
Both erectile dysfunction (ED) and rheumatoid arthritis (RA) are associated with increased cardiovascular risk. It is unknown if these diagnoses are associated or if their combination confers additional cardiovascular risk. We aim to define the incidence of ED in RA, and determine if ED correlates with increased cardiovascular risk in RA.
METHODS:
Medical information concerning RA, ED and cardiovascular diagnoses for men with RA (n=260) diagnosed in Olmsted county, Minnesota and age-matched male comparators was extracted from a comprehensive medical record system.
RESULTS:
ED incidence was similar between the RA cohort and comparators (HR 0.80; 95% CI 0.55-1.16). In men with RA, ED diagnosis was associated with a trend toward an increase in peripheral arterial disease (HR 2.22; 95% CI 0.98-5.03) and a significantly decreased rate of myocardial infarction (HR 0.26; 95% CI 0.07-0.90), heart failure (HR 0.49; 95% CI 0.25-0.94) and death (HR 0.56; 95% CI 0.36-0.87). In men with RA and ED, phosphodiesterase-5 inhibitor use was associated with a decreased risk of death (HR 0.35; 95% CI 0.16-0.79), with a trending decreased risk of some cardiovascular diagnoses.
CONCLUSION:
Incidence of ED was not statistically increased in RA. Although patients with both RA and ED had a similar overall cardiovascular risk to those with RA alone, men with both RA and ED had decreased risk of heart failure, myocardial infarction and death, as well as an increased risk of peripheral arterial disease. Further studies are needed to clarify these associations and their implications for pathogenesis and therapeutics.
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Impact of statin on long-term outcome among patients with end-stage renal disease with acute myocardial infarction (AMI): a nationwide case-control study.
Postgrad Med J2021 Jan;():. doi: postgradmedj-2019-137292.
Kuo Feng-You, Huang Wei-Chun, Tang Pei-Ling, Cheng Chin-Chang, Chiang Cheng-Hung, Lin Hsiao-Chin, Chuang Tzu-Jung, Wann Shue-Ren, Mar Guang-Yuan, Liu Chun-Peng, Cheng Juei-Tang, Wu Ming-Chang, ,
Abstract
BACKGROUND:
Use of statin has been associated with reduced risk of cardiovascular diseases events and mortality. However, in patients with end-stage renal disease (ESRD), the protective effects of statin are controversial. To evaluate the impact of chronic statin use on clinical outcomes of patients with acute myocardial infarction (AMI) with ESRD.
METHODS:
We enrolled 8056 patients with ESRD who were initially diagnosed and admitted for first AMI from Taiwan's National Health Insurance Research Database. Of which, 2134 patients underwent statin therapy. We randomly selected and use age, sex, hypertension, diabetes mellitus (DM), peripheral vascular diseases (PVD), heart failure (HF), cerebrovascular accidents (CVA), chronic obstructive pulmonary disease, matched with the study group as controls (non-stain user). We compared the effects of statin use in term of all-cause death among patients with AMI with ESRD.
RESULTS:
Statin use resulted in a significantly higher survival rate in patients ith AMI with ESRD compared with non-statin users. After adjusted the comorbidities the male patients and patients with DM, PVD, HF and CVA had lower long-term survival rate (all p<0.001). Patients who underwent percutaneous coronary intervention (p<0.001), ACE inhibitors/angiotensin II receptor blockers (p<0.001), ? receptor blockers (p<0.001) and statin therapy (p=0.007) had better long-term survival rate. Patients with AMI with ESRD on statin therapy exhibited a significantly lower risk of mortality compared with non-statin users (p<0.0001).
CONCLUSION:
Among patients with ESRD with AMI, statin therapy was associated with reduced all-cause mortality.
© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
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