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Pubblicazioni recenti - cardiac failure
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Increasing home-time after a first diagnosis of heart failure in Sweden, 20 years trends.
ESC Heart Fail2021 Nov;():. doi: 10.1002/ehf2.13714.
Ekestubbe Sofia, Fu Michael, Giang Kok Wai, Lindgren Martin, Rosengren Annika, Schioler Linus, Schaufelberger Maria,
Abstract
AIMS:
This study was performed to compare trends in home-time for patients with heart failure (HF) between those of working age and those of retirement age in Sweden from 1992 to 2012.
METHODS AND RESULTS:
The National Inpatient Register (IPR) was used to identify all patients aged 18 to 84 years with a first hospitalization for HF in Sweden from 1992 to 2012. Information on date of death, comorbidities, and sociodemographic factors were collected from the Swedish National Register on Cause of Death, the IPR, and the longitudinal integration database for health insurance and labour market studies, respectively. The patients were divided into two groups according to their age: working age (
CONCLUSIONS:
This nationwide study showed increasing home-time over the study period except for women of retirement age and older for whom the increase stalled after 2007, mainly because of a lower mortality reduction in this group. Efforts to improve patient-related outcome measures specifically targeted to this group may be warranted.
© 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Relation between brain natriuretic peptide and delayed cerebral ischemia in patients with aneurysmalsubarachnoid hemorrhage.
Clin Neurol Neurosurg2021 Nov;211():107031. doi: S0303-8467(21)00560-6.
Kaur Gurmeen, Damodara Nitesh, Feldstein Eric, Dominguez Jose, Huang Kristen T, Ogulnick Jonathan V, Nuoman Rolla, Khandelwal Priyank, El-Ghanem Mohammad, Gupta Gaurav, Mayer Stephan A, Amuluru Krishna, Gandhi Chirag D, Al-Mufti Fawaz,
Abstract
BACKGROUND:
Brain natriuretic peptide (BNP), often used to evaluate degree of heart failure, has been implicated in fluid dysregulation and inflammation in critically-ill patients. Twenty to 30% of patients with aneurysmal subarachnoid hemorrhage (aSAH) will develop some degree of neurogenic stress cardiomyopathy (NSC) and in turn elevation of BNP levels. We sought to explore the association between BNP levels and development of delayed cerebral ischemia (DCI) in patients with aSAH.
METHODS:
We retrospectively evaluated the records of 149 patients admitted to the Neurological Intensive Care Unit between 2006 and 2015 and enrolled in an existing prospectively maintained aSAH database. Demographic data, treatment and outcomes, and BNP levels at admission and throughout the hospital admission were noted.
RESULTS:
Of the 149 patients included in the analysis, 79 developed DCI during their hospital course. We found a statistically significant association between DCI and the highest recorded BNP (OR 1.001, 95% CI-1.001-1.002, p = 0.002). The ROC curve analysis for DCI based on BNP showed that the highest BNP level during hospital admission (AUC 0.78) was the strongest predictor of DCI compared to the change in BNP over time (AUC 0.776) or the admission BNP (AUC 0.632).
CONCLUSION:
Our study shows that DCI is associated not only with higher baseline BNP values (admission BNP), but also with the highest BNP level attained during the hospital course and the rapidity of change or increase in BNP over time. Prospective studies are needed to evaluate whether routine measurement of BNP may help identify SAH patients at high risk of DCI.
Copyright © 2021. Published by Elsevier B.V.
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Correction to: Off-label-dosing of non-vitamin K-dependent oral antagonists in AF patients before and after stroke: results of the prospective multicenter Berlin Atrial Fibrillation Registry.
J Neurol2021 Nov;():. doi: 10.1007/s00415-021-10907-w.
Tütüncü Serdar, Olma Manuel, Kunze Claudia, Dietzel Joanna, Schurig Johannes, Fiessler Cornelia, Malsch Carolin, Haas Tobias Eberhard, Dimitrijeski Boris, Doehner Wolfram, Hagemann Georg, Hamilton Frank, Honermann Martin, Jungehulsing Gerhard Jan, Kauert Andreas, Koennecke Hans-Christian, Mackert Bruno-Marcel, Nabavi Darius, Nolte Christian H, Reis Joschua Mirko, Schmehl Ingo, Sparenberg Paul, Stingele Robert, Völzke Enrico, Waldschmidt Carolin, Zeise-Wehry Daniel, Heuschmann Peter U, Endres Matthias, Haeusler Karl Georg,
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Changes in inferior vena cava area represent a more sensitive metric than change in filling pressures during experimental manipulation of intravascular volume and tone.
Eur J Heart Fail2021 Nov;():. doi: 10.1002/ejhf.2395.
Ivey-Miranda Juan B, Wetterling Friedrich, Gaul Robert, Sheridan Stephen, Asher Jennifer L, Rao Veena S, Maulion Christopher, Mahoney Devin, Mebazaa Alexandre, Gray Alastair P, Burkhoff Daniel, Cowie Martin R, Cox Zachary L, Butler Javed, Fudim Marat, McDonald Kenneth, Damman Kevin, Borlaug Barry A, Testani Jeffrey M,
Abstract
AIMS:
Remote monitoring of pulmonary artery (PA) pressure has reduced heart failure (HF) hospitalizations in chronic HF as elevation of PA pressure provides information that can guide treatment. The venous system is characterized by high capacitance, thus substantial increases in intravascular volume can occur before filling pressures increase. The inferior vena cava (IVC) is a highly compliant venous conduit and thus a candidate for early detection of change in intravascular volume. We aimed to compare IVC cross-sectional area using a novel sensor with cardiac filling pressures during experimental manipulation of volume status, vascular tone, and cardiac function.
METHODS AND RESULTS:
Experiments were conducted in sheep to manipulate volume status (colloid infusion), vascular tone (nitroglycerin infusion) and cardiac function (rapid cardiac pacing). A wireless implantable IVC sensor was validated ex-vivo and in-vivo, and then used to measure the cross-sectional area of the IVC. Right and left sided cardiac filling pressures were obtained via right heart catheterization. The IVC sensor provided highly accurate and precise measurements of cross-sectional area in ex-vivo and in-vivo validation. IVC area changes were more sensitive than the corresponding changes in cardiac filling pressures during colloid infusion (p
CONCLUSIONS:
IVC area can be remotely and accurately measured in real time with a wireless implantable sensor. Changes in IVC area are more sensitive than corresponding changes in filling pressures following experimental volume loading and fluid redistribution. Additional research is warranted to understand if remote monitoring of the IVC may have advantages over pressure-based monitors in HF. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Pathophysiological metabolic changes associated with disease modify the proarrhythmic risk profile of drugs with potential to prolong repolarisation.
Br J Pharmacol2021 Nov;():. doi: 10.1111/bph.15757.
TeBay Clifford, McArthur Jeffrey R, Mangala Melissa, Kerr Nicholas, Heitmann Stewart, Perry Matthew D, Windley Monique J, Vandenberg Jamie I, Hill Adam P,
Abstract
BACKGROUND AND PURPOSE:
Hydroxychloroquine, chloroquine and azithromycin are three drugs that were proposed to treat COVID-19. While concern already existed around their proarrhythmic potential there is little data regarding how altered physiological states encountered in patients such as febrile state, electrolyte imbalances or acidosis might change their risk profiles.
EXPERIMENTAL APPROACH:
Potency of hERG block was measured using high-throughput electrophysiology in the presence of variable environmental factors. These potencies informed simulations to predict population risk profiles. Effects on cardiac repolarisation were verified in human induced pluripotent stem cell-derived cardiomyocytes from multiple individuals.
KEY RESULTS:
Chloroquine and hydroxychloroquine blocked hERG with IC of 1.47±0.07 ?M and 3.78±0.17 ?M respectively, indicating proarrhythmic risk at concentrations effective against SARS-CoV-2 in vitro. Hypokalaemia and hypermagnesemia increased potency of chloroquine and hydroxychloroquine, indicating increased proarrhythmic risk. Acidosis significantly reduced potency of all drugs, whereas increased temperature decreased potency of chloroquine and hydroxychloroquine against hERG but increased potency for azithromycin. In silico simulations demonstrated that proarrhythmic risk was increased by female sex, hypokalaemia and heart failure, and identified specific genetic backgrounds associated with emergence of arrhythmia.
CONCLUSION AND IMPLICATIONS:
Our study demonstrates how proarrhythmic risk can be exacerbated by metabolic changes and pre-existing disease. More broadly, the study acts as a blueprint for how high-throughput in vitro screening, combined with in silico simulations can help guide both preclinical screening and clinical management of patients in relation to drugs with potential to prolong repolarisation.
This article is protected by copyright. All rights reserved.
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Predictive Score of Nodal Involvement in Endometrial Cancer Patients: A Large Multicentre Series.
Ann Surg Oncol2021 Nov;():. doi: 10.1245/s10434-021-11083-x.
Capozzi Vito Andrea, Sozzi Giulio, Rosati Andrea, Restaino Stefano, Gambino Giulia, Cianciolo Alessandra, Ceccaroni Marcello, Uccella Stefano, Franchi Massimo, Chiantera Vito, Scambia Giovanni, Fanfani Francesco, Berretta Roberto,
Abstract
BACKGROUND:
Sentinel lymph node (SLN) biopsy is considered the standard of care in early-stage endometrial cancer (EC). For SLN failure, a side-specific lymphadenectomy is recommended. Nevertheless, most hemipelvises show no nodal involvement. The authors previously published a predictive score of lymphovascular involvement in EC. In case of a negative score (value 3-4), the risk of nodal metastases was extremely low. This multicenter study aimed to analyze a predictive score of nodal involvement in EC patients.
METHODS:
The study enrolled patients with EC who had received comprehensive surgical staging with nodal assessment. A preoperative predictive score of nodal involvement was calculated for all the patients before surgery. The score included myometrial infiltration, tumor grading (G), tumor diameter, and Ca125 assessment. The STARD (standards for Reporting Diagnostic accuracy studies) guidelines were followed for score accuracy.
RESULTS:
The study analyzed 1038 patients and detected 155 (14.9%) nodal metastases. The score was negative (3 or 4) for 475 patients and positive (5-7) for 563 of these patients. The score had a sensitivity of 83.2%, a specificity of 50.8%, a negative predictive value of 94.5%, and a diagnostic value of 55.7%. The area under the curve was 0.75. The logistic regression showed a significant correlation between a negative score and absence of nodal metastasis (odds ration [OR], 5.133, 95% confidence interval [CI], 3.30-7.98; p
CONCLUSION:
The proposed predictive score is a useful test to identify patients at low risk of nodal involvement. In case of SLN failure, the application of the current score in the SLN algorithm could allow avoidance of unnecessary lymphadenectomies.
© 2021. Society of Surgical Oncology.
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[Geriatric and social assessment by the heart failure patients' nurse in the FIL-EAS ic].
Soins Gerontol;26(152):37-44. doi: S1268-6034(21)00142-0.
Le Caignec Mathilde, Birgy Caroline, Candel Jocelyne, Djibo Aichatoli, Tartiere Jean-Michel,
Abstract
The use of geriatric and social assessment grids by dedicated nurses for patients hospitalised for acute heart failure allows for an early and safe return home in home hospitalisation. These grids isolate a sub-group of older patients with a high risk of re-hospitalisation for whom specific actions can be envisaged.
Copyright © 2021 Elsevier Masson SAS. All rights reserved.
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Icariin Protects H9c2 Rat Cardiomyoblasts from Doxorubicin-Induced Cardiotoxicity: Role of Caveolin-1 Upregulation and Enhanced Autophagic Response.
Nutrients2021 Nov;13(11):. doi: 4070.
Scicchitano Miriam, Carresi Cristina, Nucera Saverio, Ruga Stefano, Maiuolo Jessica, Macrì Roberta, Scarano Federica, Bosco Francesca, Mollace Rocco, Cardamone Antonio, Coppoletta Anna Rita, Guarnieri Lorenza, Zito Maria Caterina, Bava Irene, Cariati Luca, Greco Marta, Foti Daniela Patrizia, Palma Ernesto, Gliozzi Micaela, Musolino Vincenzo, Mollace Vincenzo,
Abstract
Doxorubicin (Doxo) is a widely used antineoplastic drug which often induces cardiomyopathy, leading to congestive heart failure through the intramyocardial production of reactive oxygen species (ROS). Icariin (Ica) is a flavonoid isolated from Epimedii Herba (Berberidaceae). Some reports on the pharmacological activity of Ica explained its antioxidant and cardioprotective effects. The aim of our study was to assess the protective activities of Ica against Doxo-detrimental effects on rat heart-tissue derived myoblasts (H9c2 cells) and to identify, at least in part, the molecular mechanisms involved. Our results showed that pretreatment of H9c2 cells with 1 ?M and 5 ?M of Ica, prior to Doxo exposure, resulted in an improvement in cell viability, a reduction in ROS generation, the prevention of mitochondrial dysfunction and mPTP opening. Furthermore, for the first time, we identified one feasible molecular mechanism through which Ica could exerts its cardioprotective effects. Indeed, our data showed a significant reduction in Caveolin-1(Cav-1) expression levels and a specific inhibitory effect on phosphodiesterase 5 (PDE5a) activity, improving mitochondrial function compared to Doxo-treated cells. Besides, Ica significantly prevented apoptotic cell death and downregulated the main pro-autophagic marker Beclin-1 and LC3 lipidation rate, restoring physiological levels of activation of the protective autophagic process. These results suggest that Ica might have beneficial cardioprotective effects in attenuating cardiotoxicity in patients requiring anthracycline chemotherapy through the inhibition of oxidative stress and, in particular, through the modulation of Cav-1 expression levels and the involvement of PDE5a activity, thereby leading to cardiac cell survival.
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Short-Term Pre-Operative Protein Caloric Restriction in Elective Vascular Surgery Patients: A Randomized Clinical Trial.
Nutrients2021 Nov;13(11):. doi: 4024.
Kip Peter, Sluiter Thijs J, Moore Jodene K, Hart Abby, Ruske Jack, O'Leary James, Jung Jonathan, Tao Ming, MacArthur Michael R, Heindel Patrick, de Jong Alwin, de Vries Margreet R, Burak M Furkan, Mitchell Sarah J, Mitchell James R, Ozaki C Keith,
Abstract
(1) Background: Vascular surgery operations are hampered by high failure rates and frequent occurrence of peri-operative cardiovascular complications. In pre-clinical studies, pre-operative restriction of proteins and/or calories (PCR) has been shown to limit ischemia-reperfusion damage, slow intimal hyperplasia, and improve metabolic fitness. However, whether these dietary regimens are feasible and safe in the vascular surgery patient population remains unknown. (2) Methods: We performed a randomized controlled trial in patients scheduled for any elective open vascular procedure. Participants were randomized in a 3:2 ratio to either four days of outpatient pre-operative PCR (30% calorie, 70% protein restriction) or their regular ad-libitum diet. Blood was drawn at baseline, pre-operative, and post-operative day 1 timepoints. A leukocyte subset flow cytometry panel was performed at these timepoints. Subcutaneous/perivascular adipose tissue was sampled and analyzed. Follow-up was one year post-op. (3) Results: 19 patients were enrolled, of whom 11 completed the study. No diet-related reasons for non-completion were reported, and there was no intervention group crossover. The PCR diet induced weight loss and BMI decrease without malnutrition. Insulin sensitivity was improved after four days of PCR ( = 0.05). Between diet groups, there were similar rates of re-intervention, wound infection, and cardiovascular complications. Leukocyte populations were maintained after four days of PCR. (4) Conclusions: Pre-operative PCR is safe and feasible in elective vascular surgery patients.
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Higher Serum Phosphorus Is Not an Independent Risk Factor of Mortality in Heart Failure with Reduced Ejection Fraction.
Nutrients2021 Nov;13(11):. doi: 4004.
Robert Partyka, Alina Mroczek, Sylwia Duda, Jolanta Malinowska-Borowska, Marta Buczkowska, Anna G?ogowska-Gruszka, Jacek Niedziela, Bartosz Hudzik, Mariusz G?sior, Piotr Rozentryt,
Abstract
Higher serum phosphorus has detrimental health effects. Even high-normal rage sP is associated with worse outcomes. The relationship of serum phosphorus with prognostic markers in heart failure remains unclear. We investigated the association of serum phosphorus with heart failure prognostic factors and risk of mortality related to serum phosphorus. In 1029 stable heart failure patients, we investigated the distribution of markers of more advanced heart failure stage across quintiles of serum phosphorus and estimated the relative risk of mortality in comparison to reference. Higher serum phosphorus levels sP were associated with markers of a worse outcome. The best survival was observed in low-normal serum levels. The unadjusted hazard ratio for mortality increased toward higher phosphorus quintiles but not to lower levels of sP. The correction for age, sex, BMI, percent weight loss, inflammation, kidney function, and LVEF did not modify the risk profile substantially. The adjustment for NYHA, natriuretic peptides, serum sodium, and treatment characteristics broke down the risk relationship completely. A higher serum phosphorus is associated with markers of a more risky profile of heart failure. Elevated serum levels of phosphorus sP does not provide independent prognostic information beyond the strongest markers of the severity of the syndrome. The potential involvement of higher serum phosphorus as a mediator in the pathophysiology of heart failure warrants further study.
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Nutritional and Non-Nutritional Predictors of Low Spot Urinary Creatinine Concentration in Patients with Heart Failure.
Nutrients2021 Nov;13(11):. doi: 3994.
Malinowska-Borowska Jolanta, Kulik Aleksandra, Buczkowska Marta, Ostr?ga Weronika, Stefaniak Apolonia, Piecuch Ma?gorzata, Garbicz Jagoda, Nowak Jolanta Urszula, Tajstra Mateusz, Jankowska Ewa Anita, G?sior Mariusz, Rozentryt Piotr,
Abstract
Low spot urinary creatinine concentration (SUCR) is a marker of muscle wasting and clinical outcome. The risk factors for low SUCR in heart failure (HF) remain poorly understood. We explored the risk factors for low SUCR related to poor outcomes. In 721 HF patients (age: 52.3 ± 11 years, female: 14%, NYHA: 2.7 ± 0.7) SUCR and Dexa body composition scans were performed. BMI prior HF-onset, weight loss, and appendicular muscle mass were obtained. Each patient was classified as malnutrition or normal by GLIM criteria and three other biochemical indices (CONUT, PNI, and GRNI). Sarcopenia index (SI) as creatinine to cystatin C ratio was also calculated. Within 1 year, 80 (11.1%) patients died. In ROC curve we identified a SUCR value of 0.628 g/L as optimally discriminating surviving from dead. In low SUCR group more advanced HF, higher weight loss and catabolic components of weight trajectory (CCWT), more frequent under-nutrition by GLIM, and lower SI were observed. In multivariate analysis the independent predictors of low SUCR were SI, CCWT, and GNRI score. In conclusion: the risk of low SUCR was associated with a worse outcome. Low SUCR was associated with greater catabolism and sarcopenia but not with biochemical indices of malnutrition.
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Dairy Food Intake Is Not Associated with Measures of Bone Microarchitecture in Men and Women: The Framingham Osteoporosis Study.
Nutrients2021 Nov;13(11):. doi: 3940.
Millar Courtney L, Kiel Douglas P, Hannan Marian T, Sahni Shivani,
Abstract
Previous studies reported that dairy foods are associated with higher areal bone mineral density (BMD) in older adults. However, data on bone strength and bone microarchitecture are lacking. We determined the association of dairy food intake (milk, yogurt, cheese, milk + yogurt, and milk + yogurt + cheese, servings/week) with high resolution peripheral quantitative computed tomography (HR-pQCT) measures of bone (failure load, cortical BMD, cortical thickness, trabecular BMD, and trabecular number). This cross-sectional study included participants with diet from a food frequency questionnaire (in 2005-2008 and/or 1998-2001) and measurements of cortical and trabecular BMD and microarchitecture at the distal tibia and radius (from HR-pQCT in 2012-2015). Sex-specific multivariable linear regression estimated the association of dairy food intake (energy adjusted) with each bone measure adjusting for covariates. Mean age was 64 (SD 8) years and total milk + yogurt + cheese intake was 10.0 (SD 6.6) and 10.6 (6.4) servings/week in men and women, respectively. No significant associations were observed for any of the dairy foods and bone microarchitecture measures except for cheese intake, which was inversely associated with cortical BMD at the radius ( = 0.001) and tibia ( = 0.002) in women alone. In this cohort of primarily healthy older men and women, dairy intake was not associated with bone microarchitecture. The findings related to cheese intake and bone microarchitecture in women warrant further investigation.
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Effectiveness of Intensive Cardiac Rehabilitation in High-Risk Patients with Cardiovascular Disease in Real-World Practice.
Nutrients2021 Oct;13(11):. doi: 3883.
?wi?tkiewicz Iwona, Di Somma Salvatore, De Fazio Ludovica, Mazzilli Valerio, Taub Pam R,
Abstract
Structured lifestyle interventions through cardiac rehabilitation (CR) are critical to improving the outcome of patients with cardiovascular disease (CVD) and cardiometabolic risk factors. CR programs' variability in real-world practice may impact CR effects. This study evaluates intensive CR (ICR) and standard CR (SCR) programs for improving cardiometabolic, psychosocial, and clinical outcomes in high-risk CVD patients undergoing guideline-based therapies. Both programs provided lifestyle counseling and the same supervised exercise component. ICR additionally included a specialized plant-based diet, stress management, and social support. Changes in body weight (BW), low-density lipoprotein cholesterol (LDL-C), and exercise capacity (EC) were primary outcomes. A total of 314 patients (101 ICR and 213 SCR, aged 66 ± 13 years, 75% overweight/obese, 90% coronary artery disease, 29% heart failure, 54% non-optimal LDL-C, 43% depressive symptoms) were included. Adherence to ICR was 96% vs. 68% for SCR. Only ICR resulted in a decrease in BW (3.4%), LDL-C (11.3%), other atherogenic lipids, glycated hemoglobin, and systolic blood pressure. Both ICR and SCR increased EC (52.2% and 48.7%, respectively) and improved adiposity indices, diastolic blood pressure, cholesterol intake, depression, and quality of life, but more for ICR. Within 12.6 ± 4.8 months post-CR, major adverse cardiac events were less likely in the ICR than SCR group (11% vs. 17%), especially heart failure hospitalizations (2% vs. 8%). A comprehensive ICR enhanced by a plant-based diet and psychosocial management is feasible and effective for improving the outcomes in high-risk CVD patients in real-world practice.
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High Dose of Caffeine Mouth Rinse Increases Resistance Training Performance in Men.
Nutrients2021 Oct;13(11):. doi: 3800.
Karayigit Raci, Koz Mitat, Sánchez-Gómez Angela, Naderi Alireza, Yildirim Ulas Can, Domínguez Raúl, Gur Fatih,
Abstract
Caffeine mouth rinsing (CMR) has been shown to enhance exercise performance. However, no studies have analyzed the effects of different dosages of CMR on muscular performance. Therefore, the purpose of this study was to examine the effects of different dosages of CMR on strength (bench press 1 repetition maximum (1-RM)) and muscular endurance (60% of 1-RM repetitions to failure) in resistance-trained males. Fourteen resistance-trained males (age: 23 ± 2 years, height: 179 ± 3 cm, body mass: 83 ± 4 kg, BMI: 17 ± 2 kg/m) completed four conditions in random order. The four conditions consisted of a mouth rinse with 25 mL solutions containing either 1% (250 mg) of CMR (low dose of CMR: LCMR), 2% (500 mg) of CMR (moderate dose of CMR: MCMR), 3% (750 mg) of CMR (high dose of CMR: HCMR) and sweetened water (placebo: PLA) for 5 s prior to a bench press strength and muscular endurance test. Maximal strength, muscular endurance, heart rate (HR) and ratings of perceived exertion (RPE) were recorded for each condition. There were no significant differences in strength ( = 0.30) and HR ( = 0.83) between conditions. HCMR significantly increased muscular endurance performance ( = 0.01) and decreased RPE values ( = 0.01). In conclusion, CMR did not affect bench press 1-RM strength performance, but muscular endurance responses to CMR seems to be dose-dependent.
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Physiology and Inflammation Driven Pathophysiology of Iron Homeostasis-Mechanistic Insights into Anemia of Inflammation and Its Treatment.
Nutrients2021 Oct;13(11):. doi: 3732.
Lanser Lukas, Fuchs Dietmar, Kurz Katharina, Weiss Günter,
Abstract
Anemia is very common in patients with inflammatory disorders. Its prevalence is associated with severity of the underlying disease, and it negatively affects quality of life and cardio-vascular performance of patients. Anemia of inflammation (AI) is caused by disturbances of iron metabolism resulting in iron retention within macrophages, a reduced erythrocyte half-life, and cytokine mediated inhibition of erythropoietin function and erythroid progenitor cell differentiation. AI is mostly mild to moderate, normochromic and normocytic, and characterized by low circulating iron, but normal and increased levels of the storage protein ferritin and the iron hormone hepcidin. The primary therapeutic approach for AI is treatment of the underlying inflammatory disease which mostly results in normalization of hemoglobin levels over time unless other pathologies such as vitamin deficiencies, true iron deficiency on the basis of bleeding episodes, or renal insufficiency are present. If the underlying disease and/or anemia are not resolved, iron supplementation therapy and/or treatment with erythropoietin stimulating agents may be considered whereas blood transfusions are an emergency treatment for life-threatening anemia. New treatments with hepcidin-modifying strategies and stabilizers of hypoxia inducible factors emerge but their therapeutic efficacy for treatment of AI in ill patients needs to be evaluated in clinical trials.
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Molecular Remodeling of Cardiac Sinus Node Associated with Acute Chagas Disease Myocarditis.
Microorganisms2021 Oct;9(11):. doi: 2208.
Rodríguez-Angulo Héctor O, Colombet-Naranjo Diana, Maza María C, Poveda Cristina, Herreros-Cabello Alfonso, Mendoza Iván, Perera Juan C, Goyo Juan D, Gironès Núria, Fresno Manuel,
Abstract
Chagas disease principally affects Latin-American people, but it currently has worldwide distribution due to migration. Death among those with Chagas disease can occur suddenly and without warning, even in those who may not have evidence of clinical or structural cardiac disease and who are younger than 60 years old. HCN4 channels, one of the principal elements responsible for pacemaker currents, are associated with cardiac fetal reprogramming and supraventricular and ventricular arrhythmias, but their role in chagasic arrhythmias is not clear. We found that a single-dose administration of ivabradine, which blocks HCN4, caused QTc and QRS enlargement and an increase in P-wave amplitude and was associated with ventricular and supraventricular arrhythmias in mice challenged with isoproterenol, a chronotropic/ionotropic positive agent. Continuous treatment with ivabradine did not alter the QTc interval, but P-wave morphology was deeply modified, generating supraventricular arrhythmias. In addition, we found that repolarization parameters improved with ivabradine treatment. These effects could have been caused by the high HCN4 expression observed in auricular and ventricular tissue in infected mice. Thus, we suggest, for the first time, that molecular remodeling by overexpression of HCN4 channels may be related to supraventricular arrhythmias in acute Chagas disease, causing ivabradine over-response. Thus, ivabradine treatment should be administered with caution, while HCN4 overexpression may be an indicator of heart failure and/or sudden death risk.
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Indications of Persistent Glycocalyx Damage in Convalescent COVID-19 Patients: A Prospective Multicenter Study and Hypothesis.
Viruses2021 Nov;13(11):. doi: 2324.
Vollenberg Richard, Tepasse Phil-Robin, Ochs Kevin, Floer Martin, Strauss Markus, Rennebaum Florian, Kabar Iyad, Rovas Alexandros, Nowacki Tobias,
Abstract
The COVID-19 pandemic is caused by the SARS CoV-2 virus and can lead to severe lung damage and hyperinflammation. In the context of COVID-19 infection, inflammation-induced degradation of the glycocalyx layer in endothelial cells has been demonstrated. Syndecan-1 (SDC-1) is an established parameter for measuring glycocalyx injury. This prospective, multicenter, observational, cross-sectional study analyzed SDC-1 levels in 24 convalescent patients that had been infected with SARS-CoV-2 with mild disease course without need of hospitalization. We included 13 age-matched healthy individuals and 10 age-matched hospitalized COVID-19 patients with acute mild disease course as controls. In convalescent COVID-19 patients, significantly elevated SDC-1 levels were detected after a median of 88 days after symptom onset compared to healthy controls, whereas no difference was found when compared to SDC-1 levels of hospitalized patients undergoing acute disease. This study is the first to demonstrate signs of endothelial damage in non-pre-diseased, convalescent COVID-19 patients after mild disease progression without hospitalization. The data are consistent with studies showing evidence of persistent endothelial damage after severe or critical disease progression. Further work to investigate endothelial damage in convalescent COVID-19 patients should follow.
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Risk of Postoperative Gastrointestinal Bleeding and Its Associated Factors: A Nationwide Population-Based Study in Korea.
J Pers Med2021 Nov;11(11):. doi: 1222.
Kim Sang Hyuck, Han Kyungdo, Kang Gunseog, Lee Seung Woo, Park Chi-Min, Cho Jongho, Choi Jung Won, Park Se Jun, Kang Minyong, Kim Tae Jun, Hong Seo-Hee, Kwon Yong-Chol, Park Junhee, Shin Dongwook,
Abstract
Postoperative gastrointestinal bleeding (PGIB) is a serious complication with expensive medical costs and a high mortality rate. This study aims to analyze the incidence of PGIB and its associated factors, including its relationship with postoperative analgesic use. Patients aged ?20 years who received various kinds of surgery from 2013 to 2017 were included ( = 1,319,807). PGIB was defined by admission with ICD-10 codes of gastrointestinal bleeding plus transfusion within 2 months after surgery. A total of 3505 (0.27%) subjects had PGIB, and the incidence was much higher for those who underwent major gastrointestinal and major cardiovascular surgery (1.9% for both), followed by major head and neck (0.7%), major genitourinary (0.5%), and orthopedic surgery (0.45%). On multivariate analysis, older age, male sex, lower income, comorbidities, peptic ulcer disease, and congestive heart failure were associated with a higher risk of gastrointestinal bleeding. Among analgesics, steroid use was associated with increased postoperative bleeding risk (adjusted OR: 1.36, 95% CI: 1.25-1.48). Acetaminophen/nonsteroidal anti-inflammatory drugs, cyclooxygenase 2 inhibitors, anticonvulsants, antidepressants, and opioids were not associated with increased risk. PGIB is considerable for major surgeries, and its risk should be considered, especially for patients with older age and comorbidities and use of steroids.
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Risk of Re-Rupture, Vasospasm, or Re-Stroke after Clipping or Coiling of Ruptured Intracranial Aneurysms: Long-Term Follow-Up with a Propensity Score-Matched, Population-Based Cohort Study.
J Pers Med2021 Nov;11(11):. doi: 1209.
Zhang Jiaqiang, Lo Yang-Lan, Li Ming-Chang, Yu Ying-Hui, Wu Szu-Yuan,
Abstract
Scarce evidence is available in Asia for estimating the long-term risk and prognostic factors of major complications such as re-rupture, vasospasm, or re-stroke for patients with aneurysmal subarachnoid hemorrhage (SAH) undergoing endovascular coil embolization or surgical clipping. This is the first head-to-head propensity score-matched study in an Asian population to demonstrate that endovascular coil embolization for aneurysmal SAH treatment is riskier than surgical clipping in terms of re-rupture, vasospasm, or re-stroke. In addition, the independent poor prognostic factors of vasospasm or re-stroke were endovascular coil embolization, male sex, older age (?65 years; the risk of vasospasm increases with age), hypertension, congestive heart failure, diabetes, previous transient ischemic attack, or stroke in aneurysmal SAH treatment.
BACKGROUND:
To estimate the long-term complications and prognostic factors of endovascular coil embolization or surgical clipping for patients with ruptured aneurysmal subarachnoid hemorrhage (SAH).
METHODS:
We selected patients diagnosed with aneurysmal SAH between 1 January 2011 and 31 December 2017. Propensity score matching was performed, and Cox proportional hazards model curves were used to analyze the risk of re-rupture, vasospasm, and re-stroke in patients undergoing the different treatments.
FINDINGS:
Multivariate Cox regression analysis revealed that the adjusted hazard ratio (aHR) of re-rupture for endovascular coil embolization compared with surgical clipping was 1.36 (95% confidence interval [CI]: 1.17-1.57;
INTERPRETATION:
Endovascular coil embolization for aneurysmal SAH carries a higher risk than surgical clipping of both short- and long-term complications including re-rupture, vasospasm, and re-stroke.
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Very Long-Term Follow-Up in Cardiac Resynchronization Therapy: Wider Paced QRS Equals Worse Prognosis.
J Pers Med2021 Nov;11(11):. doi: 1176.
Leitz Patrick, Köbe Julia, Rath Benjamin, Reinke Florian, Frommeyer Gerrit, Andresen Christian, Güner Fatih, Wolfes Julian, Lange Philipp S, Ellermann Christian, Eckardt Lars, Dechering Dirk G,
Abstract
BACKGROUND:
Different electrocardiogram (ECG) findings are known to be independent predictors of clinical response to cardiac resynchronization therapy (CRT). It remains unknown how these findings influence very long-term prognosis.
METHODS AND RESULTS:
A total of 102 consecutive patients (75 males, mean age 65 ± 10 years) referred to our center for CRT implantation had previously been included in this prospective observational study. The same patient group was now re-evaluated for death from all causes over a prolonged median follow-up of 10.3 years (interquartile range 9.4-12.5 years). During follow-up, 55 patients died, and 82% of the clinical non-responders ( = 23) and 44% of the responders ( = 79) were deceased. We screened for univariate associations and found QRS width during biventricular (BIV) pacing ( = 0.02), left ventricular (LV) pacing (
CONCLUSION:
Our data show that QRS width duration during biventricular pacing, an ECG parameter easily obtainable during LV lead placement, is an independent predictor of mortality in a long-term follow-up. Our data add further evidence that NICM and lower NYHA class are independent predictors for better outcome after CRT implantation.
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