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Pubblicazioni recenti - cardiovascular
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Thoracic Surgery and the Elderly; Is Lobectomy Safe in Octogenarians?
Heart Lung Circ2023 Mar;():. doi: S1443-9506(23)00140-3.
Kirk Frazer, Chang Shantel, Yong Matthew S, He Cheng, Hughes Ian, Yadav Sumit, Lo Wing, Cole Christopher, Windsor Morgan, Naidoo Rishendran, Stroebel Andrie,
Abstract
PURPOSE:
Non-small cell lung cancer is the most common malignancy of the elderly, with 5-year survival estimates of 16.8%. The prognostic benefit of surgical resection for early lung cancer is irrefutable and maintained irrespective of age, even in patients over 75 years. Concerningly, despite the prognostic benefit of surgery there are deviations from standard treatment protocols with increasing age due to concerns of increased morbidity and mortality with surgery, without evidence to support this.
METHOD:
A state-wide retrospective registry study of Queensland's Cardiac Outcomes Registry's (QCOR) Thoracic Database examining the influence of age on the safety of Lung Resection (1 January 2016-20 April 2022).
RESULTS:
This included 1,232 patients, mean age at surgery was 66 years (range 14-91 years), with 918 thoracotomies performed. Three deaths occurred within 30-days (0.24%). Octogenarians (n=60) had lower rates of smoking (26% vs 6%), respiratory, cardiovascular, and cerebrovascular disease suggesting this subset of patients is carefully selected. Octogenarian status was not associated with an increased all-cause morbidity (p=0.09) or 30-day mortality (p=0.06). Further to this it was not associated with re-operation (4.4% vs 8.3%, p=0.1), increased postoperative stay (6.66 vs 6.65 days, p=0.99) or myocardial infarction. An independent predictor of morbidity was male sex (OR 1.58, CI 1.2-2.1 p=0.001).
CONCLUSION:
Age ?80 years did not increase surgical morbidity or mortality in the appropriately selected patient and should not be a barrier to referral for consideration of surgical resection.
Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.
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The power of the placebo effect in diabetes: A systematic review and meta-analysis.
Prim Care Diabetes2023 Mar;():. doi: S1751-9918(23)00067-0.
Gossenheimer Agnes Nogueira, de Freitas Michele Barreto, Pádua Borges Roberta de, Pohlmann Lauren, Dalzochio Meriane, Todendi Pâmela, Ziegelmann Patrícia Klarmann, Telo Gabriela H, Schaan E Beatriz D,
Abstract
This review aims to identify the magnitude of the placebo effect in people with type 2 diabetes mellitus. Literature research was conducted Medline, Embase and Virtual Health Library for studies published between the date of inception and June 2021. The eligibility criteria included randomized controlled trials, showing comparison to placebo, having participants with type 2 diabetes mellitus, and having glycated hemoglobin (HbA1c) as the primary outcome. Meta-analysis was conducted with the effect of changing HbA1c in relation to the baseline. Exploration of heterogeneity was performed.The meta-analysis showed an increase in the average of HbA1c compared to the baseline of 0.14% (95% CI: 0.07-0.21). There was a significant difference between follow-up times (p = 0.03) and between administration routes (p = 0.01), with an increase in HbA1c in the oral route [0.15% (95% CI: 0.07-0.23)]. The meta-regression of the year of publication showed a significant downward trend (p = 0.01) of the increase in HbA1c compared to the baseline.In this study, the expected placebo effect of Hba1c reduction was not found; instead, higher Hba1c levels were observed in the control groups, although this effect was reduced over the years. Registration: PROSPERO ID CRD42020172797.
Copyright © 2023. Published by Elsevier Ltd.
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MR Imaging Radiomics Analysis Based on Lumbar Soft Tissue to Evaluate Lumbar Fascia Changes in Patients with Low Back Pain.
Acad Radiol2023 Mar;():. doi: S1076-6332(23)00109-5.
Song Ming-Xin, Yang Hui, Yang He-Qi, Li Shan-Shan, Qin Jian, Xiao Qiang,
Abstract
RATIONALE AND OBJECTIVES:
Clinicians must precisely pinpoint the etiology of low back pain as the number of people suffering from it increases to provide targeted care. The purpose of this paper was to use MR imaging radiomics based on lumbar soft tissue to analyze changes in the lumbar fascia of patients with low back pain.
MATERIALS AND METHODS:
We retrospectively analyzed the lumbar MRI of 197 patients with low back pain. Patients were randomly assigned to either the training (n = 138) or validation (n = 59) cohorts. Multivariate logistic regression analysis was used to create radiomics model and combined nomogram model and their predictive performance were evaluated using receiver operating characteristic curves.
RESULTS:
Seven radiomics features based on lumbar soft tissue MRI images were established, which performed well in distinguishing between low back pain patients with fascial changes and normal individuals demonstrated an excellent ability to identify differences, with an Area Under Curve (AUC) of 0.92 (95% CI, 0.88-0.96) in the training cohort and 0.84 (95% CI, 0.73-0.96) in the validation cohort, which performed better than the clinical model significantly only.
CONCLUSION:
The nomogram based on clinical features and radiomics features of MR images had a good predictive ability to differentiate fascial alterations in patients with low back pain from normal subjects. It had the potential to be used as a decision support tool to assist clinicians in determining the etiology of patients with lower back pain and managing patients promptly, particularly in the early stage of the fasciitis when significant abnormalities on imaging were difficult to detect.
Copyright © 2023 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
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Single-Center Retrospective Comparison of Opioid-Based and Multimodal Analgesic Regimens in Adult Cardiac Surgery.
J Cardiothorac Vasc Anesth2023 Mar;():. doi: S1053-0770(23)00168-4.
Eisenbraun Alyssa, Schroeder Darrell, Schaff Hartzell V, Martin Erin, Wittwer Erica D,
Abstract
OBJECTIVES:
To compare the outcomes of 2 multimodal analgesic regimens with an opioid-based one.
DESIGN:
A 2-stage, retrospective study.
SETTING:
A large tertiary-care facility.
PARTICIPANTS:
Adult cardiac surgical patients.
INTERVENTIONS:
Patients received one of three regimens: opioid-only or 2 multimodal regimens. The opioid regimen included intraoperative fentanyl and patient-controlled analgesia pumps. Multimodal regimen 1 included preoperative extended-release oxycodone, intraoperative ketamine infusion, and postoperative morphine suppository. Multimodal regimen 2 included intraoperative methadone and dexmedetomidine infusion.
MEASUREMENTS AND MAIN RESULTS:
Outcomes measured included opioid use, pain scores, time to tracheal extubation, postoperative antiemetic use as a surrogate marker for postoperative nausea and vomiting (PONV), age, sex, surgical procedure(s), body mass index, time to first bowel movement, intensive care unit length of stay (LOS), and hospital LOS. Intraoperative median oral morphine equivalents (OMEs) declined from 425 mg (314, 518) to 150 mg (75, 150) and 230 mg (160, 240), p
CONCLUSIONS:
Multimodal analgesic regimens, particularly when incorporating methadone and dexmedetomidine, significantly reduced total and predischarge opioid use in cardiac surgical patients.
Copyright © 2023 Elsevier Inc. All rights reserved.
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Metabolic syndrome predicts cardiovascular risk and mortality in familial hypercholesterolemia.
J Clin Lipidol2023 Mar;():. doi: S1933-2874(23)00064-8.
Paquette Martine, Bernard Sophie, Cariou Bertrand, Hegele Robert A, Genest Jacques, Trinder Mark, Brunham Liam R, Béliard Sophie, Baass Alexis,
Abstract
BACKGROUND:
The association between familial hypercholesterolemia (FH) and premature atherosclerotic cardiovascular disease (ASCVD) is well established. Several risk factors other than the cumulative low-density lipoprotein cholesterol (LDL-C) have been shown to modulate the severity of the phenotype in these patients. However, the effect of the metabolic syndrome (MetS) on ASCVD risk in FH remains to be determined.
OBJECTIVES:
The objective was to study the association between the presence of MetS and the incidence of different ASCVD endpoints and all-cause mortality.
METHODS:
This prospective follow up study used data from 5 independent FH cohorts from Europe and North America. We analysed data of 2401 adult heterozygous FH without history of a prior ASCVD event (21,139 person-years of follow-up). Multivariate Cox proportional hazards regression was used to estimate the association between MetS and the incidence of the different endpoints.
RESULTS:
The prevalence of MetS was 14% in the study population. The presence of MetS was a significant predictor of incident 10-year ASCVD after adjustment for traditional cardiovascular risk factors (HR 2.07, 95% CI 1.34-3.19), as well as of 10-year major adverse cardiovascular event (MACE) (HR 4.59, 95% CI 2.27-9.30), 10-year myocardial infarction (MI) (HR 4.29, 95% CI 1.91-9.63), and 30-year all-cause mortality (HR 4.87, 95% CI 1.99-11.89).
CONCLUSION:
Our findings suggests that FH patients with MetS, have an increased cardiovascular risk that is independent from LDL-C and other traditional risk factors. Future studies are required to determine the most appropriate strategy to reduce the cardiovascular burden associated with MetS in this population.
Copyright © 2023. Published by Elsevier Inc.
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Comparison of discretization strategies for the model-free information-theoretic assessment of short-term physiological interactions.
Chaos2023 Mar;33(3):033127. doi: 10.1063/5.0140641.
Barà Chiara, Sparacino Laura, Pernice Riccardo, Antonacci Yuri, Porta Alberto, Kugiumtzis Dimitris, Faes Luca,
Abstract
This work presents a comparison between different approaches for the model-free estimation of information-theoretic measures of the dynamic coupling between short realizations of random processes. The measures considered are the mutual information rate (MIR) between two random processes X and Y and the terms of its decomposition evidencing either the individual entropy rates of X and Y and their joint entropy rate, or the transfer entropies from X to Y and from Y to X and the instantaneous information shared by X and Y. All measures are estimated through discretization of the random variables forming the processes, performed either via uniform quantization (binning approach) or rank ordering (permutation approach). The binning and permutation approaches are compared on simulations of two coupled non-identical Hènon systems and on three datasets, including short realizations of cardiorespiratory (CR, heart period and respiration flow), cardiovascular (CV, heart period and systolic arterial pressure), and cerebrovascular (CB, mean arterial pressure and cerebral blood flow velocity) measured in different physiological conditions, i.e., spontaneous vs paced breathing or supine vs upright positions. Our results show that, with careful selection of the estimation parameters (i.e., the embedding dimension and the number of quantization levels for the binning approach), meaningful patterns of the MIR and of its components can be achieved in the analyzed systems. On physiological time series, we found that paced breathing at slow breathing rates induces less complex and more coupled CR dynamics, while postural stress leads to unbalancing of CV interactions with prevalent baroreflex coupling and to less complex pressure dynamics with preserved CB interactions. These results are better highlighted by the permutation approach, thanks to its more parsimonious representation of the discretized dynamic patterns, which allows one to explore interactions with longer memory while limiting the curse of dimensionality.
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Japanese medical workers' sacrifice for universal health coverage.
Lancet -
Radionuclide Imaging of Heart-Brain Connections.
Cardiol Clin2023 May;41(2):267-275. doi: 10.1016/j.ccl.2023.01.013.
Abohashem Shady, Grewal Simran S, Tawakol Ahmed, Osborne Michael T,
Abstract
The heart and brain have a complex interplay wherein disease or injury to either organ may adversely affect the other. The mechanisms underlying this connection remain incompletely characterized. However, nuclear molecular imaging is uniquely suited to investigate these pathways by facilitating the simultaneous assessment of both organs using targeted radiotracers. Research within this paradigm has demonstrated important roles for inflammation, autonomic nervous system and neurohormonal activity, metabolism, and perfusion in the heart-brain connection. Further mechanistic clarification may facilitate greater clinical awareness and the development of targeted therapies to alleviate the burden of disease in both organs.
Copyright © 2023 Elsevier Inc. All rights reserved.
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Radionuclide Imaging of Infective Endocarditis.
Cardiol Clin2023 May;41(2):233-249. doi: 10.1016/j.ccl.2023.01.011.
Ferro Paola, Boni Roberto, Bartoli Francesco, Lazzeri Francesca, Slart Riemer H J A, Erba Paola A,
Abstract
Infective endocarditis (IE) is associated with high morbidity and mortality. Early diagnosis is crucial for adequate patient management. Due to difficulties in the diagnosis, a multidisciplinary discussion in addition to the integration of clinical signs, microbiology data, and imaging data is used. Imaging, including echocardiography, molecular imaging techniques, and coronary CT angiography (CTA) is central to detect infections involving heart valves and implanted cardiovascular devices, also allowing for early detection of septic emboli and metastatic. This article describes the main clinical application of white blood cell SPECT/CT and [F]FDG-PET/CT and CTA in IE and infections associated with cardiovascular implantable electronic devices.
Copyright © 2023 Elsevier Inc. All rights reserved.
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Current Status of Radionuclide Imaging of Transthyretin Cardiac Amyloidosis.
Cardiol Clin2023 May;41(2):217-231. doi: 10.1016/j.ccl.2023.01.010.
Waheed Anam, Dorbala Sharmila,
Abstract
Cardiac single photon emission computed tomography using Tc-bone avid tracers allows for an accurate noninvasive diagnosis of transthyretin (ATTR) cardiac amyloidosis, a historically underdiagnosed disease. This imaging is recommended in select populations who demonstrate clinical and imaging features of infiltrative cardiomyopathy. It is imperative to concomitantly assess for light chain (AL) cardiac amyloidosis independent of radionuclide scintigraphy for timely management of AL amyloidosis, a deadly disease requiring urgent therapy. Clinical judgement is also key and in some select scenarios an endomyocardial biopsy may be needed even after a noninvasive evaluation.
Copyright © 2023 Elsevier Inc. All rights reserved.
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Radionuclide Assessment of Sarcoidosis.
Cardiol Clin2023 May;41(2):207-215. doi: 10.1016/j.ccl.2023.01.009.
Divakaran Sanjay,
Abstract
This review provides an overview of the techniques used in nuclear cardiology for the assessment of suspected or known cardiac sarcoidosis, how radionuclide imaging assists with regard to diagnosis, risk stratification, and monitoring response to therapy, and work that is on the horizon with novel tracers.
Copyright © 2023 Elsevier Inc. All rights reserved.
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What Is New in Risk Assessment in Nuclear Cardiology?
Cardiol Clin2023 May;41(2):197-205. doi: 10.1016/j.ccl.2023.01.008.
Gimelli Alessia, Lakshmanan Suvasini, Della Tommasina Veronica, Liga Riccardo,
Abstract
Nuclear cardiology techniques allow in-depth evaluation of cardiac patients. A body of literature has established the use of nuclear cardiology. The results obtained with traditional cameras have been reinforced by those obtained with a series of innovations that have revolutionized the field of nuclear cardiology. This article highlights the role of nuclear cardiology in the risk assessment of patients with cardiac disease and sheds light on advancements of nuclear imaging techniques in the cardiovascular field. Patient risk stratification has a key role in modern precision medicine. Nuclear cardiac imaging techniques may quantitatively investigate major disease mechanisms of different cardiac pathologies.
Copyright © 2023 Elsevier Inc. All rights reserved.
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Clinical Value of Positron Emission Tomography Myocardial Perfusion Imaging and Blood Flow Quantification.
Cardiol Clin2023 May;41(2):185-195. doi: 10.1016/j.ccl.2023.01.007.
Di Carli Marcelo F,
Abstract
Myocardial blood flow (MBF) and flow reserve (MFR) measurements by PET/computed tomography provide incremental diagnostic and prognostic information over traditional quantification of ischemia and scar by myocardial perfusion imaging. A normal stress MBF and MFR (>2.0) have a very high negative predictive value for excluding high-risk obstructive coronary artery disease (CAD). These flow measurements are also used for surveillance of coronary allograft vasculopathy after heart transplantation. A global normal MFR (>2.0) identifies patients at lower clinical risk, whereas a severely reduced MFR (
Copyright © 2023 Elsevier Inc. All rights reserved.
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Novel PET Applications and Radiotracers for Imaging Cardiovascular Pathophysiology.
Cardiol Clin2023 May;41(2):129-139. doi: 10.1016/j.ccl.2023.01.002.
Kwiecinski Jacek,
Abstract
PET allows the assessment of cardiovascular pathophysiology across a wide range of cardiovascular conditions. By imaging processes directly involved in disease progression and adverse events, such as inflammation and developing calcifications (microcalcifications), PET can not only enhance our understanding of cardiovascular disease, but also, as shown for 18F-sodium fluoride, has the potential to predict hard endpoints. In this review, the recent advances in disease activity assessment with cardiovascular PET, which provide hope that this promising technology could be leveraged in the clinical setting, shall be discussed.
Copyright © 2023 Elsevier Inc. All rights reserved.
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Erratum to 'Defining Commotio Cordis': The American Journal of Cardiology Volume 124, Issue 10, 15 November 2019, Pages 1649-1650.
Am J Cardiol2023 Apr;193():133. doi: 10.1016/j.amjcard.2023.03.023.
Maron Barry J, Cooper Ste, Sheppard M N,
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Effect of Acute Cardiovascular Exercise on Cerebral Blood Flow: A Systematic Review.
Brain Res2023 Mar;():148355. doi: 10.1016/j.brainres.2023.148355.
Mulser Lisa, Moreau David,
Abstract
A single bout of cardiovascular exercise can have a cascade of physiological effects, including increased blood flow to the brain. This effect has been documented across multiple modalities, yet studies have reported mixed findings. Here, we systematically review evidence for the acute effect of cardiovascular exercise on cerebral blood flow across a range of neuroimaging techniques and exercise characteristics. Based on 52 studies and a combined sample size of 1,174 individuals, our results indicate that the acute effect of cardiovascular exercise on cerebral blood flow generally follows an inverted U-shaped relationship, whereby blood flow increases early on but eventually decreases as exercise continues. However, we also find that this effect is not uniform across studies, instead varying across a number of key variables including exercise characteristics, brain regions, and neuroimaging modalities. As the most comprehensive synthesis on the topic to date, this systematic review sheds light on the determinants of exercise-induced change in cerebral blood flow, a necessary step toward personalized interventions targeting brain health across a range of populations.
Copyright © 2023. Published by Elsevier B.V.
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Advances in receptor chromatography for drug discovery and drug-receptor interaction studies.
Drug Discov Today2023 Mar;():103576. doi: 10.1016/j.drudis.2023.103576.
Fu Jia, Qin Wei, Cao Lu-Qi, Chen Zhe-Sheng, Cao Hui-Ling,
Abstract
Receptor chromatography involves high-throughput separation and accurate drug screening based on specific drug-receptor recognition and affinity, which has been widely used to screen active compounds in complex samples. This review summarizes the immobilization methods for receptors from three aspects: random covalent immobilization methods, site-specific covalent immobilization methods and dual-target receptor chromatography. Meanwhile, it focuses on its applications from three angles: screening active compounds in natural products, in natural-product-derived DNA-encoded compound libraries and drug-receptor interactions. This review provides new insights for the design and application of receptor chromatography, high-throughput and accurate drug screening, drug-receptor interactions and more. Teaser: This review summarizes the immobilization methods of receptors and the application of receptor chromatography, which will provide new insights for the design and application of receptor chromatography, rapid drug screening, drug-receptor interactions and more.
Copyright © 2023. Published by Elsevier Ltd.
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Yamaguchi syndrome - An updated review article of electrocardiographic and echocardiographic findings.
Am J Med Sci2023 Mar;():. doi: S0002-9629(23)01125-4.
Dasari Mahati, Kumar Pramukh Arun, Bhattad Pradnya Brijmohan, Jha Anil, Sherif Akil A, Mishra Ajay K, Ramsaran Eddison,
Abstract
Apical hypertrophic cardiomyopathy (ApHCM) is thought to be an uncommon variant of hypertrophic cardiomyopathy (HCM). This article is a literature review focusing on the characteristic electrocardiogram (EKG) and 2D echocardiogram findings as currently there are no specific ACC/AHA/ESC guidelines set as diagnostic criteria for ApHCM.
Copyright © 2023. Published by Elsevier Inc.
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Global burden of cardiovascular disease from 1990 to 2019 attributable to dietary factors.
J Nutr2023 Mar;():. doi: S0022-3166(23)35504-4.
Zhang Bei, Pu Liyuan, Zhao Tian, Wang Li, Shu Chang, Xu Shan, Sun Jing, Zhang Ruijie, Han Liyuan,
Abstract
BACKGROUND:
While dietary factors play a crucial role in the incidence of cardiovascular disease, the specific dietary risk factors vary across regions and require further investigation.
OBJECTIVE:
The burden of cardiovascular disease (CVD) due to different dietary factors was analyzed by determining sex, age, and sociodemographic index (SDI) values for 204 countries and territories between 1990 and 2019.
METHODS:
Data were extracted from the Global Burden of Disease (GBD) 2019 and analyzed to determine population attributable fractions (PAFs), mortality, and disability-adjusted life years (DALYs), and trends thereof, for CVDs attributable to dietary risk factors from 1990 to 2019. We used a generalized linear model with a Gaussian distribution to calculate the estimated annual percentage changes (EPACs) in CVD mortality and DALY rates attributable to dietary risk factors. We also used a comparative risk-assessment framework to estimate the CVD mortality and DALYs attributable to dietary risk factors.
RESULTS:
Approximately 40% of CVD mortality and DALY rates were attributable to dietary risk factors, with high sodium intake, low whole-grain intake, and low legume intake being the greatest dietary risk factors globally. Moreover, high-SDI regions had the highest PAFs for CVD mortality and DALYs associated with high red and processed meat intake, middle-SDI regions had the highest PAFs with high sodium intake, and low-SDI regions had the highest PAFs with low fruit and vegetable intake. The highest PAFs for CVD mortality and DALYs were associated with low whole-grain intake in 13 and 9 regions, respectively.
CONCLUSION:
Reducing sodium intake and increasing whole-grain and legume intake should be the top priority worldwide for improving regional diets and thereby decreasing CVD burdens. Other priorities should be set for different SDI-value regions, depending on the predominant dietary risk factors for CVDs in the respective regions.
Copyright © 2023. Published by Elsevier Inc.
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Prope tolerance after pediatric liver transplantation: Experience at Shiraz Organ Transplant Center.
Transpl Immunol2023 Mar;():101827. doi: 10.1016/j.trim.2023.101827.
Shamsaeefar Alireza, Kazemi Kourosh, Nikoupour Hamed, Moosavi Seyed Ali, Mashhadiagha Amirali, Sayadi Mehrab, Gholami Sivash, Motazedian Nasrin, Nikeghbalian Saman, Malekhosseini Seyed Ali,
Abstract
BACKGROUND:
Children receive transplants at a younger age, and the period of immunosuppression therapy may extend over decades. However, immunosuppression seems to be responsible for long-term mortality and morbidity. Pediatric liver transplant recipients can benefit from achieving immune tolerance and the opportunity of freedom from lifelong immunosuppression. This study aimed to investigate the frequency of prope tolerance among pediatric liver transplant recipients and the characteristics of these patients.
METHODS:
In this retrospective cohort study of pediatric liver transplant recipients, the medical records of transplant recipients treated at Shiraz Organ Transplant Center between 1994 and 2017 were reviewed. Prope tolerance was defined as normal laboratory values and stable clinical status on low-dose monotherapy. Children treated with low-dose monotherapy were categorized as the prope tolerant group. We compared the characteristics of prope tolerant recipients on low-dose monotherapy with patients on standard immunosuppression, i.e. full-dose tacrolimus plus steroids and mycophenolate mofetil. The data were analyzed with the t-test, chi-squared test, and a Cox proportional hazard model at a 5% significance level in SPSS software version 16.
RESULTS:
A total of 585 children with a mean age of 8.32?±?5.23?years were enrolled. 341 patients were categorized as prope tolerant and 244 comprised the full immunosuppression regimen group. Mean age at transplantation and rejection frequency were lower in the prope tolerant group (p?0.001, p?0.001). Based on the underlying diseases, metabolic/genetic, biliary tract, and cryptogenic liver diseases were significantly more prevalent in the prope tolerant group (p?0.001). However, autoimmune liver disease was found to be more prevalent in the full immunosuppression regimen group. Also, those who received living organs (p?=?0.001) and recipients of organs from female donors had a greater likelihood of achieving prope tolerant. According to the multiple Cox regression results, age at transplantation (p?=?0.022), rejection frequency (p?0.001), and autoimmune liver diseases (p?=?0.028) had a prognostic effect on prope tolerance.
CONCLUSION:
Factors as underlying disease, age at transplantation, and rejection frequency were factors that were predictive of prope tolerance in this sample of children. However, the risk of rejection should be considered during the tapering period.
Copyright © 2023. Published by Elsevier B.V.
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