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Pubblicazioni recenti - cardiovascular
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Cost of primary care approaches for hypertension management and risk-based cardiovascular disease prevention in Bangladesh: a HEARTS costing tool application.
BMJ Open2022 Jun;12(6):e061467. doi: 10.1136/bmjopen-2022-061467.
Husain Muhammad Jami, Haider Mohammad Sabbir, Tarannum Renesa, Jubayer Shamim, Bhuiyan Mahfuzur Rahman, Kostova Deliana, Moran Andrew E, Choudhury Sohel Reza,
Abstract
OBJECTIVE:
To estimate the costs of scaling up the HEARTS pilot project for hypertension management and risk-based cardiovascular disease (CVD) prevention at the full population level in the four subdistricts (upazilas) in Bangladesh.
SETTINGS:
Two intervention scenarios in subdistrict health complexes: hypertension management only, and risk-based integrated hypertension, diabetes, and cholesterol management.
DESIGN:
Data obtained during July-August 2020 from subdistrict health complexes on the cost of medications, diagnostic materials, staff salaries and other programme components.
METHODS:
Programme costs were assessed using the HEARTS costing tool, an Excel-based instrument to collect, track and evaluate the incremental annual costs of implementing the HEARTS programme from the health system perspective.
PRIMARY AND SECONDARY OUTCOME MEASURES:
Programme cost, provider time.
RESULTS:
The total annual cost for the hypertension control programme was estimated at US$3.2?million, equivalent to US$2.8 per capita or US$8.9 per eligible patient. The largest cost share (US$1.35?million; 43%) was attributed to the cost of medications, followed by the cost of provider time to administer treatment (38%). The total annual cost of the risk-based integrated management programme was projected at US$14.4?million, entailing US$12.9 per capita or US$40.2 per eligible patient. The estimated annual costs per patient treated with medications for hypertension, diabetes and cholesterol were US$18, US$29 and US$37, respectively.
CONCLUSION:
Expanding the HEARTS hypertension management and CVD prevention programme to provide services to the entire eligible population in the catchment area may face constraints in physician capacity. A task-sharing model involving shifting of select tasks from doctors to nurses and local community health workers would be essential for the eventual scale-up of primary care services to prevent CVD in Bangladesh.
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Examining anti-inflammatory therapies in the prevention of cardiovascular events: protocol for a systematic review and network meta-analysis of randomised controlled trials.
BMJ Open2022 Jun;12(6):e062702. doi: 10.1136/bmjopen-2022-062702.
Boczar Kevin Emery, Shin Sheojung, Bezzina Kathryn A, Geejo Aishwarya, Pearson Alexander Liam, Shahab Saba, Fehlmann Christophe A, Visintini Sarah, Beanlands Rob, Wells George A,
Abstract
INTRODUCTION:
Inflammation is emerging as an important risk factor for atherosclerotic cardiovascular disease and has been a recent target for many novel therapeutic agents. However, comparative evidence regarding efficacy of these anti-inflammatory treatment options is currently lacking.
METHODS AND ANALYSIS:
This systematic review will include randomised controlled trials evaluating the effect of anti-inflammatory agents on cardiovascular outcomes in patients with known cardiovascular disease. Studies will be retrieved from Medline, Embase, the Cochrane Central Register of Controlled Trials, as well as clinical trial registry websites, Europe PMC and conference abstract handsearching. No publication date or language restrictions will be imposed. Eligible interventions must have some component of anti-inflammatory agent. These include (but are not limited to): non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, prednisone, methotrexate, canakinumab, pexelizumab, anakinra, succinobucol, losmapimod, inclacumab, atreleuton, LP-PLA (darapladib) and sPLA (varespladib). The primary outcomes will include major adverse cardiac events (MACE), and each individual component of MACE (myocardial infarction, stroke and cardiovascular death). Key secondary outcomes will include unstable angina, heart failure, all-cause mortality, cardiac arrest and revascularisation. Screening, inclusion, data extraction and quality assessment will be performed independently by two reviewers. Network meta-analysis based on the random effects model will be conducted to compare treatment effects both directly and indirectly. The quality of the evidence will be assessed with appropriate tools including the Grading of Recommendations, Assessment, Development and Evaluation profiler or Confidence in Network Meta-Analysis tool.
ETHICS AND DISSEMINATION:
Ethics approval is not required for this systematic review. The findings will be disseminated through a peer-reviewed journal.
PROSPERO REGISTRATION NUMBER:
CRD42022303289.
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Swinging heart seen on single-photon emission computed tomography (SPECT).
BMJ Case Rep2022 Jun;15(6):. doi: e246487.
Mishra Shreya, Zoltowska Dominika, Zenni Martin, Sattiraju Srinivasan,
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HDAC1 Promotes Myocardial Fibrosis in Diabetic Cardiomyopathy by Inhibiting BMP-7 Transcription Through Histone Deacetylation.
Exp Clin Endocrinol Diabetes2022 Jun;():. doi: 10.1055/a-1780-8768.
Ouyang Chun, Huang Lei, Ye Xiaoqiang, Ren Mingming, Han Zhen,
Abstract
OBJECTIVE:
Diabetic cardiomyopathy (DCM) constitutes a primary cause of mortality in diabetic patients. Histone deacetylase (HDAC) inhibition can alleviate diabetes-associated myocardial injury. This study investigated the mechanism of HDAC1 on myocardial fibrosis (MF) in DCM.
METHODS:
A murine model of DCM was established by a high-fat diet and streptozotocin injection. The bodyweight, blood glucose, serum insulin, and cardiac function of mice were analyzed. Lentivirus-packaged sh-HDAC1 was injected into DCM mice and high glucose (HG)-induced cardiac fibroblasts (CFs). The pathological structure of the myocardium and the level of myocardial fibrosis were observed by histological staining. HDAC1 expression in mouse myocardial tissues and CFs was determined. Collagen I, collagen III, alpha-smooth muscle actin (?-SMA), and vimentin levels in CFs were detected, and CF proliferation was tested. HDAC activity and histone acetylation levels in tissues and cells were measured. Bone morphogenetic protein-7 (BMP-7) expression in myocardial tissues and CFs was determined. Functional rescue experiments were conducted to confirm the effects of histone acetylation and BMP-7 on myocardial fibrosis.
RESULTS:
DCM mice showed decreased bodyweight, elevated blood glucose and serum insulin, and cardiac dysfunction. Elevated HDAC1 and reduced BMP-7 expressions were detected in DCM mice and HG-induced CFs. HDAC1 repressed BMP-7 transcription through deacetylation. HDAC1 silencing alleviated MF, reduced CF proliferation and decreased collagen I, -III, ?-SMA, and vimentin levels. However, reducing histone acetylation level or BMP-7 downregulation reversed the effects of HDAC1 silencing on CF fibrosis.
CONCLUSION:
HDAC1 repressed BMP-7 transcription by enhancing histone deacetylation, thereby promoting MF and aggravating DCM.
Thieme. All rights reserved.
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Serial Left and Right Ventricular Strain Analysis in Patients Recovered from COVID-19.
J Am Soc Echocardiogr2022 Jun;():. doi: S0894-7317(22)00310-8.
Young Kathleen A, Krishna Hema, Jain Vaibhav, Hamza Izhan, Scott Christopher G, Pellikka Patricia A, Villarraga Hector R,
Abstract
BACKGROUND:
Strain analysis of transthoracic echocardiography (TTE) is a sensitive tool to detect myocardial dysfunction in those affected by COVID-19. Consideration of pre-existing cardiovascular disease is important in detecting changes related to COVID-19. We sought to assess serial TTE changes in patients recovered from COVID-19 compared to baseline, pre-COVID-19 exams, with a focus on left and right ventricular longitudinal strain.
METHODS:
In this retrospective review of serial TTEs in confirmed COVID-19 patients at Mayo Clinic sites, included patients had a TTE within 2 years prior to confirmed COVID-19 diagnosis and the first available outpatient TTE after diagnosis used as comparison. Patients with interval cardiac surgery, procedure, or device placement (n=9) were excluded. Biventricular strain was retrospectively performed on both echocardiograms.
RESULTS:
Of 259 individuals, age 60±16 years, 47% female, and 88% Caucasian, post-COVID-19 TTEs were performed a median of 55 days (IQR 37-92) following diagnosis. No clinically significant TTE changes were noted, though left ventricular ejection fraction (LVEF) was higher (58% vs 57%, p=0.049) and tricuspid annulus plane systolic excursion lower (20 vs 21mm, p=0.046) following COVID-19. Baseline LV global longitudinal strain (LV GLS) and right ventricular free wall strain (RV FWS) were normal (-19.6% and -25.8%, respectively) and similar following COVID-19 (-19.6% and -25.7%, p=0.07 and 0.77, respectively). In the 74 inpatients, no significant change from baseline was seen for LV GLS (-19.4% vs -19.1%, p=0.62), RV FWS (-25.5% vs -25.0%, p=0.69), or LVEF (57% vs 57%, p=0.71). A significant worsening in strain occurred in 27 patients, 16 (6.8%) of the 237 with LV GLS and 14 (6.0%) of the 235 with RV FWS. Ten (20%) patients reporting new symptoms following COVID-19 had worsened strain, compared to 5 (7%) with persistent/progressive symptoms and 11 (9%) with no new symptoms (p=0.04).
CONCLUSIONS:
While patients with new symptoms following COVID-19 were more likely to have a worsening in absolute strain values, no clinically significant change in TTE parameters was evident in most patients following COVID-19 regardless of symptom status.
Copyright © 2022. Published by Elsevier Inc.
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Protected and Unprotected Radiation Exposure to the Eye Lens during Endovascular Procedures in Hybrid Operating Rooms.
Eur J Vasc Endovasc Surg2022 Jun;():. doi: S1078-5884(22)00401-4.
Jungi S, Ante M, Geisbüsch P, Hoedlmoser H, Kleinau P, Böckler D,
Abstract
OBJECTIVE:
Radiation cataract has been observed at lower doses than previously thought. Therefore, the annual limit for equivalent dose to the eye lens has been reduced from 150 to 20mSv. This study evaluates radiation exposure to the eye lens of operators working in a hybrid operating room before and after implementation of a dose reduction program.
METHODS:
From April-October 2019, radiation exposure to the first operator was measured during all consecutive endovascular procedures performed in the hybrid operating room using BeOSL H(3) eye lens dosimeters placed both outside and behind the lead glasses (0.75mm lead equivalent). Measured values were compared to data from a historic control group from the same hospital before implementation of a dose reduction program.
RESULTS:
A total of 181 consecutive patients underwent an endovascular procedure in the hybrid operating room. The median unprotected eye lens dose (outside lead glasses) of the main operator was 0.049mSv for EVAR (n=30), 0.042mSv for TEVAR (n=23), 0.175mSv for complex aortic endovascular procedures (F/BEVAR; n=15) and 0.042mSv for peripheral interventions (n=80). Compared to the control period, EVAR had 75% lower, TEVAR 79% lower and F/BEVAR 55% lower radiation exposure to the unprotected eye lens of the first operator. The lead glasses led to a median reduction of the exposure to the eye lens by the factor 3.4.
CONCLUSION:
The implementation of a dose reduction program has led to a relevant reduction of radiation exposure to head and eye lens of the first operator in endovascular procedures. With optimum radiation protection measures including a ceiling-mounted shield and lead glasses, more than 440 EVARs, 280 TEVARs or 128 FEVARs could be performed per year until the dose limit for the eye lens of 20 mSv would be reached.
Copyright © 2022 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.
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Abdominal aortic aneurysm in heart transplant recipients: new insights from a 30-year experience at a single center.
Ann Vasc Surg2022 Jun;():. doi: S0890-5096(22)00311-9.
Tchana-Sato Vincent, Koch Jean-Noël, Ancion Arnaud, Adelin Albert, Minga Lowampa Elie, Burelli Mara, Defraigne Jean-Olivier, Sakalihasan Natzi,
Abstract
OBJECTIVE:
The improvement in survival rates for heart transplant recipients (HTRs) has increased their risk of developing extracardiac diseases such as abdominal aortic aneurysms (AAAs). The purposes of this study were to evaluate the prevalence and to describe the clinical features and natural history of AAA in HTRs.
METHODS:
A retrospective review of all patients (375) who underwent heart transplantation (HT) at our center over a 32-year period (1983-2015) was carried out.
RESULTS:
We identified 20 patients (5.3%) with AAA. All but one patient were male (95%), and most of them (80%) had a history of ischemic heart disease (IHD) prior to transplantation. The mean age of the patients with AAA at transplant was 57.2±7.3 years (range: 42-62 years). Seven of the 20 patients with AAA already had an AAA (30 to 55 mm) prior to transplantation. The average aneurysm size at the time of diagnosis was 40.9±9.6 mm, and the average patient age at the time of diagnosis was 62.2±8.3 years. The mean linear expansion rate was 10.6±2.12 mm/y, and the exponential expansion rate was 0.220±0.040 year respectively. The median follow-up time was 5.4 years (range 0.1-27.4 years). The median survival was 143 months (95% confidence interval (CI) 65 to 180 months) for the 20 HTRs with AAA and 68.8 months (95% CI 46 to 88 months) for the other HTRs.
CONCLUSIONS:
The natural history of AAA in HTR is characterized by an increased expansion rate. Male HTR with end-stage IHD are particularly at risk and should be closely followed-up after HT.
Copyright © 2022 Elsevier Inc. All rights reserved.
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The effect of balloon-assisted pharmacomechanical catheter-directed thrombolysis on the patency and post-thrombotic syndrome in patients with acute iliofemoral deep vein thrombosis: Is it really necessary or not?
Ann Vasc Surg2022 Jun;():. doi: S0890-5096(22)00305-3.
Gumus Fatih, Arslanturk Oguz,
Abstract
OBJECTIVES:
The objective of this study was to describe the contribution and advantage of balloon-dilatation of iliac and femoral veins following pharmacomechanical catheter-directed thrombolysis (PCDT) on the development of post-thrombotic syndrome (PTS).
METHODS:
From October 2018 and January 2022, 85 patients with acute total occlusion of the iliac and femoral veins were treated with PCDT. The cohort was divided into two groups depending on the utilization of concomitant balloon dilatation of iliac and femoral veins (Group 1, n=34, 40.0%) or not (Group 2, n=51, 60.0%) during the PCDT. All patients underwent duplex ultrasound scanning for evaluating the patency of iliac veins and recanalization rates at 3, 6, and 12 months postoperatively. the Villalta score was used to score the severity of PTS at 12 months postoperatively.
RESULTS:
Patients who underwent balloon-assisted PCDT (group 1) exhibited significantly higher primary patency rates in CIV (recanalization 84.3 ± 14.6%, p = 0.003) , EIV (recanalization 82.8 ± 17.2, p = 0.003) and CFV (recanalization 88.1 ± 12.1%, p = 0.038) compared with the group 2 at the end of 12 months follow-up. Only 2 patients underwent venous stenting in follow-up due to severe venous claudication, however, 13 patients were required iliac vein stenting due to severe PTS proved with a high Villalta score at 12-month follow-up. The d-dimer level at 1-year follow-up had also significantly lower in Group 1 due to higher rates of patency and lower thrombosis burden. The most common bleeding events were hematuria (n =4) or oozing in the puncture site (n = 4).
CONCLUSIONS:
This study showed that balloon-assisted PCDT reduces the risk of PTS, is more successful in common iliac vein recanalization, reduces the need for the venous stent, and even lowers the D-dimer levels of the patients compared to routine PCDT alone.
Copyright © 2022. Published by Elsevier Inc.
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Safety and Efficacy of Ultra Short-Duration Dual Antiplatelet Therapy After Percutaneous Coronary Interventions: A Meta analysis of Randomized Controlled Trials.
Curr Probl Cardiol2022 Jun;():101295. doi: S0146-2806(22)00192-X.
Abusnina Waiel, Baral Nischit, Seri Amith, Ben-Dor Itsik, Alkhouli Mohamad, Monteleone Peter, Haddad Elias, Goldsweig Andrew M, Paul Timir K,
Abstract
INTRODUCTION:
Dual antiplatelet therapy (DAPT) is required after percutaneous coronary intervention (PCI) to reduce stent thrombosis, but DAPT increases bleeding risks. The optimal duration of DAPT that provides the maximum protective ischemic effect along with the minimum bleeding risk is unclear. This is the first meta-analysis comparing outcomes for 1-month versus longer DAPT strategies following PCI.
METHODS:
We searched PubMed, Cochrane, and ClinicalTrials.gov databases (from inception to October 2021) for randomized controlled trials (RCTs) that compared 1-month duration versus > 1-month duration of DAPT following PCI. We used a random-effects model to calculate risk ratio (RR) with 95% confidence interval (CI). The co-primary outcomes for study selection were all-cause mortality, major bleeding, and stent thrombosis. Secondary outcomes included myocardial infarction (MI), cardiovascular mortality, ischemic stroke and target vessel revascularization.
RESULTS:
A total of five RCTs were included [n=29,355; 1-month DAPT(n=14,662) vs > 1-month DAPT (n=14,693)]. There was no statistically significant difference between the two groups in terms of all-cause mortality (RR 0.89; 95% CI 0.78-1.03; p?=?0.12) and stent thrombosis (RR 1.07; 95% CI 0.80-1.43; p?=?0.65). Similarly, there were no significant differences in MI, cardiovascular mortality, ischemic stroke, and target vessel revascularization. The rate of major bleeding was significantly lower in the group treated with DAPT for 1-month (RR 0.74; 95% CI 0.56-0.99, p?=?0.04).
CONCLUSION:
There is no difference in all-cause mortality, cardiovascular mortality, MI, stent thrombosis, ischemic stroke and target vessel revascularization with 1-month of DAPT following PCI with contemporary drug eluting stents compared to longer DAPT duration.
Copyright © 2022 Elsevier Ltd. All rights reserved.
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TRPP2 ion channels: The roles in various subcellular locations.
Biochimie2022 Jun;():. doi: S0300-9084(22)00172-9.
Tian Peng-Fei, Sun Meng-Meng, Hu Xian-Yu, Du Juan, He Wei,
Abstract
TRPP2 (PC2, PKD2 or Polycytin-2), encoded by PKD2 gene, belongs to the nonselective cation channel TRP family. Recently, the three-dimensional structure of TRPP2 was constructed. TRPP2 mainly functions in three subcellular compartments: endoplasmic reticulum, plasma membrane and primary cilia. TRPP2 can act as a calcium-activated intracellular calcium release channel on the endoplasmic reticulum. TRPP2 also interacts with other Ca release channels to regulate calcium release, like IP3R and RyR2. TRPP2 acts as an ion channel regulated by epidermal growth factor through activation of downstream factors in the plasma membrane. TRPP2 binding to TRPC1 in the plasma membrane or endoplasmic reticulum is associated with mechanosensitivity. In cilium, TRPP2 was found to combine with PKD1 and TRPV4 to form a complex related to mechanosensitivity. Because TRPP2 is involved in regulating intracellular ion concentration, TRPP2 mutations often lead to autosomal dominant polycystic kidney disease, which may also be associated with cardiovascular disease. In this paper, we review the molecular structure of TRPP2, the subcellular localization of TRPP2, the related functions and mechanisms of TRPP2 at different sites, and the diseases related to TRPP2.
Copyright © 2022. Published by Elsevier B.V.
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Effects of Multimodal Inpatient Rehabilitation vs. Conventional Pulmonary Rehabilitation on Physical Recovery after Esophageal Cancer Surgery.
Arch Phys Med Rehabil2022 Jun;():. doi: S0003-9993(22)00474-9.
Do Jung Hwa, Gelvosa Ma Nessa, Choi Kyung Yong, Kim Hwal, Kim Ja Young, Stout Nicole L, Cho Young Ki, Kim Hyeong Ryul, Kim Yong-Hee, Kim Sang Ah, Jeon Jae Yong,
Abstract
OBJECTIVE:
To determine the effects of multimodal rehabilitation initiated immediately after esophageal cancer surgery on physical recovery compared to conventional pulmonary rehabilitation.
DESIGN:
Retrospective study.
SETTING:
Private quaternary care hospital.
PARTICIPANTS:
Fifty-nine inpatients who participated in either conventional pulmonary rehabilitation (n?=?30) or in multimodal rehabilitation (n?=?29) after esophageal cancer surgery were included.
INTERVENTIONS:
Both groups performed pulmonary exercises, including deep breathing, chest expansion, inspiratory muscle training, coughing, and manual vibration. In the conventional pulmonary rehabilitation group, light-intensity mat exercise, stretching, and walking were performed. The multimodal rehabilitation group performed resistance exercises and moderate-to-high-intensity aerobic interval exercises using a bicycle.
MAIN OUTCOME MEASURES:
The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire C30 (EORTC QLQ-C30), pain, 6-minute walk test (6MWT), 30-second chair stand test, and grip strengths were assessed before and after the rehabilitation programs.
RESULTS:
Symptom scales of pain, dyspnea, and insomnia in the EORTC QLQ C-30 as well as 6MWT improved significantly after each program (p
CONCLUSIONS:
A multimodal inpatient rehabilitation program instituted early after esophageal cancer surgery improved endurance for walking as measured by the 6MWT as well as the 30-second chair stand test, more than conventional pulmonary rehabilitation.
Copyright © 2022. Published by Elsevier Inc.
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Incidence and Severity of Intracerebral Hemorrhage on Oral Anticoagulation and Antiplatelet Therapy.
Neuroepidemiology2022 Jun;():. doi: 10.1159/000525699.
Araujo Tainá de, Lacerda Marcelo Pitombeira de, Safanelli Juliana, Diegoli Henrique, Reis Felipe Ibiapina Dos, Nagel Vivian, Baptista João Pedro Ribeiro, Longo Alexandre Luis,
Abstract
Safety and efficacy of oral anticoagulation (OA) and antiplatelet therapy (AP) for cardiovascular prevention in Brazil are likely to be affected by economic and health access inequalities. This study aimed to assess the occurrence of intracerebral hemorrhage (ICH) in patients using OA or AP registered in the JOINVASC between 2015 and 2020. Higher mortality among OA or AP patients was seen, with a statistically significant difference in mortality within 90 days (38% versus 25%, p=0.025). For patients with OA at the time of ICH, high stroke severity was observed, with a 71% mortality rate. Managing bleeding episodes on OA and AP is key in the effort to prevent cardiovascular death and disability, and improved access to DOAC and reversal agents is in need for this patient population.
S. Karger AG, Basel.
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Assessment of drinking water safety in the Netherlands using nationwide exposure and mortality data.
Environ Int2022 Jun;166():107356. doi: S0160-4120(22)00283-5.
Houthuijs Danny, Breugelmans Oscar R P, Baken Kirsten A, Sjerps Rosa M A, Schipper Maarten, van der Aa Monique, van Wezel Annemarie P,
Abstract
BACKGROUND:
Although drinking water in the Netherlands is generally accepted as safe, public concern about health risks of long-term intake still exist.
OBJECTIVE:
The aim was to explore associations between drinking water quality for nitrate, water hardness, calcium and magnesium and causes-of-death as related to cardiovascular diseases amongst which coronary heart disease and colorectal cancer.
METHODS:
We used national administrative databases on cause-specific mortality, personal characteristics, residential history, social economic indicators, air quality and drinking water quality for parameters specified by the EU Drinking Water Directive. We put together a cohort of 6,998,623 persons who were at least 30 years old on January 1, 2008 and lived for at least five years on the same address. The average drinking water concentration over 2000-2010 at the production stations were used as exposure indicators. We applied age stratified Cox proportional hazards models.
RESULTS:
Magnesium was associated with a reduced risk for mortality due to coronary heart diseases: HR of 0.95 (95% CI: 0.90, 0.99) per 10 mg/L increase. For mortality due to cardiovascular diseases, a 100 mg/L increase in calcium was associated with a HR of 1.08 (95% CI: 1.03, 1.13) and an increase of 2.5 mmol/L of water hardness with a HR of 1.06 (95% CI: 1.01, 1.10). The results show an elevated risk for coronary heart disease mortality at calcium concentrations below 30 mg/L, but over the whole exposure range no exposure response relation was observed. For other combinations of drinking water quality parameters and cause-specific mortality studied, no statistical significant associations were identified.
CONCLUSION:
We identified in this explorative study a protective effect of magnesium for the risk of mortality to coronary heart disease. Also we found an increased risk of mortality due to cardiovascular disease associated with the concentration of calcium and the water hardness in drinking water.
Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.
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High R wave as a risk factor for cardivoascular and all-cause mortality. A 45-year follow-up of 13 cohorts of the Seven Countries Study.
J Electrocardiol2022 Jun;73():103-107. doi: S0022-0736(22)00085-1.
Menotti Alessandro, Puddu Paolo Emilio, Tolonen Hanna, Kafatos Anthony, Adachi Hisashi,
Abstract
OBJECTIVES:
To study the role of high R waves predicting cardiovascular (CVD) and all-cause mortality in a male middle-aged population followed-up 45 years.
MATERIAL AND METHODS:
A total of 7985 CVD-free men aged 40-59 years were enrolled in 13 cohorts in seven countries (USA, Finland, the Netherlands, Italy, Serbia, Greece, Japan) and high R waves were classified by Minnesota Code 3.1 (as a dichotomous variable) from baseline resting otherwise normal ECG at entry examination together with other personal characteristics. Cox models were solved to detect the possible predictive role of high R waves for CVD and all-cause mortality.
RESULTS:
In Cox models high R waves were predictive of 45-year major CVD deaths with a hazard ratio of 1.17 (95% confidence intervals of 1.03-1.33) after adjustment for 6 major CVD risk factors (age, systolic blood pressure, serum cholesterol, cigarette smoking, physical activity and body mass index). The predictive role of high R wave was less evident for 45-year all-cause mortality and after adjustment for the 6 covariates the HR of high R wave lost its significance. A multiple logistic model indicated that body mass index, serum cholesterol, systolic blood pressure and mainly vigorous physical activity were directly related to high R wave prevalence while heart rate, subscapular skinfold, laterality index and shoulder pelvis shape did so in an inverse way.
CONCLUSION:
High R waves seem associated with an excess CVD mortality in a 45-year follow-up of middle-aged men, while their role is diluted when the end-point is all-cause mortality.
Copyright © 2022. Published by Elsevier Inc.
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Deletion of matrix metalloproteinase-12 compromises mechanical homeostasis and leads to an aged aortic phenotype in young mice.
J Biomech2022 Jun;141():111179. doi: S0021-9290(22)00222-6.
Spronck Bart, Ramachandra Abhay B, Moriyama Lauren, Toczek Jakub, Han Jinah, Sadeghi Mehran M, Humphrey Jay D,
Abstract
Mechanical homeostasis emerges following normal development of the arterial wall and requires thereafter a slow balanced degradation and deposition of extracellular matrix constituents within an unchanging mechanical state. Recent findings suggest that homeostasis is compromised in arterial aging, which contributes to the structural stiffening that is characteristic of aged central arteries. Matrix metalloproteinases (MMPs) have strong proteolytic activity and play fundamental roles in matrix turnover. Here, we use Mmp12 mice to examine effects of a potent metalloelastase, MMP-12, on the biomechanical phenotype of the thoracic and abdominal aorta in young and naturally aged mice. A key finding is that germline deletion of the gene (Mmp12) that encodes MMP-12 alters biomechanical properties from normal more in young adult than in older adult mice. Consequently, percent changes in biomechanical properties during aortic aging are greater in wild-type than in MMP-12 deficient mice, though with similar overall decreases in elastic energy storage and distensibility and increases in calculated pulse wave velocity. Reduced elastic energy storage compromises the ability of the aorta to augment antegrade and retrograde blood flow while an increased pulse wave velocity can adversely affect end organs, both conditions being characteristic of aortic aging in humans. In summary, MMP-12 is fundamental for establishing homeostatic values of biomechanical metrics in the aorta and its absence leads to a pre-aged aortic phenotype in young mice.
Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.
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Identifying peripheral arterial diseases or flow limitations of the lower limb: Important aspects for cardiovascular screening for referral in physiotherapy.
Musculoskelet Sci Pract2022 Jun;61():102611. doi: S2468-7812(22)00111-4.
Feller Daniel, Giudice Andrea, Faletra Agostino, Salomon Mattia, Galeno Erasmo, Rossettini Giacomo, Brindisino Fabrizio, Maselli Filippo, Hutting Nathan, Mourad Firas,
Abstract
Many conditions could potentially cause pain in the lower limbs. One of these is peripheral arterial disease (PAD). PAD is often a real challenge to be recognized for clinicians due to symptoms that commonly mimic musculoskeletal conditions. PAD is defined as a total or partial blockage of the vessels that supply blood from the heart to the periphery. Its prevalence is around 7 percent in subjects between 55 and 59, reaching almost 25% in individuals between 95 and 99 years old. The most dominant symptom of PAD is lower limb pain. Also, PAD can produce other symptoms such as discoloration, altered skin temperature, and, when arterial blood flow is insufficient to meet the metabolic demands of resting muscle or tissue, focal areas of ischemia. In our view, physical therapists should be capable of triaging for PAD in a direct access setting. Therefore, in this Professional Issue, we present the main characteristics of PAD and the physiotherapy role in its management. A supplementary step-by-step guide will provide further resources for testing PAD.
Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.
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Red blood cell eNOS is cardioprotective in acute myocardial infarction.
Redox Biol2022 Jun;54():102370. doi: S2213-2317(22)00142-2.
Cortese-Krott Miriam M, Suvorava Tatsiana, Leo Francesca, Heuser Sophia K, LoBue Anthea, Li Junjie, Becher Stefanie, Schneckmann Rebekka, Srivrastava Tanu, Erkens Ralf, Wolff Georg, Schmitt Joachim P, Grandoch Maria, Lundberg Jon O, Pernow John, Isakson Brant E, Weitzberg Eddie, Kelm Malte,
Abstract
Red blood cells (RBCs) were shown to transport and release nitric oxide (NO) bioactivity and carry an endothelial NO synthase (eNOS). However, the pathophysiological significance of RBC eNOS for cardioprotection in vivo is unknown. Here we aimed to analyze the role of RBC eNOS in the regulation of coronary blood flow, cardiac performance, and acute myocardial infarction (AMI) in vivo. To specifically distinguish the role of RBC eNOS from the endothelial cell (EC) eNOS, we generated RBC- and EC-specific knock-out (KO) and knock-in (KI) mice by Cre-induced inactivation or reactivation of eNOS. We found that RBC eNOS KO mice had fully preserved coronary dilatory responses and LV function. Instead, EC eNOS KO mice had a decreased coronary flow response in isolated perfused hearts and an increased LV developed pressure in response to elevated arterial pressure, while stroke volume was preserved. Interestingly, RBC eNOS KO showed a significantly increased infarct size and aggravated LV dysfunction with decreased stroke volume and cardiac output. This is consistent with reduced NO bioavailability and oxygen delivery capacity in RBC eNOS KOs. Crucially, RBC eNOS KI mice had decreased infarct size and preserved LV function after AMI. In contrast, EC eNOS KO and EC eNOS KI had no differences in infarct size or LV dysfunction after AMI, as compared to the controls. These data demonstrate that EC eNOS controls coronary vasodilator function, but does not directly affect infarct size, while RBC eNOS limits infarct size in AMI. Therefore, RBC eNOS signaling may represent a novel target for interventions in ischemia/reperfusion after myocardial infarction.
Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.
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[Time in therapeutic range and incidence of warfarin complications in a 20-year retrospective cohort].
Aten Primaria2022 Jun;54(8):102410. doi: S0212-6567(22)00130-5.
Falcone Marinela, Martín Mateo Miguel, Romero-Sandoval Natalia, ,
Abstract
OBJECTIVE:
To characterize the time in therapeutic range (TTR) and estimate the incidence rate of complications (PTIRc) in adults with warfarin protocol.
DESIGN:
Retrospective cohort based on medical records of patients older than 18years, between 1996 and 2016 and followed for at least three months. SITE: Hematology unit of a Venezuelan specialized cardiovascular center.
PARTICIPANTS:
Electronic health record.
MAIN MEASUREMENTS:
TTR and PTIRc. The variables were sex, functional illiteracy, occupation, International Normalized Ratio (INR) and follow-up time, which were analyzed with TTR and PTIRc using binomial logistic and Poisson regression models, respectively.
RESULTS:
2,770 patients were followed up for a total of 1,201,380 days, 42.3% had a TTR
CONCLUSIONS:
Despite new anticoagulant treatments, warfarin is useful. As follow-up time increased, control was better and the rate of occurrence of complications decreased; however, the conditions that showed lower TTR and higher rate of occurrence of complications require a thorough review of follow-up especially in patients with functional illiteracy.
Copyright © 2022 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.
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Risk factors of clinically significant complications in transbronchial lung cryobiopsy: A prospective multi-center study.
Respir Med2022 Jun;200():106922. doi: S0954-6111(22)00187-1.
Mononen Minna, Saari Eeva, Hasala Hannele, Kettunen Hannu-Pekka, Suoranta Sanna, Nurmi Hanna, Randell Jukka, Laurikka Jari, Uibu Toomas, Koskela Heikki, Kaarteenaho Riitta, Purokivi Minna,
Abstract
BACKGROUND:
The use of a transbronchial lung cryobiopsy (TBLC) is increasing as a diagnostic method of interstitial lung diseases (ILD). This study aimed to evaluate risk factors associated with clinically significant complications of TBLC in ILD patients.
METHODS:
Patients referred to Kuopio or Tampere university hospitals, in Finland, for a suspected ILD were included. The TBLC was performed in an outpatient setting for 100 patients. Patients were mechanically ventilated in general anesthesia. Fluoroscopy guidance and prophylactic bronchial balloon were used. Complications, such as bleeding, pneumothorax, infections, and mortality were recorded. Moderate or serious bleeding, pneumothorax, or death ?90 days were defined as clinically significant complications. A multivariable model was created to assess clinically significant complications.
RESULTS:
The extent of traction bronchiectasis (Odds ratio [OR] 1.30, Confidence interval [CI] 1.03-1.65, p = 0.027) and young age (OR 7.96, CI 2.32-27.3, p = 0.001) were associated with the risk of clinically significant complications whereas the use of oral corticosteroids ?30 days before the TBLC (OR 3.65, CI 0.911-14.6, p = 0.068) did not quite reach statistical significance. A history of serious cough was associated with the risk of pneumothorax (OR 4.18, CI 1.10-16.0, p = 0.036). Procedure associated mortality ?90 days was 1%.
CONCLUSION:
The extent of traction bronchiectasis on HRCT and young age were associated with the risk of clinically significant complications whereas oral corticosteroid use did not quite reach statistical significance. A history of serious cough was associated with the risk of clinically significant pneumothorax.
Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.
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Anti-hyperglycemic, anti-hyperlipidemic, and anti-inflammatory effect of the drug Guggulutiktaka ghrita on high-fat diet-induced obese rats.
J Ayurveda Integr Med2022 Jun;13(3):100583. doi: S0975-9476(22)00042-0.
Sheik Samreen M, Bakthavatchalam Pugazhandhi, Shenoy Revathi P, Hadapad Basavaraj S, Nayak M Deepak, Biswas Monalisa, Bolar Suryakanth Varashree,
Abstract
BACKGROUND:
Ayurveda is a holistic system of medicine and describes a vast array of herbs and herbal mixtures that are been demonstrated to possess efficacy in research investigations. Guggulutikthaka gritha (GTG) is one such drug evaluated for its role in skin and bone diseases.
OBJECTIVE:
In the current study, the hypoglycemic, hypolipidemic, and anti-inflammatory effect of the drug GTG was studied with the scope to treat dyslipidemia and thereby reduce the risk of cardiovascular disease.
MATERIALS AND METHOD:
The animals (Wistar rats) were fed a high-fat diet and dyslipidemia was induced. The control group was provided with a normal chow diet and had free access to water. The treatment with the drug GTG was given for 21 days after confirming dyslipidemia. The blood glucose was measured immediately using a glucometer. The serum was analyzed for lipid profile and Vascular Cell Adhesion Molecule - 1(VCAM 1) by ELISA method before and after treatment. The histopathology of the heart and liver was also performed.
RESULTS:
The abnormal change in lipid profile, blood glucose, and inflammatory marker along with the accumulation of intracellular fats in the arteries of the heart and liver confirmed dyslipidemia. A significant reduction in serum lipid profile (p
CONCLUSION:
The study provides scientific validation on the drug GTG being effective in hyperglycemia, hyperlipidemia, and inflammation in dyslipidemia.
Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.
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