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Pubblicazioni recenti - cardiovascular risk
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Tales of two study designs in patients with chronic kidney failure The case of the protein-energy wasting (PEW) - inflammation syndromic complex.
J Intern Med2021 Apr;():. doi: 10.1111/joim.13301.
Zoccali Carmine, Mallamaci Francesca,
Abstract
Chronic kidney failure (CKF) is among the chronic conditions with the highest risk of death. In fact, the life expectancy of these patients is inferior to that of patients with cancers. Protein-energy wasting (PEW) and inflammation (I) are common and usually concurrent conditions in CKF. In CKF patients, the most widely used biomarker of systemic inflammation - C Reactive protein (CRP) - is typically in a range between 10 and 50 mg/L, i.e., levels that at least partially overlap with those seen in patients with severe acute processes such as osteomyelitis.
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Surgical Outcomes of Non-Small Cell Lung Cancer in Single-Zone N2 in the Aortopulmonary Zone.
Thorac Cardiovasc Surg2021 Apr;():. doi: 10.1055/s-0041-1727206.
Lee Kanghoon, Jeong Yong Ho, Ryu Jin-Sook, Kim Yong-Il, Kim Hyeong Ryul, Park Seung-Il,
Abstract
OBJECTIVES:
?We evaluate the surgical outcome of clinically single-zone N2 lung cancer limited to aortopulmonary zone (AP zone; lymph node #5 or #6).
PATIENTS AND METHODS:
?We performed a retrospective analysis of patients with non-small cell lung cancer, in whom mediastinal lymph node metastasis was confined to AP zone.
RESULTS:
?A total of 84 patients who underwent upfront surgery were included in final analysis. Among these patients, pathological nodal outcomes were pN0-1 in 27 patients (32.1%), pN2a in 31 (36.9%), and pN2b in 26 (31.0%). In multivariate analysis, adenocarcinoma (?=?0.005) and staging workup without endobronchial ultrasound-transbronchial needle aspiration (?=?0.002) were independent risk factors for unexpected pN2b. The 5-year overall survival (OS) and disease-free survival (DFS) were 55.9 and 54.4%, respectively. There was no survival difference among patients with pN0-1, pN2a, and pN2b (?=?0.717). In survival analysis, there were no significant risk factors for OS. However, female sex and the ratio of positive lymph nodes to removed lymph nodes were significant risk factors for DFS in multivariate analysis (?=?0.032 and ?=?0.009).
CONCLUSION:
?In this study, cN2a in the AP zone with current diagnostic tool exhibited a relatively high false-positive rate (cN2/pN0-1; 32.1%). However, despite the possibility of pN2b, there were no significant differences in survival outcome according to the pathologic nodal stage.
Thieme. All rights reserved.
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[New aspects in Fournier's gangrene - a rapid review].
Aktuelle Urol2021 Apr;():. doi: 10.1055/a-1472-5553.
Kranz Jennifer, Dräger Desiree L, Schneidewind Laila,
Abstract
Fournier's gangrene (FG) is a sporadic, life-threatening, necrotising infection affecting the perineum, perineal region and genitals. Published literature provides hints that the outcome of this disease has failed to improve in recent years. We have therefore performed a rapid evidence synthesis by searching the database MEDLINE. The literature from 2020 was studied to identify new aspects to improve the care of FG patients and plan further therapeutic research. 18 publications were chosen for this review, 15 of these were original research and three systematic reviews. 12 were retrospective case series, 2 epidemiological studies, with one prospective clinical study, one systematic review and 2 systematic reviews, together with a meta-analysis. Most of the authors of the studies concluded that FG is still a severe disease with unacceptable mortality rates, so that there is urgent need for therapy improvement. New risk factors for higher mortality in FG have been identified in these studies, namely dyslipoproteinemia, diabetes mellitus, heart disease, as well as both acute and chronic kidney failure. Furthermore, 4 of the included studies investigated the association of SGLT2- and DDP4-inhibitors, which are drugs used in diabetes mellitus, and the incidence of FG. No studies reported a significant association between these drugs and FG, especially not a meta-analysis with 84 included studies. New promising concepts for wound conditioning are hyperbaric oxygenation (HBO), vacuum-assisted wound closure (VAC) and Maggot therapy (blowfly larvae). In summary, FG is still a severe disease, the prognosis has not improved in recent years and so there is an urgent need for improved therapy. This could only be achieved with further research in FG. In our opinion and due to the rarity of FG, this would be possible with a national registry study. For example, it might be possible to calculate risk stratification from this registry to identify patients who would benefit from treatment in a centre or with special wound conditioning.
Thieme. All rights reserved.
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Emerging causes and risk factors of heart failure: amyloidosis, myocarditis, immune checkpoint inhibitors, air pollution, and visceral adipose tissue.
Eur Heart J -
Assessment of Exercise Intolerance in Patients with Pre-Dialysis CKD with Cardiopulmonary Function Testing: Translation to Everyday Practice.
Am J Nephrol2021 Apr;():1-15. doi: 10.1159/000515384.
Pella Eva, Boutou Afroditi, Theodorakopoulou Marieta P, Sarafidis Pantelis,
Abstract
BACKGROUND:
Chronic kidney disease (CKD) is often characterized by increased prevalence of cardiovascular risk factors and increased incidence of cardiovascular events and death. Reduced cardiovascular reserve and exercise intolerance are common in patients with CKD and are associated with adverse outcomes.
SUMMARY:
The gold standard for identifying exercise limitation is cardiopulmonary exercise testing (CPET). CPET provides an integrative evaluation of cardiovascular, pulmonary, hematopoietic, neuropsychological, and metabolic function during maximal or submaximal exercise. It is useful in clinical setting for differentiation of the causes of exercise intolerance, risk stratification, and assessment of response to relevant treatments. A number of recent studies have used CPET in patients with pre-dialysis CKD, aiming to assess the cardiovascular reserve of these individuals, as well as the effect of interventions such as exercise training programs on their functional capacity. This review provides an in-depth description of CPET methodology and an overview of studies that utilized CPET technology to assess cardiovascular reserve in patients with pre-dialysis CKD. Key Messages: CPET can delineate multisystem changes and offer comprehensive phenotyping of factors determining overall cardiovascular risk. Potential clinical applications of CPET in CKD patients range from objective diagnosis of exercise intolerance to preoperative and long-term risk stratification and providing intermediate endpoints for clinical trials. Future studies should delineate the association of CPET indexes, with cardiovascular and respiratory alterations and hard outcomes in CKD patients, to enhance its diagnostic and prognostic utility in this population.
© 2021 S. Karger AG, Basel.
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Hypomagnesemia Is a Risk Factor for Cardiovascular Disease- and Noncardiovascular Disease-Related Mortality in Peritoneal Dialysis Patients.
Blood Purif2021 Apr;():1-8. doi: 10.1159/000514148.
Zhang Fengping, Wu Xianfeng, Wen Yueqiang, Zhan Xiaojiang, Peng Fen Fen, Wang Xiaoyang, Qian Zhou, Feng Xiaoran,
Abstract
PURPOSE:
Recent research has shown that hypomagnesemia is associated with increased all-cause mortality in hemodialysis patients. However, the relationship between the long-term prognosis of peritoneal dialysis (PD) and the study is not yet clear. This study will analyze the effects of hypomagnesemia on all-cause, cardiovascular diseases (CVD), and non-CVD mortality in PD patients.
METHOD:
In a retrospective cohort study, 1,004 samples were selected from 7 PD centers in China. Based on the baseline blood magnesium level at the beginning of stable dialysis, all patients were classified into blood magnesium <0.7 mmol/L group, 0.7-1.2 mmol/L group, and >1.2 mmol/L group (the end event was death). The Kaplan-Meier method was used to calculate the difference in cumulative survival rate; the Cox proportional hazard model was used to analyze the risk factors of all-cause, CVD, and non-CVD death causes.
RESULTS:
Cox multiple regression analysis results (reference comparison of 0.7-1.2 mmol/L group): patients with serum magnesium <0.7 mmol/L have a higher risk ratio of all-cause mortality (HR = 1.580, 95% CI: 1.222-2.042, p = 0.001), and it is also obvious after correction by multiple models (HR = 1.578, 95% CI: 1.196-2.083, p = 0.001). Subgroup analysis of the causes of death was as follows: CVD risk (HR = 1.628, 95% CI: 1.114-2.379, p = 0.012) and non-CVD risk (HR = 1.521, 95% CI: 1.011-2.288, p = 0.044). Further analysis of the causes of infection-related death in non-CVD is also significant (HR = 1.919, 95% CI: 1.131-3.1257, p = 0.016). On the other hand, the serum magnesium>1.2 mmol/L group had lower all-cause mortality after correction (HR = 0.687, 95% CI: 0.480-0.985, p = 0.041), and subgroup analysis of the cause of death had no statistical significance (p > 0.05).
CONCLUSIONS:
Hypomagnesemia (serum magnesium <0.7 mmol/L) during stable dialysis in PD patients is a risk factor for CVD- and non-CVD-related mortality, especially infection-related death causes.
© 2021 S. Karger AG, Basel.
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Gestational exposure to perfluoroalkyl substances and congenital heart defects: A nested case-control pilot study.
Environ Int2021 Apr;154():106567. doi: S0160-4120(21)00192-6.
Ou Yanqiu, Zeng Xiaowen, Lin Shao, Bloom Michael S, Han Fengzhen, Xiao Xiaohua, Wang Hui, Matala Rosemary, Li Xiaohong, Qu Yanji, Nie Zhiqiang, Dong Guanghui, Liu Xiaoqing,
Abstract
BACKGROUND:
Accumulating evidence suggests that environmental pollutants may contribute to the occurrence of congenital heart defects (CHDs). However, no previous studies have evaluated the impact of perfluoroalkyl substances (PFAS), persistent environmental pollutants, on CHDs. This exploratory study aimed to generate testable hypotheses of the association between gestational PFAS and the risk of CHDs.
METHODS:
A nested case-control study was conducted in a cohort of 11,578 newborns. Exposure odds ratios were compared between 158 CHD cases and 158 non-malformed controls delivered at the same hospital, individually matched by maternal age (±5 years) and parity. Concentrations of 27 PFAS, including linear and branched isomers, were determined in maternal peripheral blood and cord blood plasma collected before and during delivery using a ultra-performance liquid chromatography coupled to mass spectrometry. Conditional logistic regression was utilized to evaluate associations between individual PFAS and the risk of CHDs, adjusted for confounding variables.
RESULTS:
Maternal gestational exposure to the highly branched perfluorooctanesulfonate (PFOS) isomer potassium 6-trifluoromethyperfluoroheptanesulfonate [6 m-PFOS, adjusted odds ratio (aOR) (95% CI) = 2.47(1.05,5.83)] and perfluorodecanoic acid [PFDA, aOR (95% CI) = 2.33(1.00,5.45)] were associated with increased odds of septal defects with statistical significance, while linear PFOS [aOR (95% CI) = 3.65(1.09,12.16)] and perfluoro-n-dodecanoic acid [PFDoA, aOR (95% CI) = 6.82(1.75, 26.61)] were associated with conotruncal defects. Effect estimates also suggested associations for higher maternal 6 m-PFOS and PFDA concentrations with ventricular septal defect. However, we did not observe these associations in cord blood.
CONCLUSION:
These exploratory findings suggested that gestational exposure to most PFAS, especially linear PFOS, 6 m-PFOS, PFDA, and PFDoA, was associated with greater risks for septal and conotruncal defects. However, a larger, adequately powered study is needed to confirm our findings, and to more comprehensively investigate the potential teratogenic effects of other more recently introduced PFAS, and on associations with individual CHD subtypes.
Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.
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Safety and Efficacy of Evacetrapib in Patients with Inadequately-controlled Hypercholesterolemia and High Cardiovascular Risk; A meta-analysis of Randomized Placebo-controlled Trials.
Prostaglandins Leukot Essent Fatty Acids2021 Apr;168():102282. doi: S0952-3278(21)00045-4.
Bahbah Eshak I, Shehata Mohamed S A, Alnahrawi Safwat Ibrahim, Sayed Ahmed, Menshawey Amr, Fisal Ahmed, Morsi Mahmoud, Gabr Mohamed Essam, Elbasit Mohamed Salah Abd,
Abstract
BACKGROUND:
Low-density lipoprotein cholesterol (LDL-C) is causally related to cardiovascular disease. Inhibition of cholesteryl ester transfer protein with Evacetrapib may provide an additional treatment option for patients who do not reach their LDL-C goal with statins or patients who cannot tolerate statins. We aimed to evaluate the safety and efficacy of Evacetrapib in patients with inadequately-controlled hypercholesterolemia and high cardiovascular risk.
METHOD:
A computer literature search for PubMed, Scopus, and Science Direct was carried out from inception to 2019 and was updated from January 2019 till March 2021. We included only RCTs. Data were pooled as a mean difference in a random-effect model using the Mantel-Haenzel (M-H) method. We used Open Meta [Analyst] software (by the center of evidence-based medicine, Oxford University, UK).
RESULTS:
Five studies (n = 12,937 patients) reported in five articles were included in this meta-analysis. The overall pooled estimate showed that LDL-C was significantly lower in the evacetrapib group than the placebo group (MD -34.07 mg/dL, 95% CI [-40.66, -27.49], p<0.0001). The pooled estimate showed that Apo-B was significantly lower in the evacetrapib130 mg group than the placebo group (MD -22.64 mg/dL, 95% CI [-30.70, -14.58], p<0.0001). HDL-C was significantly higher in the evacetrapib group over the placebo group (MD 93.31 mg/dL, 95% CI [56.07, 130.56], p<0.0001).
CONCLUSION:
Current evidence from five RCTs (12,539 participants) suggests that evacetrapib has favorable outcomes in patients with inadequately-controlled Hypercholesterolemia and high cardiovascular risks. Evacetrapib could significantly increase the HDL and Apo-A1 levels and lower the LDL cholesterol and Apo-B levels with an acceptable safety profile.
Copyright © 2021 Elsevier Ltd. All rights reserved.
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The Impact of Expedited Discharge on 30-Day Readmission Following Lung Resection: A National Study.
Ann Thorac Surg2021 Apr;():. doi: S0003-4975(21)00701-3.
Tran Zachary, Chervu Nikhil, Williamson Catherine, Verma Arjun, Hadaya Joseph, Gandjian Matthew, Revels Sha'Shonda, Benharash Peyman,
Abstract
BACKGROUND:
Expedited discharge (within 24 hours) following lung resection has received scrutiny due to concerns for higher readmissions and paradoxically increased costs. The present study examined the impact of expedited discharge on hospitalization costs and unplanned readmissions using a nationally-representative sample. In addition, we sought to determine inter-hospital practice variation.
METHODS:
Adults undergoing elective lobar or sublobar resection were identified using the 2016-2018 Nationwide Readmissions Database, while those with postoperative duration of hospitalization >5 days or experienced any perioperative complication, were excluded. Patients were classified as Expedited if postoperative hospitalization was 0 or 1 day and otherwise as Routine. Inverse probability of treatment weighing was utilized to adjust for intergroup differences. Hospitals were ranked according to risk-adjusted early discharge rates. Multivariable regression models were developed to assess the association of expedited discharge on nonelective 30-day readmissions as well as associated mortality and costs.
RESULTS:
Of an estimated 84,152 patients, 13,834 (16.4%) comprised the Expedited group. Compared to Routine, Expedited were younger, less likely to have chronic obstructive pulmonary disease and undergo open procedures. Following adjustment, early discharge was associated with lower incremental costs (? coefficient: -$3.6K, 95%CI: -4.4 - -2.8) as well as similar readmissions (odds ratio: 0.89, 95%CI: 0.70 - 1.13) and related-mortality. Nearly half (48.1%) of all hospitals performed zero early discharges.
CONCLUSIONS:
Expedited discharge following lung resection is a feasible management strategy and is associated with decreased costs and similar readmission risk compared to the norm. Select individuals should be strongly considered for expedited discharge following lung resection.
Copyright © 2021. Published by Elsevier Inc.
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A case of statin-induced liver injury with positive rechallenge with a second statin. Is there a class effect?
J Basic Clin Physiol Pharmacol2021 Apr;():. doi: 10.1515/jbcpp-2021-0013.
Onfiani Giovanna, Nascimbeni Fabio, Carubbi Francesca,
Abstract
OBJECTIVES:
Statins have proved to reduce cardiovascular morbidity and mortality in high-risk population and are generally well tolerated, although adverse events can occur. Up to 3% of patients develop aminotransferases elevation, which usually normalizes with continued treatment and hardly is associated with clinical symptoms. Serious statin-related liver injury is exceedingly rare. Furthermore, literature regarding rechallenge with a second statin is extremely poor. Some authors caution that re-exposure to these drugs is associated with a more serious liver injury but safe switching to a second statin after drug-induced liver injury (DILI) is also reported.
CASE PRESENTATION:
We describe a case of a middle-aged woman who developed hepatocellular liver injury after simvastatin dose escalation; a rechallenge with low dose rosuvastatin caused rapid recurrence of DILI.
CONCLUSIONS:
In our opinion, clinicians should be very cautious upon rechallenge and closely follow-up patients who experienced statin-induced liver injury when trying re-exposure to another statin.
© 2021 Walter de Gruyter GmbH, Berlin/Boston.
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Cognitive impairment reversed by cinacalcet administration in primary hyperparathyroidism.
Hormones (Athens)2021 Apr;():. doi: 10.1007/s42000-021-00292-4.
Timmons J G, Manners R, Bailey M, McDougall C,
Abstract
Primary hyperparathyroidism (pHPT) is a common endocrine disorder. Often serum calcium is minimally elevated with few symptoms. In elderly patients with multiple co-morbidities, the decision to "watch and wait" is often most clinically appropriate as operative intervention is associated with high peri-operative risk. We present an elderly patient with mild hypercalcemia secondary to primary hyperparathyroidism. The clinical decision was initially to watch and wait. The patient subsequently developed cognitive impairment and was diagnosed with mixed Alzheimer's disease/vascular dementia. She became dependent for all care and housebound. A therapeutic trial of cinacalcet was commenced following a further acute rise in serum calcium. Significant reversal of her functional and cognitive deficit occurred. She was no longer fully dependent. Mini mental state examination (MMSE) improved from 8/30 to 21/30. In vulnerable neural systems, even mild elevation in serum calcium may have a profound effect on cognition and function. We propose a therapeutic trial of cinacalcet in such patients.
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Association of carotid ultrasonography with perioperative stroke after thoracic aortic aneurysm treatment: a retrospective study.
J Med Ultrason (2001)2021 Apr;():. doi: 10.1007/s10396-021-01096-0.
Ito Michiko, Shimada Hirofumi, Ogata Toshiyasu, Teratani Hiromitsu, Tsuboi Yoshio, Inoue Tooru, Wada Hideichi,
Abstract
PURPOSE:
The purpose of this study was to verify whether carotid ultrasonography (CUS) findings could be associated with the occurrence of perioperative stroke after thoracic aortic aneurysm (TAA) treatment.
METHODS:
Patients with TAAs who were treated by either total arch replacement or thoracic endovascular aortic repair (TEVAR) were retrospectively enrolled. Left subclavian artery (LSA) embolization and bypass surgery of the left common carotid artery (CCA) to the LSA before TEVAR were additionally performed for some patients. CUS was performed before TAA treatment to evaluate carotid atherosclerosis and flow velocities of bilateral cervical arteries. After dividing patients into those with and without perioperative stroke, their background, atherosclerotic risk factors, history of stroke, TAA location and size, treatment procedures, and CUS parameters were compared between the two groups.
RESULTS:
Of the 60 patients (18 women, 42 men; mean age 73.5?±?10.2 years) with TAA, four (7.5%) developed perioperative stroke. There were no significant differences in the patients' characteristics and their TAAs between those with and without perioperative stroke. For the CUS parameters, end-diastolic velocity (EDV) of bilateral CCAs was significantly decreased in perioperative stroke patients (with vs without stroke; right: 9.2?±?1.8 vs. 14.5?±?4.6 cm/s, P?=?0.025, left: 9.1?±?0.3 vs. 15.0?±?4.5 cm/s, P?=?0.012), whereas the resistance index (RI) of bilateral CCAs was significantly elevated (right: 0.76 vs. 0.87, P?=?0.008, left: 0.76 vs. 0.87, P?
CONCLUSIONS:
Lower EDV and higher RI of bilateral CCAs were significantly associated with perioperative stroke after TAA treatment. Thus, CUS findings may help predict the occurrence of perioperative stroke.
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Integrating Measures of Myocardial Fibrosis in the Transition from Hypertensive Heart Disease to Heart Failure.
Curr Hypertens Rep2021 Apr;23(4):22. doi: 10.1007/s11906-021-01135-8.
Stacey R Brandon, Hundley W Gregory,
Abstract
PURPOSE OF REVIEW:
This review aims to summarize recent developments in identifying and quantifying both the presence and amount of myocardial fibrosis by imaging and biomarkers. Further, this review seeks to describe in general ways how this information may be used to identify hypertension and the transition to heart failure with preserved ejection fraction.
RECENT FINDINGS:
Recent studies using cardiac magnetic resonance imaging highlight the progressive nature of fibrosis from normal individuals to those with hypertension to those with clinical heart failure. However, separating hypertensive patients from those with heart failure remains challenging. Recent studies involving echocardiography show the subclinical myocardial strain changes between hypertensive heart disease and heart failure. Lastly, recent studies highlight the potential use of biomarkers to identify those with hypertension at the greatest risk of developing heart failure. In light of the heterogeneous nature between hypertension and heart failure with preserved ejection fraction, an integrated approach with cardiac imaging and biomarker analysis may enable clinicians and investigators to more accurately characterize, prevent, and treat heart failure in those with hypertension.
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Pregnancy in catecholaminergic polymorphic ventricular tachycardia: therapeutic optimization and multidisciplinary care are key to success.
Herzschrittmacherther Elektrophysiol2021 Apr;():. doi: 10.1007/s00399-021-00755-6.
Roston Thomas M, Grewal Jasmine, Krahn Andrew D,
Abstract
Women of child-bearing age comprise a large proportion of the patients followed by inherited arrhythmia clinics. Despite being a rare and dangerous diagnosis, cardiac and obstetric care providers should know that catecholaminergic polymorphic ventricular tachycardia (CPVT) is not a contraindication to pregnancy. In fact, pregnancy was not associated with an increased risk of CPVT-associated arrhythmias in a recent large cohort study, and most guideline-based anti-arrhythmic drug treatments are life-saving and carry a low risk of teratogenesis. In principle, the potential for CPVT destabilization may be more likely to occur after anti-arrhythmic drugs are decreased or stopped during pregnancy, when an implantable cardioverter defibrillator (ICD) shock exacerbates catecholamine release, or if adrenaline surges are triggered by labor and delivery. Therefore, all pregnant women should be followed by a cardio-obstetrics team with extensive knowledge of CPVT diagnosis, as well as arrhythmia risk stratification fand management. This multidisciplinary care should begin preconception and involve counseling on preimplantation genetic testing, choosing safe and effective anti-arrhythmic drugs, stopping contraindicated medications, optimal programming of ICDs, and planning for the brief hyper-adrenergic period of labor and delivery. The latest data on pregnancy in CPVT is reviewed here and the optimal care for this rare and complex patient population outlined.
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Long-Term Outcomes After Fenestration Closure in High-Risk Fontan Candidates.
Pediatr Cardiol2021 Apr;():. doi: 10.1007/s00246-021-02619-9.
Ozawa Hideto, Hoashi Takaya, Ohuchi Hideo, Kurosaki Kenichi, Ichikawa Hajime,
Abstract
The study aimed to assess the long-term outcomes after fenestration closure in patients at risk for Fontan failure. Of 119 patients who underwent Fontan operation between 1995 and 2004, fenestration was not created in 89 patients (NF group) and created in 30 patients with hypoplastic left heart syndrome, heterotaxy syndrome, high pulmonary arterial pressure, high systemic ventricular end-diastolic pressure, low ventricular ejection fraction, or atrioventricular valve regurgitation. All fenestrations were closed spontaneously or by catheter/surgical interventions, excepting two patients, and therefore, they were excluded. In fenestration group, patients with pre-Fontan mean pulmonary arterial pressure???15 mmHg or systemic atrioventricular valve regurgitation???moderate were classified as high-risk Fontan candidates (F-HR group, n?=?16), and the remaining patients were as standard-risk (F-SR group, n?=?12). Protein-losing enteropathy-free survival rates did not differ among the three groups (p?=?0.72). Serial follow-up catheter examinations after Fontan operation were completed in 69 patients in NF group and 11 patients in both F-SR and F-HR groups. Cardiac index and pulmonary vascular resistance significantly and similarly decreased over time in all groups, though the F-HR group showed lowest arterial oxygen saturation, lowest cardiac index, and highest pulmonary vascular resistance. The F-HR group also showed much veno-venous collaterals (p?=?0.049), low peak oxygen consumption (p?=?0.019), and low anaerobic threshold (p?=?0.023) as compared to those in the F-SR group. In F-HR group, cyanosis remained after fenestration closure due to transformation from fenestration to veno-venous collaterals, which resulted in elevation of pulmonary vascular resistance, low cardiac index, and deterioration of exercise tolerance.
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Associations of dietary and lifestyle oxidative balance scores with mortality risk among older women: the Iowa Women's Health Study.
Eur J Nutr2021 Apr;():. doi: 10.1007/s00394-021-02557-5.
Mao Ziling, Prizment Anna E, Lazovich DeAnn, Bostick Roberd M,
Abstract
PURPOSE:
Substantial basic science evidence suggests that oxidative stress may play a role in aging-related health outcomes, including cardiovascular diseases (CVD) and cancer, and oxidative stress markers were linked with all-cause and cause-specific mortality in epidemiologic studies. However, the associations of many individual dietary and lifestyle anti-/pro-oxidant exposures with mortality are inconsistent. Oxidative balance scores (OBS) that incorporated multiple dietary and lifestyle factors were previously developed and reported to reflect the collective oxidative effects of multiple exposures.
METHODS:
We investigated associations of 11-component dietary and 4-component (physical activity, adiposity, alcohol, and smoking) lifestyle OBS (higher scores were considered more anti-oxidative) with all-cause and cause-specific mortality among women 55-69 years of age at baseline in the prospective Iowa Women's Health Study (1986-2012). We assessed OBS-mortality associations using multivariable Cox proportional hazards regression.
RESULTS:
Of the 34,137 cancer-free women included in the analytic cohort, 18,058 died (4521 from cancer, and 6825 from CVD) during a mean/median 22.0/26.1 person-years of follow-up. Among participants in the highest relative to the lowest lifestyle OBS quintiles, the adjusted hazards ratios and their 95% confidence intervals for all-cause, all-cancer, and all-CVD mortality were 0.50 (0.48, 0.53), 0.47 (0.43, 0.52), and 0.54 (0.50, 0.58) (all P?
CONCLUSION:
Our findings, combined with results from previous studies, suggest that a predominance of antioxidant over pro-oxidant lifestyle exposures may be associated with lower all-cause, all-CVD, and all-cancer mortality risk.
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Acute kidney injury is associated with subtle but quantifiable neurocognitive impairments.
Nephrol Dial Transplant2021 Apr;():. doi: gfab161.
Vanderlinden Jessica A, Semrau Joanna S, Silver Samuel A, Holden Rachel M, Scott Stephen H, Boyd J Gordon,
Abstract
BACKGROUND:
Acute kidney injury (AKI) is associated with long-term morbidity and mortality. The effects of AKI on neurocognitive functioning remain unknown. Our objective was to quantify neurocognitive impairment after an episode of AKI.
METHODS:
Survivors of AKI were compared to age-matched controls, as well as a convenience sample of patients matched for cardiovascular risk factors with normal kidney function (active control group). Patients with AKI completed two assessments, while the active control group completed one assessment. The assessment included a standardized test: The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and a robotic assessment: Kinarm.
RESULTS:
The cohort consisted of 21 patients with AKI, 16 of whom completed both assessments, and 21 active control patients. The majority of patients with AKI had Kidney Disease Improving Global Outcomes stage 3 AKI (86%), 57% received dialysis, and 43% recovered to???25% of their baseline serum creatinine by their first assessment. Compared to the RBANS, which detected little impairment, the Kinarm categorized patients as impaired in visuomotor (10/21, 48%), attention (10/20, 50%), and executive tasks (11/21, 52%) compared to healthy controls. Additionally, patients with AKI performed significantly worse in attention and visuomotor domains when compared to the active controls. Neurocognitive performance was generally not impacted by the need for dialysis or whether kidney function recovered.
CONCLUSION:
Robotic technology identified quantifiable neurocognitive impairment in survivors of AKI. Deficits were noted particularly in attention, visuomotor, and executive domains. Further investigation into the downstream health consequences of these neurocognitive impairments is warranted.
© The Author(s) 2021. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
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Arrhythmogenesis in the aged heart following ischaemia-reperfusion: Role of Transient Receptor Potential Vanilloid 4.
Cardiovasc Res2021 Apr;():. doi: cvab141.
Peana Deborah, Polo-Parada Luis, Domeier Timothy L,
Abstract
AIMS:
Cardiomyocyte Ca2+ homeostasis is altered with ageing and predisposes the heart to Ca2+ intolerance and arrhythmia. Transient Receptor Potential Vanilloid 4 (TRPV4) is an osmotically-activated cation channel with expression in cardiomyocytes of the aged heart. The objective of this study was to examine the role of TRPV4 in Ca2+ handling and arrhythmogenesis following ischaemia-reperfusion (I/R), a pathological scenario associated with osmotic stress.
METHODS AND RESULTS:
Cardiomyocyte membrane potential was monitored prior to and following I/R in Langendorff-perfused hearts of Aged (19-28?month) male and female C57BL/6 mice ± TRPV4 inhibition (1??M HC067047, HC). Diastolic resting membrane potential was similar between Aged and Aged HC at baseline, but following I/R Aged exhibited depolarized diastolic membrane potential versus Aged HC. The effects of TRPV4 on cardiomyocyte Ca2+ signaling following I/R were examined in isolated hearts of Aged cardiac-specific GCaMP6f mice (±HC) using high-speed confocal fluorescence microscopy, with cardiomyocytes of Aged exhibiting an increased incidence of pro-arrhythmic Ca2+ signaling versus Aged HC. In the isolated cell environment, cardiomyocytes of Aged responded to sustained hypoosmotic stress (250mOsm) with an increase in Ca2+ transient amplitude (fluo-4) and higher incidence of pro-arrhythmic diastolic Ca2+ signals versus Aged HC. Intracardiac electrocardiogram measurements in isolated hearts following I/R revealed an increased arrhythmia incidence, an accelerated time to ventricular arrhythmia, and increased arrhythmia score in Aged versus Aged HC. Aged exhibited depolarized resting membrane potential, increased pro-arrhythmic diastolic Ca2+ signaling, and greater incidence of arrhythmia when compared to Young (3-5?mo).
CONCLUSIONS:
TRPV4 contributes to pro-arrhythmic cardiomyocyte Ca2+ signaling, electrophysiological abnormalities, and ventricular arrhythmia in the aged mouse heart.
TRANSLATIONAL PERSPECTIVE:
Aged populations are at high risk for myocardial infarction, I/R injury, and ventricular arrhythmia. The TRPV4 channel contributes to I/R-induced changes in cardiomyocyte Ca2+ handling and promotes ventricular arrhythmia in the aged mouse heart. Pharmacological TRPV4 inhibition may represent a potential anti-arrhythmic strategy for aged populations following myocardial infarction and I/R.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions please email: journals.permissions@oup.com.
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A phenomapping-derived tool to personalize the selection of anatomical vs. functional testing in evaluating chest pain (ASSIST).
Eur Heart J2021 Apr;():. doi: ehab223.
Oikonomou Evangelos K, Van Dijk David, Parise Helen, Suchard Marc A, de Lemos James, Antoniades Charalambos, Velazquez Eric J, Miller Edward J, Khera Rohan,
Abstract
AIMS:
Coronary artery disease is frequently diagnosed following evaluation of stable chest pain with anatomical or functional testing. A more granular understanding of patient phenotypes that benefit from either strategy may enable personalized testing.
METHODS AND RESULTS:
Using participant-level data from 9572 patients undergoing anatomical (n?=?4734) vs. functional (n?=?4838) testing in the PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain) trial, we created a topological representation of the study population based on 57 pre-randomization variables. Within each patient's 5% topological neighbourhood, Cox regression models provided individual patient-centred hazard ratios for major adverse cardiovascular events and revealed marked heterogeneity across the phenomap [median 1.11 (10th to 90th percentile: 0.52-2.61]), suggestive of distinct phenotypic neighbourhoods favouring anatomical or functional testing. Based on this risk phenomap, we employed an extreme gradient boosting algorithm in 80% of the PROMISE population to predict the personalized benefit of anatomical vs. functional testing using 12 model-derived, routinely collected variables and created a decision support tool named ASSIST (Anatomical vs. Stress teSting decIsion Support Tool). In both the remaining 20% of PROMISE and an external validation set consisting of patients from SCOT-HEART (Scottish COmputed Tomography of the HEART Trial) undergoing anatomical-first vs. functional-first assessment, the testing strategy recommended by ASSIST was associated with a significantly lower incidence of each study's primary endpoint (P?=?0.0024 and P?=?0.0321 for interaction, respectively), as well as a harmonized endpoint of all-cause mortality or non-fatal myocardial infarction (P?=?0.0309 and P?
CONCLUSION:
We propose a novel phenomapping-derived decision support tool to standardize the selection of anatomical vs. functional testing in the evaluation of stable chest pain, validated in two large and geographically diverse clinical trial populations.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.
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Towards cardiovascular disease prevention in Nigeria: A mixed method study of how adolescents and young adults in a university setting perceive cardiovascular disease and risk factors.
Afr J Prim Health Care Fam Med2021 Apr;13(1):e1-e9. doi: 10.4102/phcfm.v13i1.2200.
Odunaiya Nse A, Adesanya Temilade, Okoye Emmanuel C, Oguntibeju Oluwafemi O,
Abstract
BACKGROUND:
Cardiovascular disease (CVD) is a global problem but its increasing prevalence in the working age group in developing countries like Nigeria is concerning and needs urgent attention.
METHODS:
The study was a mixed method design: quantitative phase with 402 participants and qualitative phase with 16 participants in two focus groups. The participants in the quantitative survey phase completed two questionnaires on the knowledge and perception of CVD and its risk factors. Data from the quantitative cross-sectional survey were analysed using descriptive and inferential statistics. The qualitative data were analysed using content thematic analysis.
RESULTS:
We report that 39.1% of the participants had high knowledge whilst 61.9% had low and average knowledge of CVD and its risk factors. Of the participants, 78.1% had a wrong perception of CVD and its risk factors. Participants from faculties of veterinary medicine and basic medical sciences had better knowledge than others who were not medically inclined (F = 16.11; p 0.001). Only participants from the faculty of veterinary medicine had the right perception of CVD and its risk factors. There was no significant difference in knowledge and perception scores between male and female participants. The qualitative study buttressed the results from the cross-sectional survey, where adolescents and young adults highlighted academic stress and poverty as major risk factors for CVD.
CONCLUSION:
Adolescents and young adults in this study did not have good knowledge of CVD and its risk factors. They also had a wrong perception about CVD and its risk factors.
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