Pubblicazioni recenti - cardiovascular risk
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Improving clinical suspicion of acute mesenteric ischemia among patients with acute abdomen: a cross-sectional study from an intestinal stroke center.
World J Emerg Surg2023 Jun;18(1):37. doi: 10.1186/s13017-023-00505-8.
Nuzzo Alexandre, Peoc'h Katell, Vaittinada Ayar Prabakar, Tran-Dinh Alexy, Weiss Emmanuel, Panis Yves, Ronot Maxime, Garzelli Lorenzo, Eloy Philippine, Ben Abdallah Iannis, Castier Yves, Corcos Olivier,
Abstract
BACKGROUND:
Early diagnosis of acute mesenteric ischemia (AMI) is essential for a favorable outcome. Selection of patients requiring a dedicated multiphasic computed tomography (CT) scan remains a clinical challenge.
METHODS:
In this cross-sectional diagnostic study conducted from 2016 to 2018, we compared the presentation of AMI patients admitted to an intestinal stroke center to patients with acute abdominal pain of another origin admitted to the emergency room (controls).
RESULTS:
We included 137 patients-52 with AMI and 85 controls. Patients with AMI [median age: 65 years (interquartile range 55-74)] had arterial and venous AMI in 65% and 35% of cases, respectively. Relative to controls, AMI patients were significantly older, more likely to have risk factors or a history of cardiovascular disease, and more likely to present with sudden-onset and morphine-requiring abdominal pain, hematochezia, guarding, organ dysfunction, higher white blood cell and neutrophil counts, and higher plasma C-reactive protein (CRP) and procalcitonin concentrations. On multivariate analysis, two independent factors were associated with the diagnosis of AMI: the sudden-onset (OR?=?20, 95%CI 7-60, p?0.001) and the morphine-requiring nature of the acute abdominal pain (OR?=?6, 95%CI 2-16, p?=?0.002). Sudden-onset and/or morphine-requiring abdominal pain was present in 88% of AMI patients versus 28% in controls (p?0.001). The area under the receiver operating characteristic curve for the diagnosis of AMI was 0.84 (95%CI 0.77-0.91), depending on the number of factors.
CONCLUSIONS:
Sudden onset and the need for morphine are suggestive of AMI in patients with acute abdominal pain and should prompt multiphasic CT scan including arterial and venous phase images for confirmation.
© 2023. The Author(s).
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Alcohol consumption and all-cause and cause-specific mortality among US adults: prospective cohort study.
BMC Med2023 Jun;21(1):208. doi: 10.1186/s12916-023-02907-6.
Tian Yalan, Liu Jiahui, Zhao Yue, Jiang Nana, Liu Xiao, Zhao Gang, Wang Xia,
Abstract
BACKGROUND:
Previous studies have shown inconsistent findings regarding the association of light to moderate alcohol consumption with cause-specific mortality. Therefore, this study sought to examine the prospective association of alcohol consumption with all-cause and cause-specific mortality in the US population.
METHODS:
This was a population-based cohort study of adults aged 18 years or older in the National Health Interview Survey (1997 to 2014) with linkage to the National Death Index records through December 31, 2019. Self-reported alcohol consumption was categorized into seven groups (lifetime abstainers; former infrequent or regular drinkers; and current infrequent, light, moderate, or heavy drinkers). The main outcome was all-cause and cause-specific mortality.
RESULTS:
During an average follow-up of 12.65 years, among the 918,529 participants (mean age 46.1 years; 48.0% male), 141,512 adults died from all causes, 43,979 from cardiovascular disease (CVD), 33,222 from cancer, 8246 from chronic lower respiratory tract diseases, 5572 from accidents (unintentional injuries), 4776 from Alzheimer's disease, 4845 from diabetes mellitus, 2815 from influenza and pneumonia, and 2692 from nephritis, nephrotic syndrome, or nephrosis. Compared with lifetime abstainers, current infrequent, light, or moderate drinkers were at a lower risk of mortality from all causes [infrequent-hazard ratio: 0.87; 95% confidence interval: 0.84 to 0.90; light: 0.77; 0.75 to 0.79; moderate 0.82; 0.80 to 0.85], CVD, chronic lower respiratory tract diseases, Alzheimer's disease, and influenza and pneumonia. Also, light or moderate drinkers were associated with lower risk of mortality from diabetes mellitus and nephritis, nephrotic syndrome, or nephrosis. In contrast, heavy drinkers had a significantly higher risk of mortality from all causes, cancer, and accidents (unintentional injuries). Furthermore, binge drinking???1 day/week was associated with a higher risk of mortality from all causes (1.15; 1.09 to 1.22), cancer (1.22; 1.10 to 1.35), and accidents (unintentional injuries) (1.39; 1.11 to 1.74).
CONCLUSIONS:
Infrequent, light, and moderate alcohol consumption were inversely associated with mortality from all causes, CVD, chronic lower respiratory tract diseases, Alzheimer's disease, and influenza and pneumonia. Light or moderate alcohol consumption might also have a beneficial effect on mortality from diabetes mellitus and nephritis, nephrotic syndrome, or nephrosis. However, heavy or binge had a higher risk of all-cause, cancer, and accidents (unintentional injuries) mortality.
© 2023. The Author(s).
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Update of dialysis initiation timing in end stage kidney disease patients: is it a resolved question? A systematic literature review.
BMC Nephrol2023 Jun;24(1):162. doi: 10.1186/s12882-023-03184-4.
Jia Xiaoyan, Tang Xueqing, Li Yunfeng, Xu Dongmei, Moreira Paulo,
Abstract
BACKGROUND:
The exact optimal timing of dialysis for ESKD patients remains unknown. This study systematically reviewed the available evidence with regard to the optimal initiation of maintenance dialysis in ESKD patients.
METHODS:
An electronic search was performed in Embase, PubMed and the Cochrane Library in order to find studies investigating associations between variables reference to "start of dialysis" and outcomes. Quality assessment and bias assessment were performed by the Newcastle-Ottawa scale and the ROBINSI tool. Due to the heterogeneity of studies, a meta-analysis could not be performed.
RESULTS:
Thirteen studies were included; four studies included only haemodialysis patients, three peritoneal dialysis, six both; study outcomes included mortality, cardiovascular events, technique failure, quality of life and others. Nine studies mainly focused on the optimal GFR of maintenance dialysis initiation; five studies showed none association between GFR and mortality or other adverse outcomes, two studies showed dialysis initiation at higher GFR levels were with poor prognosis, and 2 studies showed higher GFR levels with better prognosis. Three studies paid attention to comprehensive assessment of uremic signs and/or symptoms for optimal dialysis initiation; uremic burden based on 7 uremic indicators (hemoglobin, serum albumin, blood urea nitrogen, serum creatinine, potassium, phosphorus, and bicarbonate) were not associated with mortality; another equation (combination of sex, age, serum creatinine, blood urea nitrogen, serum albumin, haemoglobin, serum phosphorus, diabetes mellitus, and heart failure) based on fuzzy mathematics to assess the timing of haemodialysis initiation was accuracy to prognose 3-year survival; the third study found that volume overload or hypertension was associated with the highest risk for subsequent mortality. Two studies compared urgent or optimal start in dialysis, a study reported increased survival in optimal start patients, another reported no differences between Urgent-Start-PD and Early-Start-PD regarding 6-month outcomes.
LIMITATIONS:
Heterogeneity among the studies was quite high, with differences in sample size, variable and group characteristics; no RCT studies were included, which weakened the strength of evidences.
CONCLUSIONS:
The criteria for dialysis initiation were varied. Most studies proved that GFR at dialysis initiation was not associated with mortality, timing of dialysis initiation should not be based on GFR, assessments of volume load and patient's tolerance to volume overload are prospective approaches.
© 2023. The Author(s).
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Prediction of post-operative atrial fibrillation in patients after cardiac surgery using heart rate variability.
BMC Cardiovasc Disord2023 Jun;23(1):290. doi: 10.1186/s12872-023-03309-5.
Veselá Jana, Osman?ík Pavel, He?man Dalibor, Hassouna Sabri, Raková Radka, Veselý Tomá?, Budera Petr,
Abstract
PURPOSE:
Post-operative atrial fibrillation (PoAF) occurs in ~?30% of patients after cardiac surgery. The etiology of PoAF is complex, but a disbalance in autonomic systems plays an important role. The goal of this study was to assess whether pre-operative heart rate variability analysis can predict the risk of PoAF.
METHODS:
Patients without a history of AF with an indication for cardiac surgery were included. Two-hour ECG recordings one day before surgery was used for the HRV analysis. Univariate and multivariate logistic regression, including all HRV parameters, their combination, and clinical variables, were calculated to find the best predictive model for post-operative AF.
RESULTS:
One hundred and thirty-seven patients (33 women) were enrolled in the study. PoAF occurred in 48 patients (35%, AF group); the remaining 89 patients were in the NoAF group. AF patients were significantly older (69.1?±?8.6 vs. 63.4?±?10.5 yrs., p?=?0.002), and had higher CHADS-VASc score (3?±?1.4 vs. 2.5?±?1.3, p?=?0.01). In the multivariate regression model, parameters independently associated with higher risk of AF were pNN50, TINN, absolute power VLF, LF and HF, total power, SD2, and the Porta index. A combination of clinical variables with HRV parameters in the ROC analysis achieved an AUC of 0.86, a sensitivity of 0.95, and a specificity of 0.57 and was more effective in PoAF prediction than a combination of clinical variables alone.
CONCLUSION:
A combination of several HRV parameters is helpful in predicting the risk of PoAF. Attenuation of heart rate variability increases the risk for PoAF.
© 2023. The Author(s).
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Simulation of bempedoic acid and ezetimibe in the lipid-lowering treatment pathway in Austria using the contemporary SANTORINI cohort of high and very high risk patients.
Wien Klin Wochenschr2023 Jun;():. doi: 10.1007/s00508-023-02221-4.
Toplak Hermann, Bilitou Aikaterini, Alber Hannes, Auer Johann, Clodi Martin, Ebenbichler Christoph, Fließer-Görzer Evelyn, Gelsinger Carmen, Hanusch Ursula, Ludvik Bernhard, Maca Thomas, Schober Andreas, Sock Reinhard, Speidl Walter S, Stulnig Thomas M, Weitgasser Raimund, Zirlik Andreas, Koch Marina, Wienerroither Sebastian, Wolowacz Sorrel E, Diamand Françoise, Catapano Alberico L,
Abstract
OBJECTIVE:
The low-density lipoprotein cholesterol goals in the 2019 European Society of Cardiology/European Atherosclerosis Society dyslipidaemia guidelines necessitate greater use of combination therapies. We describe a real-world cohort of patients in Austria and simulate the addition of oral bempedoic acid and ezetimibe to estimate the proportion of patients reaching goals.
METHODS:
Patients at high or very high cardiovascular risk on lipid-lowering treatments (excluding proprotein convertase subtilisin/kexin type 9 inhibitors) from the Austrian cohort of the observational SANTORINI study were included using specific criteria. For patients not at their risk-based goals at baseline, addition of ezetimibe (if not already received) and subsequently bempedoic acid was simulated using a Monte Carlo simulation.
RESULTS:
A cohort of patients (N?=?144) with a mean low-density lipoprotein cholesterol of 76.4?mg/dL, with 94% (n?=?135) on statins and 24% (n?=?35) on ezetimibe monotherapy or in combination, were used in the simulation. Only 36% of patients were at goal (n?=?52). Sequential simulation of ezetimibe (where applicable) and bempedoic acid increased the proportion of patients at goal to 69% (n?=?100), with a decrease in the mean low-density lipoprotein cholesterol from 76.4?mg/dL at baseline to 57.7?mg/dL overall.
CONCLUSIONS:
The SANTORINI real-world data in Austria suggest that a proportion of high and very high-risk patients remain below the guideline-recommended low-density lipoprotein cholesterol goals. Optimising use of oral ezetimibe and bempedoic acid after statins in the lipid-lowering pathway could result in substantially more patients attaining low-density lipoprotein cholesterol goals, likely with additional health benefits.
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Impact of estimated plasma volume status on clinical outcomes in patients with lower extremity artery disease who underwent endovascular therapy.
Hypertens Res2023 Jun;():. doi: 10.1038/s41440-023-01315-w.
Kurokawa Tasuku, Otaki Yoichiro, Takahashi Hiroki, Watanabe Tetsu, Shikama Taku, Tamura Harutoshi, Kato Shigehiko, Nishiyama Satoshi, Arimoto Takanori, Watanabe Masafumi,
Abstract
Lower extremity artery disease (LEAD) is an arterial occlusive disease associated with high morbidity and mortality. Estimated plasma volume status (ePVS), a marker of plasma volume expansion and contraction, is gaining attention in the field of cardiovascular diseases. However, the impact of ePVS on the clinical outcomes of patients with LEAD remains unclear. We calculated ePVS using two different formulas, Kaplan-Hakim (KH-ePVS) and Duarte (D-ePVS), in 288 patients (mean age, 73 years; 77% male) with LEAD who underwent the first endovascular therapy (EVT), and prospectively followed them up between 2014 and 2019. All patients were divided into two groups based on the median ePVS values. The primary endpoints were composite events, including all-cause death and major adverse limb events (death/MALE). The median follow-up duration was 672 days. There were 183, 40 and 65 patients in Fontaine classes II, III, and IV, respectively. The median KH-ePVS and D-ePVS was 5.96 and 5.09, respectively. The ePVS significantly increased with advancing Fontaine classes. Kaplan-Meier analysis demonstrated that the high ePVS group had higher rates of death/MALE than the low ePVS group. Multivariate Cox proportional hazard analysis revealed that each ePVS was an independent predictor for death/MALE after adjusting for confounding risk factors. The prognostic ability for death/MALE was significantly improved by adding ePVS to the basic predictors. ePVS was associated with LEAD severity and clinical outcomes, suggesting that ePVS could be an additional risk factor for death/MALE in patients with LEAD who underwent EVT. We demonstrated that the association between ePVS and the clinical outcomes of patients with LEAD. The prognostic ability for death/MALE was significantly improved by adding ePVS to the basic predictors. LEAD lower extremity artery disease, MALE major adverse limb events, PVS plasma volume status.
© 2023. The Author(s), under exclusive licence to The Japanese Society of Hypertension.
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Circulating Cytokine Levels and Cardiovascular Disease Risk Profile in Young Adult Offspring of Women with Type 1 Diabetes.
Diabetes Ther2023 Jun;():. doi: 10.1007/s13300-023-01428-y.
Somersalo Erik, Kuuliala Krista, Kuuliala Antti, Wasenius Niko S, Klemetti Miira M, Kivimäki Anne S, Kautiainen Hannu, Eriksson Johan G, Laine Merja K,
Abstract
INTRODUCTION:
Cytokines are key players in the development of both type 1 diabetes (T1D) and cardiovascular disease (CVD). Offspring of women with T1D are known to have an increased risk of early-onset CVD. We studied whether an increased risk of CVD can be observed in the cytokine profile among young adult offspring of women with T1D.
METHODS:
This cross-sectional case-control study included 67 offspring of women with T1D (cases) and 79 control participants (controls). At an age of 18-23 years, they participated in a clinical assessment including laboratory tests and questionnaires. Cytokine levels were analyzed from venous blood samples after 10 h fasting using Quansys biosciences Q-Plex? High Sensitivity Human Cytokine Array.
RESULTS:
Circulating cytokine levels were in general similar between the groups. The circulating levels of interferon-? (1.78 [IQR 1.20, 2.36] pg/mL versus 2.57 [IQR 1.50, 3.89] pg/mL) (p?=?0.006) were lower in cases than controls.
CONCLUSION:
The findings did not support our hypothesis that serum cytokine profile, determined in early adulthood, was associated with a more adverse CVD risk profile in offspring of women with T1D. Further studies are warranted to find out whether cytokines could serve as early biomarkers of CVD development or whether changes in the cytokine levels over years could be used to monitor CVD progression in offspring of women with T1D.
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Deep learning-based prognostic model using non-enhanced cardiac cine MRI for outcome prediction in patients with heart failure.
Eur Radiol2023 Jun;():. doi: 10.1007/s00330-023-09785-9.
Gao Yifeng, Zhou Zhen, Zhang Bing, Guo Saidi, Bo Kairui, Li Shuang, Zhang Nan, Wang Hui, Yang Guang, Zhang Heye, Liu Tong, Xu Lei,
Abstract
OBJECTIVES:
To evaluate the performance of a deep learning-based multi-source model for survival prediction and risk stratification in patients with heart failure.
METHODS:
Patients with heart failure with reduced ejection fraction (HFrEF) who underwent cardiac magnetic resonance between January 2015 and April 2020 were retrospectively included in this study. Baseline electronic health record data, including clinical demographic information, laboratory data, and electrocardiographic information, were collected. Short-axis non-contrast cine images of the whole heart were acquired to estimate the cardiac function parameters and the motion features of the left ventricle. Model accuracy was evaluated using the Harrell's concordance index. All patients were followed up for major adverse cardiac events (MACEs), and survival prediction was assessed using Kaplan-Meier curves.
RESULTS:
A total of 329 patients were evaluated (age 54?±?14 years; men, 254) in this study. During a median follow-up period of 1041 days, 62 patients experienced MACEs and their median survival time was 495 days. When compared with conventional Cox hazard prediction models, deep learning models showed better survival prediction performance. Multi-data denoising autoencoder (DAE) model reached the concordance index of 0.8546 (95% CI: 0.7902-0.8883). Furthermore, when divided into phenogroups, the multi-data DAE model could significantly discriminate between the survival outcomes of the high-risk and low-risk groups compared with other models (p?0.001).
CONCLUSIONS:
The proposed deep learning (DL) model based on non-contrast cardiac cine magnetic resonance imaging could independently predict the outcome of patients with HFrEF and showed better prediction efficiency than conventional methods.
CLINICAL RELEVANCE STATEMENT:
The proposed multi-source deep learning model based on cardiac magnetic resonance enables survival prediction in patients with heart failure.
KEY POINTS:
? A multi-source deep learning model based on non-contrast cardiovascular magnetic resonance (CMR) cine images was built to make robust survival prediction in patients with heart failure. ? The ground truth definition contains electronic health record data as well as DL-based motion data, and cardiac motion information is extracted by optical flow method from non-contrast CMR cine images. ? The DL-based model exhibits better prognostic value and stratification performance when compared with conventional prediction models and could aid in the risk stratification in patients with HF.
© 2023. The Author(s), under exclusive licence to European Society of Radiology.
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Effectiveness of Medical Student Counseling for Hospitalized Patients Addicted to Tobacco (MS-CHAT): a Randomized Controlled Trial.
J Gen Intern Med2023 Jun;():. doi: 10.1007/s11606-023-08243-y.
Satish Priyanka, Khetan Aditya, Shah Dharav, Srinivasan Shuba, Balakrishnan Rojith, Padmanandan Arun, Hejjaji Vittal, Hull Leland, Samuel Reema, Josephson Richard,
Abstract
BACKGROUND:
Low-middle-income countries face an enormous burden of tobacco-related illnesses. Counseling for tobacco cessation increases the chance of achieving quit outcomes, yet it remains underutilized in healthcare settings.
OBJECTIVE:
We tested the hypothesis that utilizing trained medical students to counsel hospitalized patients who use tobacco will lead to an increase in patient quit rates, while also improving medical student knowledge regarding smoking cessation counseling.
DESIGN:
Investigator-initiated, two-armed, multicenter randomized controlled trial conducted in three medical schools in India.
PARTICIPANTS:
Eligibility criteria included age 18-70 years, active admission to the hospital, and current smoking.
INTERVENTION:
A medical student-guided smoking cessation program, initiated in hospitalized patients and continued for 2 months after discharge.
MAIN MEASURES:
The primary outcome was self-reported 7-day point prevalence of smoking cessation at 6 months. Changes in medical student knowledge were assessed using a pre- and post-questionnaire delivered prior to and 12 months after training.
KEY RESULTS:
Among 688 patients randomized across three medical schools, 343 were assigned to the intervention group and 345 to the control group. After 6 months of follow up, the primary outcome occurred in 188 patients (54.8%) in the intervention group, and 145 patients (42.0%) in the control group (absolute difference, 12.8%; relative risk, 1.67; 95% confidence interval, 1.24-2.26; p?0.001). Among 70 medical students for whom data was available, knowledge increased from a mean score of 14.8 (±?0.8) (out of a maximum score of 25) at baseline to a score of 18.1 (±?0.8) at 12 months, an absolute mean difference of 3.3 (95% CI, 2.3-4.3; p?0.001).
CONCLUSIONS:
Medical students can be trained to effectively provide smoking cessation counseling to hospitalized patients. Incorporating this program into the medical curriculum can provide experiential training to medical students while improving patient quit rates.
TRIAL REGISTRATION:
URL: http://www.
CLINICALTRIALS:
gov . Unique identifier: NCT03521466.
© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.
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N6-methyladenosine (m6A) Modification in Preeclampsia.
Reprod Sci2023 Jun;():. doi: 10.1007/s43032-023-01250-8.
Zhang Tingting, Jiang Ziyan, Yang Nana, Ge Zhiping, Zuo Qing, Huang Shiyun, Sun Lizhou,
Abstract
Recently, epitranscriptional modification of N6-methyladenosine (m6A) has received growing attention in the research on the pathogenesis of preeclampsia. Advances in m6A sequencing have revealed the molecular mechanism and importance of m6A modification. In addition, epitranscriptional modification of m6A is closely related to the metabolic processes of placental tissues and cells in preeclampsia. This article reviews the composition, mode of action, and bioinformatics analysis of m6A modification-related proteins, and their biological function in the progression of preeclampsia. The relationship between m6A modification and preeclampsia risk factors, such as diabetes, cardiovascular disease, obesity, and psychological stress, is summarized to provide new ideas for studying PE-targeting molecules.
© 2023. The Author(s), under exclusive licence to Society for Reproductive Investigation.
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Large scale proteomic studies create novel privacy considerations.
Sci Rep2023 Jun;13(1):9254. doi: 10.1038/s41598-023-34866-6.
Hill Andrew C, Guo Claire, Litkowski Elizabeth M, Manichaikul Ani W, Yu Bing, Konigsberg Iain R, Gorbet Betty A, Lange Leslie A, Pratte Katherine A, Kechris Katerina J, DeCamp Matthew, Coors Marilyn, Ortega Victor E, Rich Stephen S, Rotter Jerome I, Gerzsten Robert E, Clish Clary B, Curtis Jeffrey L, Hu Xiaowei, Obeidat Ma-En, Morris Melody, Loureiro Joseph, Ngo Debby, O'Neal Wanda K, Meyers Deborah A, Bleecker Eugene R, Hobbs Brian D, Cho Michael H, Banaei-Kashani Farnoush, Bowler Russell P,
Abstract
Privacy protection is a core principle of genomic but not proteomic research. We identified independent single nucleotide polymorphism (SNP) quantitative trait loci (pQTL) from COPDGene and Jackson Heart Study (JHS), calculated continuous protein level genotype probabilities, and then applied a naïve Bayesian approach to link SomaScan 1.3K proteomes to genomes for 2812 independent subjects from COPDGene, JHS, SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) and Multi-Ethnic Study of Atherosclerosis (MESA). We correctly linked 90-95% of proteomes to their correct genome and for 95-99% we identify the 1% most likely links. The linking accuracy in subjects with African ancestry was lower (~?60%) unless training included diverse subjects. With larger profiling (SomaScan 5K) in the Atherosclerosis Risk Communities (ARIC) correct identification was?>?99% even in mixed ancestry populations. We also linked proteomes-to-proteomes and used the proteome only to determine features such as sex, ancestry, and first-degree relatives. When serial proteomes are available, the linking algorithm can be used to identify and correct mislabeled samples. This work also demonstrates the importance of including diverse populations in omics research and that large proteomic datasets (>?1000 proteins) can be accurately linked to a specific genome through pQTL knowledge and should not be considered unidentifiable.
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Imaging of atherosclerosis with [Cu]Cu-DOTA-TATE in a translational head-to-head comparison study with [F]FDG, and Na[F]F in rabbits.
Sci Rep2023 Jun;13(1):9249. doi: 10.1038/s41598-023-35302-5.
Grandjean Constance E, Pedersen Sune F, Christensen Camilla, Dibenedetto Altea, Eriksen Thomas, Binderup Tina, Kjaer Andreas,
Abstract
Atherosclerosis is a chronic inflammatory disease of the larger arteries that may lead to cardiovascular events. Identification of patients at highest risk of cardiovascular events is challenging, but molecular imaging using positron emission tomography (PET) may prove useful. The aim of this study was to evaluate and compare head-to-head three different PET tracers. Furthermore, tracer uptake is compared to gene expression alterations of the arterial vessel wall. Male New Zealand White rabbits (control group; n?=?10, atherosclerotic group; n?=?11) were used for the study. Vessel wall uptake was assessed with the three different PET tracers: [F]FDG (inflammation), Na[F]F (microcalcification), and [Cu]Cu-DOTA-TATE (macrophages), using PET/computed tomography (CT). Tracer uptake was measured as standardized uptake value (SUV), and arteries from both groups were analyzed ex vivo by autoradiography, qPCR, histology, and immunohistochemistry. In rabbits, the atherosclerotic group showed significantly higher uptake of all three tracers compared to the control group [F]FDG: SUV 1.50?±?0.11 versus 1.23?±?0.09, p?=?0.025; Na[F]F: SUV 1.54?±?0.06 versus 1.18?±?0.10, p?=?0.006; and [Cu]Cu-DOTA-TATE: SUV 2.30?±?0.27 versus 1.65?±?0.16; p?=?0.047. Of the 102 genes analyzed, 52 were differentially expressed in the atherosclerotic group compared to the control group and several genes correlated with tracer uptake. In conclusion, we demonstrated the diagnostic value of [Cu]Cu-DOTA-TATE and Na[F]F for identifying atherosclerosis in rabbits. The two PET tracers provided information distinct from that obtained with [F]FDG. None of the three tracers correlated significantly to each other, but [Cu]Cu-DOTA-TATE and Na[F]F uptake both correlated with markers of inflammation. [Cu]Cu-DOTA-TATE was higher in atherosclerotic rabbits compared to [F]FDG and Na[F]F.
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Association of reproductive factors and exogenous hormone use with distal sensory polyneuropathy among postmenopausal women in the United States: results from 1999 to 2004 NHANES.
Sci Rep2023 Jun;13(1):9274. doi: 10.1038/s41598-023-35934-7.
Li Jiayu, Chongpison Yuda, Amornvit Jakkrit, Chaikittisilpa Sukanya, Santibenchakul Somsook, Jaisamrarn Unnop,
Abstract
Postmenopausal status is a risk factor for distal sensory polyneuropathy-the most common type of peripheral neuropathy. We aimed to investigate associations between reproductive factors and history of exogenous hormone use with distal sensory polyneuropathy among postmenopausal women in the United States using data from the National Health and Nutrition Examination Survey 1999-2004, and to explore the modifying effects of ethnicity on these associations. We conducted a cross-sectional study among postmenopausal women aged???40 years. Women with a history of diabetes, stroke, cancer, cardiovascular disease, thyroid disease, liver disease, weak or failing kidneys, or amputation were excluded. Distal sensory polyneuropathy was measured using a 10-g monofilament test, and a questionnaire was used to collect data on reproductive history. Multivariable survey logistic regression was used to test the association between reproductive history variables and distal sensory polyneuropathy. In total, 1144 postmenopausal women aged???40 years were included. The adjusted odds ratios were 8.13 [95% confidence interval (CI) 1.24-53.28] and 3.18 (95% CI 1.32-7.68) for age at menarche?11 years and time since menopause?>?20 years, respectively, which were positively associated with distal sensory polyneuropathy; adjusted odds ratios were 0.45 for the history of breastfeeding (95% CI 0.21-0.99) and 0.41 for exogenous hormone use (95% CI 0.19-0.87) were negatively associated. Subgroup analysis revealed ethnicity-based heterogeneity in these associations. Age at menarche, time since menopause, breastfeeding, and exogenous hormone use were associated with distal sensory polyneuropathy. Ethnicity significantly modified these associations.
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Clinical Significance of Physical Examination for Hypertrophic Cardiomyopathy.
Circ J2023 Jun;():. doi: 10.1253/circj.CJ-23-0131.
Kawasaki Tatsuya, Shiraishi Hirokazu, Matoba Satoaki,
Abstract
BACKGROUND:
Patients with hypertrophic cardiomyopathy (HCM) show various physical findings, but their clinical significance has not been systematically evaluated.Methods?and?Results: This study evaluated 105 consecutive patients with HCM who had undergone phonocardiography and external pulse recording. Physical examinations included a visible jugular a-wave (Jug-a), audible 4th sound (S4), and double or sustained apex beat. The primary outcome was a composite of all-cause death and hospitalization for cardiovascular disease. A total of 104 non-HCM subjects served as controls. The prevalence of visible Jug-a in the seated or supine position, audible S4, and a sustained or double apex beat in patients with HCM were 10%, 71%, 70%, 42%, and 27%, respectively, all of which were significantly higher than in the controls (0%, 20%, 11%, 17%, and 2%; P
CONCLUSIONS:
Detection of these findings has clinical importance in the diagnosis and risk stratification of HCM prior to the use of advanced imaging techniques.
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High JAK2V617F variant allele frequency is associated with coronary artery but not aortic valve calcifications in patients with Philadelphia-negative myeloproliferative neoplasms.
Eur J Haematol2023 Jun;():. doi: 10.1111/ejh.14019.
Solli Camilla Nordheim, Chamat-Hedemand Sandra, Elming Hanne, Ngo Anh, Kjaer Lasse, Skov Vibe, Sørensen Anders Lindholm, Ellervik Christina, Hasselbalch Hans, Bruun Niels Eske,
Abstract
BACKGROUND:
Patients with Philadelphia-negative myeloproliferative neoplasms (MPNs) have a higher burden of cardiac calcifications compared to the general population. It is not known whether the JAK2V617F mutation is associated with increased cardiac calcification.
AIM:
To investigate if a higher JAK2V617F variant allele frequency (VAF) is associated with severe coronary atherosclerosis and the presence of aortic valve calcification (AVC).
METHODS:
Patients with MPNs were examined by cardiac computer tomography to establish coronary artery calcium score (CACS) and AVC score. The first VAF after diagnosis was registered. Severe coronary atherosclerosis was defined as a CACS >400 and AVC was defined as an AVC score >0.
RESULTS:
Among 161 patients, 137 were JAK2V617F mutation-positive, with a median VAF of 26% (interquartile range 12%-52%). A VAF in the upper quartile range was associated with a CACS >400 [odds ratio (OR) 15.96, 95% confidence interval [CI] 2.13-119.53, p?=?.0070], after adjustment for cardiovascular risk factors and MPN subtype. An association was not found for the presence of AVC (OR 2.30, 95% CI 0.47-11.33, p?=?0.31).
CONCLUSION:
In patients with MPNs, there is a significant association between having a VAF in the upper quartile (>52%), and severe coronary atherosclerosis, defined as a CACS >400. The presence of AVC is not associated with VAF.
© 2023 The Authors. European Journal of Haematology published by John Wiley & Sons Ltd.
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Association Between Insomnia Symptoms and Trajectory With the Risk of Stroke in the Health and Retirement Study.
Neurology2023 Jun;():. doi: 10.1212/WNL.0000000000207449.
Sawadogo Wendemi, Adera Tilahun, Alattar Maha, Perera Robert, Burch James B,
Abstract
BACKGROUND AND OBJECTIVES:
Insomnia is a common condition affecting over a third of the United States population. However, the link between insomnia symptoms and stroke is understudied and the underlying mechanism remains unclear. This study aimed to investigate the relationship between insomnia symptoms and the incidence of stroke.
METHODS:
The Health and Retirement Study, a survey of Americans older than 50 years and their spouses, from 2002 to 2020 was used as the data source. Only those who were stroke-free at baseline were included in the present study. The exposure variable was insomnia symptoms and was derived from self-reported sleep-related factors including difficulty initiating sleep, difficulty maintaining sleep, waking up too early, and nonrestorative sleep. Repeated measures latent class analysis was used to identify insomnia trajectories over time. To investigate the relationship between insomnia symptoms and stroke events reported during the follow-up period, cox proportional hazards regression models were employed. Mediation analyses of comorbidities were performed utilizing causal mediation within a counterfactual framework.
RESULTS:
A total of 31,126 participants were included with a mean follow-up of 9 years. The mean age was 61 years (SD=11.1) and 57% were female. Insomnia symptom trajectories remained constant over time. Compared to subjects with no insomnia symptoms, an increased risk of stroke was observed for those with insomnia symptom scores ranging from 1 to 4 and 5 to 8 (hazard ratio (HR) = 1.16, 95% confidence interval (CI): 1.02, 1.33) and (HR =1.51, 95% CI: 1.29, 1.77), respectively indicating a dose-response relationship. The association was stronger in participants aged less than 50 years (HR=3.84, 95% CI: 1.50, 9.85) than those 50 years and above (HR=1.38, 95% CI: 1.18, 1.62) comparing those with insomnia symptoms ranging from 5 to 8 to those with no insomnia symptoms. This association was mediated by diabetes, hypertension, heart disease, and depression.
DISCUSSION:
Insomnia symptoms were associated with an increased risk of stroke, especially in adults younger than 50 years, and the risk was mediated by certain comorbidities. Increased awareness and management of insomnia symptoms may contribute to the prevention of stroke occurrence.
© 2023 American Academy of Neurology.
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Anzhen Risk Evaluation System for Acute Aortic Syndrome (AZSCORE-AAS): protocol for a multicentre prospective cohort study in northern China.
BMJ Open2023 Jun;13(6):e067469. doi: 10.1136/bmjopen-2022-067469.
Wang Han-Zhang, Chen Su-Wei, Zhong Yong-Liang, Ge Yi-Peng, Qiao Zhi-Yu, Li Cheng-Nan, Guo Ru-Tao, Zhang Zhe, Qiao Chen-Hui, Zhu Jun-Ming,
Abstract
INTRODUCTION:
Acute aortic syndrome (AAS) is a group of acute and critical conditions, including acute aortic dissection (AAD), acute intramural haematoma and penetrating aortic ulcer. High mortality and morbidity rates result in a poor patient prognosis. Prompt diagnoses and timely interventions are paramount for saving patients' lives. In recent years, risk models for AAD have been established worldwide; however, a risk evaluation system for AAS is still lacking in China. Therefore, this study aims to develop an early warning and risk scoring system in combination with the novel potential biomarker soluble ST2 (sST2) for AAS.
METHODS AND ANALYSIS:
This multicentre, prospective, observational study will recruit patients diagnosed with AAS at three tertiary referral centres from 1 January 2020 to 31 December 2023. We will analyse the discrepancies in sST2 levels in patients with different AAS types and explore the accuracy of sST2 in distinguishing between them. We will also incorporate potential risk factors and sST2 into a logistic regression model to establish a logistic risk scoring system for predicting postoperative death and prolonged intensive care unit stay in patients with AAS.
ETHICS AND DISSEMINATION:
This study was registered on the Chinese Clinical Trial Registry website (http://www. chictr. org. cn/). Ethical approval was obtained from the human research ethics committees of Beijing Anzhen Hospital (KS2019016). The ethics review board of each participating hospital agreed to participate. The final risk prediction model will be published in an appropriate journal and disseminated as a mobile application for clinical use. Approval and anonymised data will be shared.
TRIAL REGISTRATION NUMBER:
ChiCTR1900027763.
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Efficacy of autologous plateletpheresis in adult aortic surgery: study protocol for a randomised controlled trial.
BMJ Open2023 Jun;13(6):e073341. doi: 10.1136/bmjopen-2023-073341.
Gao Jie, Jia Jinna, Gao Xurong, Ji Hongwen,
Abstract
INTRODUCTION:
Perioperative coagulopathy is common in patients undergoing aortic surgery, increasing the risk of excessive blood loss and subsequent allogeneic transfusion. Blood conservation has become a vital part of cardiovascular surgery, but measures to protect platelets from destruction by cardiopulmonary bypass (CPB) are still lacking. Autologous platelet concentrate (APC) may have potential benefits for intraoperative blood preservation, but its efficacy has not been studied extensively. This study aims to evaluate the efficacy of APC as a blood conservation technique to reduce blood transfusion in adult aortic surgery.
METHODS AND ANALYSIS:
This is a prospective, single-centre, single-blind randomised controlled trial. A total of 344 adult patients undergoing aortic surgery with CPB will be enrolled and randomised to either the APC group or the control group with a 1:1 randomisation ratio. Patients in the APC group will receive autologous plateletpheresis before heparinisation, while those in the control group will not. The primary outcome is the perioperative packed red blood cell (pRBC) transfusion rate. Secondary endpoints include the volume of perioperative pRBC transfusion; drainage volume within 72 hours post-surgery; postoperative coagulation and platelet function; and the incidence of adverse events. Data will be analysed according to the intention-to-treat principle.
ETHICS AND DISSEMINATION:
This study was approved by the institutional review board of Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (no. 2022-1806). All procedures included in this study will be performed in adherence to the Helsinki Declaration. The results of the trial will be published in an international peer-reviewed journal.
TRIAL REGISTRATION NUMBER:
Chinese Clinical Trial Register (ChiCTR2200065834).
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Hemodynamic-Guided Heart Failure Management in Patients With Either Prior HF Hospitalization or Elevated Natriuretic Peptides.
JACC Heart Fail2023 Jun;11(6):691-698. doi: 10.1016/j.jchf.2023.01.007.
Desai Akshay S, Maisel Alan, Mehra Mandeep R, Zile Michael R, Ducharme Anique, Paul Sara, Sears Samuel F, Smart Frank, Bhatt Kunjan, Krim Selim, Henderson John, Johnson Nessa, Adamson Philip B, Costanzo Maria Rosa, Lindenfeld JoAnn, ,
Abstract
BACKGROUND:
In patients with symptomatic heart failure (HF) and previous heart failure hospitalization (HFH), hemodynamic-guided HF management using a wireless pulmonary artery pressure (PAP) sensor reduces HFH, but it is unclear whether these benefits extend to patients who have not been recently hospitalized but remain at risk because of elevated natriuretic peptides (NPs).
OBJECTIVES:
This study assessed the efficacy and safety of hemodynamic-guided HF management in patients with elevated NPs but no recent HFH.
METHODS:
In the GUIDE-HF (Hemodynamic-Guided Management of Heart Failure) trial, 1,000 patients with New York Heart Association (NYHA) functional class II to IV HF and either previous HFH or elevated NP levels were randomly assigned to hemodynamic-guided HF management or usual care. The authors evaluated the primary study composite of all-cause mortality and total HF events at 12 months according to treatment assignment and enrollment stratum (HFH vs elevated NPs) by using Cox proportional hazards models.
RESULTS:
Of 999 evaluable patients, 557 were enrolled on the basis of a previous HFH and 442 on the basis of elevated NPs alone. Those patients enrolled by NP criteria were older and more commonly White persons with lower body mass index, lower NYHA class, less diabetes, more atrial fibrillation, and lower baseline PAP. Event rates were lower among those patients in the NP group for both the full follow-up (40.9 per 100 patient-years vs 82.0 per 100 patient-years) and the pre-COVID-19 analysis (43.6 per 100 patient-years vs 88.0 per 100 patient-years). The effects of hemodynamic monitoring were consistent across enrollment strata for the primary endpoint over the full study duration (interaction P = 0.71) and the pre-COVID-19 analysis (interaction P = 0.58).
CONCLUSIONS:
Consistent effects of hemodynamic-guided HF management across enrollment strata in GUIDE-HF support consideration of hemodynamic monitoring in the expanded group of patients with chronic HF and elevated NPs without recent HFH. (Hemodynamic-Guided Management of Heart Failure [GUIDE-HF]; NCT03387813).
Copyright © 2023. Published by Elsevier Inc.
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Ventricular Arrhythmias Associated With Over-the-Counter and Recreational Opioids.
J Am Coll Cardiol2023 Jun;81(23):2258-2268. doi: 10.1016/j.jacc.2023.04.009.
Krantz Mori J, Rudo Todd J, Haigney Mark C P, Stockbridge Norman, Kleiman Robert B, Klein Michael, Kao David P,
Abstract
BACKGROUND:
Epidemic increases in opioid deaths prompted policies limiting access to prescription opioids in North America. Consequently, the over-the-counter opioids loperamide (Imodium A-D) and mitragynine, the herbal ingredient in kratom, are increasingly used to avert withdrawal or induce euphoria. Arrhythmia events related to these nonscheduled drugs have not been systematically studied.
OBJECTIVES:
In this study, we sought to explore opioid-associated arrhythmia reporting in North America.
METHODS:
The U.S. Food and Drug Administration Adverse Event Reporting System (FAERS), Center for Food Safety and Applied Nutrition Adverse Event Reporting System (CAERS), and Canada Vigilance Adverse Reaction (CVAR) databases were searched (2015-2021). Reports involving nonprescription drugs (loperamide, mitragynine) and diphenoxylate/atropine (Lomotil) were identified. Methadone, a prescription opioid (full agonist), served as a positive control owing to its established arrhythmia risk. Buprenorphine (partial agonist) and naltrexone (pure antagonist), served as negative controls. Reports were classified according to Medical Dictionary for Regulatory Activities terminology. Significant disproportionate reporting required a proportional reporting ratio (PRR) of ?2, ?3 cases, and chi-square ?4. Primary analysis used FAERS data, whereas CAERS and CVAR data were confirmatory.
RESULTS:
Methadone was disproportionately associated with ventricular arrhythmia reports (PRR: 6.6; 95% CI: 6.2-7.0; n = 1,163; chi-square = 5,456), including 852 (73%) fatalities. Loperamide was also significantly associated with arrhythmia (PRR: 3.2; 95% CI: 3.0-3.4; n = 1,008; chi-square = 1,537), including 371 (37%) deaths. Mitragynine demonstrated the highest signal (PRR: 8.9; 95% CI: 6.7-11.7; n = 46; chi-square = 315), with 42 (91%) deaths. Buprenorphine, diphenoxylate, and naltrexone were not associated with arrhythmia. Signals were similar in CVAR and CAERS.
CONCLUSIONS:
The nonprescription drugs loperamide and mitragynine are associated with disproportionate reports of life-threatening ventricular arrhythmia in North America.
Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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