Pubblicazioni recenti - cardiovascular events
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Combined platelet and red blood cell recovery during on-pump cardiac surgery using same? by i-SEP autotransfusion device: a first-in-human non-comparative study (i-TRANSEP study).
Anesthesiology2023 Jun;():. doi: 10.1097/ALN.0000000000004642.
Mansour Alexandre, Beurton Antoine, Godier Anne, Rozec Bertrand, Zlotnik Diane, Nedelec Fabienne, Gaussem Pascale, Fiore Mathieu, Boissier Elodie, Nesseler Nicolas, Ouattara Alexandre,
Abstract
BACKGROUND:
Centrifugation-based autotransfusion devices only salvage red blood cells while platelets are removed. The same? device (i-SEP, France) is an innovative filtration-based autotransfusion device able to salvage both red blood cells and platelets. We tested the hypothesis that this new device could allow a red blood cell recovery exceeding 80% with a post-treatment hematocrit exceeding 40%, and would remove more than 90% of heparin and 75% of free hemoglobin.
METHODS:
Adults undergoing on-pump elective cardiac surgery were included in a non-comparative multicenter trial. The device was used intraoperatively to treat shed and residual cardiopulmonary bypass blood. The primary outcome was a composite of cell recovery performance, assessed in the device by red blood cell recovery and post-treatment hematocrit, and of biological safety assessed in the device by the washout of heparin and free hemoglobin expressed as removal ratios. Secondary outcomes included platelet recovery and function and adverse events (clinical and device-related adverse events) up to 30 days after surgery.
RESULTS:
We included 50 patients of whom 18 (35%) underwent isolated CABG, 26 (52%) valve surgery and 6 (12%) aortic root surgery. The median red blood cell recovery per cycle was 86.1 (25th-75th; 80.8-91.6) % with post-treatment hematocrit of 41.8 (39.7-44.2) %. Removal ratios for heparin and free-hemoglobin were 98.9 (98.2-99.7) % and 94.6 (92.7-96.6) % respectively. No adverse device effect was reported. Median platelet recovery was 52.4 (44.2-60.1) %, with a post-treatment concentration of 116 (93-146) 109.L-1. Platelet activation state and function, evaluated by flow cytometry, was found unaltered by the device.
CONCLUSIONS:
In this first-in-human study, the sameTM device was able to simultaneously recover and wash both platelets and red blood cell. Compared pre-clinical evaluations, the device achieved a higher platelet recovery of 52% with minimal platelet activation while maintaining platelet ability to be activated in vitro.
Copyright © 2023 American Society of Anesthesiologists. All Rights Reserved.
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Incidence of 12 common cardiovascular diseases and subsequent mortality risk in the general population.
Eur J Prev Cardiol2023 Jun;():. doi: zwad192.
Prugger Christof, Perier Marie-Cécile, Gonzalez-Izquierdo Arturo, Hemingway Harry, Denaxas Spiros, Empana Jean-Philippe,
Abstract
BACKGROUND:
Incident events of cardiovascular diseases (CVD) are heterogenous and may results in different mortality risks. Such evidence may help inform patient and physician decisions in CVD prevention and risk factor management.
AIM:
To determine the extent to which incident events of common CVD show heterogeneous associations with subsequent mortality risk in the general population.
METHODS:
Based on England-wide linked electronic health records, we established a cohort of 1,310,518 people ?30 years of age initially free of CVD and followed up for non-fatal events of 12 common CVD and cause-specific mortality. The 12 CVD were considered as time-varying exposures in Cox's proportional hazards models to estimate hazard rate ratios (HRR) with 95% confidence intervals (CI).
RESULTS:
Over the median follow-up of 4.2 years (2010-2016), 81,516 non-fatal CVD, 10,906 cardiovascular deaths, and 40,843 non-cardiovascular deaths occurred. All 12 CVD were associated with increased risk of cardiovascular mortality, with HRR (95% CI) ranging from 1.67 (1.47-1.89) for stable angina to 7.85 (6.62-9.31) for haemorrhagic stroke. All 12 CVD were also associated with increased non-cardiovascular and all-cause mortality risk but to a lesser extent: HRR (95% CI) ranged from 1.10 (1.00-1.22) to 4.55 (4.03-5.13) and from 1.24 (1.13-1.35) to 4.92 (4.44-5.46) for transient ischaemic attack and sudden cardiac arrest, respectively.
CONCLUSIONS:
Incident events of 12 common CVD show significant adverse and markedly differential associations with subsequent cardiovascular, non-cardiovascular, and all-cause mortality risk in the general population.
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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Arterial stiffness tested by pulse wave velocity and augmentation index for cardiovascular risk stratification in antiphospholipid syndrome.
Rheumatology (Oxford)2023 Jun;():. doi: kead267.
Evangelatos Gerasimos, Konstantonis George, Tentolouris Nikolaos, Sfikakis Petros P, Tektonidou Maria G,
Abstract
OBJECTIVES:
Cardiovascular disease is a major cause of morbidity and mortality in antiphospholipid syndrome (APS). Arterial stiffness (ArS) has emerged as predictor of future cardiovascular events in the general population. We aimed to assess ArS in patients with thrombotic APS versus diabetes mellitus (DM) and healthy controls (HC), and identify predictors of increased ArS in APS.
METHODS:
ArS was evaluated by carotid-femoral Pulse Wave Velocity (cfPWV) and Augmentation Index normalized to 75 beats/min (AIx@75), using the SphygmoCor device. Participants also underwent carotid/femoral ultrasound for atherosclerotic plaques detection. We used linear regression to compare ArS measures among groups and assess ArS determinants in APS group.
RESULTS:
We included 110 patients with APS (70.9% female, mean age: 45.4?years), 110?DM patients and 110 HC, all age/sex matched. After adjustment for age, sex, cardiovascular risk factors and plaque presence, APS patients exhibited similar cfPWV (beta=-0.142, 95% CI: -0.514-0.230, p= 0.454) but increased AIx@75 (beta?=?4.525, 1.372-7.677, p= 0.005) compared with HC, and lower cfPWV (p
CONCLUSION:
APS patients exhibit elevated AIx@75 versus HC, and similar to DM, indicating enhanced arterial stiffening in APS. Given its prognostic value, ArS evaluation may help to improve cardiovascular risk stratification in APS.
© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.
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Impact of hemoglobin A1c level on the association between non-steroidal anti-inflammatory drug use and cardiovascular events in patients with type 2 diabetes: A population-based cohort study.
Pharmacoepidemiol Drug Saf2023 Jun;():. doi: 10.1002/pds.5652.
Bonnesen Kasper, Pedersen Lars, Ehrenstein Vera, Sørensen Henrik T, Lash Timothy L, Schmidt Morten,
Abstract
OBJECTIVE:
Non-steroidal anti-inflammatory drugs (NSAIDs) should be used cautiously in patients with type 2 diabetes. We examined whether the cardiovascular risks associated with NSAID use depended on HbA1c level in patients with type 2 diabetes.
METHODS:
We conducted a population-based cohort study of all adult Danes with a first-time HbA1c measurement ?48?mmol/mol during 2012-2020 (n=103,308). We used information on sex, age, comorbidity burden, and drug use to calculate time-varying inverse probability of treatment weights. After applying these weights in a pooled logistic regression, we estimated hazard ratios (HRs) of the association between use of NSAIDs (ibuprofen, naproxen, or diclofenac) and cardiovascular events (a composite of myocardial infarction, ischemic stroke, congestive heart failure, atrial fibrillation or flutter, and all-cause death). We stratified all analyses by HbA1c level (
RESULTS:
For ibuprofen use, the HR of a cardiovascular event was 1.53 (95% confidence interval [CI]: 1.34-1.75) in patients with HbA1c
CONCLUSIONS:
In patients with type 2 diabetes, glycemic dysregulation did not affect the cardiovascular risk associated with NSAID use.
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The efficacy of aspirin to inhibit platelet aggregation in patients hospitalised with a severe infection: a multicentre, open-label, randomised controlled trial.
Clin Exp Med2023 Jun;():. doi: 10.1007/s10238-023-01101-5.
van Zijverden Lieve Mees, Schutte Moya Henriëtte, Madsen Milou Cecilia, Bonten Tobias Nicolaas, Smulders Yvo Michiel, Wiepjes Chantal Maria, van Diemen Jeske Joanna Katarina, Thijs Abel,
Abstract
Patients with severe infection have an increased risk of cardiovascular events. A possible underlying mechanism is inflammation-induced platelet aggregation. We investigated whether hyperaggregation occurs during infection, and whether aspirin inhibits this. In this multicentre, open-label, randomised controlled trial, patients hospitalised due to acute infection were randomised to receive 10 days of aspirin treatment (80 mg 1dd or 40 mg 2dd) or no intervention (1:1:1 allocation). Measurements were performed during infection (T1; days 1-3), after intervention (T2; day 14) and without infection (T3; day?>?90). The primary endpoint was platelet aggregation measured by the Platelet Function Analyzer® closure time (CT), and the secondary outcomes were serum and plasma thromboxane B2 (sTxB2 and pTxB2). Fifty-four patients (28 females) were included between January 2018 and December 2020. CT was 18% (95%CI 6;32) higher at T3 compared with T1 in the control group (n?=?16), whereas sTxB2 and pTxB2 did not differ. Aspirin prolonged CT with 100% (95%CI 77; 127) from T1 to T2 in the intervention group (n?=?38), while it increased with only 12% (95%CI 1;25) in controls. sTxB2 decreased with 95% (95%CI - 97; - 92) from T1 to T2, while it increased in the control group. pTxB2 was not affected compared with controls. Platelet aggregation is increased during severe infection, and this can be inhibited by aspirin. Optimisation of the treatment regimen may further diminish the persisting pTxB2 levels that point towards remaining platelet activity. This trial was registered on 13 April 2017 at EudraCT (2016-004303-32).
© 2023. The Author(s).
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Features and outcomes of bailout repeat transcatheter aortic valve implantation (TAVI): the Bailout Acute TAVI-in-TAVI to Lessen Events (BATTLE) international registry.
Clin Res Cardiol2023 Jun;():. doi: 10.1007/s00392-023-02239-8.
Giordano Arturo, Corcione Nicola, Barbanti Marco, Costa Giuliano, Dipietro Elena, Amat-Santos Ignacio J, Gómez-Herrero Javier, Latib Azeem, Scotti Andrea, Testa Luca, Bedogni Francesco, Schaefer Andreas, Russo Marco, Musumeci Francesco, Ferraro Paolo, Morello Alberto, Cimmino Michele, Albanese Michele, Pepe Martino, Giordano Salvatore, Biondi-Zoccai Giuseppe,
Abstract
AIM:
Transcatheter aortic valve implantation (TAVI) is a mainstay in the management of severe aortic stenosis in patients with intermediate to prohibitive surgical risk. When a single TAVI device fails and cannot be retrieved, TAVI-in-TAVI must be performed acutely, but outcomes of bailout TAVI-in-TAVI have been incompletely appraised. We aimed at analyzing patient, procedural and outcome features of patients undergoing bailout TAVI-in-TAVI in a multicenter registry.
METHODS:
Details of patients undergoing bailout TAVI-in-TAVI, performed acutely or within 24 h of index TAVI, in 6 international high-volume institutions, were collected. For every case provided, 2 same-week consecutive controls (prior TAVI, and subsequent TAVI) were provided. Outcomes of interest were procedural and long-term events, including death, myocardial infarction, stroke, access site complication, major bleeding, and reintervention, and their composite (i.e. major adverse events [MAE]).
RESULTS:
A total of 106 patients undergoing bailout TAVI-in-TAVI were included, as well as 212 controls, for a total of 318 individuals. Bailout TAVI-in-TAVI was less common in younger patients, those with higher body mass index, or treated with Portico/Navitor or Sapien devices (all p?0.05). Bailout TAVI-in-TAVI was associated with higher in-hospital rates of death, emergency surgery, MAE, and permanent pacemaker implantation (all p?0.05). Long-term follow-up showed that bailout TAVI-in-TAVI was associated with higher rates of death and MAE (both?0.05). Similar findings were obtained at adjusted analyses (all p?0.05). However, censoring early events, outlook was not significantly different when comparing the two groups (p?=?0.897 for death, and p?=?0.645 for MAE).
CONCLUSIONS:
Bail-out TAVI-in-TAVI is associated with significant early and long-term mortality and morbidity. Thus, meticulous preprocedural planning and sophisticated intraprocedural techniques are of paramount importance to avoid these emergency procedures.
© 2023. The Author(s).
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Dapagliflozin in Heart Failure With Mildly Reduced or Preserved Ejection Fraction According to Polypharmacy Status.
JACC Heart Fail2023 May;():. doi: S2213-1779(23)00250-0.
Peikert Alexander, Goyal Parag, Vaduganathan Muthiah, Claggett Brian L, Kulac Ian J, Miao Zi Michael, Vardeny Orly, Kosiborod Mikhail N, Desai Akshay S, Jhund Pardeep S, Lam Carolyn S P, Inzucchi Silvio E, Martinez Felipe A, de Boer Rudolf A, Hernandez Adrian F, Shah Sanjiv J, Petersson Magnus, Langkilde Anna Maria, McMurray John J V, Solomon Scott D,
Abstract
BACKGROUND:
Patients with heart failure (HF) have a high burden of multimorbidity, often necessitating numerous medications. There may be clinical concern about introducing another medication, especially among individuals with polypharmacy.
OBJECTIVES:
This study examined the efficacy and safety of addition of dapagliflozin according to the number of concomitant medications in HF with mildly reduced or preserved ejection fraction.
METHODS:
In this post hoc analysis of the DELIVER (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure) trial, 6,263 participants with symptomatic HF with left ventricular ejection fraction >40% were randomized to dapagliflozin or placebo. Baseline medication use (including vitamins and supplements) was collected. Efficacy and safety outcomes were assessed by medication use categories ("nonpolypharmacy":
RESULTS:
Overall, 3,795 (60.6%) patients met polypharmacy and 1,886 (30.1%) met hyperpolypharmacy criteria. Higher numbers of medications were strongly associated with higher comorbidity burden and increased rates of the primary outcome. Compared with placebo, dapagliflozin similarly reduced the risk of the primary outcome irrespective of polypharmacy status (nonpolypharmacy HR: 0.88 [95% CI: 0.58-1.34]; polypharmacy HR: 0.88 [95% CI: 0.75-1.03]; hyperpolypharmacy HR: 0.73 [95% CI: 0.60-0.88]; P = 0.30). Similarly, benefits with dapagliflozin were consistent across the spectrum of total medication use (P = 0.06). Although adverse events increased with higher number of medications, they were not more frequent with dapagliflozin, regardless of polypharmacy status.
CONCLUSIONS:
In the DELIVER trial, dapagliflozin safely reduced worsening HF or cardiovascular death across a broad range of baseline medication use, including among individuals with polypharmacy (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure [DELIVER]; NCT03619213).
Copyright © 2023. Published by Elsevier Inc.
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Transcatheter Exclusion of the Left Atrial Appendage: Preclinical and Early Clinical Results With the Laminar Device.
JACC Cardiovasc Interv2023 May;():. doi: S1936-8798(23)00762-8.
Wong Gordon X, Kar Saibal, Smith Thomas W, Spangler Taylor, Bolling Steven F, Rogers Jason H,
Abstract
BACKGROUND:
The Laminar device rotates and closes the left atrial appendage (LAA) using an integrated ball and lock that excludes and eliminates the LAA pouch. There is a low device surface area, minimizing the risk of peridevice leak (PDL) and device-related thrombus (DRT) formation.
OBJECTIVES:
This study evaluates the safety and efficacy of the Laminar LAA exclusion device in healthy animals and human subjects with nonvalvular atrial fibrillation at risk of ischemic stroke and systemic thromboembolism.
METHODS:
The preclinical study implanted the Laminar device into canine subjects that underwent transesophageal echocardiography (TEE) and fluoroscopic evaluation, followed by necropsy and histological assessment at 45 and 150-days post-implant. The early clinical study implanted the device in human subjects, followed to 12 months postimplantation. Procedural success was defined as device implantation in the intended location without residual LAA leak >5 mm as seen by TEE. Safety endpoints included freedom from stroke, systemic embolism, pericardial effusion, or tamponade, life-threatening/major bleeding, or death.
RESULTS:
The Laminar device was successfully implanted in 10 canines. In all animals at 45 days and 150 days, no PDL or DRT was found, and histological examination showed fully closed LAAs covered with neo-endocardium. The device was successfully implanted in 15 human subjects with no safety events out to 12 months postimplantation. All subjects had successful protocol-defined LAA closure without DRT at 45 days by TEE and computed tomography, which remained stable through 12 months' follow-up.
CONCLUSIONS:
The preclinical and early clinical results demonstrate a promising safety and efficacy profile for the Laminar LAA exclusion device.
Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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End-tidal oxygen partial pressure is a strong prognostic predictive factor in patients with cardiac disease.
Clin Physiol Funct Imaging2023 Jun;():. doi: 10.1111/cpf.12838.
Ogura Asami, Izawa Kazuhiro P, Tawa Hideto, Wada Masaaki, Kanai Masashi, Kubo Ikko, Makihara Ayano, Yoshikawa Ryohei, Matsuda Yuichi,
Abstract
BACKGROUND:
Cardiopulmonary exercise testing (CPET) variables represent central and peripheral factors and combined factors in the pathology of patients with cardiac disease. The difference in end-tidal oxygen partial pressure from resting to anaerobic threshold (?PETO ) may represent predominantly peripheral factors. This study aimed to verify the prognostic significance of ?PETO for major adverse cardiac and cerebrovascular events (MACCE) in cardiac patients, including comparison with the minute ventilation-carbon dioxide production relationship (VE/VCO slope), and peak oxygen uptake (VO ).
METHODS:
In total, 185 patients with cardiac disease who underwent CPET were consecutively enrolled in this retrospective study. The primary endpoint was 3-year MACCE. The ability of ?PETO , VE/VCO slope, and peak VO to predict MACCE was examined.
RESULTS:
Optimal cut-off values for predicting MACCE were 2.0 mmHg for ?PETO (area under the curve [AUC]: 0.829), 29.8 for VE/VCO slope (AUC: 0.734), and 19.0 mL/min/kg for peak VO (AUC: 0.755). The AUC of ?PETO was higher than those of VE/VCO slope and peak VO . The MACCE-free survival rate was significantly lower in the ?PETO ?2.0 group versus the ?PETO >2.0 group (44.4% vs. 91.2%, P
CONCLUSION:
?PETO was a strong predictor of MACCE independent of and superior to VE/VCO slope and peak VO in patients with cardiac disease. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Very long-term outlook of acute coronary syndromes after percutaneous coronary intervention with implantation of polymer-free versus durable-polymer new-generation drug-eluting stents.
Minerva Med2023 Jun;():. doi: 10.23736/S0026-4806.23.08684-6.
Versaci Francesco, Kufner Sebastian, Cassese Salvatore, Joner Michael, Mayer Katharina, Xhepa Erion, Koch Tobias, Wiebe Jens, Ibrahim Tareq, Laugwitz Karl-Ludwig, Schunkert Heribert, Kastrati Adnan, Byrne Robert A, Spagnoli Alessandra, Bernardi Marco, Spadafora Luigi, Biondi-Zoccai Giuseppe, ,
Abstract
BACKGROUND:
Detailed long-term follow-up data on patients with acute coronary syndromes (ACS) in general, and those with ST-elevation myocardial infarction (STEMI) in particular, are limited. We aimed to appraise the long-term outlook of patients undergoing percutaneous coronary intervention (PCI) with state-of-the-art coronary stents for STEMI, other types of ACS and stable coronary artery disease (CAD), and also explore the potential beneficial impact of new-generation polymer-free drug-eluting stents (DES) in this setting.
METHODS:
Baseline, procedural and very long-term outcome data on patients undergoing PCI and randomized to implantation of new-generation polymer-free vs. durable polymer DES were systematically collected, explicitly distinguishing subjects with admission diagnosis of STEMI, non-ST-elevation ACS (NSTEACS), and stable CAD. Outcomes of interest included death, myocardial infarction, revascularization (i.e. patient-oriented composite endpoints [POCE]), major adverse cardiac events (MACE), and device-oriented composite endpoints (DOCE).
RESULTS:
A total of 3002 patients were included, 1770 (59.0%) with stable CAD, 921 (30.7%) with NSTEACS, and 311 (10.4%) with STEMI. At long-term follow-up (7.5±3.1 years), all clinical events were significantly more common in the NSTEACS group and, to a lesser extent, in the stable CAD group (e.g. POCE occurred in, respectively, 637 [44.7%] vs. 964 [37.9%] vs. 133 [31.5%], P
CONCLUSIONS:
Unstable coronary artery disease, especially when presenting without ST-elevation, represents an informative marker of adverse long-term prognosis in current state-of-the-art invasive cardiology practice. Even considering admission diagnosis, and despite of using no polymer, polymer-free DES showed similar results with regards to safety and efficacy when compared with DES with permanent polymer.
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Weight loss improves inflammation by T helper 17 cells in an obese patient with psoriasis at high risk for cardiovascular events.
J Diabetes Investig2023 Jun;():. doi: 10.1111/jdi.14037.
Maezawa Yoshiro, Endo Yusuke, Kono Satomi, Ohno Tomohiro, Nakamura Yuumi, Teramoto Naoya, Yamaguchi Ayano, Aono Kazuto, Minamizuka Takuya, Kato Hisaya, Ishikawa Takahiro, Koshizaka Masaya, Takemoto Minoru, Nakayama Toshinori, Yokote Koutaro,
Abstract
Psoriasis is a chronic inflammatory skin disease that is associated with obesity and myocardial infarction. Obesity-induced changes in lipid metabolism promote T?helper 17 (Th17) cell differentiation, which in turn promotes chronic inflammation. Th17 cells have central roles in many inflammatory diseases, including psoriasis and atherosclerosis; however, whether treatment of obesity attenuates Th17 cells and chronic inflammatory diseases has been unknown. In this study, we found an increase in Th17 cells in a patient with obesity, type?2 diabetes and psoriasis. Furthermore, weight loss with diet and exercise resulted in a decrease in Th17 cells and improvement of psoriasis. This case supports the hypothesis that obesity leads to an increase in Th17 cells and chronic inflammation of the skin and blood vessel walls, thereby promoting psoriasis and atherosclerosis.
© 2023 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.
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Cystatin C as a Predictor of Major Adverse Cardiovascular Event in Patients with Acute Myocardial Infarction Without Cardiogenic Shock and Renal Impairment After Coronary Intervention.
Int J Gen Med2023 ;16():2219-2227. doi: 10.2147/IJGM.S415595.
Wasyanto Trisulo, Yasa Ahmad, Yudhistira Yoga,
Abstract
PURPOSE:
To prove that cystatin C is a predictor of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI), either with ST-segment Elevation (AMI-EST) or without ST-segment elevation (AMI-NEST), without cardiogenic shock or renal impairment.
PATIENT AND METHODS:
This was an observational cohort study. Samples were obtained from AMI patients who underwent PCI between February 2022 and March 2022 at the Intensive Cardiovascular Care Unit. Cystatin C levels were measured before PCI. MACE were observed within 6 months. Comparisons between normally distributed continuous data were performed using the -test; test was used for non-normally distributed data. Categorical data were compared using the chi-squared test. The cut-off point of cystatin C levels to predict MACE was analyzed using Receiver Operating Characteristics (ROC).
RESULTS:
The participants were 40 AMI patients, consisting of 32 patients (80%) with AMI-EST and eight patients (20%) diagnosed with AMI-NEST, who were evaluated for the occurrence of MACE within 6 months after PCI. Ten patients (25%) developed MACE during follow-up [(MACE (+)], and the rest were in the MACE (-) group. Cystatin C levels were significantly higher in the MACE (+) group (p=0.021). ROC analysis revealed a cystatin C level of 1.21 mg/dL; cystatin C > 1.21 is associated with MACE risk, showing a significant relationship with the odds ratio value reaching 26.00, with 95% CI (3.99-169.24).
CONCLUSION:
Cystatin C level is an independent predictor of MACE in patients with AMI without cardiogenic shock or renal impairment after PCI.
© 2023 Wasyanto et al.
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SARS-CoV-2 reinfection: Adding insult to dysfunctional endothelium in patients with atherosclerotic cardiovascular disease.
Atheroscler Plus2023 Sep;53():1-5. doi: 10.1016/j.athplu.2023.06.002.
Kovanen Petri T, Vuorio Alpo,
Abstract
In this short narrative review, we aim at defining the pathophysiological role endothelial dysfunction in the observed COVID-19-associated rise in risk of cardiovascular disease. Variants of the SARS-CoV-2 virus have caused several epidemic waves of COVID-19, and the emergence and rapid spread of new variants and subvariants are likely. Based on a large cohort study, the incidence rate of SARS-CoV-2 reinfection is about 0.66 per 10 000 person-weeks. Both the first infection and reinfection with SARS-CoV-2 increase cardiac event risk, particularly in vulnerable patients with cardiovascular risk factors and the accompanying systemic endothelial dysfunction. By worsening pre-existing endothelial dysfunction, both the first infection and reinfection with ensuing COVID-19 may turn the endothelium procoagulative and prothrombotic, and ultimately lead to local thrombus formation. When occurring in an epicardial coronary artery, the risk of an acute coronary syndrome increases, and when occurring in intramyocardial microvessels, scattered myocardial injuries will ensue, both predisposing the COVID-19 patients to adverse cardiovascular outcomes. In conclusion, considering weakened protection against the cardiovascular risk-enhancing reinfections with emerging new subvariants of SARS-CoV-2, treatment of COVID-19 patients with statins during the illness and thereafter is recommended, partly because the statins tend to reduce endothelial dysfunction.
© 2023 The Authors.
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Successful extended use of Impella 5.5 as a bridge to heart transplantation.
J Surg Case Rep2023 Jun;2023(6):rjad262. doi: rjad262.
Sharaf Omar M, Diaz-Ayllon Hannia P, Myers Elisha M, Ahmed Mustafa M, Bleiweis Mark S, Jeng Eric I,
Abstract
We present the case of a 60-year-old gentleman who was admitted with acute-on-chronic cardiogenic shock and was supported with axillary Impella 5.5® for 123 days prior to heart transplantation. Total length of temporary mechanical circulatory support (MCS) was 132 days, which included 9 days with an intra-aortic balloon pump prior to Impella. During support, the patient remained extubated, participated in regular ambulation and rehabilitation with physical therapy and had continuous monitoring of device positioning. He did not experience any vascular or septic events while on temporary MCS and had improved hemodynamics and renal function after Impella initiation. Post-transplantation course was uncomplicated, and he is doing well without evidence for allograft dysfunction over 581 days post-transplantation. To our knowledge, this is the longest Impella 5.5®-supported patient during the new United Network for Organ Sharing Heart Allocation era who was successfully bridged to heart transplantation with over 1-year follow-up.
Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2023.
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Novel ultrasound techniques in the identification of vulnerable plaques-an updated review of the literature.
Front Cardiovasc Med2023 ;10():1069745. doi: 1069745.
Yao Yujuan, Zhang Pingyang,
Abstract
Atherosclerosis is an inflammatory disease partly mediated by lipoproteins. The rupture of vulnerable atherosclerotic plaques and thrombosis are major contributors to the development of acute cardiovascular events. Despite various advances in the treatment of atherosclerosis, there has been no satisfaction in the prevention and assessment of atherosclerotic vascular disease. The identification and classification of vulnerable plaques at an early stage as well as research of new treatments remain a challenge and the ultimate goal in the management of atherosclerosis and cardiovascular disease. The specific morphological features of vulnerable plaques, including intraplaque hemorrhage, large lipid necrotic cores, thin fibrous caps, inflammation, and neovascularisation, make it possible to identify and characterize plaques with a variety of invasive and non-invasive imaging techniques. Notably, the development of novel ultrasound techniques has introduced the traditional assessment of plaque echogenicity and luminal stenosis to a deeper assessment of plaque composition and the molecular field. This review will discuss the advantages and limitations of five currently available ultrasound imaging modalities for assessing plaque vulnerability, based on the biological characteristics of the vulnerable plaque, and their value in terms of clinical diagnosis, prognosis, and treatment efficacy assessment.
© 2023 Yao and Zhang.
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Guideline-directed medical therapies for comorbidities among patients with atrial fibrillation: results from GARFIELD-AF.
Eur Heart J Open2023 May;3(3):oead051. doi: oead051.
Camm Alan John, Steffel Jan, Virdone Saverio, Bassand Jean-Pierre, Fox Keith A A, Goldhaber Samuel Z, Goto Shinya, Haas Sylvia, Turpie Alexander G G, Verheugt Freek W A, Misselwitz Frank, Herreros Ramón Corbalán, Kayani Gloria, Pieper Karen S, Kakkar Ajay K, ,
Abstract
AIMS:
This study aimed to identify relationships in recently diagnosed atrial fibrillation (AF) patients with respect to anticoagulation status, use of guideline-directed medical therapy (GDMT) for comorbid cardiovascular conditions (co-GDMT), and clinical outcomes. The Global Anticoagulant Registry in the FIELD (GARFIELD)-AF is a prospective, international registry of patients with recently diagnosed non-valvular AF at risk of stroke (NCT01090362).
METHODS AND RESULTS:
Guideline-directed medical therapy was defined according to the European Society of Cardiology guidelines. This study explored co-GDMT use in patients enrolled in GARFIELD-AF (March 2013-August 2016) with CHADS-VASc ? 2 (excluding sex) and ?1 of five comorbidities-coronary artery disease, diabetes mellitus, heart failure, hypertension, and peripheral vascular disease ( = 23 165). Association between co-GDMT and outcome events was evaluated with Cox proportional hazards models, with stratification by all possible combinations of the five comorbidities. Most patients (73.8%) received oral anticoagulants (OACs) as recommended; 15.0% received no recommended co-GDMT, 40.4% received some, and 44.5% received all co-GDMT. At 2 years, comprehensive co-GDMT was associated with a lower risk of all-cause mortality [hazard ratio (HR) 0.89 (0.81-0.99)] and non-cardiovascular mortality [HR 0.85 (0.73-0.99)] compared with inadequate/no GDMT, but cardiovascular mortality was not significantly reduced. Treatment with OACs was beneficial for all-cause mortality and non-cardiovascular mortality, irrespective of co-GDMT use; only in patients receiving all co-GDMT was OAC associated with a lower risk of non-haemorrhagic stroke/systemic embolism.
CONCLUSION:
In this large prospective, international registry on AF, comprehensive co-GDMT was associated with a lower risk of mortality in patients with AF and CHADS-VASc ? 2 (excluding sex); OAC therapy was associated with reduced all-cause mortality and non-cardiovascular mortality, irrespective of co-GDMT use.
CLINICAL TRIAL REGISTRATION:
Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362.
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
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The impact of population screening for cardiovascular disease on quality of life.
Eur Heart J Open2023 May;3(3):oead055. doi: oead055.
Søgaard Rikke, Diederichsen Axel, Lindholt Jes,
Abstract
AIMS:
To examine the impact of population screening-generated events on quality of life: invitation, positive test result, initiation of preventive medication, enrolment in follow-up at the surgical department, and preventive surgical repair.
METHODS AND RESULTS:
A difference-in-difference design based on data collected alongside two randomized controlled trials where general population men were randomized to screening for cardiovascular disease or to no screening. Repeated measurements of health-related quality of life (HRQoL) were conducted up to 3 years after inclusion using all relevant scales of the EuroQol instrument: the anxiety/depression dimension, the EuroQol 5-dimension profile index (using Danish preference weights), and the visual analogue scale for global health. We compare the mean change scores from before to after events for groups experiencing vs. not experiencing the events. Propensity score matching is additionally used to provide both unmatched and matched results. Invitees reported to be marginally better off than non-invitees on all scales of the EuroQol. For events of receiving the test result, initiating preventive medication, being enrolled in surveillance, and undergoing surgical repair, we observed no impact on overall HRQoL but a minor impact of being enrolled in surveillance on emotional distress, which did not persist after matching.
CONCLUSION:
The often-claimed detrimental consequences of screening to HRQoL could not be generally confirmed. Amongst the screening events assessed, only two possible consequences were revealed: a reassurance effect after a negative screening test and a minor negative impact to emotional distress of being enrolled in surveillance that did not spill over to overall HRQoL.
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Brain Connectivity Correlates of Breathing and Cardiac Irregularities in SUDEP: A Resting-State fMRI Study.
bioRxiv2023 May;():. doi: 2023.05.19.541412.
Kassinopoulos Michalis, Rolandi Nicolo, Alphan Laren, Harper Ronald M, Oliveira Joana, Scott Catherine, Kozák Lajos R, Guye Maxime, Lemieux Louis, Diehl Beate,
Abstract
Sudden unexpected death in epilepsy (SUDEP) is the leading cause of premature mortality among people with epilepsy. Evidence from witnessed and monitored SUDEP cases indicate seizure-induced cardiovascular and respiratory failures; yet, the underlying mechanisms remain obscure. SUDEP occurs often during the night and early morning hours, suggesting that sleep or circadian rhythm-induced changes in physiology contribute to the fatal event. Resting-state fMRI studies have found altered functional connectivity between brain structures involved in cardiorespiratory regulation in later SUDEP cases and in individuals at high-risk of SUDEP. However, those connectivity findings have not been related to changes in cardiovascular or respiratory patterns. Here, we compared fMRI patterns of brain connectivity associated with regular and irregular cardiorespiratory rhythms in SUDEP cases with those of living epilepsy patients of varying SUDEP risk, and healthy controls. We analysed resting-state fMRI data from 98 patients with epilepsy (9 who subsequently succumbed to SUDEP, 43 categorized as low SUDEP risk (no tonic-clonic seizures (TCS) in the year preceding the fMRI scan), and 46 as high SUDEP risk (>3 TCS in the year preceding the scan)) and 25 healthy controls. The global signal amplitude (GSA), defined as the moving standard deviation of the fMRI global signal, was used to identify periods with regular ('low state') and irregular ('high state') cardiorespiratory rhythms. Correlation maps were derived from seeds in twelve regions with a key role in autonomic or respiratory regulation, for the low and high states. Following principal component analysis, component weights were compared between the groups. We found widespread alterations in connectivity of precuneus/posterior cingulate cortex in epilepsy compared to controls, in the low state (regular cardiorespiratory activity). In the low state, and to a lesser degree in the high state, reduced anterior insula connectivity (mainly with anterior and posterior cingulate cortex) in epilepsy appeared, relative to healthy controls. For SUDEP cases, the insula connectivity differences were inversely related to the interval between the fMRI scan and death. The findings suggest that anterior insula connectivity measures may provide a biomarker of SUDEP risk. The neural correlates of autonomic brain structures associated with different cardiorespiratory rhythms may shed light on the mechanisms underlying terminal apnea observed in SUDEP.
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Increased plasma lipopolysaccharide-binding protein and altered inflammatory mediators in overweight women suggest a state of subclinical endotoxemia.
bioRxiv2023 May;():. doi: 2023.05.18.540879.
Metz Christine N, Xue Xiangying, Chatterjee Prodyot K, Adelson Robert, Brines Michael, Tracey Kevin J, Gregersen Peter K, Pavlov Valentin A,
Abstract
BACKGROUND:
Over 65% of American women are overweight or obese. Obesity and the closely related metabolic syndrome increase the probability for developing several diseases, including cardiovascular disease (CVD). Chronic low-grade inflammation has been recognized as an underlying event linking obesity to CVD. However, inflammatory alterations in individuals who are overweight remain understudied. To provide insight, we performed a pilot study to determine the levels of key circulating biomarkers of endotoxemia and inflammation in overweight vs. lean women with high cholesterol and/or high blood pressure - two important conventional risk factors for CVD.
METHODS:
Plasma samples from adult female subjects who were lean (n=20, BMI=22.4±1.6 kg/m ) or overweight (n=20, BMI=27.0±1.5 kg/m ) with similar ages (55.65±9.1 years and 59.7±6.1 years), and race/ethnicity, and self-reported high cholesterol and/or high blood pressure were analyzed and compared. Samples were obtained through the Northwell Health "Genotype and Phenotype, GaP" registry. Plasma levels of lipopolysaccharide-binding protein (LBP), CRP, IL-6, leptin, and adiponectin were analyzed using commercially available assay kits.
RESULTS:
Plasma levels of LBP (a recognized marker of metabolic endotoxemia in obesity) were significantly higher in the overweight group compared with the lean group (p=0.005). The levels of CRP, a general marker of inflammation, were also significantly higher in overweight subjects (p=0.01), as were those of the cytokine IL-6 (p=0.02) and the adipokine leptin (p=0.002), pro-inflammatory mediators associated with cardiovascular risk. Levels of adiponectin, an adipokine with anti-inflammatory and anti-atherogenic functions, were significantly lower in the overweight group (p=0.002). The leptin/adiponectin ratio, a preferential atherogenic marker was significantly increased in women who are overweight (p=0.02). Alterations in LBP, CRP, leptin, and adiponectin significantly correlated with BMI, but not with age. The absolute levels of these analytes were within the ranges reported for healthy subjects evaluated in larger clinical trials and thus can be classified as consistent with subclinical endotoxemia.
CONCLUSION:
These results document the presence of a pro-inflammatory state in overweight compared with lean women and are of interest for further evaluation of evidence of inflammation in overweight individuals as an additional risk factor for cardiometabolic disease.
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The Association of QRS Duration with Risk of Adverse Outcomes in Sex- and Race- Based Subgroups: The Dallas Heart Study.
medRxiv2023 May;():. doi: 2023.05.15.23290016.
Kondamudi Nitin, Zeleke Yihun, Rosenblatt Anna, Hu Gene, Grubb Christopher, Link Mark S,
Abstract
INTRODUCTION:
We explored sex and race differences in the prognostic implications of QRS prolongation among healthy adults.
METHODS:
Participants from the Dallas Heart Study (DHS) free of cardiovascular (CV) disease who underwent ECG testing and cMRI evaluation were included. Multivariable linear regression was used to examine the cross-sectional association of QRS duration with left ventricular (LV) mass, LV ejection fraction (LVEF), and LV end diastolic volume (LVEDV). Association of QRS duration with risk of MACE was evaluated using Cox models. Interaction testing was performed between QRS duration and sex/race respectively for each outcome of interest. QRS duration was log transformed.
RESULTS:
The study included 2,785 participants. Longer QRS duration was associated with higher LV mass, lower LVEF, and higher LVEDV, independent of CV risk factors ([?: 0.21, P
DISCUSSION:
In healthy adults, QRS duration is differentially associated with abnormalities in LV structure and function. These findings inform the use of QRS duration in identifying subgroups at risk for CV disease, and caution against using QRS duration cut offs uniformly for clinical decision making.
WHAT IS KNOWN?:
QRS prolongation in healthy adults is associated with higher risk of death, cardiovascular disease, and left ventricular hypertrophy.
WHAT THE STUDY ADDS?:
QRS prolongation may reflect a higher degree of underlying LV hypertrophy in Blacks compared to Whites. Longer QRS interval may reflect higher risk of adverse cardiac events, driven by prevalent cardiovascular risk factors.
GRAPHIC ABSTRACT:
Risk of underlying left ventricular hypertrophy in demographic groups based on QRS prolongation.
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