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  • Resting coronary velocity and myocardial performance in women with impaired coronary flow reserve: Results from the Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-23
    Nissi Suppogu; Janet Wei; Michael D. Nelson; Galen Cook-Wiens; Susan Cheng; Chrisandra L. Shufelt; Louise E.J. Thomson; Balaji Tamarappoo; Daniel S. Berman; Bruce Samuels; Babak Azarbal; R. David Anderson; John W. Petersen; Eileen M. Handberg; Carl J. Pepine; C. Noel Bairey Merz

    Background Women with evidence of ischemia and no obstructive coronary arteries (INOCA) often have coronary microvascular dysfunction (CMD) indicated by impaired coronary flow reserve (CFR) to adenosine. Low CFR is associated with an adverse prognosis, including incident heart failure. Because the CFR calculation relies on the baseline intrinsic coronary vasomotor flow velocity, a major determinate of CFR and the degree of variation in baseline flow alone may be an important contributor to risk of adverse outcomes in women with CMD. A better understanding of baseline blood flow in the setting of low CFR and its association with myocardial performance would be helpful. Methods We evaluated 74 women who underwent invasive coronary reactivity testing in the Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study and had impaired CFR (<2.32). We assessed the relationship between coronary artery baseline average peak velocity (bAPV) at rest and cardiac magnetic resonance imaging measures of left ventricular (LV) structure and function. Results When stratified as low (<22 cm/s) versus high (≥22 cm/s) bAPV, there were no differences in cardiovascular risk factors, coronary plaque burden, or LV structure. However, low bAPV was associated with higher LV end-diastolic filling pressure (P = 0.04), lower LV ejection fraction (P = 0.001), and differences in late systolic and diastolic strain rates (P = 0.01 to 0.05). Conclusions In women with impaired CFR, low resting coronary flow velocity is associated with more adverse myocardial performance, which may contribute to risk for adverse outcomes and particularly heart failure in women with CMD.

    更新日期:2020-01-23
  • Non-physiologic closing of bi-leaflet mechanical heart prostheses requires a new tri-leaflet valve design
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-23
    Thierry Carrel; Walter P. Dembitsky; Bas de Mol; Dominik Obrist; Gilles Dreyfus; Bart Meuris; Bernhard Vennemann; Didier Lapeyre; Hartzell Schaff

    Mechanical heart valve prostheses are based on older designs without changes during the last 40 years. Today, there is an unmet need for less thrombogenic mechanical prostheses. Analysis of the relationship between flow characteristics and thromboembolic complications is possible using numerical and biomolecular flow studies that have shown that the reverse rather than the forward flow is responsible for local platelet activation and thrombosis. After peak flow, leaflets experience flow deceleration and the leaflets are still widely open when the flow becomes zero. The closure of the valve starts with the onset of reverse flow. Therefore, the valve closes extremely fast with most of the leaflet traveling angle occurring in <10 ms with excessively high reverse flow velocities. The pivoting spaces, so-called “Hot Spots” should be eliminated to prevent pathologic shear stress that result in thrombosis. A novel tri-leaflet valve combines favorable hemodynamics with the durability of mechanical heart valve. This valve closes within 60 ms, much slower than bi-leaflet valves and similar to the closing mode of a tissue valve. Micro-particle image velocimetry did not show critical regions of flow stagnation and zones of excessive shear in the pivoting region suggesting low potential for thrombogenic events that should allow to avoid long-term anticoagulation.

    更新日期:2020-01-23
  • Predictors of cardiac neuromodulation achieved by cryoballoon ablation performed in patients with atrial fibrillation who were in sinus rhythm before the ablation
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-22
    Maj Riccardo; Borio Gianluca; Osório Thiago Guimarães; Iacopino Saverio; Ströker Erwin; Sieira Juan; Terasawa Muryo; Rizzo Alessandro; Galli Alessio; Varnavas Varnavas; Bala Gazim; Paparella Gaetano; Brugada Pedro; De Asmundis Carlo; Chierchia Gian Battista

    Background The impact of pulmonary vein isolation (PVI) performed with cryoballoon (CB) on the intrinsic cardiac autonomic nervous system (ICANS) remains unclear. Objective The purpose of this study was to evaluate the predictors and the clinical meaning of cardiac neuromodulation achieved by CB-ablation as assessed by sinus heart rate (HR) response after the procedure. Methods Patients who underwent CB-ablation for drug-resistant atrial fibrillation (AF) from January 2014 to October 2018 were included. Twelve‑leads rest ECG was taken both before and after the procedure. After discharge, patients were scheduled for follow-up visits at 1, 3, 6, and 12 months and 24 h Holter recordings were obtained at each follow-up visit. All documented AF episodes of >30 s were considered as recurrence. Results Four-hundred seventy-two patients (62.3% male, age 56.7 ± 13.6 years, 97.2% paroxysmal AF) were included. Mean HR before the procedure was 60.17 ± 10.4 bpm, while the morning after the procedure mean HR was 75.48 ± 12.0 bpm. Age at enrollment (R = −0.26; p < 0.001), baseline HR before the CB-A (R = −0.32; p < 0.001), nadir temperature in each right pulmonary vein (R = −0.11, p = 0.022; R = −0.16; p = 0.001) were significantly associated with the ∆HR. At 2-year follow-up, freedom from recurrences was 83.1% for the patients with HR increase ≥15 bpm after CB-A and 66.3% in patients with HR increase ˂15 bpm (p = 0.021). Conclusion Sinus HR increase is a frequent phenomenon after CB-A, that can be predicted by both clinical and procedural factors and that correlates with better outcome after cryo-PVI.

    更新日期:2020-01-22
  • Routine exercise-based cardiac rehabilitation does not increase aerobic fitness: A CARE CR study
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-22
    S. Nichols; C. Taylor; T. Goodman; R. Page; A. Kallvikbacka-Bennett; F. Nation; A.L. Clark; S.T. Birkett; S. Carroll; L. Ingle

    Background Recent evidence suggests that routine exercise-based cardiac rehabilitation (CR) may not lead to a substantial increase in estimated peak oxygen uptake (V̇O2peak). This could reduce the potential benefits of CR and explain why CR no longer improves patient survival in recent studies. We aimed to determine whether routine exercise-based CR increases V̇O2peak using gold-standard maximal cardiopulmonary exercise testing (CPET), and to quantify the exercise training stimulus which might be insufficient in patients undertaking CR. Methods We studied the effects of a routine, twice weekly, exercise-based CR programme for eight weeks (intervention group) compared with abstention from supervised exercise training (control group) in patients with coronary heart disease. The primary outcome was V̇O2peak measured using CPET. We also measured changes in body composition using dual X-ray absorptiometry, carotid intima-media thickness, hs-CRP and N-terminal pro B-type natriuretic peptide at baseline, 10 weeks and one year. We also calculated the Calibre 5-year all-cause mortality risk score. Results Seventy patients (age 63.1 SD 10.0 years; BMI 29.2 SD 4.0 kg·m−2; 86% male) were recruited (n = 48 intervention; n = 22 controls). The mean aerobic exercise training duration was 23 min per training session, and the mean exercise training intensity was 45.9% of heart rate reserve. V̇O2peak was 23·3 ml·kg-1·min−1 at baseline, and there were no changes in V̇O2peak between groups at any time point. The intervention had no effect on any of the secondary endpoints. Conclusion Routine CR does not lead to an increase in V̇O2peak and is unlikely to improve long-term outcomes.

    更新日期:2020-01-22
  • Left atrial sphericity as a marker of atrial remodeling: Comparison of atrial fibrillation patients and controls
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-22
    Mark J. Mulder; Michiel J.B. Kemme; Charlotte L. Visser; Luuk H.G.A. Hopman; Pepijn A. van Diemen; Peter M. van de Ven; Marco J.W. Götte; Ibrahim Danad; Paul Knaapen; Albert C. van Rossum; Cornelis P. Allaart

    Background Left atrial (LA) sphericity has been proposed as a more sensitive marker of atrial fibrillation (AF)-associated atrial remodeling compared to traditional markers such as LA size. However, mechanisms that underlie changes in LA sphericity are not fully understood and studies investigating the predictive value of LA sphericity for AF ablation outcome have yielded conflicting results. The present study aimed to assess correlates of LA sphericity and to compare LA sphericity in subjects with and without AF. Methods Measures of LA size (LA diameter, LA volume, LA volume index), LA sphericity and thoracic anteroposterior diameter (APd) at the level of the LA were determined using computed tomography (CT) imaging data in 293 AF patients (62% paroxysmal AF) and 110 controls. Results LA diameter (40.1 ± 6.8 mm vs. 35.2 ± 5.1 mm; p < 0.001), LA volume (116.0 ± 33.0 ml vs. 80.3 ± 22.6 ml; p < 0.001) and LA volume index (56.1 ± 15.3 ml/m2 vs. 41.6 ± 11.1 ml/m2; p < 0.001) were significantly larger in AF patients compared to controls, also after adjustment for covariates. LA sphericity did not differ between AF patients and controls (83.7 ± 2.9 vs. 83.9 ± 2.4; p = 0.642). Multivariable linear regression analysis demonstrated that LA diameter, LA volume, female sex, body length and thoracic APd were independently associated with LA sphericity. Conclusions The present study suggests that thoracic constraints rather than the presence of AF determine LA sphericity, implying LA sphericity to be unsuitable as a marker of AF-related atrial remodeling.

    更新日期:2020-01-22
  • Myeloid-related protein 8/14 and high-sensitivity cardiac troponin I to differentiate type 2 myocardial infarction
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-21
    Johanna Bormann; Dimitrios A. Psyrakis; Beatrice von Jeinsen; Dimitri Grün; Laura K. Elsner; Jan S. Wolter; Maren Weferling; Katharina Diouf; Steffen Kriechbaum; Christian Troidl; Oliver Dörr; Holger Nef; Christian W. Hamm; Christoph Liebetrau; Till Keller

    Myocardial infarction(MI) not only defines acute MI with obstructed coronary arteries (T1MI) but also myocardial necrosis caused by myocardial oxygen supply/demand mismatch as type 2 MI(T2MI); only T1MI patients benefit from an early invasive management. Myeloid-related protein(MRP)-8/14 is a biomarker described in various inflammatory diseases and in MI patients. Here we evaluate the potential of MRP-8/14 and high-sensitivity troponin I(hs-cTnI) to differentiate T2MI from T1MI. Patients with final diagnosis NSTEMI(n = 254; 33.1% female) enrolled in a prospective biomarker registry between 08/2011 and 10/2016 were analysed. Median baseline MRP-8/14 levels were higher in T2MI(n = 55; 3.37(1.88–6.48)μg/mL) than in T1MI (n = 199; 2.4(1.4–3.79)μg/mL)(p = .013) patients, in contrast to hs-cTnI (T2MI:52[11.65–321.4]ng/L vs. T1MI:436.5 [61.25–1973.8]ng/L; p < .001). To detect the strength of this association odds ratios(OR) were calculated with MRP-8/14 yielding 2.13(1.16–3.92; p = .015) to predict T2MI and 0.47(0.26–0.87; p = .015) for T1MI. As expected, hs-cTnI yielded an OR of to predict T2MI 0.34(0.17–0.65; p = .001) and 2.98(1.53–5.81; p = .001) for T1MI. Both markers show comparable and independent results if adjust to hs-cTnI/MRP-8/14, TIMI risk score and CRP. T2MI is associated with higher MRP-8/14 and lower hs-cTnI concentrations than T1MI. Our data suggest that MRP-8/14 as a marker of inflammation might provide usable discriminatory information complementing hs-cTnI in a diagnostic procedure evaluating the type of MI directly upon hospital admission.

    更新日期:2020-01-22
  • Comparison of clinical outcomes in STEMI patients treated with primary PCI according to day-time of medical attention and its relationship with circadian pattern
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-21
    Juan J. Rodríguez-Arias; Luis Ortega-Paz; Salvatore Brugaletta; Xavier Freixa; Mónica Masotti; Ander Regueiro; Albert Ariza; Xavier Carrillo; Rosa-Maria Lidon; Joan Garcia; Merida Cardenas; Sergio G. Rojas; Juan F. Muñoz; Marta Zielonka; Helena Tizon-Marcos; Manel Sabaté

    Objective Relationship between STEMI time of presentation, its circadian pattern and cardiovascular outcomes is unclear. Our objective is to analyze clinical outcomes of STEMI according to time of presentation and circadian pattern. Methods We analyzed data from patients treated within the regional STEMI Network from January 2010 to December 2015. On-hour group included patients treated between 8:00 h and 19:59 h on weekdays, the rest were catalogued as off-hour group. The primary endpoint was 1-year all-cause mortality. Secondary endpoints were 30-day all-cause mortality and in-hospital complications. Results A total of 8608 patients were included, 44.1% in the on-hour group and 55.9% in the off-hour group. We observed a shorter patient delay and longer system delay in the off-hour group compared to on-hour group with no difference in total ischemic time. At 30-day and 1-year follow-up there were no differences in adjusted all-cause mortality between groups [OR 0.91 (CI95%: 0.73–1.12; p = 0.35) and OR 0.99 (CI95%: 0.83–1.17; p = 0.87), respectively]. A circadian pattern was observed between 9:00 am and 12:30 pm, with no differences in 30-day and 1-year mortality between patients included in this time interval [OR 1.02 (IC95%: 0.81–1.30; p = 0.85) and OR 1.12 (IC95%: 0.92–1.36; p = 0.25) respectively]. Conclusions Off-hour STEMI presentation was associated with a shorter patient delay and longer system delay without an increase in total ischemic time. The off-hour presentation was not related to an increase in 1-year all-cause mortality when compared to on-hour. A circadian pattern was found, without differences in 30-day and 1-year mortality.

    更新日期:2020-01-22
  • Prognostic value of sST2 in patients with heart failure with reduced, mid-range and preserved ejection fraction
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-21
    Yu Song; Fuhai Li; Yamei Xu; Yuan Liu; Yanyan Wang; Xueting Han; Yuyuan Fan; Juan Cao; Jie Luo; Aijun Sun; Kai Hu; Jingmin Zhou; Junbo Ge

    Backgrounds Prognostic value of soluble suppression of tumorigenecity (sST2), a novel circulating biomarker for myocardial fibrosis, remains elusive in the heart failure patients with preserved ejection fraction (HFpEF). Methods 405 consecutive patients with heart failure (HF) were enrolled prospectively, and were grouped into HF with reduced ejection fraction (HFrEF, N = 215), HF with mid-range ejection fraction (HFmrEF, N = 80) and HFpEF (N = 110). The primary endpoint was the composite endpoint of all-cause death and HF rehospitalization. Results After a median of 12 months, 139 patients reached the primary endpoint, with 57 patients died and 82 patients rehospitalized. Multivariate analysis confirmed that sST2 was an independent risk factor of the primary endpoint for all HF patients [hazard ratio (HR) 2.35, 95% confidence interval (CI) 1.30–4.22, P = 0.004]. Predicting efficacy of sST2 on outcomes was higher for HFpEF (HR 6.48, 95%CI 1.89–22.21, P = 0.003) as compared to HFrEF (HR 3.21, 95% CI 1.67–6.19, P = 0.000). But the association between sST2 and outcomes in HFmrEF is not statistical (HR 3.38, 95%CI 0.82–13.86, P = 0.091). The combined use of sST2 and N terminal pro B type natriuretic peptide (NT-proBNP) could improve the prognostic value compared to using NT-proBNP alone in HFrEF (AUC = 0.794 vs. 0.752, P = 0.034). Conclusion Higher baseline sST2 levels are associated with increased risk of all-cause death and HF rehospitalization in patients with HF independent of ejection fraction. The combined use of sST2 and NT-proBNP could improve the prognostic value than using these two values alone, especially for HFrEF patients.

    更新日期:2020-01-22
  • Temporal trends of patients with acute coronary syndrome and multi-vessel coronary artery disease - from the ACSIS registry
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-21
    Arthur Shiyovich; Nir Shlomo; Tal Cohen; Zaza Iakobishvili; Ran Kornowski; Alon Eisen

    Introduction Multi-vessel coronary artery disease (MV-CAD) is common among patients with acute coronary syndrome (ACS) and is associated with worse outcomes. Objectives To examine temporal trends of patients presenting with ACS and MV-CAD. Methods Time-dependent analysis of patients enrolled in the ACS Israeli Surveys (ACSIS) between 2004–2016 by 3 time periods: early (2004–2006; n = 2111), mid (2008–2010; n = 2049), and late (2013–2016; n = 2010). MV-CAD was defined as >50% stenosis in ≥2 separate coronary territories at the index coronary catheterization. Outcomes were 30-day MACE and 1-year all-cause mortality. Results Overall 6170/9321 patients (66%) had MV-CAD (age 64.5 ± 12.1, males 80%). Patients from later periods were older with a higher prevalence of cardiovascular risk-factors and comorbidity. Among patients with MV-CAD, STEMI decreased significantly (early-46% vs. late-37%, p < 0.001). The rates of PCI were similar, however rates of MV-PCI have increased (early-16.8% vs. late −37.1%, p < 0.001) while the rates of CABG decreased over-time (early-12.7% vs. late −9.2%, p < 0.001). Thirty-day outcomes improved significantly; MACE (early-18.2%, mid-12.6%, late-11.2%, p < 0.001), mortality (early-4.7%, mid-4.2%, late-3.1%, p = 0.03) and re-infarction (early = 3.0%, mid = 2.4% and late 1.1%, p < 0.001). No significant change in 1-year mortality was observed (early = 9.3%, mid = 7.8%, late = 7.7%, p = 0.13). A multivariate adjusted analysis demonstrated that the mid and late periods (vs. the early period) were associated with significantly reduced risk for 30-day MACE (OR = 0.65 [0.54–0.77] and 0.54 [0.45–0.65], respectively). Conclusions During the last decade, the burden of cardiovascular risk factors among ACS patients with MV- CAD has increased, more invasive treatment was provided and a significant improvement in 30-day outcomes was observed.

    更新日期:2020-01-22
  • Outcome of pitavastatin versus atorvastatin therapy in patients with hypercholesterolemia at high risk for atherosclerotic cardiovascular disease
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-20
    Masao Moroi; Daiji Nagayama; Fumihiko Hara; Atsuhito Saiki; Kazuhiro Shimizu; Mao Takahashi; Naoko Sato; Teruo Shiba; Hideki Sugimoto; Toshiki Fujioka; Tatsuo Chiba; Kosuke Nishizawa; Shuki Usui; Yasuo Iwasaki; Ichiro Tatsuno; Kaoru Sugi; Junichi Yamasaki; Shigeo Yamamura; Kohji Shirai

    Background There has been no report about outcome of pitavastatin versus atorvastatin therapy in high-risk patients with hypercholesterolemia. Methods Hypercholesterolemic patients with one or more risk factors for atherosclerotic diseases (n = 664, age = 65, male = 54%, diabetes = 76%, primary prevention = 74%) were randomized to receive pitavastatin 2 mg/day (n = 332) or atorvastatin 10 mg/day (n = 332). Follow-up period was 240 weeks. The primary end point was a composite of cardiovascular death, sudden death of unknown origin, nonfatal myocardial infarction, nonfatal stroke, transient ischemic attack, or heart failure requiring hospitalization. The secondary end point was a composite of the primary end point plus clinically indicated coronary revascularization for stable angina. Results The mean low-density lipoprotein cholesterol (LDL-C) level at baseline was 149 mg/dL. The mean LDL-C levels at 1 year were 95 mg/dL in the pitavastatin group and 94 mg/dL in the atorvastatin group. There were no differences in LDL-C levels between both groups, however, pitavastatin significantly reduced the risk of the primary end point, compared to atorvastatin (pitavastatin = 2.9% and atorvastatin = 8.1%, HR, 0.366; 95% CI 0.170–0.787; P = 0.01 by multivariate Cox regression) as well as the risk of the secondary end point (pitavastatin = 4.5% and atorvastatin = 12.9%, HR = 0.350; 95%CI = 0.189–0.645, P = 0.001). The results for the primary and secondary end points were consistent across several prespecified subgroups. There were no differences in incidence of adverse events between the statins. Conclusion Pitavastatin therapy compared with atorvastatin more may prevent cardiovascular events in hypercholesterolemic patients with one or more risk factors for atherosclerotic diseases despite similar effects on LDL-C levels.

    更新日期:2020-01-21
  • Outpatient volumes and medical staffing resources as predictors for continuity of follow-up care during transfer of adolescents with congenital heart disease
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-17
    Sandra Skogby; Philip Moons; Bengt Johansson; Jan Sunnegårdh; Christina Christersson; Edit Nagy; Per Winberg; Katarina Hanséus; Aleksandra Trzebiatowska-Krzynska; Shalan Fadl; Eva Fernlund; Kalliopi Kazamia; Annika Rydberg; Liesl Zühlke; Eva Goossens; Ewa-Lena Bratt
    更新日期:2020-01-17
  • Sarcoidosis diagnosed on granulomas in the explanted heart after transplantation: Results of a French nationwide study
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-17
    Thibaud Chazal; Shaida Varnous; Julien Guihaire; Céline Goeminne; David Launay; Aude Boignard; Emmanuelle Vermes; Richard Dorent; Lionel Camilleri; Bernard Lelong; Eric Epailly; Guillaume Lebreton; Xavier Waintraub; Philippe Cluzel; Philippe Maksud; Pierre Fouret; Pascal Leprince; Philippe Grenier; Fleur Cohen Aubart

    Background Cardiac sarcoidosis (CS) is a challenging diagnosis. Patients may progress to end-stage congestive heart failure and require cardiac transplantation without ever having been diagnosed. Characteristics and outcomes of patients with granulomas in the explanted hearts are unknown. Methods All French heart transplantation centers were contacted to participate in the study. Each center searched through local databases for the cases of non-caseating granuloma in the explanted hearts between 2000 and 2017. Data before and after transplantation were recorded from medical charts. Survival of CS and all- cause heart transplantation patients were compared. Results Fifteen patients (10 men, 5 women) received a diagnosis of CS based on pathologic data of the explanted heart and were recruited for the study. All patients were diagnosed as non-ischemic dilated or hypertrophic cardiomyopathy and presented congestive heart failure. Eight patients (53%) had ventricular rhythm disturbances, and 3 (20%) a complete heart block. Ten out of 13 patients (77%) had extracardiac radiological signs compatible with sarcoidosis on chest computed tomography (CT) scans. One patient died 3 months after transplantation from infectious complications. The 14 remaining patients were still alive at the end of the study (median follow-up of 28.8 months). One patient had a second heart transplantation 5 years later because of chronic allograft vasculopathy. One patient presented a relapse of CS confirmed by myocardial biopsies 9 years after transplantation, requiring an escalation of immunosuppressive therapy. Conclusion CS may be undiagnosed before heart transplantation. In 77% of cases, sarcoidosis could have been detected before transplantation with non-invasive imaging techniques.

    更新日期:2020-01-17
  • Prominent basal and middle strain longitudinal involvement in newly-diagnosed and never treated hypertensive patients without clear-cut hypertrophy
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-16
    Maria Lembo; Ciro Santoro; Regina Sorrentino; Valeria Fazio; Mario Enrico Canonico; Luigi Chiariello; Maurizio Galderisi; Roberta Esposito

    Background Left ventricular (LV) global longitudinal strain (GLS) can detect an early dysfunction in arterial hypertension. We investigated regional LV patterns of longitudinal strain (LS) and base-to-apex behaviour in newly diagnosed, never-treated hypertensive patients (HTN) without LV hypertrophy. Methods 180 HTN and 115 healthy controls underwent standard echocardiography, including regional LS and GLS assessment (in absolute values). The average LS of six basal (BLS), six middle (MLS), and six apical (ALS) segments and relative regional strain ratio = [ALS/(BLS + MLS)] were also computed. Results The two groups were comparable for sex, age and heart rate. Body mass index (BMI), systolic, diastolic and mean blood pressure (BP) (all p < 0.0001) were higher in HTN. Despite LV ejection fraction (EF) was comparable, GLS, BLS and MLS resulted lower in HTN (all p < 0.0001), without difference in ALS. Relative regional strain ratio resulted higher in HTN (p < 0.001). Dividing HTN group according to lower normal values derived from the controls, BLS was able to identify a higher rate of LV dysfunction than GLS. By a multiple linear regression analysis performed in the pooled population after adjusting for age, sex, BMI, end-systolic stress, relative wall thickness and LV mass index, the association between BLS and mean BP remained significant (β coefficient = −0.42, p < 0.0001), despite the significant impact of male sex. In a similar model, MLS and mean BP resulted also independently associated (β = −0.21, p < 0.002). Conclusions Despite normal LV EF, LS dysfunction is detectable in HTN, mainly involving basal and middle segments, resulting in higher relative regional strain ratio.

    更新日期:2020-01-16
  • Modulation of activated astrocytes in the hypothalamus paraventricular nucleus to prevent ventricular arrhythmia complicating acute myocardial infarction
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-16
    Jugang Chen; Dechun Yin; Xiaojing He; Meng Gao; Yongsub Choi; Guanghui Luo; Haixing Wang; Xiufen Qu

    Background Sympathetic overactivation after acute myocardial infarction (AMI) contributes to ventricular arrhythmia (VA). Paraventricular nucleus (PVN) of the hypothalamus may play an important role on this context, however, the mechanisms remain unknown. In this study, we investigated whether inhibition of activated astrocytes in the PVN could reduce VA in rats with AMI. Methods The anesthetized rats were randomly divided into four groups of sham-operated, AMI, AMI + vehicle and AMI + fluorocitrate (FCA). Electrocardiogram was continuously recorded. RNA sequencing, sympathetic nerve activity (heart rate variability and norepinephrine levels) and ventricular electrical instability (ventricular effective refractory period and ventricular fibrillation inducibility) were measured. Furthermore, brain tissues were extracted to detect expression of inflammatory cytokines (IL-6, and TNF-α), astrocyte and neuro activation. Results RNA sequencing analysis showed that functions of differentially expressed genes in the PVN of AMI rats were significantly enriched in immune system- and neuroactive-related pathways, along with enhance expression of cytokines and Glial fibrillary acidic protein (GFAP). We further characterized that astrocytes were activated in PVN and intervention of activation astrocytes by FCA significantly inhibited sympathetic nerve activity and decreased the incidence of VA and ventricular electrical instability in rats with AMI. Moreover, FCA significantly attenuated neurons activation and downregulated expression of inflammatory cytokines in the PVN. Conclusions Inhibition of activated astrocytes in the PVN could reduce VA occurrence and improve ventricular electrical instability in AMI rats by central neuro-immune pathway. These findings suggest that astrocytes are a potential target for prevention and treatment of VA complicating AMI.

    更新日期:2020-01-16
  • Layer-specific distribution of myocardial deformation from anthracycline-induced cardiotoxicity in patients with breast cancer—From bedside to bench
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-16
    Wei-Ting Chang; Yin-Hsun Feng; Yu Hsuan Kuo; Wei-Yu Chen; Hong-Chang Wu; Chien-Tai Huang; Tzu-Ling Huang; Zhih-Cherng Chen

    Background Anthracycline anticancer drugs such as epirubicin and doxorubicin may induce myocardial dysfunction, leading to poor prognosis. Early detection of minor left ventricular (LV) myocardial dysfunction is important for the prevention of anthracylcine-induced cardiotoxicity. Using layer-specific speckle tracking echocardiography (STE), we investigated the progressive distribution of myocardial dysfunction in both breast cancer patients and an animal toxicity model. Methods Patients with preserved LV ejection fraction (LVEF) preparing for epirubicin chemotherapy (N = 125) were prospectively enrolled. Layer-specific STE, including LV longitudinal and circumferential strains on subepicardium and subendocardium, were evaluated at baseline and after the first cycle, third cycle and six months of epirubicin therapy. A decline of LVEF above 10% to <55% at six months was defined as cardiotoxicity. These same strain measures were obtained in doxorubicin-treated rats and the distribution of myocardial fibrosis evaluated. Results In patients developing cardiotoxicity, LV longitudinal strain on subendocardium (LVLSendo) was significantly reduced after three cycles of therapy despite no significant changes in conventional LV systolic, diastolic parameters as well as LV circumferential strains at that moment. Compared to conventional echocardiographic parameters, LVLSendo was significantly predictive of cardiotoxicity. Declines in LVLSendo were also observed in doxorubicin-treated rats at an early stage. These reductions also predicted significant fibrosis in the subendocardial layer. Conclusion LVLSendo is useful for the early detection of minor cardiac dysfunction during chemotherapy, thereby implicating endocardial involvement in the development of cardiotoxicity.

    更新日期:2020-01-16
  • Inferior vena cava agenesis in patients with lower limb deep vein thrombosis in the RIETE registry. When and why to suspect
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-15
    Antonella Tufano; Luciano López-Jiménez; Behnood Bikdeli; Fernando García-Bragado; Lucia Mazzolai; Maria Amitrano; Covadonga Gómez-Cuervo; Pablo Javier Marchena; Olga Madridano; Manuel Monreal; Pierpaolo Di Micco

    Background Limited data exist about the clinical presentation and outcomes of patients with inferior vena cava agenesis (IVCA) who develop deep vein thrombosis (DVT). Methods We used the RIETE (Registro Informatizado Enfermedad Trombo Embólica) registry to compare clinical characteristics and outcomes of patients with lower limb DVT, according to the presence or absence of IVCA. Major outcomes included recurrent DVT, major bleeding and post-thrombotic syndrome (PTS). Results Among 50,744 patients with lower-limb DVT recruited in October 2018, 31 (0.06%) had IVCA. On multivariable analysis, patients aged < 30 years (odds ratio [OR]: 17.9; 95%CI: 7.05–45.3), with unprovoked DVT (OR: 2.49; 95%CI: 1.17–5.29), proximal (OR: 2.81; 95%CI: 1.05–7.53) or bilateral DVT (OR: 11.5; 95%CI: 4.75–27.8) were at increased risk to have IVCA. Patients with DVT and IVCA had lower odds to present with coexisting PE (OR: 0.22; 95%CI: 0.07–0.73). During the first year of follow-up, the rates of DVT recurrences (hazard ratio [HR]: 1.30; 95%CI: 0.07–6.43), pulmonary embolism (HR: 2.30; 95%CI: 0.11–11.4) or major bleeding (HR: 1.32; 95%CI: 0.07–6.50) were not significantly different with those with versus those without IVCA. One year after the index DVT, IVCA patients had a higher rate of skin induration (OR: 3.70; 95%CI: 1.30–9.52), collateral vein circulation (OR: 3.57; 95%CI: 1.42–8.79) or venous ulcer (OR: 5.87; 95%CI: 1.36–1.87) in the lower limb than those without IVCA. Conclusions Certain clinical features such as unprovoked and bilateral proximal DVT in young patients should raise the suspicion for IVCA. Patients with IVCA had higher odds for symptoms of post-thrombotic syndrome.

    更新日期:2020-01-15
  • Ticagrelor versus clopidogrel in patients undergoing implantation of paclitaxel-eluting stent in the femoropopliteal district: A randomized pilot study using frequency-domain optical coherence tomography
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-15
    Kenneth Ducci; Francesco Liistro; Italo Porto; Giorgio Ventoruzzo; Paolo Angioli; Giovanni Falsini; Rocco Vergallo; Leonardo Bolognese

    Objectives Aim of this study was to evaluate different response in platelet reactivity and vessel healing using high-resolution frequency-domain optical coherence tomography (FD-OCT) in patients with femoropopliteal artery disease treated with ZILVER PTX drug eluting stents (DES), and randomly assigned to clopidogrel or ticagrelor for 12 months. Background The optimal antithrombotic regimen for long-term management of patients with peripheral artery disease (PAD) after revascularization is poorly defined and often extrapolated from trials performed on patients undergoing percutaneous coronary intervention. Methods In this single center randomized trial 40 patients with femoropopliteal artery disease treated with ZILVER PTX DES stents, were randomized to Ticagrelor (T) + Aspirin for 3 months, subsequently continuing Ticagrelor alone for another 9 months or Clopidogrel (C) + Aspirin for 3 months, subsequently continuing Clopidogrel alone for 9 months. Platelet reactivity via the P2Y12 pathway was evaluated at baseline and at 3 months follow-up, angiographic and FD-OCT follow-up along the entire stented segment was performed at 12 months. Results No significant difference between T and C group was found concerning net percentage volume obstruction (29.7% ± 17.6% vs. 31.2% ± 10.7%; p = 0.78). FD-OCT at 12 months showed a high percentage of uncovered stent struts in both groups: 24.2% ± 32.8% in the T group vs 15.3% ± 15.8% in the C group (p = 0.4). Mean values of platelet reactivity units (PRU) at 3 month follow-up were 81 ± 72 in the T group and 200 ± 61 in the C group (p < 0.001). Conclusions Significantly higher platelet reactivity remains in patients treated with clopidogrel as compared to ticagrelor 3 months after PTA and stent implantation. Ticagrelor does not reduce neointimal proliferation in patients treated with DES in the femoropopliteal district as compared with clopidogrel. A large amount of uncovered stent struts at 12-month follow-up was found in these patients regardless of the antiplatelet treatment assumed.

    更新日期:2020-01-15
  • Patient and hospital characteristics associated with ticagrelor uptake in acute MI: An analysis of the Chest Pain–MI Registry
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-15
    Benjamin A. Rodwin; Di Lu; Antonio Giaimo; Amarnath Annapureddy; Ramesh Daggubati; Jeptha Curtis; Christopher T. Sciria; Tracy Y. Wang; Nihar R. Desai

    Background ACC/AHA guidelines support the use of the P2Y12 inhibitors clopidogrel, prasugrel, or ticagrelor in acute myocardial infarction (AMI). Little is known about trends in P2Y12 inhibitor selection over time. Methods Multicenter, longitudinal analysis of patients and hospitals in the National Cardiovascular Data Registry (NCDR) Chest Pain – MI Registry from the third quarter of 2013 to the first quarter of 2017. Results A total of 362,354 AMI patients treated at 801 hospitals were included in our analysis. Ticagrelor use increased over time, from 6.1% in 2013 to 33.7% in 2017, with corresponding reductions in the use of clopidogrel and prasugrel (p < 0.001 for all trends). In multivariable models, patients of white race, with private insurance, or STEMI were more likely to receive ticagrelor (p < 0.05 for all). Hospitals in the highest quartile of ticagrelor uptake had use rates ranging from 29% to 88%, and were more likely to have the lowest volume of MI patients. The correlation between prasugrel and ticagrelor adoption was weakly positive (correlation coefficient: 0.15, p = 0.004); hospitals with the lowest early adoption of prasugrel started with the lowest rate of ticagrelor use and had the slowest rate of increase in ticagrelor use. Conclusions There has been a rapid increase in use of ticagrelor since its approval by the FDA and both patient and hospital characteristics were associated with variation in its adoption and utilization. Further examination of the characteristics associated with the rapid adoption of new evidence may provide insights about improving health system performance.

    更新日期:2020-01-15
  • Effect of intracoronary bone marrow-derived mononuclear cell injection early and late after myocardial infarction on CMR-derived myocardial strain
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-15
    M. Gastl; D. Sürder; R. Corti; Faruque Osmany; A. Gotschy; J. von Spizcak; J. Sokolska; D. Metzen; H. Alkadhi; F. Ruschitzka; S. Kozerke; R. Manka

    Background Studies indicate no clear impact of intracoronary injection of bone-marrow unselected mononuclear cells (BM-MNC) after acute myocardial infarction (AMI) on left-ventricular function (LVEF). Strain parameters by cardiovascular magnetic resonance (CMR) have been proposed to be more sensitive to functional changes of the heart. The aim of the present study was to assess changes of global longitudinal (GLS) and circumferential strain (GCS) in a group of patients treated with BM-MNC after AMI. Methods One-hundred and forty-nine patients with successfully reperfused AMI and LV dysfunction (LVEF<45%) were retrospectively included into this sub-study of the SWISS-AMI multicentre trial. Patients were divided into control (N = 54), early (5–7 days after AMI, N = 51) and late BM-MNC treatment groups (3–4 weeks, N = 44). The endpoint was the change of GLS and GCS as obtained from cine sequences 4 and 12 months after AMI using feature tracking algorithm. Results In unadjusted analyses, the absolute change of GLS for the early treatment group from baseline to 4 months was 2.5 ± 4.3 (p < 0.01), to 12 months 2.7 ± 5.7% (p = 0.004). For late treatment, it was 1.5 ± 4.0% (p = 0.039, 4 months) and 2.5 ± 5.6% (p = 0.015, 12 months). For controls 0.7 ± 4.7% (p = 0.378), 0.8 ± 3.9% (p = 0.253) respectively. Adjusting for different baseline values, neither an overall treatment effect (both time-points) of BM-MNC nor a treatment time-related (only early or late) effect could be shown for all functional parameters. Conclusions Among patients after AMI with successful reperfusion and LV dysfunction, intracoronary infusion of BM-MNC either early or late after AMI did not improve global strain parameters at 4- or 12-months follow-up. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00355186.

    更新日期:2020-01-15
  • Test-retest reliability and validity of the timed up and go test and 30 second sit to stand test in patients with pulmonary hypertension
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-15
    Buse Ozcan Kahraman; Ismail Ozsoy; Bahri Akdeniz; Ebru Ozpelit; Can Sevinc; Serap Acar; Sema Savci

    Background Timed up and go (TUG) and sit to stand (STS) tests that required less space and easier to be performed in respiratory and cardiac diseases for assessing functionality. Aim was to test the reliability of TUG and 30-second STS (30STS) tests and determine the validity of TUG and 30STS tests in patients with Pulmonary Hypertension (PH). Methods Thirty-eight patients with diagnosed PH were included. We collected TUG, 30STS, quadriceps muscle strength, physical activity level, and 6MWT. Intra-class correlation coefficient (ICC) was used to determine test-retest reliability and correlations with quadriceps muscle strength, physical activity level and 6MWT for validity of the TUG and 30STS tests. Results The TUG and 30STS tests were associated with age, functional class, muscle strength, physical activity and functional exercise capacity in patients with PAH (p < 0.05). 6MWT was associated with age, functional class, muscle strength, physical activity and functional exercise capacity (p < 0.05). ICC (95%) for TUG test and 30STS were 0.96 (0.93–0.98) and 0.95 (0.90–0.97), respectively. Conclusions The TUG and 30STS tests were reliable and valid tests for measuring physical performance in PH. This study supports using the TUG and 30STS tests as practical assessment tools in patients with PH.

    更新日期:2020-01-15
  • An Utstein-based model score to predict survival to hospital admission: The UB-ROSC score
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-15
    Enrico Baldi; Maria Luce Caputo; Simone Savastano; Roman Burkart; Catherine Klersy; Claudio Benvenuti; Vito Sgromo; Alessandra Palo; Roberto Cianella; Elisa Cacciatore; Luigi Oltrona Visconti; Gaetano Maria De Ferrari; Angelo Auricchio

    Aims To develop and validate a multi-parametric practical score to predict the probability of survival to hospital admission of an out-of-hospital cardiac arrest (OHCA) victim by using Utstein Style-based variables. Methods All consecutive OHCA cases occurring from 2015 to 2017 in two regions, Pavia Province (Italy) and Canton Ticino (Switzerland) were included. We used random effect logistic regression to model survival to hospital admission after an OHCA. We computed the model area under the ROC curve (AUC ROC) for discrimination and we performed both internal and external validation by considering all OHCAs occurring in the aforementioned regions in 2018. The Utstein-Based ROSC (UB-ROSC) score was derived by using the coefficients estimated in the regression model. The score value was obtained adding the pertinent score components calculated for each variable. The score was then plotted against the probability of survival to hospital admission. Results 1962 OHCAs were included (62% male, mean age 73 ± 16 years). Age, aetiology, location, witnessed OHCA, bystander CPR, EMS arrival time and shockable rhythm were independently associated with survival to hospital admission. The model showed excellent discrimination (AUC 0.83, 95%CI 0.81–0.85) for predicting survival to hospital admission, also at internal cross-validation (AUC 0.82, 95%CI 0.80–0.84). The model maintained good discrimination after external validation by using the 2018 OHCA cohort (AUC 0.77, 95%CI 0.74–0.80). Conclusions UB-ROSC score is a novel score that predicts the probability of survival to hospital admission of an OHCA victim. UB-ROSC shall help in setting realistic expectations about sustained ROSC achievement during resuscitation manoeuvres.

    更新日期:2020-01-15
  • Validation of cardiac damage classification and addition of albumin in a large cohort of patients undergoing transcatheter aortic valve replacement
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-15
    Anat Berkovitch; Israel M. Barbash; Ariel Finkelstein; Abid R. Assali; Haim Danenberg; Paul Fefer; Elad Maor; Sophia Zhitomirsky; Katia Orvin; Sagit Ben Zekry; Arik Steinvil; Alon Barsheshet; Amir Halkin; Victor Guetta; Ran Kornowski; Amit Segev

    Aims We aimed to validate a new scoring system based on extent of cardiac damage for risk stratification in patients undergoing transcatheter aortic valve replacement (TAVR) in a real-world cohort and to examine the addition of baseline albumin in risk assessment. Methods and results We investigated 2608 patients undergoing TAVR. Subjects were divided into five groups based on their echocardiography findings. Patients were further assessed by incorporating baseline albumin. Multivariable analysis demonstrated that each increase in stage was associated with significant increased risk of 1-year mortality (HR 1.37, 95%CI 1.23–1.54, p < .001). Among patients at increased stage (3–4), incorporation of baseline of albumin identified the highest risk group, such that each 1 decrement in albumin levels was associated with more than triple increase in mortality among patients at stage 3 and 4 (HR 2.77, 95% CI 1.48–5.18, p-value = .001). Conclusions Cardiac damage classification is validated in a real-world cohort of patients undergoing TAVR. Incorporation of low baseline albumin may further identify patients at the highest risk group. Condensted abstract We evaluated 2608 patients undergoing transcatheter aortic valve replacement (TAVR) in order to validate a new scoring system dividing patients in to 5 stages (0–4) based on extent of cardiac damage. Patients were further assessed by incorporating baseline albumin. Multivariable analysis demonstrated that each increase in stage was associated with significant increased risk of 1-year mortality. Furthermore, among patients at increased stage (3–4), incorporation of baseline of albumin identified the highest risk group, such that each 1 decrement in albumin levels was associated with more than triple increase in mortality among patients at stage 3 and 4.

    更新日期:2020-01-15
  • Prevalence, predictors and complications with defibrillation threshold testing in pediatric patients: Results from the NCDR
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-15
    Jordan M. Prutkin; Yongfei Wang; Carolina A. Escudero; Elizabeth A. Stephenson; Karl E. Minges; Jeptha P. Curtis; Jonathan C. Hsu

    Background There are little data about the prevalence and safety of DFT testing in pediatric populations. We analyzed the predictors and outcomes of defibrillation threshold (DFT) testing at the time of implantable cardioverter-defibrillator (ICD) implant and factors associated with inadequate defibrillation safety margin (DSM) in pediatric patients. Methods We performed a retrospective analysis of initial transvenous ICD implantations in the National Cardiovascular Data Registry (NCDR) ICD Registry of patients ≤21 years. DSM was defined as the lowest successful energy tested <10 J than the maximum output of the ICD. Subjects were followed to hospital discharge. Results Of all ICD recipients (n = 3943), DFT testing was performed in 64.0% (n = 2522) though decreased over time. In those with DFT data available (n = 2500), an inadequate DSM occurred in 13.6% (n = 339). After multivariable adjustment, DFT testing was not associated with in-hospital complications or death (OR 0.789, 95% CI 0.579–1.076), but was associated with lower odds of prolonged hospital stay (>3 days) (OR 0.543, 95% CI 0.436–0.677). An inadequate DSM was associated with an increased risk of complications or death (OR 1.893, 95% CI 1.203–2.979) but not with a prolonged hospital stay (OR 1.307, 95% CI 0.878–1.947). Conclusions In the largest dataset of DFT testing in pediatric ICD recipients, we found that DFT testing use decreased over time and was not associated with an increase in in-hospital complications in pediatric patients. An inadequate DSM, however, was associated with a higher rate of in-hospital complications or death.

    更新日期:2020-01-15
  • Presentation and management of calcific mitral valve disease
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-11
    Isabel Shamsudeen; Linda Yi Ning Fei; Ian G. Burwash; Luc Beauchesne; Vincent Chan; David Glineur; Kwan L. Chan; Thierry Mesana; David Messika-Zeitoun

    Little is known about the prevalence, presentation and management of calcific mitral valve disease (CMVD). We identified 167 patients (80 ± 10 years; 79% women) with significant CMVD undergoing transthoracic echocardiography at our institution in 2016. Patients presented with significant co-morbidities, 47% had moderate/severe mitral stenosis, 38% had 3+/4+ mitral regurgitation and 15% had a combination of both. Fifty-eight percent were symptomatic. Most symptomatic patients were managed conservatively and incurred higher mortality and mortality/heart failure admission rates than those managed surgically. These data highlight the importance of gaining mechanistic insights into CMVD to prevent its occurrence and avoid the need for high-risk surgery, which is seldom performed in contemporary practice.

    更新日期:2020-01-13
  • Multidisciplinary evaluation and management of obstructive hypertrophic cardiomyopathy in 2020: Towards the HCM Heart Team
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-11
    Francesco Pelliccia; Ottavio Alfieri; Paolo Calabrò; Franco Cecchi; Paolo Ferrazzi; Felice Gragnano; Juan Pablo Kaski; Giuseppe Limongelli; Martin Maron; Claudio Rapezzi; Hubert Seggewiss; Magdi H. Yacoub; Iacopo Olivotto

    Patients with hypertrophic cardiomyopathy (HCM) exhibit a variable phenotype with ventricular hypertrophy as the cardinal manifestation and left ventricular (LV) outflow tract obstruction (LVOTO) as a key pathophysiologic determinant. Patients with severe LVOTO usually present with exertional dyspnea, exertional syncope, and heart failure symptoms, while successful relief of LVOTO by pharmacological or invasive interventions leads to a dramatic improvement in clinical status. Proper management of obstructive HCM remains challenging and poses numerous clinical dilemmas. Since the development of surgical myectomy over half a century ago, progress in the management of LVOTO in HCM has paralleled technological advances in genetic testing, cardiac imaging, arrhythmic prophylaxis, cardiac surgery and interventional cardiology. These changes have been incorporated in dedicated scientific guidelines on both sides of the Atlantic. However, either the 2011 American guidelines or the 2014 European guidelines remain largely based on expert consensus for lack of recommendations with level of evidence A regarding any of the treatment options commonly employed in HCM. Consequently, management of obstructive HCM patients remains largely subjective and dependent on clinical judgment, local expertise, and patient preference. Following the trend that has emerged for other cardiac diseases amenable to invasive interventions, adequate evaluation and management of obstruction in HCM today requires a multidisciplinary team capable of optimizing referral, choosing the best available options, minimizing complications and ensuring state-of-the-art results. The concept of an HCM Heart Team is coming of age. This review aims to provide an update of available pharmacologic and invasive options for the management of LVOTO in HCM, either in adulthood or in childhood, highlighting areas for multidisciplinary integration and future development.

    更新日期:2020-01-13
  • Iron deficiency in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention
    Int. J. Cardiol. (IF 3.471) Pub Date : 2019-07-31
    Nicola Cosentino; Jeness Campodonico; Gianluca Pontone; Marco Guglielmo; Mirella Trinei; Maria Teresa Sandri; Daniela Riggio; Andrea Baggiano; Valentina Milazzo; Marco Moltrasio; Giuseppe Muscogiuri; Alice Bonomi; Simone Barbieri; Emilio Assanelli; Gianfranco Lauri; Antonio Bartorelli; Giancarlo Marenzi

    Background Iron deficiency (ID) is a known co-morbidity and a potential therapeutic target in heart failure. Whether ID is frequent also in ST-segment elevation acute myocardial infarction (STEMI) patients and is associated with worse in-hospital outcomes has never been evaluated. Methods We defined ID as a serum ferritin < 100 μg/L or transferrin saturation < 20% at hospital admission. We assessed the association between ID and the primary endpoint (a composite of in-hospital mortality and Killip class ≥ 3). We explored the potential association between ID, circulating cell-free mitochondrial DNA (mtDNA), and cardiac magnetic resonance (CMR) parameters. Results Four-hundred-twenty STEMI patients undergoing primary percutaneous coronary intervention (pPCI) were included. Of them, 237 (56%) had ID. They had significantly higher admission high-sensitivity troponin and mtDNA levels as compared to non-ID patients (145 ± 35 vs. 231 ± 66 ng/L, P < 0.001; 917 [404–1748] vs. 1368 [908–4260] copies/μL; P < 0.003, respectively). A lower incidence of the primary endpoint (10% vs. 18%, P = 0.01) was observed in ID patients (adjusted OR 0.50 [95% CI 0.27–0.93]; P = 0.02). At CMR (n = 192), ID patients had a similar infarct size (21 ± 18 vs. 21 ± 19 g; P = 0.95), but a higher myocardial salvage index (0.56 ± 0.30 vs. 0.43 ± 0.27; P = 0.002), and a smaller microvascular obstruction extent (3.6 ± 2.2 vs. 6.9 ± 3.9 g; P < 0.001). Conclusions Iron deficiency is frequent in STEMI patients, it is coupled with mitochondrial injury, and, paradoxically, with a better in-hospital outcome. This unexpected clinical result seems to be associated with a smaller myocardial reperfusion injury. The mechanisms underlying our findings and their potential clinical implications warrant further investigation.

    更新日期:2020-01-11
  • Health care utilisation and medication one year after myocardial infarction in Germany – a claims data analysis
    Int. J. Cardiol. (IF 3.471) Pub Date : 2019-07-18
    Raven Ulrich; Tobias Pischon; Bernt-Peter Robra; Christian Freier; Christoph Heintze; Wolfram J. Herrmann
    更新日期:2020-01-11
  • Impact of telephone follow-up and 24/7 hotline on 30-day readmission rates following aortic valve replacement -A randomized controlled trial
    Int. J. Cardiol. (IF 3.471) Pub Date : 2019-07-30
    Stein Ove Danielsen; Philip Moons; Leiv Sandvik; Marit Leegaard; Svein Solheim; Theis Tønnessen; Irene Lie
    更新日期:2020-01-11
  • Sacubitril/valsartan for heart failure in adults with complex congenital heart disease
    Int. J. Cardiol. (IF 3.471) Pub Date : 2019-06-13
    Susanne J. Maurer; Claudia Pujol Salvador; Sandra Schiele; Alfred Hager; Peter Ewert; Oktay Tutarel

    Background Heart failure is an important cause of morbidity and mortality in adults with congenital heart disease (ACHD). Sacubitril/valsartan is an established treatment for heart failure with reduced ejection fraction due to acquired cardiovascular disease. Data in adults with complex congenital heart disease (CHD) is lacking. Methods Retrospective study of ACHD patients with CHD of moderate/severe complexity and heart failure under treatment with sacubitril/valsartan. Clinical data was retrieved from medical records. Results Altogether, 23 patients (mean age 41.2 ± 11.9 years, female 17.4%) were included. A systemic right ventricle was present in 12 pat. (52.2%), a single ventricle physiology in 4 (17.4%), and a systemic left ventricle in 7 (30.4%). During a median follow-up of 221 days [IQR 79–430], systemic ventricular function (p = 0.88) and functional status according to New York Heart Association class (p = 0.38) did not improve. While NT-proBNP levels did not change significantly under treatment (2561 ± 2042 ng/l vs. 1938 ± 1524 ng/l, p = 0.20), creatinine levels increased (1.14 ± 0.52 mg/dl vs. 1.35 ± 0.74 mg/dl, p = 0.002). Systolic (110 ± 15 mm Hg vs. 103 ± 14 mm Hg, p = 0.02) and diastolic blood pressures (68 ± 10 mm Hg vs. 61 ± 12 mm Hg, p = 0.01) were reduced under therapy. Five patients discontinued therapy, four of these due to side effects. Conclusion In this small group of complex ACHD patients with heart failure, treatment with sacubitril/valsartan did not improve systemic ventricular function or functional status. Renal function needs close surveillance.

    更新日期:2020-01-11
  • Prevalence of cardiac amyloidosis among adult patients referred to tertiary centres with an initial diagnosis of hypertrophic cardiomyopathy
    Int. J. Cardiol. (IF 3.471) Pub Date : 2019-07-17
    Niccolò Maurizi; Valeria Rella; Carlo Fumagalli; Sabrina Salerno; Silvia Castelletti; Federica Dagradi; Margherita Torchio; Azzurra Marceca; Martino Meda; Massimo Gasparini; Beatrice Boschi; Francesca Girolami; Gianfranco Parati; Iacopo Olivotto; Lia Crotti; Franco Cecchi

    Background Differential diagnosis of genetic causes of left ventricular hypertrophy (LVH) is crucial for disease-specific therapy. We aim to describe the prevalence of Cardiac Amyloidosis (CA) among patients ≥40 years with an initial diagnosis of HCM referred for second opinion to national cardiomyopathy centres. Methods Consecutive patients aged ≥40 years referred with a tentative HCM diagnosis in the period 2014–2017 underwent clinical evaluation and genetic testing for HCM (including trans-thyretin-TTR). Patients with at least one red flag for CA underwent blood/urine tests, abdominal fat biopsy and/or bone-scintigraphy tracing and eventually ApoAI sequencing. Results Out of 343 patients (age 60 ± 13 years), 251 (73%) carried a likely/pathogenic gene variant, including 12 (3.5%) in the CA-associated genes TTR (n = 11) and ApoAI (n = 1). Furthermore, 6 (2%) patients had a mutation in GLA. Among the remaining, mutation-negative patients, 26 with ≥1 CA red-flag were investigated further: 3 AL-CA and 17 wild-type-TTR-CA were identified. Ultimately, 32(9%) patients were diagnosed with CA. Prevalence of CA increased with age: 1/75 (1%) at age 40–49, 2/86 (2%) at age 50–59, 8/84 (9%) at age 60–69, 13/61 (21%) at age 70–79, 8/31 (26%) at age ≥80 (p for trend <0.01). Conclusions Among patients referred with and initial diagnosis of HCM, CA was the most common unrecognized mimic (9% prevalence) and increased with age (from 1% at ages 40–49 years to 26% >80 years). Age at diagnosis should be considered one of the most relevant red flags for CA in patients with HCM phenotypes; however, there is no clear age cut-off mandating scintigraphy and other second level investigations in the absence of other features suggestive of CA.

    更新日期:2020-01-11
  • Fontan-associated nephropathy: Predictors and outcomes
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-10
    Jacqueline Nguyen Khuong; Thomas G. Wilson; Leeanne E. Grigg; Andrew Bullock; David Celermajer; Patrick Disney; Vishva A. Wijesekera; Tim Hornung; Diana Zannino; Ajay J. Iyengar; Yves d'Udekem

    Background Nephropathy is a known complication of the Fontan circulation, but its determinants have not been identified and patient outcomes are also still unknown. Methods The Australia and New Zealand Fontan Registry was used to identify those who underwent Fontan operation before and survived beyond 16-years-old with an intact Fontan circulation. Serum creatinine values were collected for each patient between 16 and 25 years and at recent follow-up. The Modification of Diet in Renal Disease (MDRD) equation was used to calculate eGFR. Patient outcomes were obtained from the Registry. Fontan failure was defined as death, transplantation, plastic bronchitis, protein losing enteropathy, Fontan takedown and NYHA class III-IV. Results Serum creatinine measurements were available for 328 patients. Renal dysfunction was defined as eGFR <90 mL/min/1.72m2. Renal dysfunction was present in 67/328 (20%) and 3/328 (1%) patients had an eGFR <60 mL/min/1.72m2. The 10-year survival and 10-year freedom from death and transplantation were the same, 96% (95% CI: 0.9–1) for those with renal dysfunction, and 89% (0.83–0.95; p = 0.1) and 87% (95% CI: 0.81–0.94; p = 0.05) for patients without dysfunction. The 10-year freedom from failure were also similar, 83% (95% CI: 0.70–0.97) for those without renal dysfunction vs 80% (95% CI: 0.74–0.89; p = 0.84). There was no change in mean eGFR for the renal dysfunction group over a mean of 8 ± 5.5 years. Conclusion By the time they reach adulthood, 20% of patients with a Fontan circulation have renal dysfunction by eGFR calculation. Over the course of one decade, Fontan-associated nephropathy appears well tolerated.

    更新日期:2020-01-11
  • Incidence of Type 1 diabetes mellitus and effect on mortality in young patients with congenital heart defect – A nationwide cohort study
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-10
    Anna Björk; Zacharias Mandalenakis; Kok Wai Giang; Annika Rosengren; Peter Eriksson; Mikael Dellborg

    Background 1% of all live born children are born with a congenital heart defect (CHD) and currently 95% reach adulthood. Type 1 diabetes mellitus (T1DM) is an autoimmune disease that can develop due to i.e. heredity, exposure to infections and stress-strain. The incidence of T1DM in patients with CHD is unknown and we analysed the risk of developing T1DM for patients with CHD, and how this influences mortality. Methods By combining registries, the incidence of T1DM and the mortality was analysed in patients with CHD by birth cohort (1970–1993, 1970–1984 and 1984–1993) matched with population-based controls matched for sex, county and year of birth without CHD and followed from birth until a maximum of 42 years. Results 221 patients with T1DM among 21,982 patients with CHD and 1553 patients with T1DM among 219,816 matched controls were identified. The hazard ratio (HR) for developing T1DM was 1.50 (95%, CI 1.31–1.73) in patients with CHD compared to the controls and the first birth cohort (1970–1984) had the highest risk for T1DM, HR 1.87 (95%, CI 1.56–2.24). After onset, mortality risk was 4.21 times higher (95%, CI 2.40–7.37) in patients with CHD and T1DM compared to controls with T1DM. Conclusion From a nationwide cohort of patients with CHD and controls, the incidence of developing T1DM was 50% higher in patients with CHD, showing a significant increase in risk among birth cohort 1970–1984. The combination of CHD and T1DM was associated with a 4-fold increase in mortality compared to controls with only T1DM.

    更新日期:2020-01-11
  • Height is associated with incident atrial fibrillation in a large Asian cohort
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-10
    Young Min Park; Jeonggeun Moon; In Cheol Hwang; Hyunsun Lim; Bokeum Cho

    Background Although increased height is associated with a risk of atrial fibrillation (AF), the mechanism is not well understood. We aimed to explore whether this association varies with metabolic conditions. Methods and results We used the database from the 14-year Korea National Health Insurance Service–National Sample Cohort. The data of 368,206 adults older than 20 years who received a health check-up were analyzed to explore the association of height and AF risk. Cox proportional hazards regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for associations of height with the risk of AF. During the median follow up duration of 8.46 years, 2641 (0.72%) patients were diagnosed with AF at 3,070,724 person-years. Overall, greater height was significantly associated with AF risk (HR per 5 cm, 1.22; 95% CI, 1.03–1.05). The association did not vary with age, sex, obesity, hypertension, and diabetes. Conclusion Metabolic conditions do not affect the higher risk of AF in tall people.

    更新日期:2020-01-11
  • Impacts of hippocampal blood flow on changes in left ventricular wall thickness in patients with chronic heart failure
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-10
    Hideaki Suzuki; Yasuharu Matsumoto; Koichiro Sugimura; Jun Takahashi; Satoshi Miyata; Yoshihiro Fukumoto; Yasuyuki Taki; Hiroaki Shimokawa

    Background Although depressive symptoms increased mortality and hospitalization in chronic heart failure (CHF) patients, the underlying mechanism remains unclear. The aim of this study was to investigate whether an alteration in hippocampal perfusion, which is the neural substrate of depressive symptoms, is associated with changes in cardiac structures and/or functions in CHF patients. Methods We used baseline data of 70 CHF patients (66.8 ± 8.9 yrs, 32.5% women), including cerebral blood flow (CBF) in the hippocampus, geriatric depression scale (GDS) scores and echocardiographic parameters, in the Brain Assessment and Investigation in Heart Failure Trial (B-HeFT) (UMIN000008584). Echocardiography was repeated at 3.1 ± 0.5 years after the baseline evaluation. We first tested voxel-wise regression model with hippocampal CBF as dependent variable and each of echocardiographic parameter change as independent variable, adjusted for age and sex. Structural equation modeling was used to test a mediation effect of cognitive test scores on associations between hippocampal perfusion and changes in cardiac structures and/or functions. Results Baseline anterior hippocampal CBF was negatively correlated with changes in left ventricular posterior wall thickness (PWT) (P < 0.05 with family-wise error corrections). An existence of depressive symptoms was positively correlated with the baseline anterior CBF and negatively with the PWT changes (P < 0.05, both). There were both direct effects of the baseline anterior hippocampal CBF on PWT thinning and effects mediated through the depressive symptoms (P < 0.05, both). Conclusions This study provides the first evidence that the alteration in hippocampal perfusion may lead to changes in cardiac structures via increase in depressive symptoms in CHF patients.

    更新日期:2020-01-11
  • Inspiratory muscle training did not improve exercise capacity and lung function in adult patients with Fontan circulation: A randomized controlled trial
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-09
    Celina Fritz; Jan Müller; Renate Oberhoffer; Peter Ewert; Alfred Hager

    Backgrounds Patients with Fontan circulation have no subpulmonary ventricle and a passive pulmonary perfusion. Considerable percentage of the pulmonary blood flow is driven by pressure shift due to respiration. Impairments in respiratory musculature strength are associated with a reduced exercise capacity. This study investigated the effect of a daily six months inspiratory muscle training (IMT) on exercise and lung capacity in adult Fontan patients. Methods After a lung function and cardiopulmonary exercise test (CPET), 42 Fontan patients (50% female; 30.5 ± 8.1 years) were randomized into either an intervention group (IG), or a control group (CG). The IG performed a telephone-supervised, daily IMT of three sets with 10–30 repetitions for six months. Results After six months of IMT, the IG did not improve in any exercise and lung capacity parameter compared to CG. VO2peak (ΔVO2peak: IG: 0.05 [−1.53; 1.33] ml/kg/min vs. CG: −0.50 [−1.20; 0.78] ml/kg/min; p = .784) and FVC (ΔFVC: IG: 0.07 [−0.16; 0.22] l vs. CG:−0.05 [−0.24; 0.18] l; p = .377) remained unchanged, while FEV1 trended to improve (ΔFEV1: IG: 0.05 [−0.07; 0.13] l vs. CG: −0.10 [−0.19; 0.03] l; p = .082). Only oxygen saturation at rest improved significantly (ΔSpO2: IG: 1.50 [−0.25; 3.00] % vs. CG: −0.50 [−1.75; 0.75] %; p = .017). Conclusions A daily six months IMT did not improve exercise and lung capacity and lung volumes in Fontan patients.

    更新日期:2020-01-09
  • Outcomes of percutaneous coronary intervention (PCI) among patients with connective tissue disease: Propensity match analysis
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-09
    Samson Alliu; Justin Ugwu; Omotooke Babalola; Chukwudi Obiagwu; Norbert Moskovits; Sergey Ayzenberg; Gerald Hollander; Robert Frankel; Jacob Shani

    Background Inflammation is the hallmark of coronary artery disease (CAD) and CTD. There are reports of increased prevalence of CAD among patients with CTD such as Rheumatoid Arthritis. However, there is a paucity of data regarding the outcomes of PCI among patients with CTD. Methods Using the National Inpatient Database, patients that underwent PCI between 2007 and 2015 were identified using ICD-9-CM codes. Propensity match analysis with 1: 3 matching of patients with and without CTD was performed. Outcomes were acute kidney injury (AKI), access site complication (ASC), ventricular fibrillation (VF), cardiogenic shock (CS), Stroke, In-hospital mortality and hospital length of stay (LOS) compared between both groups. Result We identified 17,422 patients with CTD and matched with 52, 266 patients without CTD. Patients were predominantly female (63.1%) and white (77.2%), with a mean age of 63 ± 12.1 years. AKI (8.3% vs. 6.6%, p < 0.001), ASC (3.2% vs. 2.7%, p = 0.01) and hospital stay (4.2 ± 4.8 vs. 3.8 ± 5.2, p < 0.001) were higher among patients with CTD. There was no statistically significant difference in rates of VF, CS, stroke, and In-hospital mortality among the two groups. However, in subgroup analysis, rates of VF were lower among patients with Systemic Lupus Erythematosus (SLE) (1.5% vs. 2.2%, p = 0.006). Conclusions Patients with CTD undergoing PCI have a higher rate of AKI, Access site complications, and prolonged hospital stay.

    更新日期:2020-01-09
  • Heart failure with preserved ejection fraction: Similarities and differences between women and men
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-09
    Carl J. Pepine; C. Noel Bairey Merz; Stephanie El Hajj; Keith C. Ferdinand; Michele A. Hamilton; Kathryn J. Lindley; Michael D. Nelson; Odayme Quesada; Nanette K. Wenger; Jerome L. Fleg

    The syndrome of heart failure (HF) with preserved ejection fraction (HFpEF) is now recognized to account for up to half of HF cases and is the dominant form of HF in older adults, especially women. Multiple factors conspire in this predilection of HFpEF for older women. This review will discuss the epidemiology, pathophysiology, prognosis, and treatment of HFpEF with emphasis on the similarities and differences in cardiovascular aging changes, and the differential impact of comorbidities in women versus men. Responses to pharmacologic and lifestyle interventions are also reviewed. We conclude by suggesting future directions for both prevention and treatment of this common and highly morbid cardiovascular disorder.

    更新日期:2020-01-09
  • Biomarker profile in stable Fontan patients
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-09
    Anita Saraf; Christine De Staercke; Ian Everitt; Alice Haouzi; Yi-An Ko; Staci Jennings; Jonathan H. Kim; Fred H. Rodriguez; Andreas P. Kalogeropoulos; Arshed Quyyumi; Wendy Book

    Background As the population of adults with congenital heart disease (CHD) grows, cardiologists continue to encounter patients with complex anatomies that challenge the standard treatment of care. Single ventricle Fontan palliated patients are the most complex within CHD, with a high morbidity and mortality burden. Factors driving this early demise are largely unknown. Methods and results We analyzed biomarker expression in 44 stable Fontan outpatients (29.2 ± 10.7 years, 68.2% female) seen in the outpatient Emory Adult Congenital Heart Center and compared them to 32 age, gender and race matched controls. In comparison to controls, Fontan patients had elevated levels of multiple cytokines within the inflammatory pathway including Tumor Necrosis Factor-α (TNF-α) (p < 0.001), Interleukin-6 (IL-6) (p < 0.011), Growth Derived Factor-15 (GDF-15) (p < 0.0001), β2-macroglobulin, (p = 0.0006), stem cell mobilization: SDF-1α (p = 0.006), extracellular matrix turnover: Collagen IV (p < 0.0001), neurohormonal activation: Renin (p < 0.0001), renal dysfunction: Cystatin C (p < 0.0001) and Urokinase receptor (uPAR) (p = 0.022), cardiac injury: Troponin-I (p < 0.0004) and metabolism: Adiponectin (p = 0.0037). Within our baseline - stable - Fontan patients, 50% had hospitalizations, arrhythmias and worsening hepatic function within 1 year. GDF-15 was significantly increased in Fontan patients with clinical events (p < 0.0001). In addition, GDF-15 moderately correlated with longer duration of Fontan (r = 0.55, p = 0.01) and was elevated in atriopulmonary (AP) Fontan circulation. Finally, in a multivariate model, VEGF-D and Collagen IV levels were found to be associated with a change in MELDXI, a marker of liver function. Conclusion Multiple clinical and molecular biomarkers are upregulated in Fontan patients, suggesting a state of chronic systemic dysregulation.

    更新日期:2020-01-09
  • Upregulation of microRNA-195 ameliorates calcific aortic valve disease by inhibiting VWF via suppression of the p38-MAPK signaling pathway
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-08
    Lieming Yang; Dawei Wu; Mengqi Li; Xinyuan Zhu; Yikui Tian; Zhi Chen; Mingbiao Li; Hao Zhang; Degang Liang

    Background Growing evidence has indicated that microRNAs (miRNAs) are involved in the progression of calcific aortic valve disease (CAVD), a progressive pathological condition with no effective pharmacological therapy. This study was set out with the aim to investigate possible roles of miR-195 in CAVD. Methods and results Initially, the differential expressed genes (DEGs) associated with CAVD were screened out and miRNAs potentially regulating VWF were predicted from microarray analysis. Next, we quantified VWF and miR-195 expression in isolated aortic valve interstitial cells (AVICs) and aortic valve tissues, followed by confirmation of the target relationship between miR-195 and VWF using the dual luciferase reporter assay. Furthermore, we evaluated the biological functions of miR-195 and VWF on ALP activity, cell differentiation, and the levels of miR-195, VWF, Runx2, OCN, ALP, p38 and phosphorylated p38 in AVICs. VWF was highly expressed, while miR-195 was poorly expressed in CAVD. Furthermore, miR-195 targeted VWF and negatively regulated its expression. Upregulation of miR-195 or silencing VWF could reduce ALP activity, calcified deposition, and the mRNA and protein levels of Runx2, OCN, and ALP by inhibiting the p38-MAPK signaling pathway, thereby ameliorating aortic valve calcification in vitro. Conclusions On all accounts, miR-195 can potentially inhibit aortic valve calcification by repressing VWF and p38-MAPK signaling pathway, highlighting a theoretical basis for pharmacological treatment of CAVD.

    更新日期:2020-01-09
  • The history of the evolution of the knowledge about the diagnosis and the pathogenetic aspects of heart failure: From the Egyptians to James Mackenzie
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-07
    Reinaldo B. Bestetti; Augusto Cardinalli-Neto; Lucélio B. Couto

    The recognition of the syndrome of heart failure (HF) dates back to the Egyptians, although it is still a mystery how they did that because they had an erroneous notion of the blood flow. Some cardinal aspects of the clinical picture of HF were associated with cardiac disease 1600 years later. Dyspnea was associated with cardiac disease in 1000 CE by Avicenna; pedal edema was associated with cardiac disease by Pawl in 1615. Lower associated dyspnea with pedal edema in 1669, and Bonet associated ascites with cardiac disease in 1679. Lancisi associated the jugular venous distention with right ventricular dilatation in 1728. However, it was not until 1748 when Albertini associated pedal edema and dyspnea with the myocardial disease. The evolution of the understanding that myocardial contractility abnormality was the mechanism behind HF partially started with Lower in 1669, it was clearly pointed out by Albertini in 1748 and refined by Mackenzie in 1908. At that time, it was clear that the exhausted myocardial would lead to the appearance of HF. However, the full understanding of the pathogenesis of HF had to wait for the hemodynamic studies which would appear in the second decade of the 20th century, and for the neurohormonal theory of the 90's.

    更新日期:2020-01-07
  • The association between renin angiotensin aldosterone system blockers and future osteoporotic fractures in a hypertensive population – A population-based cohort study in Taiwan
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-07
    Yung-Ta Kao; Chun-Yao Huang; Yu-Ann Fang; Ju-Chi Liu

    Some cohort studies showed the possibility of renin-angiotensin-aldosterone system (RAAS) blockade in preventing future osteoporotic fractures. The study aimed to evaluate the association between angiotensin converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), and future osteoporotic fracture in a hypertensive population. We queried the Taiwan Longitudinal Health Insurance Database between 2001 and 2012. We used propensity score matching and the total cohort was made up of 57,470 participants (28,735 matched-pairs using or not using RAAS blockers). The mean follow-up period was 6 years. The number of incident fractures was 3757. Hazard ratios (HRs) [95% confidence interval (CI)] of ACEIs and ARBs use with incident fractures were calculated. The incidence of future osteoporotic fracture was significantly lower in the ACEI and ARB user groups but not in the group using an ACEI plus ARB concomitantly, when compared with RAAS blocker nonusers. Comparing ACEI users with RAAS blocker non-users and ARB users with RAAS blocker non-users, the HRs for composite fractures were 0.70 (0.62–0.79) and 0.58 (0.51–0.65), respectively. Sensitivity analysis confirmed a lower incidence of future osteoporotic fracture in patients taking an ACEI for >55 cumulative defined daily doses (cDDDs) and those who received an ARB for >90 cDDDs. These results suggested a lower incidence of future osteoporotic fracture in a hypertensive population who were using an ACEI or ARB compared with RAAS blocker nonusers but not in the group taking an ACEI and ARB concomitantly.

    更新日期:2020-01-07
  • Noninvasive biomarker-based risk stratification for development of new onset atrial fibrillation after coronary artery bypass surgery
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-07
    Farhan Rizvi; Mahek Mirza; Susan Olet; Melissa Albrecht; Stacie Edwards; Larisa Emelyanova; David Kress; Gracious R. Ross; Ekhson Holmuhamedov; A. Jamil Tajik; Bijoy K. Khanderia; Arshad Jahangir

    Background Postoperative atrial fibrillation (PoAF) is a common complication after cardiac surgery. A pre-existing atrial substrate appears to be important in postoperative development of dysrhythmia, but its preoperative estimation is challenging. We tested the hypothesis that combining clinical predictors, noninvasive surrogate markers for atrial fibrosis defining abnormal left atrial (LA) mechanics, and biomarkers of collagen turnover is superior to clinical predictors alone in identifying patients at-risk for PoAF. Methods In patients without prior AF undergoing coronary artery bypass grafting, concentrations of biomarkers reflecting collagen synthesis and degradation, extracellular matrix, and regulatory microRNA29s were determined in serum from preoperative blood samples and correlated to atrial fibrosis extent, alteration in atrial deformation properties determined by 3D speckle-tracking echocardiography, and AF development. Results Of 90 patients without prior AF, 34 who developed PoAF were older than non-PoAF patients (72.04 ± 10.7 y; P = 0.043) with no significant difference in baseline comorbidities, LA size, or ventricular function. Global (P = 0.007) and regional longitudinal LA strain and ejection fraction (P = 0.01) were reduced in PoAF vs. non-PoAF patients. Preoperative amino-terminal-procollagen-III-peptide (PIIINP) (103.1 ± 39.7 vs. 35.1 ± 19.3; P = 0.041) and carboxy-terminal-procollagen-I-peptide levels were elevated in PoAF vs. non-PoAF patients with a reduction in miR-29 levels and correlated with atrial fibrosis extent. Combining age as the only significant clinical predictor with PIIINP and miR-29a provided a model that identified PoAF patients with higher predictive accuracy. Conclusions In patients without previous history of AF, using age and biomarkers of collagen synthesis and regulation, a noninvasive tool was developed to identify those at risk for new-onset PoAF.

    更新日期:2020-01-07
  • Sex-related electrocardiographic differences in patients with different types of atrial fibrillation: Results from the SWISS-AF study
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-03
    Rita Laureanti; Giulio Conte; Valentina D.A. Corino; Stefan Osswald; David Conen; Laurent Roten; Nicolas Rodondi; Peter Ammann; Christine S. Meyer-Zuern; Leo Bonati; Luca T. Mainardi; Angelo Auricchio

    Background Sex-related electrocardiographic differences are a well-known phenomenon, but not their expression in patients with atrial fibrillation (AF). In this study we aim to assess the presence of significant sex-related differences in ECG features, with particular attention to P-wave parameters, of a large cohort of patients affected by different types of AF. Methods A 5-min resting 16-lead ECG was evaluated for 1119 AF patients in sinus rhythm. The durations of the main ECG waves and intervals were measured for both atrial and ventricular activity. Moreover, the beat-to-beat P-wave variability was computed for lead II and for the first principal component (PC1) computed across the 16 leads. The percentage of variance explained by PC1 was computed. Results Males compared to females showed significantly longer RR interval (1.02 ± 0.16 s vs 0.97 ± 0.15 s, p < .001), PQ interval (191 ± 34 ms vs 183 ± 35 ms, p = .008), QRS duration (105 ± 17 ms vs 98 ± 13 ms, p = .021), significantly lower percentage of variance explained by PC1 and P-wave variability. Males with paroxysmal AF compared to females with paroxysmal AF had significantly longer RR interval (1.01 ± 0.17 s vs 0.96 ± 0.14 s, p < .001), shorter QTc (388 ± 27 ms vs 402 ± 27 ms, p < .001), lower P-wave variability in PC1. Males with persistent AF compared to females with persistent AF had significantly shorter QTc interval (396 ± 30 ms vs 407 ± 26 ms, p = .019), longer PQ interval (194 ± 35 ms vs 182 ± 30 ms, p = .037), higher V1 terminal force (2.1 ± 1.2 mV*ms vs 1.8 ± 1 mV*ms, p = .007), lower percentage of variance explained by PC1. Conclusions AF patients present with several sex-related ECG differences. Consequently, sex should be taken into account when developing ECG algorithms identifying patients at risk for AF progression.

    更新日期:2020-01-04
  • Pulmonary hypertension after shunt closure in patients with simple congenital heart defects
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-02
    Astrid Elisabeth Lammers; Leona J. Bauer; Gerhard-Paul Diller; Paul C. Helm; Hashim Abdul-Khaliq; Ulrike M.M. Bauer; Helmut Baumgartner

    Background Patients with simple shunt lesions, such as atrial septal defect (ASD), ventricular septal defect (VSD) and persistent arterial duct (PDA) remain at risk of developing pulmonary hypertension (PH) even after correction of their cardiac defect. We aimed to assess the contemporary prevalence of PH in a well characterized nationwide group of patients based on the German National Register for Congenital Heart Defects. Methods and results We included all patients >16 years of age with an isolated diagnosis of ASD, VSD or PDA. Only patients with previous surgical or interventional closure of the defect were included. Patients with genetic syndromes were excluded. Out of 49,597 CHD patients in the register we identified 825 patients with closed, isolated simple defects (52% ASD, 41% VSD, 7% PDA). Of these, 25 (3%) developed PH after a median follow-up of 16 years from defect closure. The risk of PH increased significantly with age at follow-up (p < 0.0001) and age at repair (p < 0.0001) on logistic regression analysis Patients with PH were significantly more likely to be symptomatic (59% vs. 9% in NYHA class ≥2, p < 0.0001) and had significantly higher mortality (hazard ratio 13.4, p < 0.0001) compared to the remaining patients. Conclusions Based on data from the German National Register CHD Register we report a PH prevalence of 3.0% in patients with corrected, simple lesions. Patients with PH were more symptomatic and had significantly increased mortality risk. Life-long surveillance and low threshold for workup is recommended to ascertain diagnosis of PH, which has important prognostic and clinical implications.

    更新日期:2020-01-02
  • One-year all-cause mortality risk among atrial fibrillation patients in Middle East with and without diabetes: The Gulf SAFE registry
    Int. J. Cardiol. (IF 3.471) Pub Date : 2020-01-02
    Magdalena Domek; Yan-Guang Li; Jakub Gumprecht; Nidal Asaad; Wafa Rashed; Alawi Alsheikh-Ali; Katarzyna Nabrdalik; Janusz Gumprecht; Mohammad Zubaid; Gregory Y.H. Lip

    Background Atrial fibrillation (AF) poses a great risk of mortality, especially when associated with diabetes mellitus (DM). Objectives We aimed to investigate the rate and risk factors for mortality among AF patients with and without DM in the population from the Middle East where it has never been investigated before. Methods We analyzed the Gulf-SAFE registry, involving patients with nonvalvular AF from the Middle East, for one-year all-cause mortality. The predictive capability of the CHA2DS2-VASc score for death was also investigated. Results Among a total of 2043 AF patients 606 had DM. Patients with DM were older and had significantly higher prevalence of multiple comorbidities (p < 0.05, respectively). Among patients with DM, age ≥ 75 (relative risk 2.34, 95% confidence interval 1.19–4.61), heart failure (HF) (RR 2.14, 95%CI 1.03–4.43), peripheral vascular disease (PVD) (RR 3.36, 95%CI 1.22–9.30) and chronic kidney disease (CKD) (RR 2.60, 95%CI 1.16–5.81) were independent risk factors for one year all-cause mortality. Patients with DM had significantly higher rates of heart failure and AF-related hospital admissions, all-cause mortality and composite outcome rates, in one year follow up. Among patients with DM, the CHA2DS2-VASc score was predictive of one-year all-cause mortality with c-index of 0.741 (95%CI 0.688–0.794). Conclusions AF patients in Middle East with DM have a higher risk for all-cause mortality, HF and AF admission and composite outcome, compared to patients without DM. Multiple risk factors contribute to the higher mortality rate among patients with DM.

    更新日期:2020-01-02
  • Dietary measures among patients with coronary heart disease in Europe. ESC EORP Euroaspire V
    Int. J. Cardiol. (IF 3.471) Pub Date : 2019-12-31
    Pedro Marques-Vidal; Piotr Jankowski; Dirk De Bacquer; Kornelia Kotseva

    Objective Assess the dietary recommendations provided to patients hospitalized for a coronary heart disease (CHD) event. Design Cross-sectional, multicentre observational study (ESC EORP Euroaspire V). Methods 8261 participants (25.8% women, 9.3% aged<50 years) from 27 countries, 6 to 24 months after hospitalization for a CHD event were included. Participants were asked if they had been advised to reduce salt, fat or sugar intake, change type of fat consumed, and increase consumption of plant stanols/sterols, fruit & vegetables, fish and oily fish. Self-reported changes were recorded. Results Advice to reduce energy intake, salt, fat and sugar was provided to 64.5% [range: 9.2–90.5], 73.2% [38.6–95.2], 77.3% [42.3–95.6] and 67.0% [39.4–93.3] of patients, respectively. Advice to change fat type, increase consumption of plant stanols/sterols, fruit & vegetables, fish and oily fish was provided to 68.3% [33.7–92.3], 36.7% [0.6–75.2], 73.2% [39.2–93.6], 66.5% [8.0–90.8] and 53.5% [3.7–83.3] of patients, respectively. Advices were more frequently provided to patients aged 50 to 69, with a high educational level, or obesity. One-eighth [0–55.0] of patients reported having consulted a dietician. Reductions in energy intake, salt, fat and sugar were reported by 57.7% [4.9–81.0], 69.9% [32.1–85.9], 71.8% [40.4–88.4] and 61.2% [29.0–84.0] of patients, respectively. Changes in fat type and increased consumption of plant stanols/sterols, fruit & vegetables, fish and oily fish were reported by 60.9% [4.9–81.0], 25.8% [0.6–54.1], 69.2% [27.7–88.4], 54.8% [4.0–80.1] and 40.4% [2.0–66.8] of patients, respectively. Conclusion Dietary advice is not systematically provided to patients with CHD, and considerable differences exist between regions in various European countries.

    更新日期:2019-12-31
  • Sex-differential effect of frailty on long-term mortality in elderly patients after an acute coronary syndrome
    Int. J. Cardiol. (IF 3.471) Pub Date : 2019-12-31
    Julio Núñez; Patricia Palau; Clara Sastre; Giulio D'Ascoli; Vicente Ruiz; Clara Bonanad; Gema Miñana; Eduardo Núñez; Juan Sanchis

    Background The potential sex-differential effect of frailty in patients with acute coronary syndromes (ACS) has not been well-evaluated. We sought to examine the sex-differential association between frailty status on long-term mortality in elderly patients with an ACS. Methods and results This is a prospective observational single-center study that included 488 elderly patients (>65 years) hospitalized for ACS who survived the index hospitalization. Multivariate Cox regression was used to determine the association among the exposures (interaction of sex with Fried score and sex with Fried ≥ 3) and all-cause mortality. The mean age of the sample was 78 ± 7 years; 41% were female and the median Fried score was higher in women [3 (2–3) vs. 2 (1–2) points, p < 0.001]. At a median follow-up of 3.12 years (IQR:1.38–5.13), 182 deaths (37.3%) were registered. The association of Fried ≥ 3 with mortality varied across sex (p-value for interaction = 0.022). In males, Fried ≥ 3 was independently associated with all-cause death (HR = 1.89; CI 95%:1.25–2.85, p = 0.003). However, it showed a neutral effect on women (HR = 0.92; CI 95%:0.57–1.49, p = 0.726). Conclusions In this work, we found that the frailty status assessed by Fried score was independently associated with mortality in elderly males but not in females with ACS.

    更新日期:2019-12-31
  • Early expressed circulating long noncoding RNA CHAST is associated with cardiac contractile function in patients with acute myocardial infarction
    Int. J. Cardiol. (IF 3.471) Pub Date : 2019-12-30
    Xuehui Wang; Lei Wang; Zhiyuan Ma; Wanqian Liang; Jianhua Li; Yan Li; Yingying Gui; Sizhi Ai

    Background The mortality rate during the acute myocardial infarction (AMI) phase has substantially decreased, but post-AMI cardiac remodeling remains an important factor affecting patient prognosis. Several circulating long noncoding RNAs (lncRNAs) are reportedly involved in the chronic pathological process of cardiac function and remodeling in cardiovascular diseases. However, the potential roles of these circulating lncRNAs as biomarkers of cardiac function and remodeling during early-stage AMI remain unclear. Methods Fifty-three patients with AMI and 90 controls without AMI were consecutively enrolled in this study. Clinical parameters and blood samples at different time points (i.e., 24 h and 3 days) were collected. Results Compared with the controls, the circulating levels of cardiac hypertrophy-associated transcript (CHAST) significantly increased in AMI patients, and the CHAST levels obviously decreased at 3 days. In AMI patients, the expression levels of CHAST at 24 h were positively associated with cardiac contractile function and measured as left ventricular ejection fraction and left ventricular short-axis shortening rate (all P < 0.050). Multivariate regression analysis indicated that the expression level of CHAST at 24 h was an independent predictor of cardiac contractile function (standardized β = 0.319, P = 0.034). When grouped according to the quartile values of the CHAST in the AMI population, patients with the highest quartiles of CHAST expression level showed better cardiac contractile function than all the other quartiles (all P < 0.050). Conclusion CHAST was an independent predictor of cardiac contractile function at early-stage AMI and may serve as a candidate biomarker for cardiac remodeling.

    更新日期:2019-12-30
  • Prevalence of Anderson-Fabry disease in a cohort with unexplained late gadolinium enhancement on cardiac MRI
    Int. J. Cardiol. (IF 3.471) Pub Date : 2019-12-30
    Avalon Moonen; Sean Lal; Jodie Ingles; Laura Yeates; Chris Semsarian; Raj Puranik

    Introduction Fabry disease is a rare X-linked genetic disorder in which cardiac manifestations include LVH, contractile dysfunction, and fibrosis, visible on cardiac MRI (cMRI) as late gadolinium enhancement (LGE) of the myocardium. Fabry's disease is an important diagnosis to make as treatment is available as lifelong replacement of the deficient enzyme. Aim To define the prevalence of Fabry disease in a cohort of patients with unexplained LGE on cMRI. Methods The study population was recruited from patients aged >16 years who had cMRI performed between 2010 and 2018 to investigate LVH, idiopathic LV dysfunction and/or idiopathic ventricular arrhythmia. Patients with ‘unexplained’ LGE i.e. without a genetic diagnosis of an alternate cardiomyopathy such as HCM or biopsy-proven infiltrative cardiomyopathy such as sarcoid or amyloid, were tested for Fabry disease by either genetic testing or the Dried Blood Spot test (Sanofi-Genzyme). Results Of the 79 patients with unexplained LGE on cMRI, 2 patients tested positive for Fabry disease, both using genetic sequencing techniques. The prevalence of Fabry disease in this selected cohort was 2.5%. Specifically, 1 patient was a 65 year old male and the other patient a 75 year old female. In both cases, the pattern and distribution of LGE on cMRI was of patchy mid-wall enhancement in the inferoseptum. Conclusion Unexplained LGE on cMRI may be an isolated manifestation of late-onset Fabry disease. This finding should prompt testing for Fabry disease given this is a potentially treatable condition.

    更新日期:2019-12-30
  • Hyperglycemia-induced endothelial dysfunction is alleviated by thioredoxin mimetic peptides through the restoration of VEGFR-2-induced responses and improved cell survival
    Int. J. Cardiol. (IF 3.471) Pub Date : 2019-12-30
    Pia Hemling; Darya Zibrova; Jasmin Strutz; Yahya Sohrabi; Gernot Desoye; Henny Schulten; Hannes Findeisen; Regine Heller; Rinesh Godfrey; Johannes Waltenberger

    Background Diabetes mellitus is an important cardiovascular risk factor characterized by elevated plasma glucose levels. High glucose (HG) negatively influences endothelial cell (EC) function, which is characterized by the inability of ECs to respond to vascular endothelial growth factor (VEGF-A) stimulation. We aimed to identify potential strategies to improve EC function in diabetes. Methods and results Human umbilical cord endothelial cells (HUVECs) were subjected to hyperglycemic milieu by exposing cells to HG together with glucose metabolite, methylglyoxal (MG) in vitro. Hyperglycemic cells showed reduced chemotactic responses towards VEGF-A as revealed by Boyden chamber migration assays, indicating the development of “VEGF resistance” phenotype. Furthermore, HG/MG-exposed cells were defective in their general migratory and proliferative responses and were in a pro-apoptotic state. Mechanistically, the exposure to HG/MG resulted in reactive oxygen species (ROS) accumulation which is secondary to the impairment of thioredoxin (Trx) activity in these cells. Pharmacological and genetic targeting of Trx recapitulated VEGF resistance. Functional supplementation of Trx using thioredoxin mimetic peptides (TMP) reversed the HG/MG-induced ROS generation, improved the migration, proliferation, survival and restored VEGF-A-induced chemotaxis and sprouting angiogenesis of hyperglycemic ECs. Importantly, TMP treatment reduced ROS accumulation and improved VEGF-A responses of placental arterial endothelial cells isolated from gestational diabetes mellitus patients. Conclusions Our findings suggest a putative role for Trx in modulating EC function and its functional impairment in HG conditions contribute to EC dysfunction. Supplementation of TMP could be used as a novel strategy to improve endothelial cell function in diabetes.

    更新日期:2019-12-30
  • Cardiovascular complications in patients with total cavopulmonary connection: A nationwide cohort study
    Int. J. Cardiol. (IF 3.471) Pub Date : 2019-12-30
    Michelle D. Schmiegelow; Lars Idorn; Gunnar Gislason; Mark Hlatky; Lars Køber; Christian Torp-Pedersen; Lars Søndergaard

    Background Long-term outcomes are not well established at the population level after completion of the total cavopulmonary connection (TCPC) among patients with functional univentricular hearts. Purpose To evaluate the incidence of cardiovascular events after TCPC completion. Methods From a validated population-based cohort, we identified 178 patients with TCPC circulation completed after January 1, 1995. We established a comparison cohort by frequency-matching patients 1:200 on sex, and month and year of birth to the general Danish population (n = 35,600 population controls). We started follow-up at date of TCPC completion for cases and, for controls, at the index date of their matched case. The risks of cardiovascular events were assessed using cumulative incidence rates and Poisson regression models adjusted for age, sex, and calendar year. Results The median age at TCPC completion was 3.3 years (interquartile range 2.6 to 5.3 years). Over a median follow-up of 12.5 years, 10 (5.6%) TCPC patients died and 7 (4.5%) had a heart transplantation compared with a 0.2% mortality in the matched population. In TCPC patients, 15.7% had an arrhythmia (11.8% supraventricular tachycardia), 3.4% had a stroke (all ischemic), and 21.4% of TCPC patients initiated a combination of a diuretic and a renin-angiotensin system (RAS)-inhibitor. These rates were >50-fold higher than in the comparison cohort: 0.2% arrhythmia, 0.06% stroke, and 0.04% starting a diuretic and a RAS-inhibitor. Conclusions Patients with TCPC circulation face a high risk of cardiovascular events during intermediate term follow-up.

    更新日期:2019-12-30
  • Regional variation in clinical characteristics and outcomes in patients with atrial fibrillation: Findings from the ARISTOTLE trial
    Int. J. Cardiol. (IF 3.471) Pub Date : 2019-12-30
    M. Cecilia Bahit; Christopher B. Granger; John H. Alexander; Hillary Mulder; Daniel M. Wojdyla; Michael Hanna; Shinya Goto; Denis Xavier; Freek W.A. Verheugt; Fernando Lanas; Ziad Hijazi; Lars Wallentin; Renato D. Lopes

    Background Variation in patient characteristics and practice patterns may influence outcomes at a regional level. Methods We assessed differences in demographics, practice patterns, outcomes, and the effect of apixaban compared with warfarin in ARISTOTLE (n = 18,201) by prespecified regions: North America, Latin America, Europe, and Asia Pacific. The primary outcomes were stroke/systemic embolism and major bleeding. Results Compared with other regions, patients from Asia Pacific were younger, more women were enrolled in Latin America. Coronary artery disease was more prevalent in Europe and Asia Pacific had the highest rate of prior stroke and renal impairment. Over 50% of patients in North America were taking ≥9 drugs at randomization, compared with 10% in Latin America. North America had the highest rates of temporary study drug discontinuation and procedures. Time in therapeutic range (INR 2.0–3.0) on warfarin was highest in North America and lowest in Asia Pacific. After adjustment and compared with Europe, patients in Asia Pacific had 2-fold higher risk of stroke/systemic embolism and 3-fold higher risk of intracranial hemorrhage. Patients in Latin America had 2-fold increased risk of all-cause death compared with Europe. The benefits of apixaban compared with warfarin were consistent across regions; there was a pronounced reduction in major bleeding in patients from Asia Pacific compared with other regions (p-interaction = 0.03). Conclusions Patients with AF enrolled in prespecified regions in ARISTOTLE had differences in clinical baseline characteristics and practice patterns. After adjustment, patients in Asia Pacific and Latin America had worse outcomes than patients from other regions. The relative benefits of apixaban compared with warfarin were consistent across regions with an even greater treatment effect in the reduction of bleeding in patients from Asia Pacific.

    更新日期:2019-12-30
  • Double or triple antithrombotic therapy after coronary stenting and atrial fibrillation: A systematic review and meta-analysis of randomized clinical trials
    Int. J. Cardiol. (IF 3.471) Pub Date : 2019-12-28
    Giuseppe Andò; Francesco Costa

    Aims Double or triple antithrombotic therapy (DAT/TAT) including or excluding aspirin in association with oral anticoagulant and P2Y12 inhibitor are currently two available options in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). We evaluated efficacy and safety outcomes for DAT vs. TAT. Methods and results Four non-vitamin K oral anticoagulants (NOAC)-based randomized controlled trials comparing DAT vs. TAT with a total of 10,938 patients were pooled. Bleeding events occurred more frequently than ischemic events. DAT as compared to TAT was associated to an increased risk of stent thrombosis (RR 1.54, 95% CI 1.10–2.14; p = 0.03), myocardial infarction (RR 1.23, 95% CI 1.04–1.46; p = 0.03) and cardiovascular mortality (RR 1.09, 95% CI 1.01–1.19; p = 0.04) and to a reduced risk of ISTH major or clinically relevant non-major bleeding (RR 0.59, 95% CI 0.62–0.93; p = 0.03). A consistent effect was observed in all safety endpoints. Intracranial haemorrhage was numerically reduced by DAT. No difference for all-cause death was observed. Conclusion Antithrombotic treatment in patients with AF undergoing PCI represents a trade-off between ischemia and bleeding. A careful patient selection based on baseline ischemic and bleeding risk may optimize the net clinical balance in this population.

    更新日期:2019-12-29
  • Validation of the Larissa Heart Failure Risk Score for risk stratification in acute heart failure
    Int. J. Cardiol. (IF 3.471) Pub Date : 2019-12-28
    Takeshi Kitai; Andrew Xanthopoulos; W.H. Wilson Tang; Shuichiro Kaji; Yutaka Furukawa; Shogo Oishi; Eiichi Akiyama; Satoshi Suzuki; Masayoshi Yamamoto; Keisuke Kida; Takahiro Okumura; John Skoularigis; Filippos Triposkiadis; Yuya Matsue

    Background The LHFRS is a simple score derived from three factors (history of hypertension, history of coronary artery disease/myocardial infarction, and red blood cell distribution width) deployed for the risk stratification of AHF in Greek population. This study aimed to validate the Larissa Heart Failure Risk Score (LHFRS) in patients with acute heart failure (AHF) in a Japanese population. Methods We performed post-hoc analysis of 1670 consecutive patients enrolled in the REALITY-AHF. In all, 964 patients were finally enrolled. Exclusion criteria included patients with anemia, malignancies and sepsis. The primary outcome was defined as a composite of all-cause mortality and/or heart failure readmission, and the secondary outcome was defined as all-cause mortality. Results The median admission LHFRS value was 1 (interquartile range [IQR]: 0–2). During a median follow-up of 365 (IQR: 161–365) days, the primary and secondary outcomes were observed in 321 and 157 patients, respectively. LHFRS was an independent predictor of both the primary (adjusted hazard ratio per 1-point increase, 95% confidence interval: 1.17 [1.04–1.32], p = 0.011), and the secondary outcomes (1.31 [1.12–1.55], p = 0.001). Patients with higher LHFRS scores (≥2) exhibited significantly worse outcomes than those with lower scores (<2) both for the primary outcome (1.40 [1.07–1.83], p = 0.014) and the secondary outcome (1.60 [1.09–2.34], p = 0.015). Additionally, LHFRS revealed an excellent goodness of fit (observed versus predicted outcomes) for predicting both the primary and the secondary outcomes (p > 0.99 and p = 0.99, respectively). Conclusion The simple LHFRS was proved as a reliable predictor of outcomes in patients with AHF.

    更新日期:2019-12-29
  • Extraction of infected cardiac implantable electronic devices and the need for subsequent re-implantation
    Int. J. Cardiol. (IF 3.471) Pub Date : 2019-12-27
    Michael Döring; Lisa Hienzsch; Micaela Ebert; Johannes Lucas; Nikolaos Dagres; Michael Kühl; Gerhard Hindricks; Helge Knopp; Sergio Richter

    Background Little is known about rates of re-implantation and outcomes of patients not implanted with a device after transvenous lead extraction (TLE) in cardiac device related infections (CDRI). Methods All patients with CDRI were included in a prospective registry. After TLE, the indication for re-implantation was evaluated according to the patients' history and most recent cardiac examinations. All patients were followed for complications and mortality. In addition, in patients discharged without device the frequency of device implantations was analyzed. Results Among 302 patients, only 123 (40.7%) met the indication for implantation of the same cardiac implantable electronic device (CIED), 68 (22.5%) received a different device and 111 (36.8%) patients were discharged without CIED. Reimplanted patients were younger (70 ± 11 vs. 73 ± 13 years; p = 0.004), more often male (83 vs. 69%, p = 0.006), had less systemic infection (38 vs. 60%; p < 0.001) and a higher prevalence of complete heart block (28 vs. 7%, p < 0.001). Reasons against re-implantation were: loss of indication (45%), never met indication (27%), patients' preference (17%), persistent infection (8%) and advanced age (3%). During 26 ± 18 months of follow-up, mortality in both groups was similar after adjusting for cofactors (HR 0.79; 95% CI 0.49–1.29; p = 0.352). Conclusion More than one third of patients undergoing TLE for CDRI in our study are not implanted with a new device. Careful evaluation of the initial CIED indication allows for detection of over treated patients and may avoid unnecessary device–related complications.

    更新日期:2019-12-27
  • Multiple genetic variants in adolescent patients with left ventricular noncompaction cardiomyopathy
    Int. J. Cardiol. (IF 3.471) Pub Date : 2019-12-26
    Shenghua Liu; Yuanyuan Xie; Hongliang Zhang; Zongqi Feng; Jian Huang; Jie Huang; Shengshou Hu; Yingjie Wei

    Background Left ventricular noncompaction cardiomyopathy (LVNC) is a primary cardiomyopathy with an unclear aetiology. The clinical symptoms range from asymptomatic to heart failure, arrhythmias and sudden cardiac death. This study aimed to characterize the genetic features and clinical outcomes of LVNC who underwent heart transplantation (HTx) to reveal the potential genetic pathogenesis. Methods and results We recruited 16 cases who underwent HTx in our hospital. Exome-sequencing was performed to reveal genetic background. Clinical information and histopathology features of patients were investigated. Gene expression profiling of tissue fibrosis were evaluated by quantitative PCR. The median age of patients was 21 years. Of the 16 patients, 14 harboured multiple gene variants involved in LVNC. Ten of the patients harboured biallelic variants and/or truncating variants. Young patients (<18) with biallelic variants and/or truncating variants and lower LVEF (<45%) at initial symptom deteriorated quickly. Except for noncompaction myocardium, myocardial fibrosis was a remarkable pathological feature, and gene profiles related to immune inflammation and extracellular matrix remodelling were upregulated. Conclusions This study showed that multiple pathologic variants were underlie genetic mechanism of LVNC who in high risks, suggesting that genetic screening should be applied to the diagnosis of LVNC. LVNC patient with multiple variants should be considered carefully follow-up. Genetics involved in the phenotype and cardiac fibrosis, and is the major causing for LVNC.

    更新日期:2019-12-27
  • Coronary microcirculation and peri-procedural myocardial injury during elective percutaneous coronary intervention
    Int. J. Cardiol. (IF 3.471) Pub Date : 2019-12-24
    Fabio Mangiacapra; Edoardo Bressi; Giuseppe Di Gioia; Mariano Pellicano; Luigi Di Serafino; Aaron J. Peace; Jozef Bartunek; Carmine Morisco; William Wijns; Bernard De Bruyne; Emanuele Barbato

    Background Coronary microvascular dysfunction before percutaneous coronary intervention (PCI) predicts PCI-related myocardial injury in patients with stable coronary artery disease (CAD). Whether the dynamic changes of the microcirculation during PCI might be associated with the occurrence of procedure-related myocardial injury and infarction is still unclear. We aimed to investigate the impact of pre- and post-PCI microvascular function, evaluated with the index of microvascular resistance (IMR) on the occurrence of PCI-related myocardial injury and infarction. Methods In consecutive patients with stable CAD referred for elective PCI, coronary physiological indexes, including IMR, were measured before and after revascularization. High sensitivity Troponin T (hs-TnT) was assessed up to 24 h after PCI, and PCI-related myocardial injury and type 4a myocardial infarction (MI) were defined according to the fourth universal definition of myocardial infarction. Results In the 50 patients enrolled, a significant correlation was found between maximum post-PCI hs-Tn and IMR, both at baseline (rho = 0.309, p=0.029) and post-PCI (rho = 0.378, p=0.007). Patients who developed type 4a MI, compared with patients who did not, presented significantly higher IMR levels, both at baseline (28.3 ± 12.2 vs. 19.6 ± 8.8, p=0.020) and post-PCI (45.4 ± 21.3 vs. 21.6 ± 11.2, p<0.0001). Patients with post-PCI IMR > 38 showed significantly higher maximum post-PCI hs-Tn levels (105.4 [49.4–126.9] vs. 22.4 [11.7–38.6] ng/ml, p<0.0001), and developed type 4a MI more frequently (66.8% vs. 4.9%, p<0.0001). Conclusions Dynamic changes of microvascular resistance post-PCI are strongly correlated with PCI-related myocardial injury and post-PCI IMR is a strong predictor of type 4a MI in patients with stable CAD undergoing elective PCI.

    更新日期:2019-12-25
  • Serial cardiovascular magnetic resonance feature tracking indicates early worsening of cardiac function in Fontan patients
    Int. J. Cardiol. (IF 3.471) Pub Date : 2019-12-24
    Sophie L. Meyer; Floris-Jan S. Ridderbos; Djoeke Wolff; Graziella Eshuis; Joost P. van Melle; Tjark Ebels; Rolf M.F. Berger; Tineke P. Willems

    Background In Fontan patients, attrition of ventricular function is well recognized, but early detection of ventricular dysfunction is difficult. The aim of this study is to longitudinally assess ventricular strain in Fontan patients using a new method for cardiac magnetic resonance (CMR) feature tracking, and to investigate the relationship between ventricular strain and cardiac systolic function. Methods and results In this prospective, standardized follow-up study in 51 Fontan patients, age ≥ 10 years, CMR and concomitant clinical assessment was done at the start of the study and after 2 years. CMR feature tracking was done combining the dominant and hypoplastic ventricles. Global longitudinal strain (GLS) (−17.3% versus −15.9%, P = 0.041) and global circumferential strain (GCS) (−17.7 versus −16.1, P = 0.047) decreased over 2 years' time. Ejection fraction (EF) (57%), cardiac index (CI) (2.7 L/min/m2) and NYHA functional class (97% in class I/II) were preserved. The strain values of the combined dominant and hypoplastic ventricles were significantly worse compared to those of the dominant ventricle only (GLS −16.8 (−19.5- -14.0) versus −18.8 (−21.3- -15.3) respectively, P = 0.001, GCS −18.3 (−22.1- -14.8) versus −22.5 (−26.3- -19.4) respectively, P < 0.001). Conclusions This study showed a decrease in cardiac strain over 2 years in Fontan patients without clinical signs of Fontan failure, where EF, CI and clinical status were still preserved. Cardiac strain might be a sensitive early indicator of systolic ventricular decline. Furthermore, combined strain of the hypoplastic and dominant ventricles seems a more accurate representation of cardiac strain in functionally univentricular hearts.

    更新日期:2019-12-25
  • The value of plasma fibrillin-1 level in patients with spontaneous coronary artery dissection
    Int. J. Cardiol. (IF 3.471) Pub Date : 2019-12-19
    Hui Peng; Bai Yang; Su Xing; Quan Nanhu; Qiao Bokang; Zheng Yang; Shi Jiangcheng; Du Xiaoyu; Lu Jie

    Background Spontaneous coronary artery dissection (SCAD) has emerged as an important etiology of myocardial infarction and sudden death, especially in young women. Early diagnosis is essential for appropriate management. Objectives To explore the value of plasma fibrillin-1 (FBN1) levels in patients with SCAD. Methods 70 patients with non-atherosclerotic SCAD between January 2014 and September 2018 were age and sex matched with 70 patients with non-SCAD acute coronary syndrome (ACS) and 70 healthy controls. The plasma FBN1 level was measured and compared among three groups. The value of FBN1 for prognosis and treatment decision making was further explored. Results The plasma FBN1 level of SCAD group (58.44 ± 7.06 ng/mL) was higher than that of non-SCAD ACS group (52.39 ± 6.92 ng/ml, P < 0.001) or healthy controls (50.56 ± 4.48 ng/mL, P < 0.001). Compared with controls, significantly higher percentages of patients with SCAD were found in the highest compared with lowest quartile of FBN1 concentration. The area under the curve (AUC) for plasma FBN1 level to discriminate patients with SCAD from non-SCAD ACS was 0.81 (95% CI 0.74–0.88, P < 0.001). A cut-off value of 54.64 ng/mL was determined to differentiate SCAD from non-SCAD ACS with a sensitivity of 0.77 (95%CI: 0.66–0.86) and specificity of 0.76 (95%CI: 0.64–0.85). After a median follow-up of 28.35 (14.07 ± 44.69) months, 11 (15.7%) cases suffered from major adverse cardiac events (MACE). Higher FBN1 level was detected in patients with MACE (63.71 ± 7.49 vs. 57.45 ± 6.58 ng/mL) (P = 0.006). A cut-point of 58.14 was determined for SCAD patients to identify MACE. At this point, FBN1 might also have potential use for decision making in SCAD patients. Conclusion Plasma FBN1 is a promising biomarker for aiding the diagnosis of SCAD and have potential value in prognosis prediction.

    更新日期:2019-12-19
  • Maternal administration of tadalafil improves fetal ventricular systolic function in a Hey2 knockout mouse model of fetal heart failure
    Int. J. Cardiol. (IF 3.471) Pub Date : 2019-12-18
    Takekazu Miyoshi; Takashi Hisamitsu; Hatsue Ishibashi-Ueda; Kenji Ikemura; Tomoaki Ikeda; Mikiya Miyazato; Kenji Kangawa; Yusuke Watanabe; Osamu Nakagawa; Hiroshi Hosoda

    Background There is no established transplacental treatment for heart failure (HF) in utero, and no animal models or experimental systems of fetal HF have been established. This study aimed to investigate the effect of maternal tadalafil administration on fetal cardiovascular function and uteroplacental circulation in a murine model of fetal HF. Methods and results We first used an ultra-high-frequency ultrasound imaging system in utero and demonstrated that Hey2−/− embryos had worsening right ventricular hypoplasia and marked left ventricular (LV) dilatation as gestation progressed. In both ventricles, fractional shortening (FS) and the E/A ratio were significantly lower in Hey2−/− embryos than in wild-type embryos, indicating that the embryos can be used as a murine model of fetal HF. Subsequently, we evaluated the effect of tadalafil treatment (0.04 or 0.08 mg/ml; T0.04 or T0.08 groups, respectively) on fetoplacental circulation in Hey2−/− embryos. LV FS was significantly higher in the T0.04 group than in control (P < 0.01), whereas LV dilation, mitral E/A ratio, and umbilical artery resistance index were not significantly different among all groups. The thinness of the LV compacted layer did not differ between the T0.04 and vehicle-treated Hey2−/− embryos. Conclusions A phenotype comprising marked dilatation and reduced FS of the left ventricles was identified in Hey2−/− embryos, suggesting these embryos as a murine model of fetal HF. In addition, maternal administration of tadalafil improved LV systolic function without altering LV morphological abnormalities in Hey2−/− embryos. Our findings suggest that tadalafil is a potential agent to treat impaired fetal ventricular systolic function.

    更新日期:2019-12-18
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