Journal: Int J Cardiol

Sorted by: date / impact
Abstract

Quantification of patient-specific coronary material properties and their correlations with plaque morphological characteristics: An in vivo IVUS study.

Wang L, Maehara A, Zhang X, Lv R, ... Mintz GS, Tang D

Background:
A method using in vivo Cine IVUS and VH-IVUS data has been proposed to quantify material properties of coronary plaques. However, correlations between plaque morphological characteristics and mechanical properties have not been studied in vivo.

Method
In vivo Cine IVUS and VH-IVUS data were acquired at 32 plaque cross-sections from 19 patients. Six morphological factors were extracted for each plaque. These samples were categorized into healthy vessel, fibrous plaque, lipid-rich plaque and calcified plaque for comparisons. Three-dimensional thin-slice models were constructed using VH-IVUS data to quantify in vivo plaque material properties following a finite element updating approach by matching Cine IVUS data. Effective Young\'s moduli were calculated to represent plaque stiffness for easy comparison. Spearman\'s rank correlation analysis was performed to identify correlations between plaque stiffness and morphological factor. Kruskal-Wallis test with Bonferroni correction was used to determine whether significant differences in plaque stiffness exist among four plaque groups.
Result
Our results show that lumen circumference change has a significantly negative correlation with plaque stiffness (r = -0.7807, p = 0.0001). Plaque burden and calcification percent also had significant positive correlations with plaque stiffness (r = 0.5105, p < 0.0272 and r = 0.5312, p < 0.0193) respectively. Among the four categorized groups, calcified plaques had highest stiffness while healthy segments had the lowest.
Conclusion
There is a close link between plaque morphological characteristics and mechanical properties in vivo. Plaque stiffness tends to be higher as coronary atherosclerosis advances, indicating the potential to assess plaque mechanical properties in vivo based on plaque compositions.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 26 Sep 2022; epub ahead of print
Wang L, Maehara A, Zhang X, Lv R, ... Mintz GS, Tang D
Int J Cardiol: 26 Sep 2022; epub ahead of print | PMID: 36174818
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Abstract

Optimization of pharmacotherapies for ambulatory patients with heart failure and reduced ejection fraction is associated with improved outcomes.

Jarjour M, Leclerc J, Bouabdallaoui N, Ahnadi C, ... Rouleau JL, Ducharme A
Background
In heart failure, specific target doses for each drug are recommended, but some patients receive suboptimal dosing, others are undertreated or remain chronically in a titration phase, despite having no apparent contraindication or intolerance. We assessed the association of different levels of adherence to guidelines with outcomes in patients with heart failure and reduced ejection fraction (HFrEF).
Methods
Medical records of patients with HFrEF followed at our heart failure (HF) clinic for at least 6 months (n = 511) were reviewed and patients categorized as: 1) optimized (25.4%); 2) in-titration (29.0%); 3) undertreated (32.7%); and 4) intolerant/contraindicated (12.9%). Risk of mortality or HF events (hospitalization, emergency visit or ambulatory administration of intravenous diuretics) within one year was assessed using Cox regression models and Kaplan-Meier curves.
Results
Compared to optimized patients, those intolerant (HR: 4.60 [95%CI: 2.23-9.48]; p < 0.0001) had the highest risk of outcomes, followed by those undertreated (3.45 [1.78-6.67]; p = 0.0002) and in-titration (1.99 [0.97-4.06]; p = 0.0588). Overall predictors of outcomes included loop diuretics\' use (4.54 [2.39-8.60]), undertreatment (2.38 [1.22-4.67]), intolerance/ contraindication to triple therapy (3.08 [1.47-6.42]), peripheral vascular disease (2.13 [1.29-3.50]) and NYHA class III-IV (1.89 [1.25-2.85]); all p < 0.05.
Conclusion
Level of adherence to guidelines is associated with outcomes, with intolerant/contraindicated patients having the worst prognosis and those undertreated and in-titration at intermediate risk compared to those optimized. Up-titration of therapy should be attempted whenever possible, considering patients\' limitations, to potentially improve outcomes.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 26 Sep 2022; epub ahead of print
Jarjour M, Leclerc J, Bouabdallaoui N, Ahnadi C, ... Rouleau JL, Ducharme A
Int J Cardiol: 26 Sep 2022; epub ahead of print | PMID: 36174819
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Abstract

Impact of SGLT2 inhibitors on old age patients with heart failure and chronic kidney disease.

Amioka M, Sanada R, Matsumura H, Kinoshita H, ... Morishima N, Nakano Y
Background
The heart failure (HF) \"pandemic\" is an ongoing critical issue related to the aging population. Among the new heart failure medications, sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been shown to provide clinical benefit in HF patients with chronic kidney disease (CKD). However, the efficacy and safety of SGLT2i in old age patients remains uncertain.
Methods
The OSHO-heart (Optimal Solution after Hospitalization in Onomichi for heart failure) is a prospective study of 213 patients aged ≥75 years-old hospitalized for acute decompensated HF with stage 3 to 4 CKD. The composite outcomes of HF rehospitalizations or cardiovascular death and the rate of decline in the estimated glomerular filtration rate (eGFR) were compared between the Loop (n = 76), tolvaptan (TLV) (n = 80) and SGLT2i (n = 57) groups, respectively.
Results
During follow-up (17.2 months, median), composite of HF rehospitalization or cardiovascular death events occurred in 30 (39.5%) in Loop, 19 (23.8%) in TLV and 8 (14%) in SGLT2i groups, respectively (Log-rank: P = 0.015). A multivariate analysis demonstrated that the continuation of SGLT2i (hazard ratio, 0.41; 95% CI, 0.19 to 0.78; P = 0.022) and an EF < 30% (hazard ratio, 2.19; 95% CI, 1.22 to 3.92; P = 0.009) were independently associated with the composite outcome. The rate of decline in the eGFR was significantly less in TLV and SGLT2i groups than Loop group (-1.64 vs. -1.28 vs. -5.41 ml/min/1.73 m2 per year, P = 0.007, respectively).
Conclusions
SGLT2i therapy might reduce the combined risk of HF hospitalizations or cardiac death and preserve a worsening renal function in old age patients with HF and CKD.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 26 Sep 2022; epub ahead of print
Amioka M, Sanada R, Matsumura H, Kinoshita H, ... Morishima N, Nakano Y
Int J Cardiol: 26 Sep 2022; epub ahead of print | PMID: 36174820
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Abstract

Disopyramide is a safe and effective treatment for children with obstructive hypertrophic cardiomyopathy.

Topriceanu CC, Field E, Boleti O, Cervi E, Kaski JP, Norrish G
Background
Left ventricular outflow tract obstruction (LVOTO) is present in 1/3 of children with Hypertrophic Cardiomyopathy (HCM). Disopyramide improves symptoms associated with LVOTO and delays surgical intervention in adults, but it is not licensed in children.
Aim
To describe a single-centre thirty-year experience of using disopyramide to treat LVOTO-related symptoms in a paediatric HCM cohort.
Methods
Clinical data were collected for all patients meeting diagnostic criteria for HCM (<18 years) at the time of initiation, 6 months after, and last follow-up or end of disopyramide treatment. It included demographics, clinical history, 12‑lead electrocardiography, and echocardiography. Comparisons between baseline and 6 month follow up, and end of follow up respectively were performed.
Results
Fifty-one patients with HCM were started on disopyramide at a mean age 10.2±5.3 years. At 6 months, of those previously symptomatic, 33(86.8%) reported an improvement of symptoms and 12(31.6%) were asymptomatic. PR interval, corrected QT interval and maximal LVOT gradient had not significantly changed, but fewer participants were noted to have systolic anterior motion of the mitral valve 31 (72.1%) vs. 26 (57.80%). Patients were followed up for a median of 1.9 years (IQR 0.83-4.5). Nine patients (17.6%) reported side effects, and eleven patients (33.3%) with initial improvement in symptoms reported a return or worsening of symptoms requiring a change in medication (n = 4, 12.1%) or left ventricular septal myomectomy (n = 7, 21.2%) during follow up.
Conclusion
Disopyramide is a safe and effective treatment for LVOTO-related symptoms in childhood obstructive HCM. Any delay in the need for invasive intervention, particularly during childhood, is of clear clinical benefit.

Copyright © 2022 The Author. Published by Elsevier B.V. All rights reserved.

Int J Cardiol: 26 Sep 2022; epub ahead of print
Topriceanu CC, Field E, Boleti O, Cervi E, Kaski JP, Norrish G
Int J Cardiol: 26 Sep 2022; epub ahead of print | PMID: 36174821
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Abstract

Clinical Outcome and Risk Factors for Acute Fulminant Myocarditis Supported by Venoarterial Extracorporeal Membrane Oxygenation: an Analysis of Nationwide CSECLS Database in China.

Hao T, Jiang Y, Wu C, Li C, ... Yang Y, Qiu H
Background
To assess the outcomes and risk factors for adult patients with acute fulminant myocarditis (AFM) supported with venoarterial extracorporeal membrane oxygenation (VA ECMO) in China mainland.
Methods
Data were extracted from Chinese Society of ExtraCorporeal Life Support (CSECLS) Registry database. Data from adult patients who were diagnosed with AFM and needed VA ECMO in the database were retrospectively analyzed. The primary outcome was 90-day mortality after ECMO initiation in patients with AFM supported with VA ECMO. Cox proportional hazard regression model was used to examine the risk factors associated with 90-day mortality.
Results
Among 221 patients enrolled and followed up to 90 days, 186 (84.2%) patients weaned from ECMO and 159 (71.9%) patients survived and discharged home. The median age was 38 years (IQR 29-49) and males (n = 115) represented 52.0% of the total accounted patients. The median ECMO duration was 134 h (IQR 96-177 h). The main adverse event during ECMO course was bleeding (16.3%), followed by infection (15.4%). In the multivariate Cox model analysis, cardiac arrest prior to ECMO initiation (adjusted HR 2.529; 95%CI: 1.341-4.767, p = 0.004), lower pH value (adjusted HR 0.016; 95%CI: 0.010-0.059, p < 0.001) and higher lactate concentration at 24 h after ECMO initiation (adjusted HR 1.146; 95%CI: 1.075-1.221, p < 0.001) were associated with 90-day mortality.
Conclusions
71.9% patients with AFM (clinical diagnosed) supported with VA ECMO survived. Cardiac arrest prior to ECMO, lower pH and higher lactate concentration at 24 h after ECMO initiation were correlated with 90-day mortality of AFM patients supported with VA ECMO.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 26 Sep 2022; epub ahead of print
Hao T, Jiang Y, Wu C, Li C, ... Yang Y, Qiu H
Int J Cardiol: 26 Sep 2022; epub ahead of print | PMID: 36174824
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Abstract

Effectiveness and safety evaluation of sacubitril/valsartan in blood pressure control and clinical outcomes for elderly patients with heart failure and hypertension: A prospective cohort study.

Li X, Zuo C, Chen C, Tian D, ... Li X, Lv Q
Aim
This study was conducted to investigate the safety and effectiveness of sacubitril/valsartan (sac/val) for elderly patients with hypertension and heart failure in the real-world setting.
Methods
Patients with established hypertension complicated with structural or functional impairment of ventricular fillings [New York Heart Association (NYHA) functional class II-IV)] were enrolled. The effectiveness of sac/val in terms of BP reduction and improvement in frailty and echocardiographic evaluation of cardiac function were examined from baseline to 6-month administration.
Results
Overall, 241 patients were treated with sac/val and 227 with renin angiotensin aldosterone system inhibitor (RAASi) for hypertension control. There were significant difference in the degree of systolic blood pressure reduction between two groups. Echocardiography showed that sac/val significantly improved left ventricular ejection fraction [4.0% (95% CI: 2.0-7.5) vs -1.0 (95% CI: -4.0-2.0), P = 0.001] during the follow-up visits. Significant improvements in NYHA function class and FRAIL scores post sac/val were observed after 3 and 6 month treatment. The rate of primary cardiovascular composite outcome was higher in patients in the RAASi group (26.9%; 95% CI: 19.6-34.0) than in the sac/val group (22.0%; 95% CI: 16.7-27.3).
Conclusions
Sac/val may be useful not only for reducing BP, but also for improving the structural and functional parameters of echocardiography, eventually resulting in a significant improvement of the overall symptomatic status, a significant reduction in NYHA class, and functional improvement.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 26 Sep 2022; epub ahead of print
Li X, Zuo C, Chen C, Tian D, ... Li X, Lv Q
Int J Cardiol: 26 Sep 2022; epub ahead of print | PMID: 36174825
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Abstract

How many and who are patients with heart failure eligible to SGLT2 inhibitors? Responses from the combination of administrative healthcare and primary care databases.

Piccinni C, Dondi L, Calabria S, Ronconi G, ... Martini N, Maggioni AP

Background:
Recent successful findings (i.e. DAPA-HF trial) in patients with heart failure (HF) with/without diabetes treated with sodium-glucose co-transporter inhibitors (SGLT2-I) have fostered real-world data analyses. Fondazione Ricerca e Salute\'s (ReSD) administrative and Health Search\'s (HSD) primary healthcare databases were combined in the ReS-HS DB Consortium, to identify and characterize HF-patients eligible to SGLT2-I, and assess their costs charged to the Italian National Health Service (INHS).
Methods and results:
Eligibility to SGLT2-I was HF diagnosis, age ≥ 18 years, reduced (≤40%) ejection fraction (HFrEF) and glomerular filtration rate (GFR) ≥30 ml/min. The HSD, including 13,313 HF-patients (1.5% of the total HSD population) was used to develop and test the algorithms for imputing HFrEF and GFR ≥ 30 ml/min, based on a set of covariates, to the ReSD, including 67,369 (1.5% of the total ReSD population). Subjects eligible to SGLT2-I were 2187 in HSD (61.1% of HFrEF); after the imputation, 15,145 in ReSD (58.8% of HFrEF). Prevalence of eligibility to SGLT2-I was higher in males then in females and increased with age; diabetic patients were 44.3% and 33.4% of HSD and ReSD populations eligible to SGLT2-I, respectively. Estimated from ReSD, the mean annual cost charged to the INHS per patient with HF eligible to SGLT2-I was €7122 (68% due to hospitalizations). Conclusions: Approximately 20% of patients with HF was eligible to SGLT2-I. real-world data can identify, quantify and characterize patients eligible to SGLT2-Is and assess related costs for the health care system, thus providing useful information to Regulatory Decision makers.


Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 26 Sep 2022; epub ahead of print
Piccinni C, Dondi L, Calabria S, Ronconi G, ... Martini N, Maggioni AP
Int J Cardiol: 26 Sep 2022; epub ahead of print | PMID: 36174826
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Abstract

Reference values for intracoronary Doppler flow velocity-derived hyperaemic microvascular resistance index.

Feenstra RGT, Seitz A, Boerhout CKM, de Winter RJ, ... Sechtem U, van de Hoef TP
Background
Invasive assessments of microvascular function are rapidly becoming an integral part of physiological assessment in chronic coronary syndromes.
Objective
We aimed to establish a reference range for Doppler flow velocity-derived hyperaemic microvascular resistance index (HMR) in a cohort of angina with no significant epicardial coronary obstruction (ANOCA) patients with no structural pathophysiological alterations in the coronary circulation.
Methods
The reference population consisted of ANOCA patients undergoing invasive coronary vasomotor function assessment who had a coronary flow reserve (CFR) >2.5, and had either (Suda et al., 2019 (1)) tested negatively for spasm provocation (n = 12) or (Narbeh Melikian and William, 2010 (2)) tested positively with only angina at rest (n = 29). A reference range for HMR was established using a non-parametric method and correlations with clinical characteristics were determined using a spearman rank correlation analysis.
Results
In 41 patients median HMR amounted to 1.6 mmHg/cm/s [Q1, Q3: 1.3, 2.2 mmHg/cm/s]. The reference range for HMR that is applicable to 95% of the population was 0.8 mmHg/cm/s (90% CI: 0.8-1.0 mmHg/cm/s) to 2.7 mmHg/cm/s (90% CI: 2.6-2.7 mmHg/cm/s). No significant correlations were found between HMR and clinical characteristics.
Conclusion
In this reference population undergoing invasive coronary vasomotor function testing, the 90% confidence interval of the HMR upper limit of normal ranges from 2.6 to 2.7 mmHg/cm/s. A > 2.5 mmHg/cm/s HMR threshold can be used to identify abnormal microvascular resistance in daily clinical practice.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 26 Sep 2022; epub ahead of print
Feenstra RGT, Seitz A, Boerhout CKM, de Winter RJ, ... Sechtem U, van de Hoef TP
Int J Cardiol: 26 Sep 2022; epub ahead of print | PMID: 36174827
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Abstract

Hypoxia-induced long non-coding RNA plasmacytoma variant translocation 1 upregulation aggravates pulmonary arterial smooth muscle cell proliferation by regulating autophagy via miR-186/Srf/Ctgf and miR-26b/Ctgf signaling pathways.

Xia X, Huang L, Zhou S, Han R, ... Zeng D, Wang R
Background
The lncRNA PVT1 reportedly functions as a competing endogenous RNA (ceRNA) of miR-186 and miR-26b in different tissue types. In this study, we investigated the possible involvement of the miR-186/Srf/Ctgf and miR-26b/Ctgf signaling pathways in the pathogenesis of hypoxia-induced PAH.
Methods
Expression of PVT1, miR-186, miR-26b, and Srf and Ctgf mRNAs were evaluated by real-time polymerase chain reaction. Protein expression of SRF, CTGF, LC3B-I, LC3B-II, and Beclin-I was evaluated using western blotting. The regulatory relationship between the lncRNA, miRNAs, and target mRNAs was explored using luciferase assays. Immunohistochemistry was used to evaluate the expression of SRF and CTGF in situ. MTT assay was performed to assess the proliferation of PASMCs.
Results
Exposure to hypoxia markedly altered the expression of PVT1, Srf, Ctgf, miR-186, and miR-26b in a rat model. MiR-186 binding sites in the sequences of Srf mRNA and PVT1 were confirmed by luciferase assays, indicating that miR-186 may interact with both PVT1 and Srf mRNA. Additionally, miR-26b binding sites were identified in the sequences of Ctgf mRNA and PVT1, suggesting that miR-26b may interact with both PVT1 and Ctgf mRNA. In line with this, we found that overexpression of PVT1 reduced expression of miR-26b and miR-186 but activated expression of Srf, Ctgf, LC3B-II, and Beclin-I.
Conclusions
Upregulation of PVT1 by exposure to hypoxia promoted the expression of CTGF, leading to deregulation of autophagy and abnormal proliferation of PASMCs. Dysregulation of the miR-186/Srf/Ctgf and miR-26b/Ctgf signaling pathways may be involved in the pathogenesis of hypoxia-induced PASMCs.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 26 Sep 2022; epub ahead of print
Xia X, Huang L, Zhou S, Han R, ... Zeng D, Wang R
Int J Cardiol: 26 Sep 2022; epub ahead of print | PMID: 36174828
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Abstract

Different characteristics of apical aneurysm in hypertrophic cardiomyopathy are related to difference in long-term prognosis.

Kim EK, Hwang JW, Chang SA, Park SJ, ... Choe YH, Lee SC
Background
Data regarding long-term cardiac and cerebrovascular adverse events in patients with hypertrophic cardiomyopathy (HCM) and apical aneurysm (AAn) are scarce and specific treatment strategies that include the use of anticoagulants have not yet been established. We aimed to evaluate the prevalence and long-term prognostic implication based on characteristics of AAn in patients with HCM.
Methods
A total of 458 consecutive patients diagnosed with HCM underwent cardiovascular magnetic resonance imaging and echocardiography from August 1, 2008 to December 31, 2015. AAn was classified into Grade 1 and Grade 2 based on size and morphology. The patients were followed up for a median duration of 6.3 years (range, 4.2-8.7 years) for major adverse cardiac and cerebral events (MACCEs); a composite of cardiac death, HCM-related hospitalization, cerebrovascular accident (CVA), heart transplantation, myocardial infarction, and implantable cardiac defibrillator/cardiac resynchronization therapy.
Results
AAn was detected in 9.2%. MACCEs developed more frequently in patients with AAn than in those without AAn (30.1% vs. 20.7%, P = 0.015), with the rate of CVA as the main difference (9.7% vs. 5.3%, P = 0.011). Grade 2 AAn group showed significantly higher MACCE than Grade 1 AAn group (41.8% vs. 21.9%, P < 0.001). In multivariate analysis, the presence of AAn was independently associated with increased risk of MACCEs (adjusted hazard ratio: 1.95; 95% confidence interval, CI: 1.16-3.28; P = 0.012).
Conclusions
AAn is independently associated with increased risk of HCM-related adverse events, especially cerebral infarction, with significant relationship between aneurysm size and adverse events.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 26 Sep 2022; epub ahead of print
Kim EK, Hwang JW, Chang SA, Park SJ, ... Choe YH, Lee SC
Int J Cardiol: 26 Sep 2022; epub ahead of print | PMID: 36174829
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Abstract

Salivary biomarkers for diagnosis of acute myocardial infarction: A systematic review.

Domenico T, Rita A, Giacomo S, Diego A, ... Marco M, Diana C
Background
Acute myocardial infarction (AMI) accounts for about 7 million deaths per year worldwide. The early identification of signs and symptoms and the detection of specific serological markers of this disease are mandatory to reach a prompt diagnosis and begin potentially life-saving treatment. Point-of-care technologies applied to salivary diagnostics can provide rapid, simple, low-cost, and accurate measurements of specific markers and can also be used in emergency settings. The present systematic review was developed to answer the following question: \"Are salivary biomarkers useful in identifying patients with acute myocardial infarction?\"
Methods
Following the \"Preferred Reporting Item for Systematic Reviews and Meta-analysis\" (PRISMA) guidelines, we selected 17 papers. The critical appraisal and quality assessment were performed following the National Institute of Health and the classification of the Oxford Center for Evidence-Based Medicine.
Results
Twenty-six salivary biomarkers were explored in association with AMI. Troponins, C-reactive protein, and adiponectin were the most frequently investigated molecules. We found that the evaluated biomarkers had different levels of diagnostic accuracy in discriminating patients with AMI from healthy controls. We also observed a lack of good-quality studies on the association between the occurrence of AMI and the presence of related salivary biomarkers.
Conclusions
There is evidence that salivary isoforms of cardiac troponin, C-reactive protein, and creatine phosphokinase (CPK) could be useful markers for the prompt diagnosis of AMI. However, the effective use of these markers as possible substitutes for serological markers should be confirmed by further studies that avoid the bias highlighted in the present review.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 24 Sep 2022; epub ahead of print
Domenico T, Rita A, Giacomo S, Diego A, ... Marco M, Diana C
Int J Cardiol: 24 Sep 2022; epub ahead of print | PMID: 36167219
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Abstract

The Association Between Cancer Diagnosis, Care, and Outcomes in 1 Million Patients Hospitalized for Acute Pulmonary Embolism.

Mai AS, Matetić A, Elgendy IY, Mattei JL, ... Van Spall HGC, Mamas MA
Objectives
To evaluate the clinical care provided to cancer patients hospitalized for acute pulmonary embolism (PE), as well as the association between type of cancer, in-hospital care, and clinical outcomes.
Methods
This study examined the in-hospital care (systemic thrombolysis, catheter-directed thrombolysis, and surgical thrombectomy/embolectomy) and clinical outcomes (mortality, major bleeding, and hemorrhagic stroke) among adults hospitalized due to acute PE between October 2015 to December 2018 using the National Inpatient Sample (NIS). Multivariable logistic regression analysis was used to determine adjusted odds ratios (aOR) with 95% confidence interval (95% CI).
Results
Of 1,090,130 hospital records included in the analysis, 216,825 (19.9%) had current cancer diagnoses, including lung (4.7%), hematological (2.5%), colorectal (1.6%), breast (1.3%), prostate (0.8%), and \'other\' cancer (9.0%). Cancer patients had lower adjusted odds of receiving systemic thrombolysis, catheter-directed therapy, and surgical thrombectomy/embolectomy compared with their non-cancer counterparts (P<0.001), except for systemic thrombolysis (aOR 0.96, 95% CI 0.85-1.09, P=0.553) and catheter-directed therapy (aOR 0.82, 95% CI 0.67-1.00, P=0.053) for prostate cancer. Cancer patients had greater odds of mortality (P<0.05). Lung cancer patients had the highest odds of mortality (aOR 2.68, 95% CI 2.61-2.76, P<0.001) and hemorrhagic stroke (aOR 1.75, 95% CI 1.61-1.90, P<0.001), while colorectal cancer patients had the greatest odds of bleeding (aOR 2.04, 95% CI 1.94-2.15, P<0.001).
Conclusion
Among those hospitalized for PE, cancer diagnoses were associated with lower odds of invasive management and poorer in-hospital outcomes, with metastatic status being an especially important determinant. Appropriateness of care could not be assessed in this study.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 24 Sep 2022; epub ahead of print
Mai AS, Matetić A, Elgendy IY, Mattei JL, ... Van Spall HGC, Mamas MA
Int J Cardiol: 24 Sep 2022; epub ahead of print | PMID: 36167220
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Abstract

Ischemia with no obstructive coronary artery disease (INOCA): A patient self-report quality of life survey from INOCA international.

Gulati M, Khan N, George M, Berry C, ... Marzilli M, Merz CNB
Background
There is limited information available regarding evidence of ischemia with no obstructive coronary arteries (INOCA) and quality of life.
Purpose
To determine associations between INOCA and self-reported physical, social, and mental health.
Methods
We conducted a survey of all members (n = 1579) of the INOCA International patient support group. Current self-reported diagnosis and health measures were collected. Functional capacity was retrospectively estimated using the Duke Activity Status Index (DASI), assessing levels of activities performed prior and after symptom onset.
Results
A total of 297 (20.8% response rate, 91% women) reported symptoms of chest pain, pressure, or discomfort in 92.9%. Overall, 34.4% were living with symptoms for ≥3 years before an INOCA diagnosis, and 77.8% were told their symptoms were not cardiac. Estimated functional capacity was higher prior to compared to after symptom onset (8.6 ± 1.8 METs vs 5.6 ± 1.8 METs; P < 0.0001). Most respondents reported an adverse impact of symptoms on their home life (80.5%), social life (80.1%), mental health (70.4%), outlook on life (69.7%), sex life (55.9%), and their partner/spouse relationship (53.9%), while approximately three-quarters reduced their work hours or stopped work completely, 47.5% retired early, and 38.4% applied for disability.
Conclusions
INOCA symptoms are associated with adverse physical, mental and social health quality of life. Increased patient awareness, physician recognition and diagnosis, and clinical trials are needed to develop evidence-based guidelines for this increasingly recognized cardiovascular disorder.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 23 Sep 2022; epub ahead of print
Gulati M, Khan N, George M, Berry C, ... Marzilli M, Merz CNB
Int J Cardiol: 23 Sep 2022; epub ahead of print | PMID: 36162521
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Abstract

Impact of training on combined cardiopulmonary exercise test with stress echocardiography parameters in HFrEF patients.

Marine K, Feriel M, Aurelia LT, Oksana K, ... Damien V, Marie-Christine I
Background
Exercise-based cardiac rehabilitation is recognized to improve quality of life in heart failure patients. However, the effects on the cardiac function are understudied. The main objective was to assess the impact of a 4-week cardiac rehabilitation program on cardiopulmonary exercise testing (CPET) combined with simultaneous echocardiography parameters in chronic heart failure (CHF) patients. The secondary aim was to investigate patients\' responses to training.
Methods
Forty-one CHF patients with reduced ejection fraction (29.3 ± 0.1%) underwent CPET and stress echocardiography before and after a 4-week of exercise-training program. Blood parameters, echocardiography and cardiopulmonary parameters were assessed before and after training. Potential echocardiography derived predictive parameters like left and right contractile reserves, left ventricle elastance, end systolic volume and right ventricle S wave response to exercise were also assessed.
Results
The training program increased the peak oxygen consumption (VO2) (P < 0.001), the peak systolic blood pressure, the left ventricular outflow tract velocity time integral (P < 0.05) and the circulatory (P < 0.001) and ventilatory (P < 0.01) powers. It also decreased the VE/VCO2 slope (P < 0.001). As the median value of peak VO2 gain was 17%, patients above this value were considered as responders and patients below as non-responders to training. The responders presented a higher left ventricle contractile reserve compared to non-responder patients. The peak left ventricle elastance and peak right ventricle S wave response tended to be higher in responders.
Conclusion
Combination of CPET and stress echocardiography may contribute to establish the disease severity stratification and to predict response to training in CHF patients with reduced ejection fraction.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 23 Sep 2022; epub ahead of print
Marine K, Feriel M, Aurelia LT, Oksana K, ... Damien V, Marie-Christine I
Int J Cardiol: 23 Sep 2022; epub ahead of print | PMID: 36162522
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Impact:
Abstract

Why do guidelines recommend screening for abdominal aortic aneurysms, but not for asymptomatic carotid stenosis? A Plea for a randomized controlled trial.

Paraskevas KI, Spence JD, Mikhailidis DP, Antignani PL, ... Zeebregts CJ, Nicolaides AN
Background
Current guidelines do not recommend screening for asymptomatic carotid artery stenosis (AsxCS). The rationale behind this recommendation is that detection of AsxCS may lead to an unnecessary carotid intervention. In contrast, screening for abdominal aortic aneurysms is strongly recommended.
Methods
A critical analysis of the literature was performed to evaluate the implications of detecting AsxCS.
Results
Patients with AsxCS are at high risk for future stroke, myocardial infarction and vascular death. Population-wide screening for AsxCS should not be recommended. Additionally, screening of high-risk individuals for AsxCS with the purpose of identifying candidates for a carotid intervention is inappropriate. Instead, selective screening for AsxCS should be considered and should be viewed as an opportunity to identify individuals at high risk for atherosclerotic cardiovascular disease and future cardiovascular events for the timely initiation of intensive medical therapy and risk factor modification.
Conclusions
Although mass screening should not be recommended, there are several arguments suggesting that selective screening for AsxCS should be considered. The rationale supporting such selective screening is to optimize risk factor control and to initiate intensive medical therapy for prevention of future cardiovascular events, rather than to identify candidates for an intervention.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 23 Sep 2022; epub ahead of print
Paraskevas KI, Spence JD, Mikhailidis DP, Antignani PL, ... Zeebregts CJ, Nicolaides AN
Int J Cardiol: 23 Sep 2022; epub ahead of print | PMID: 36162523
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Impact:
Abstract

Real world long-term outcomes among adults undergoing transcatheter patent foramen closure with amplatzer PFO occluder.

Abrahamyan L, Barker M, Dharma C, Lee DS, ... Osten M, Horlick EM
Background
Patent foramen ovale (PFO) is a congenital heart defect associated with an increased risk of cryptogenic stroke. We aimed to evaluate real-world outcomes of adult patients undergoing transcatheter PFO closure with the Amplatzer PFO Occluder.
Methods
In this single centre, retrospective cohort study, we linked a detailed clinical registry with provincial administrative databases to obtain short and long-term outcomes. Validated algorithms were used to established baseline comorbidities and adverse outcomes.
Results
Between 1999 and 2017, 479 patients had PFO closure with an Amplatzer PFO Occluder. The average age of the patients was 47.3 years (standard deviation (SD) = 12.4), and 54.7% were males. The procedural success was 100%, and 96% of patients were discharged on the same day. Any in-hospital complication was observed in 2.5% (n = 12) of patients. At 30 days post-discharge, 18% of patients had an ED visit and 5% a hospitalization. Over a mean follow-up of 9.1 (SD = 3.8) years, 4% experienced TIA, 1.5% stroke, and 7.6% atrial fibrillation. The composite outcome of stroke/TIA/death was observed in 10.9% of patients (1.22 events per 100 person-years). Patients >60 years old experienced higher rates of adverse events than younger patients.
Conclusions
In this large real-world cohort of patients with cryptogenic stroke, we observed excellent safety and effectiveness outcomes for PFO closure conducted with Amplatzer PFO Occluder, similar to randomized controlled trials or other long-term cohort studies. New onset atrial fibrillation was one of the most commonly adverse events. Future studies should investigate early post-discharge management of patients to prevent readmissions.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 19 Sep 2022; epub ahead of print
Abrahamyan L, Barker M, Dharma C, Lee DS, ... Osten M, Horlick EM
Int J Cardiol: 19 Sep 2022; epub ahead of print | PMID: 36165815
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Impact:
Abstract

Prognostic implications of weight gain and weight loss in adults with congenital heart disease.

Egbe AC, Miranda WR, Anderson JH, Connolly HM
Background
There are conflicting data about the association between obesity and clinical outcomes in adults with congenital heart disease (CHD), and the effects of weight gain or weight loss remain unclear. The purpose of this study was to determine whether a temporal change in body mass index (BMI) was associated with clinical outcomes independent of baseline BMI in adults with CHD.
Methods
Retrospective cohort study of adults with CHD that had clinical assessments at baseline and 5 years afterwards. Weight gain and weight loss were defined as ≥5% change from baseline BMI. Atherosclerotic cardiovascular disease (ASCVD) risk profile (blood pressure [BP], low density lipoprotein cholesterol [LDL-C] and hemoglobin A1C [HBA1c]) and cardiovascular events (heart failure hospitalization, transplant, death) were ascertained.
Results
Of the 3407, 1804 (53%) had stable weight, 1291 (38%) had weight gain, and 312 (9%) had weight loss at follow-up assessment. The median change in BMI (∆ BMI) was +3% (1-5). The baseline BMI and ∆ BMI were associated with worsening ASCVD risk profile (higher BP, LDL-C and HBA1C), and an increase in cardiovascular events in patients with obesity at baseline.
Conclusions
Collectively, the results provide evidence to support lifestyle interventions aimed at weight maintenance in patients with normal weight, and to promote weight loss in patients that are overweight or obese. Further studies are required to determine the optimal type of lifestyle interventions that will be most effective in this population.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 18 Sep 2022; epub ahead of print
Egbe AC, Miranda WR, Anderson JH, Connolly HM
Int J Cardiol: 18 Sep 2022; epub ahead of print | PMID: 36130618
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Impact:
Abstract

Does a standard myectomy exist for obstructive hypertrophic cardiomyopathy? From the Morrow variations to precision surgery.

Stefàno P, Argirò A, Bacchi B, Iannone L, ... Cerillo A, Olivotto I
Objectives
The purpose of this work is to revisit the history of surgical treatment for obstructive hypertrophic cardiomyopathy (oHCM) over the last 60 years, in the light of advancing knowledge of the pathophysiology of obstruction.
Methods
In this narrative review the contribution of the different surgical approaches to the field will be assessed in our personal experience in Florence.
Results
Septal myectomy is the treatment of choice in patients with obstructive hypertrophic cardiomyopathy who remain symptomatic despite optimal medical treatment. Over the decades, numerous \"theme variations\" of the Morrow operation have been proposed, each of them targeting a specific pathophysiological determinant of left ventricular outflow tract obstruction.
Conclusions
Precision surgery in oHCM patients today depends on the ability of the surgeon to combine and master these variations, with the bird\'s eye view allowed by climbing on the shoulders of giants.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 18 Sep 2022; epub ahead of print
Stefàno P, Argirò A, Bacchi B, Iannone L, ... Cerillo A, Olivotto I
Int J Cardiol: 18 Sep 2022; epub ahead of print | PMID: 36130619
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Impact:
Abstract

Atrial flutter and fibrillation in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension in the ASPIRE registry: Comparison of rate versus rhythm control approaches.

Sammut MA, Condliffe R, Elliot C, Hameed A, ... Turner R, Charalamopoulos A
Background
The development of atrial flutter and fibrillation (AFL/AF) in patients with pre-capillary pulmonary hypertension has been associated with an increased risk of morbidity and mortality. Rate and rhythm control strategies have not been directly compared.
Methods
Eighty-four patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) with new-onset AFL/AF were identified in the ASPIRE registry. First, baseline characteristics and rates of sinus rhythm (SR) restoration of 3 arrhythmia management strategies (rate control, medical rhythm control and DC cardioversion, DCCV) in an early (2009-13) and later (2014-19) cohort were compared. Longer-term outcomes in patients who achieved SR versus those who did not were then explored.
Results
Sixty (71%) patients had AFL and 24 (29%) AF. Eighteen (22%) patients underwent rate control, 22 (26%) medical rhythm control and 44 (52%) DCCV. SR was restored in 33% treated by rate control, 59% medical rhythm control and 95% DCCV (p < 0.001). Restoration of SR was associated with greater improvement in functional class (FC) and Incremental Shuttle Walk Distance (p both <0.05). It also independently predicted superior survival (3-year survival 62% vs 23% in those remaining in AFL/AF, p < 0.0001). In addition, FC III/IV independently predicted higher mortality (HR 2.86, p = 0.007). Right atrial area independently predicted AFL/AF recurrence (OR 1.08, p = 0.01). DCCV was generally well tolerated with no immediate major complications.
Conclusions
Restoration of SR is associated with superior functional improvement and survival in PAH/CTEPH compared with rate control. DCCV is generally safe and is more effective than medical therapy at achieving SR.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 18 Sep 2022; epub ahead of print
Sammut MA, Condliffe R, Elliot C, Hameed A, ... Turner R, Charalamopoulos A
Int J Cardiol: 18 Sep 2022; epub ahead of print | PMID: 36130620
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Impact:
Abstract

Clinical profile and outcome of cardiomyopathies in infants and children seen at a tertiary centre.

Pagano M, Fumagalli C, Girolami F, Passantino S, ... Olivotto I, Favilli S
Introduction
Due to their rare prevalence and marked heterogeneity, pediatric cardiomyopathies (CMPs) are little known and scarcely reported. We report the etiology, clinical profile and outcome of a consecutive cohort of children diagnosed with CMP and followed at Meyer Children\'s Hospital over a decade.
Patients and methods
We retrospectively reviewed patients consecutively referred from May 2008 to May 2019 for pediatric onset CMP (<18 years). Heart disease caused by arrhythmic disorders, toxic agents, rheumatic conditions and maternal disease were excluded.
Results
We enrolled 110 patients (65 males), diagnosed at a median age of 27 [4-134] months; 35% had an infant onset (<1 year of age). A positive family history was more often associated with childhood-onset (38.8%). Hypertrophic cardiomyopathy (HCM; 48 patients) was the most frequent phenotype, followed by dilated cardiomyopathy (DCM; 35 patients). While metabolic and idiopathic etiologies were preponderant in infants, metabolic and sarcomeric diseases were most frequent in the childhood-onset group. Major adverse cardiac events (MACE) occurred in 31.8% of patients, including hospitalization for acute heart failure in 25.5% of patients, most commonly due to DCM. Overall, the most severe outcomes were documented in patients with metabolic diseases.
Conclusions
In a consecutive cohort of pediatric patients with CMP, those with infantile onset and with a metabolic etiology had the worst prognosis. Overall, MACE occurred in 41% of the entire population, most commonly associated with DCM, inborn errors of metabolism and genetic syndromes. Systematic NGS genetic testing was critical for etiological diagnosis and management.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 18 Sep 2022; epub ahead of print
Pagano M, Fumagalli C, Girolami F, Passantino S, ... Olivotto I, Favilli S
Int J Cardiol: 18 Sep 2022; epub ahead of print | PMID: 36130621
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Impact:
Abstract

Management and outcomes of patients admitted with type 2 myocardial infarction with and without standard modifiable risk factors.

Sokhal BS, Matetić A, Paul TK, Velagapudi P, ... Mallen C, Mamas MA
Background
Whilst it is known patients without standard modifiable cardiovascular risk factors (SMuRF; hypertension, diabetes, hypercholesterolaemia, smoking) have worse outcomes in Type 1 acute myocardial infarction (AMI), the relationship between type 2 AMI (T2AMI) and outcomes in patients with and without SMuRF is unknown. This study aimed to determine the prevalence, characteristics and clinical outcomes of patients hospitalised with T2AMI based on the presence of SMuRF.
Methods
Using the National Inpatient Sample, all hospitalizations with a primary discharge diagnosis of T2AMI were stratified according to SMuRF status (SMuRF and SMURF-less). Primary outcome was all-cause mortality while secondary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE), major bleeding and ischemic stroke. Multivariable logistic regression was used to determine adjusted odds ratios (aOR) with 95% confidence intervals (95% CI).
Results
Among 17,595 included hospitalizations, 1345 (7.6%) were SMuRF-less and 16,250 (92.4%) were SMuRF. On adjusted analysis, SMuRF-less patients had increased odds of all-cause mortality (aOR 2.43, 95% CI 1.83 to 3.23), MACCE (aOR 2.32, 95% CI 1.79 to 2.90) and ischaemic stroke (aOR 2.57, 95% CI 1.56 to 4.24) compared to their SMuRF counterparts. Secondary diagnoses among both cohorts were similar, with respiratory disorders most prevalent followed by cardiovascular and renal disorders.
Conclusions
T2AMI in the absence of SMuRF was associated with worse in-hospital outcomes compared to SMuRF-less patients. There was no SMuRF-based difference in the secondary diagnoses with the most common being respiratory, cardiovascular, and renal disorders. Further studies are warranted to improve overall care and outcomes of SMuRF-less patients.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 18 Sep 2022; epub ahead of print
Sokhal BS, Matetić A, Paul TK, Velagapudi P, ... Mallen C, Mamas MA
Int J Cardiol: 18 Sep 2022; epub ahead of print | PMID: 36130622
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Impact:
Abstract

Meta-analysis of short- and long-term clinical outcomes of the self-expanding Evolut R/pro valve versus the balloon-expandable Sapien 3 valve for transcatheter aortic valve implantation.

Lerman TT, Levi A, Kornowski R
Background
The Evolut R/Pro and the Sapien 3 are the most commonly valve systems used today for transcatheter aortic valve implantation (TAVI). However, there is a still uncertainty regarding the efficacy and safety comparison of these two valves.
Methods
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies comparing the Evolut R/Pro versus the Sapien 3. The primary outcome was all-cause mortality (short and long-term). The secondary outcomes were stroke, bleeding, permanent pacemaker implantation (PPI), acute kidney injury (AKI), major vascular complication, device success, moderate- severe aortic regurgitation (AR), and pressure gradients.
Results
Twenty-one publications totaling 35,248 patients were included in the analysis. Evolut R/Pro was associated with higher risk of short-term all-cause mortality (OR = 1.31;95% CI 1.15-1.49, p < 0.001) and a trend of higher long-term mortality (OR = 1.07;95% CI 1.00-1.16, p = 0.06). The Evolut R/Pro was associated with higher risk of PPI and AR and lower risk for bleeding, major vascular complication, and pressure gradients. There was no significant difference between the groups regarding the risk of stroke, AKI and device success.
Conclusions
The Evolut R/Pro valve system compared to the Sapien 3 is associated with higher risk of short-term mortality, significant AR and PPI while providing the advantage of lower risk of bleeding, major vascular complication, and lower residual transvalvular gradients.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 18 Sep 2022; epub ahead of print
Lerman TT, Levi A, Kornowski R
Int J Cardiol: 18 Sep 2022; epub ahead of print | PMID: 36130623
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Impact:
Abstract

HbA1c level is associated with the development of heart failure with recovered ejection fraction in hospitalized heart failure patients with type 2 diabetes.

Yang CD, Aihemaiti M, Quan JW, Chen JW, ... Pan WQ, Wang XQ
Background
Due to advances in medical treatments, a substantial proportion of heart failure (HF) patients with reduced left ventricular ejection fraction (EF, HFrEF) have experienced partial or complete recovery of EF, termed HFrecEF, and markedly improved clinical outcomes. In the present study, we sought to investigate the relationship between glycemic control and the incidence of HFrecEF in hospitalized HFrEF patients with type 2 diabetes mellitus (T2DM).
Methods
A total of 463 hospitalized T2DM patients with HFrEF were consecutively enrolled. Follow-up echocardiogram was performed after around 12 months. Patients who had an absolute EF improvement ≥10% and a second EF > 40% were classified into HFrecEF, and those who did not meet these criteria were defined as persistent HFrEF.
Results
During the 12-month follow-up, 44.5% of T2DM patients developed HFrecEF. Patients with HFrecEF had significantly lower HbA1c level than those with persistent HFrEF (6.5% [IQR 5.8% ~ 7.2%] vs. 6.7% [IQR 6.1% ~ 7.8%], P = 0.003), especially in HF of an ischemic etiology. HbA1c levels were inversely correlated with changes in EF during follow-up. After multivariate adjustment, every 1% increase in HbA1c conferred a 17.4% (OR: 0.826 [95% CI 0.701-0.968]) lower likelihood of HFrecEF. Compared to patients with good glycemic control (HbA1c ≤ 6.2%), those with poor glycemic control (HbA1c > 7.1%) had a 52.0% (OR: 0.480 [95% CI 0.281-0.811] decreased likelihood of HFrecEF.
Conclusions
This study demonstrates that uncontrolled HbA1c level is associated with compromised development of HFrecEF in T2DM patients with HF, especially in those with an ischemic etiology.

Copyright © 2022 Elsevier Ireland Ltd. All rights reserved.

Int J Cardiol: 15 Sep 2022; epub ahead of print
Yang CD, Aihemaiti M, Quan JW, Chen JW, ... Pan WQ, Wang XQ
Int J Cardiol: 15 Sep 2022; epub ahead of print | PMID: 36116615
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Impact:
Abstract

Periprocedural anticoagulation therapy in patients undergoing Micra leadless pacemaker implantation.

Kadado AJ, Chalhoub F
Over the past decade, there has been significant improvement in the treatment cardiac diseases and symptomatic bradyarrhythmias with the development of leadless pacemaker systems. The Micra transcatheter pacemaker system has been shown to mitigate a lot of the complications associated with traditional pacing systems, which are notably skin pocket and lead-related complications. Numerous studies have shown the low complication rates associated with Micra procedure; however, there have been no specific guidelines or recommendations surrounding periprocedural anticoagulant therapy. This is important because a significant percentage of patients requiring pacemaker therapy have an indication for anticoagulation therapy as well. Multiple studies have shown the safety of uninterrupted anticoagulation during Micra implant, however, there is insufficient high-quality data to recommend periprocedural systemic use of anticoagulation. In this paper, we review the available data surrounding anticoagulation therapy in patients undergoing Micra implantation and the potential bleeding risks associated with this procedure.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 14 Sep 2022; epub ahead of print
Kadado AJ, Chalhoub F
Int J Cardiol: 14 Sep 2022; epub ahead of print | PMID: 36115436
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Impact:
Abstract

Apical aneurysm formation in apical hypertrophic cardiomyopathy: Pilot study with cardiac magnetic resonance.

Yang K, Yu SQ, Chen XY, Song YY, ... Lu MJ, Zhao SH
Background
The dynamic changes and apical aneurysm formation in apical hypertrophic cardiomyopathy (HCM) have not been specifically described. This study aimed to describe these changes to better understand the progression of apical HCM.
Methods and results
Seventy-two patients with apical HCM who underwent at least two cardiac magnetic resonance (CMR) examinations were retrospectively included in this study. The mean interval between the first and last CMR examinations was 50.1 ± 26.8 months (ranging from 4 to 118 months). Compared with the initial values, the left atrial diameter, maximum left ventricular wall thickness and late gadolinium enhancement extent significantly increased (all P < 0.05), while the left ventricular ejection fraction significantly decreased (P < 0.05), at the latest CMR examination. More importantly, the dynamic process of apical aneurysm formation in apical HCM was observed in a subset of patients, which may follow these four stages: starting with systolic apical cavity obliteration, then broadening of the apical slit in systole, further developing into an apical outpouching, and finally forming an apical aneurysm. Eleven patients experienced adverse cardiovascular events, including new-onset or progressive atrial fibrillation (n = 7), hospitalization with heart failure (n = 3) and implantable cardioverter defibrillator intervention (n = 1), at the time of the latest CMR examination.
Conclusions
In the progression of apical HCM, cardiac structure and function will change accordingly. Apical aneurysm formation in apical HCM is a chronic and continuous dynamic process that may follow a 4-step pathway of disease progression.

Copyright © 2022 Elsevier Ireland Ltd. All rights reserved.

Int J Cardiol: 14 Sep 2022; epub ahead of print
Yang K, Yu SQ, Chen XY, Song YY, ... Lu MJ, Zhao SH
Int J Cardiol: 14 Sep 2022; epub ahead of print | PMID: 36115439
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Impact:
Abstract

Usefulness of cardiac magnetic resonance for early detection of cancer therapeutics-related cardiac dysfunction in breast cancer patients.

Terui Y, Sugimura K, Ota H, Tada H, ... Yasuda S, Shimokawa H
Background
Prognosis of breast cancer patients has been improved along with the progress in cancer therapies. However, cancer therapeutics-related cardiac dysfunction (CTRCD) has been an emerging issue. For early detection of CTRCD, we examined whether native T1 mapping and global longitudinal strain (GLS) using cardiac magnetic resonance (CMR) and biomarkers analysis are useful.
Methods
We prospectively enrolled 83 consecutive chemotherapy-naïve female patients with breast cancer (mean age, 56 ± 13 yrs.) between 2017 and 2020. CTRCD was defined based on echocardiography as left ventricular ejection fraction (LVEF) below 53% at any follow-up period with LVEF>10% points decrease from baseline after chemotherapy. To evaluate cardiac function, CMR (at baseline and 6 months), 12‑lead ECG, echocardiography, and biomarkers (at baseline and every 3 months) were evaluated.
Results
A total of 164 CMRs were performed in 83 patients. LVEF and GLS were significantly decreased after chemotherapy (LVEF, from 71.2 ± 4.4 to 67.6 ± 5.8%; GLS, from -27.9 ± 3.9 to -24.7 ± 3.5%, respectively, both P < 0.01). Native T1 value also significantly elevated after chemotherapy (from 1283 ± 36 to 1308 ± 39 msec, P < 0.01). Among the 83 patients, 7 (8.4%) developed CTRCD. Of note, native T1 value before chemotherapy was significantly higher in patients with CTRCD than in those without it (1352 ± 29 vs. 1278 ± 30 msec, P < 0.01). The multivariable logistic regression analysis revealed that native T1 value was an independent predictive factor for the development of CTRCD [OR 2.33; 95%CI 1.15-4.75, P = 0.02].
Conclusions
These results indicate that CMR is useful to detect chemotherapy-related myocardial damage and predict for the development of CTRCD in breast cancer patients.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 14 Sep 2022; epub ahead of print
Terui Y, Sugimura K, Ota H, Tada H, ... Yasuda S, Shimokawa H
Int J Cardiol: 14 Sep 2022; epub ahead of print | PMID: 36115441
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Impact:
Abstract

Peri-procedural and mid-term follow-up age-related differences in leadless pacemaker implantation: Insights from a multicenter European registry.

Gulletta S, Schiavone M, Gasperetti A, Breitenstein A, ... Saguner AM, Forleo GB
Background
Age-related differences on leadless pacemaker (LP) are poorly described. Aim of this study was to compare clinical indications, periprocedural and mid-term device-associated outcomes in a large real-world cohort of LP patients, stratified by age at implantation.
Methods
Two cohorts of younger and older patients (≤50 and > 50 years old) were retrieved from the iLEAPER registry. The primary outcome was to compare the underlying indication why a LP was preferred over a transvenous PM across the two cohorts. Rates of peri-procedural and mid-term follow-up major complications as well as LP electrical performance were deemed secondary outcomes.
Results
1154 patients were enrolled, with younger patients representing 6.2% of the entire cohort. Infective and vascular concerns were the most frequent characteristics that led to a LP implantation in the older cohort (45.8% vs 67.7%, p < 0.001; 4.2% vs 16.4%, p = 0.006), while patient preference was the leading cause to choose a LP in the younger (47.2% vs 5.6%, p < 0.001). Median overall procedural (52 [40-70] vs 50 [40-65] mins) and fluoroscopy time were similar in both groups. 4.3% of patients experienced periprocedural complications, without differences among groups. Threshold values were higher in the younger, both at discharge and at last follow-up (0.63 [0.5-0.9] vs 0.5 [0.38-0-7] V, p = 0.004).
Conclusion
When considering LP indications, patient preference was more common in younger, while infective and vascular concerns were more frequent in the older cohort. Rates of device-related complications did not differ significantly. Younger patients tended to have a slightly higher pacing threshold at mid-term follow-up.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 14 Sep 2022; epub ahead of print
Gulletta S, Schiavone M, Gasperetti A, Breitenstein A, ... Saguner AM, Forleo GB
Int J Cardiol: 14 Sep 2022; epub ahead of print | PMID: 36115442
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Impact:
Abstract

Sex-specific impact of anthropometric parameters on outcomes after transcatheter edge-to-edge repair for secondary mitral regurgitation.

Higuchi S, Orban M, Adamo M, Giannini C, ... Metra M, Hausleiter J
Background
Body surface area (BSA) has been reported to be the stronger predictor for prognosis than body mass index in heart failure (HF) patients. The sex-specific association of BSA with mortality has been unclear.
Methods
EuroSMR, a European multicenter registry, included patients who underwent edge-to-edge repair (TEER) for secondary mitral regurgitation (SMR). The outcome was two-year all-cause mortality.
Results
The present cohort included 1594 HF patients (age, 74 ± 10 years; male, 66%). Association of calculated BSA with two-year all-cause mortality was evaluated. Patients were classified into three BSA groups: the lowest 10% (S), the highest 10% (L), and intermediate between S and L (M). Mean BSA was 1.87 ± 0.21 m2 (male, 1.94 ± 0.18 m2; female, 1.73 ± 0.18 m2). The association of BSA with the endpoint in females showed a U-shaped curve, indicating worse prognosis for both S and L. The association in males followed a linear regression, demonstrating better prognosis for L. Hazard ratio (HR) of L to S in males was 0.43 (95% confidence interval [CI], 0.25-0.74; p = 0.002), whereas HR of L to M in females was 1.76 (95% CI, 1.11-2.78; p = 0.016) (p for interaction = 0.003).
Conclusions
Sex-specific association patterns demonstrate the complex influence of anthropomorphic factors in HF patients scheduled for TEER. Further investigation beyond simple evaluation of weight and height is needed for better comprehension of the obesity paradox and better prediction of the results of transcatheter therapy in HF patients.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 14 Sep 2022; epub ahead of print
Higuchi S, Orban M, Adamo M, Giannini C, ... Metra M, Hausleiter J
Int J Cardiol: 14 Sep 2022; epub ahead of print | PMID: 36115443
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Impact:
Abstract

Does moderate hyperkalemia influence survival in HF? Insights from the MECKI score data base.

Toto F, Salvioni E, Magrì D, Sciomer S, ... Agostoni P, MECKI score research group (see appendix)
Background
The prognostic role of moderate hyperkalemia in reduced ejection fraction (HFrEF) patients is still controversial. Despite this, it affects the use of renin-angiotensin-aldosterone system inhibitors (RAASi) with therapy down-titration or discontinuation.
Objectives
Aim of the study was to assess the prognostic impact of moderate hyperkalemia in chronic HFrEF optimally treated patients.
Methods and results
We retrospectively analyzed MECKI (Metabolic Exercise test data combined with Cardiac and Kidney Indexes) database, with median follow-up of 4.2 [IQR 1.9-7.5] years. Data on K+ levels were available in 7087 cases. Patients with K+ plasma level ≥ 5.6 mEq/L and < 4 mEq/L were excluded. Remaining patients were categorized into normal >4 and < 5 mEq/L (n = 4826, 68%) and moderately high ≥5.0 and ≤ 5.5 mEq/L (n = 496, 7%) K+. Then patients were matched by propensity score in 484 couplets of patients. MECKI score value was 7% [IQR 3.1-14.1%] and 7.3% [IQR 3.4-15%] (p = 0.678) in patients with normal and moderately high K+ values while cardiovascular mortality events at two years follow-up were 41 (4.2%) and 33 (3.4%) (p = 0.333) in each group respectively.
Conclusions
Moderate hyperkalemia does not influence patients\' outcome in a large cohort of ambulatory HFrEF patients.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 14 Sep 2022; epub ahead of print
Toto F, Salvioni E, Magrì D, Sciomer S, ... Agostoni P, MECKI score research group (see appendix)
Int J Cardiol: 14 Sep 2022; epub ahead of print | PMID: 36115445
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Impact:
Abstract

Prognostic role of endocarditis in isolated tricuspid valve surgery. A propensity-weighted study.

Di Mauro M, Russo M, Saitto G, Lio A, ... Musumeci F, Andreas M
Objectives
The role of the underlying etiology in isolated tricuspid valve surgery has not been investigated extensively in current literature. Aim of this study was to analyse outcomes of patients undergoing surgery due to endocarditis compared to other pathologies.
Methods
The SURTRI study is a multicenter study enrolling adult patients who underwent isolated tricuspid valve surgery (n = 406, 55 ± 16 y.o.; 56% female) at 13 international sites. Propensity weighted analysis was performed to compare groups (IE group n = 107 vs Not-IE group n = 299).
Results
No difference was found regarding the 30-day mortality (Group IE: 2.8% vs Group Not-IE = 6.8%; OR = 0.45) and major adverse events. Weighted cumulative incidence of cardiac death was significantly higher for patients with endocarditis (p = 0.01). The composite endpoint of cardiac death and reoperation at 6 years was reduced in the Group IE (63.2 ± 6.8% vs 78.9 ± 3.1%; p = 0.022). Repair strategy resulted in an increased late survival even in IE cases.
Conclusions
Data from SURTRI study report acceptable 30-day results but significantly reduced late survival in the setting of endocarditis of the tricuspid valve. Multi-disciplinary approach, repair strategy and earlier treatment may improve outcomes.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 13 Sep 2022; epub ahead of print
Di Mauro M, Russo M, Saitto G, Lio A, ... Musumeci F, Andreas M
Int J Cardiol: 13 Sep 2022; epub ahead of print | PMID: 36108764
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Abstract

Common genetic variants improve risk stratification after the atrial switch operation for transposition of the great arteries.

Woudstra OI, Skoric-Milosavljevic D, Mulder BJM, Meijboom FJ, ... Bouma BJ, Tanck MWT
Background
Clinical factors are used to estimate late complication risk in adults after atrial switch operation (AtrSO) for transposition of the great arteries (TGA), but heterogeneity in clinical course remains. We studied whether common genetic variants are associated with outcome and add value to a clinical risk score in TGA-AtrSO patients.
Methods and results
This multicenter study followed 133 TGA-AtrSO patients (aged 28 [IQR 24-35] years) for 13 (IQR 9-16) years and examined the association of genome-wide single-nucleotide polymorphisms (SNPs) with a composite endpoint of symptomatic ventricular arrhythmia, heart failure hospitalization, ventricular assist device implantation, heart transplantation, or mortality. Thirty-two patients (24%) reached the endpoint. The genome-wide association study yielded one genome-wide significant (p < 1 × 10-8) locus and 18 suggestive loci (p < 1 × 10-5). A genetic risk score constructed on the basis of independent SNPs with p < 1 × 10-5 was associated with outcome after correction for the clinical risk score (HR = 1.26/point increase [95%CI 1.17-1.35]). Risk stratification improved with a combined risk score (clinical score + genetic score) compared to the clinical score alone (p = 2 × 10-16, C-statistic 0.95 vs 0.85). In 51 patients with a clinical intermediate (5-20%) 5-year risk of events, the combined score reclassified 32 patients to low (<5%) and 5 to high (>20%) risk. Stratified by the combined score, observed 5-year event-free survival was 100%, 79% and 31% for low, intermediate, and high-risk patients, respectively.
Conclusions
Common genetic variants may explain some variation in the clinical course in TGA-AtrSO and improve risk stratification over clinical factors alone, especially in patients at intermediate clinical risk. These findings support the hypothesis that including genetic variants in risk assessment may be beneficial.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 12 Sep 2022; epub ahead of print
Woudstra OI, Skoric-Milosavljevic D, Mulder BJM, Meijboom FJ, ... Bouma BJ, Tanck MWT
Int J Cardiol: 12 Sep 2022; epub ahead of print | PMID: 36108765
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Abstract

The association between Day-1 urine cadmium excretion and 30-day mortality in patients with acute myocardial infarction: A multi-institutional cohort study.

Lin HC, Chou SH, Fan PC, Zhu Z, ... Chen SW, Chu PH
Background
The aim of this study was to investigate the relationship between day-1 urine cadmium excretion and 30-day mortality in patients with acute myocardial infarction (AMI) at two centers.
Methods
A total of 286 patients (222 males and 64 females) with AMI from Huashan Hospital, Shanghai and Chang Gung Memorial Hospital, Taiwan were enrolled. Basic vital signs, history, laboratory results, and day-1 urine excretion of cadmium (D1UECd) were recorded. Disease severity was assessed during the first hospitalization using Killip score, APACHE II score, and SOFA score. The main endpoint was 30-day mortality.
Results
Among the 286 patients, 218 were from Chung Gung Memorial Hospital and 68 were from Huashan Hospital with an average age of 64.2 years. Forty (14%) patients died within 30 days after AMI. The average 24-h urine cadmium level among the Chung Gung Memorial Hospital cohort was 1.5 ± 2.4 μg compared to 1.7 ± 1.7 μg among Huashan Hospital cohort, both higher than the local populations. A higher D1UECd level was significantly associated with a greater risk of 30-day mortality (odds ratio 1.68, 95% confidence interval 1.30-2.16) after controlling for a number of covariates. The ability of D1UECd to discriminate 30-day mortality was excellent, with a very high area under the curve (87.2%, 95% CI 82.0-92.5%).
Conclusion
D1UECd was positively correlated and an independent predictor of 30-day mortality in the enrolled AMI patients. D1UECd may be a simple, objective prognostic scoring system in AMI patients.

Copyright © 2022 Elsevier Ireland Ltd. All rights reserved.

Int J Cardiol: 11 Sep 2022; epub ahead of print
Lin HC, Chou SH, Fan PC, Zhu Z, ... Chen SW, Chu PH
Int J Cardiol: 11 Sep 2022; epub ahead of print | PMID: 36103945
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Abstract

Incremental prognostic value of digital positron emission tomography derived myocardial flow reserve: A prospective cohort study.

Ahmed AI, Al Rifai M, Alahdab F, Saad JM, ... Mahmarian JJ, Al-Mallah MH
Background
Positron Emission Tomography (PET) Myocardial Perfusion Imaging (MPI) is a robust diagnostic and prognostic test in patients with suspected or known coronary artery disease (CAD). We aimed to assess the incremental prognostic value of myocardial flow reserve (MFR) using the latest generation of digital PET scanners.
Methods
Consecutive patients with clinically indicated PET MPI for suspected or known CAD were included. Myocardial blood flow (MBF) in ml/min/g was obtained from dynamic images at rest and peak hyperemia, and the myocardial flow reserve (MFR) was calculated as the ratio of stress to rest MBF. Patients were followed from the date of PET imaging for the occurrence of the primary outcome (composite of all-cause death, myocardial infarction, and Percutaneous Coronary Intervention or Coronary Artery Bypass Graft occurring >90 days after imaging). Nested multivariable Cox regression models were used to assess the incremental prognostic role of MFR over traditional risk factors and PET relative perfusion parameters.
Results
The final cohort consisted of 3534 patients (mean age 67 ± 12 years, 48% female, 67% Caucasian, 53% obese, 55% hypertension, 32% diabetes, 42% dyslipidemia). During a median follow-up of 8.5 (3.0-15.4) months, 229 patients (6.5%, 6.4 per 1000 person-years) experienced the primary outcome. In nested multivariable Cox models, impaired MFR (MFR < 2) was significantly associated with the primary outcome (HR 2.9, 95% CI 2.0-4.1, p < 0.001) and significantly improved discrimination (Harrell\'s C 0.77, p = 0.002).
Conclusion
MFR derived from digital PET scanners has an independent and incremental prognostic role in patients with suspected or known CAD.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 09 Sep 2022; epub ahead of print
Ahmed AI, Al Rifai M, Alahdab F, Saad JM, ... Mahmarian JJ, Al-Mallah MH
Int J Cardiol: 09 Sep 2022; epub ahead of print | PMID: 36096273
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Abstract

Patient preferences for newer Oral therapies in type 2 diabetes.

Savarese G, Sharma A, Pang C, Wood R, Soleymanlou N
Background
We aimed to evaluate patient preferences towards three oral antihyperglycaemic therapies using conjoint analysis to determine which attributes may influence use.
Methods
We used an online survey, completed by 553 US respondents with type 2 diabetes mellitus (T2DM; mean age 64 ± 9 years; 55% had cardiovascular [CV] risk; 27% had CV disease), to present hypothetical, blinded, pairwise, drug profile comparison choices, between different benefit-risk attributes and effect ranges. Attributes were derived from phase 3 trials for empagliflozin 25 mg (SGLT2 inhibitor), oral semaglutide 14 mg (GLP-1 receptor agonist) and sitagliptin 100 mg (DPP-4 inhibitor). Predicted therapy preference outcomes and relative importance of each attribute were calculated (presented as a percentage).
Results
Preference score was highest for the profile matching empagliflozin (56%), versus sitagliptin (38%; z-test, P < 0.001) and oral semaglutide (6%, z-test, P < 0.001). Results were overall consistent in subgroup analyses. Genital infection risk was the most important attribute (relative score: 19% [z-test, P = 0.077]). Other important attributes were fasting requirements (15%), weight reduction (15%), risk of vomiting (14%), CV benefit (12%) and risk of nausea (11%). HbA1c reduction (8%) and ability to take medication with other drugs (6%) were considered less important. While blinded to drug name/dose, respondents chose a drug profile similar to empagliflozin (41%) versus sitagliptin (31%), oral semaglutide (11%), or \'none of the options\' (17%).
Conclusion
While the drug profile comparable to empagliflozin was preferred, CV benefit was not the top patient priority. A shared physician-patient decision model and increased patient education are needed to ensure optimal use of guideline-directed T2DM therapies.

Copyright © 2022 The Author. Published by Elsevier B.V. All rights reserved.

Int J Cardiol: 09 Sep 2022; epub ahead of print
Savarese G, Sharma A, Pang C, Wood R, Soleymanlou N
Int J Cardiol: 09 Sep 2022; epub ahead of print | PMID: 36096275
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Abstract

Organizational and patient-level predictors for attaining key risk factor targets in cardiac rehabilitation after myocardial infarction: The perfect-CR study.

Michelsen HÖ, Henriksson P, Wallert J, Bäck M, ... Zaman MJ, Leosdottir M
Background
Benefits of cardiac rehabilitation (CR) programme components on attaining risk factor targets post-myocardial infarction (MI) and their predictive strength relative to patient characteristics remain unclear. We aimed to identify organizational and patient-level predictors of risk factor target attainment at one-year post-MI.
Methods
In this observational study data on CR organization at 78 Swedish CR centres was collected and merged with patient-level registry data (n = 7549). Orthogonal partial least squares discriminant analysis identified predictors (Variables of Importance for the Projection (VIP) values >0.8) of attaining low-density lipoprotein-cholesterol (LDL-C) <1.8 mmol/L, blood pressure (BP) <140/90 mmHg and smoking abstinence.
Results
The strongest predictors (VIP [95% CI]) for attaining LDL-C and BP targets were offering psychosocial management (2.14 [1.78-2.50]; 2.45 [1.91-2.99]), having a psychologist in the CR team (1.62 [1.36-1.87]; 2.05 [1.67-2.44]), extended opening hours (2.13 [2.00-2.27]; 1.50 [0.91-2.10]), adequate facilities (1.54 [0.91-2.18]; 1.89 [1.38-2.40]), and having a medical director (1.70 [0.91-2.48]; 1.46 [1.04-1.88]). The strongest patient-level predictors of attaining LDL-C and/or BP targets were low baseline LDL-C (3.95 [3.39-4.51]) and having no history of hypertension (2.93 [2.60-3.26]), respectively, followed by exercise-based CR participation (1.38 [0.66-2.10]; 1.46 [1.14-1.78]). For smoking abstinence, the strongest organizational predictor was varenicline being prescribed by CR physicians (1.88 [0.95-2.80]) and patient-level predictors were participation in exercise-based CR (2.47 [2.07-2.88]) and group education (1.92 [1.43-2-42]), and no cardiovascular disease history (2.13 [1.78-2.48]).
Conclusions
We identified multiple CR organizational and patient-level predictors of attaining risk factor targets post-MI. These results may influence the future design of comprehensive CR programmes.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 08 Sep 2022; epub ahead of print
Michelsen HÖ, Henriksson P, Wallert J, Bäck M, ... Zaman MJ, Leosdottir M
Int J Cardiol: 08 Sep 2022; epub ahead of print | PMID: 36089158
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Abstract

Moderate walking speed and survival association across 23-years follow-up in female patients with cardiovascular disease.

Raisi A, Zerbini V, Myers J, Masotti S, ... Mazzoni G, Mandini S
Aims
To estimate the association between average walking speed (WS), determined using a moderate 1-km treadmill-walking test (1 k-TWT), and all-cause mortality in female patients with stable cardiovascular disease (CVD).
Methods
A sample of 431 patients (age 67 [34-88] years), performed a 1 k-TWT and were followed for all-cause mortality for up to 23 years. Variables significantly associated with mortality were determined by Cox proportional hazard models. Based on average WS during the 1k_TWT the sample was subdivided into tertiles, and mortality risk was calculated. Receiver-operating-characteristic curves were constructed to assess the discriminatory accuracy of WS for estimating survival.
Results
During a median follow-up of 10.4 years, a total of 135 deaths from any cause occurred, with an average mortality rate of 4.2%. The strongest predictor of mortality was WS (c-statistic for all-cause mortality 0.801, 95% confidence intervals: 0.51-1.11, p < 0.0001). Survival rate decreased from the fastest to the lowest tertile. Compared to the group with the lowest WS, the hazard ratios (95% confidence intervals) for the second and third tertiles were 0.73 (0.48-1.12) and 0.47 (0.25-0.91), respectively (p for trend <0.0001).
Conclusion
Average WS maintained during a moderate treadmill-walk is inversely related to survival in female patients with CVD. The 1 k-TWT is a simple and useful tool for assessing progress and stratifying risk in women undergoing secondary prevention programs.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 08 Sep 2022; epub ahead of print
Raisi A, Zerbini V, Myers J, Masotti S, ... Mazzoni G, Mandini S
Int J Cardiol: 08 Sep 2022; epub ahead of print | PMID: 36089160
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Abstract

E-cigarettes and myocardial infarction: A systematic review and Meta-analysis.

Sharma A, Gupta I, Venkatesh U, Singh AK, Golamari R, Arya P
Background
With widespread awareness about the harmful effects of traditional smoking, many people are considering using an e-cigarette. However, many studies have shown that e-cigarettes are not entirely harmless, and their use has been implicated in causing major adverse cardiovascular events.
Methods
We adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to conduct this systematic review. An electronic search was conducted comprehensively through five databases to find the relevant articles. The odds ratio (OR) was used for comparing groups. Meta-analysis was conducted using R statistical software version 3.4.3. A random-effect model was used.
Results
A total of 4 studies were included in the analysis incorporating data on 585,306 individuals. Of these, 19,435 were e-cigarettes users, while 1693 used only traditional cigarette users, and 553,095 were non-e-cigarette users. 7.0% of e-cigarettes users suffered an MI (myocardial infarction), while 7.7% and 6.5% of traditional smoking and non-e-cigarettes users suffered an MI. The OR of getting an MI in e-cigarettes (e-cigarettes only or e-cigarettes + traditional smoking) users was 1.33 (95% CI = 1.14-1.56, p-value = 0.01) in comparison to non e-cigarette users (traditional smoking or no smoking). While it is 0.61 (95% CI = 0.40-0.93, p-value 0.02) when compared with traditional smoking.
Conclusion
Those using e-cigarettes have higher odds of suffering from an MI in comparison to not using e-cigarettes. However, using e-cigarettes is associated with half risk of the risk of MI in comparison to traditional smoking.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 07 Sep 2022; epub ahead of print
Sharma A, Gupta I, Venkatesh U, Singh AK, Golamari R, Arya P
Int J Cardiol: 07 Sep 2022; epub ahead of print | PMID: 36087629
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Abstract

Mechanical circulatory device utilization in cardiac arrest: Racial and gender disparities and impact on mortality.

Gilani A, Maknojia A, Mufty M, Patel S, Grines CL, Ghatak A
The objectives of this retrospective study include identifying the utilization trend of mechanical circulatory devices (MCD) such as Intra-Aortic Balloon Pump (IABP), Impella and Extracorporeal Membrane Oxygenation (ECMO) in admissions with cardiac arrest, determining whether racial or gender disparities exist in their usage, and discerning if their use is associated with a reduction in mortality. By leveraging the National Inpatient Sample, we identified 229,180 weighted adult cardiac arrest admissions between October 1, 2015 and December 31, 2018. MCD were used in 6005 admissions (2.6%). IABP had the highest utilization, representing 77.8% of all MCDs, followed by Impella at 24.8%. The utilization of IABP decreased from 90.6% to 71.6%, while the use of Impella increased from 13.5% to 29.8% in this study period; both trends were statistically significant. MCD use was found to be lower in women compared to men (1.4% vs 3.6, P < 0.001) and in the Black population compared to White (1.5% vs 2.8%, P < 0.001). There was no difference in MCD utilization between Hispanic and the White cohorts. In-hospital mortality was lower in admissions associated with MCD (31.4% vs 45.9%, P < 0.001). ECMO was associated with the lowest mortality rate at 14.3%, followed by IABP at 28.1%. The use of Impella and combination therapy were not associated with a significant decrease in mortality. In conclusion, MCD use may decrease mortality in cardiac arrest, however their utilization appears to be lower in African Americans and in women.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 07 Sep 2022; epub ahead of print
Gilani A, Maknojia A, Mufty M, Patel S, Grines CL, Ghatak A
Int J Cardiol: 07 Sep 2022; epub ahead of print | PMID: 36087630
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Abstract

Gender differences in health-related quality of life and psychological distress among coronary patients: Does comorbidity matter? Results from the ESC EORP EUROASPIRE V registry.

Vynckier P, Van Wilder L, Kotseva K, Wood D, ... De Smedt D, EUROASPIRE V investigators group
Aims
This study aimed to provide an overview on contemporary gender differences in HRQoL/psychological distress and their relationship with comorbidity burden among European coronary heart disease (CHD) patients.
Methods
Analyses were based on the cross-sectional ESC EORP EUROASPIRE V survey. Consecutive patients (aged 18-80 years), hospitalized for a first or recurrent coronary event were included in this study. Data at hospital discharge and at follow-up (6 to 24 months after hospitalisation) were collected.
Results
Data were available for 8261 patients of which 25.8% women. Overall, women reported a worse EQ-5D-5L index score (0.73 vs. 0.81; P < 0.001), EQ-VAS (63.1 vs. 66.0; P = 0.001), global HeartQoL (1.94 vs. 2.26; P < 0.001), physical HeartQoL (1.96 vs. 2.30; P < 0.001), emotional HeartQoL (1.88 vs. 2.18; P < 0.001), HADS-A (6.69 vs. 4.99; P < 0.001), and HADS-D (5.73 vs. 4.62; P < 0.001) compared to men. Also, women were more likely to have comorbidities compared to men (1 comorbidity: 38.7% vs. 35.0%, 2 comorbidities: 9.7% vs. 7.5%; P < 0.001). There is indication that heart failure (EQ-VAS) and diabetes (global HeartQoL, emotional HeartQoL, physical HeartQoL, and HADS-D) interacted with gender and modulate the relationship with HRQoL, in disfavour of women.
Conclusion
Substantial gender-based health inequalities in terms of HRQoL and psychological distress were found, in disfavour of women. Women had worse HRQoL and psychological distress outcomes when having comorbidities. To a limited extent, comorbidity and women had a negative/synergistic effect on HRQoL. Special attention should be given to this population groups within daily clinical practice.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 07 Sep 2022; epub ahead of print
Vynckier P, Van Wilder L, Kotseva K, Wood D, ... De Smedt D, EUROASPIRE V investigators group
Int J Cardiol: 07 Sep 2022; epub ahead of print | PMID: 36087631
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Abstract

The juvenile ECG pattern in adolescent athletes and non-athletes in a national cardiac screening program (BEAT-IT).

Abela M, Yamagata K, Borg L, Xuereb S, ... Xuereb RG, Grech V
Background
Anterior T wave inversion (TWI) is frequent in healthy adolescent individuals (juvenile ECG pattern), normalising after puberty. Its clinical implications are uncertain. Aim This study assessed a) national prevalence of anterior TWI, b) ST segment morphology, c) proportion of individuals with a juvenile ECG pattern whose ECG normalises and d) factors predicting TWI persistence >16 years.
Methods
Adolescents (mean 15y) in Malta were systematically invited to enrol in a cardiac screening program. Subjects completed a health questionnaire and an ECG at their school. Participants with TWI were labelled as TWI in V1-V2 or extended TWI (V1-V3/4). The latter were followed at 1 year with a repeat ECG. Those with persistent extended anterior TWI were offered evaluation and surveillance.
Results
The prevalence of isolated anterior TWI was 5.0%, commoner in females (6.3%) independent of athletic ability. Extended TWI was commoner in female athletes (4.2%, non-athletes 2.1%). Females often had shallow TWI without overt ST segment abnormalities. Deep TWI and ST segment changes were more frequent in males. Only 0.2% of cases persisted ≥16 years of age. ST segment characteristics were not able to predict T wave normalisation. No events took place during follow up (40 ± 9 months).
Conclusion
Anterior TWI is a frequent phenomenon in adolescents, especially in females. Female athletes are also more likely to have extended anterior TWI. Only 0.2% of cases have persistent anterior TWI at 16 years of age. Chest wall anatomy may explain this phenomenon in females. It is uncommon in males, hence why surveillance is more prudent.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 07 Sep 2022; epub ahead of print
Abela M, Yamagata K, Borg L, Xuereb S, ... Xuereb RG, Grech V
Int J Cardiol: 07 Sep 2022; epub ahead of print | PMID: 36087635
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Abstract

Left ventricular contractance: A new measure of contractile function.

MacIver DH, Scrase T, Zhang H
Aims
Myocardial contractility is poorly defined and difficult to compare between studies. Contractance or myocardial active strain energy (MASED) measures the mechanical work done per unit volume (with units of kJ/m3) of any cardiac tissue in generating contractile stress and undergoing strain. Contractance is an ideal candidate for measuring contractile function as it combines information from both stress and strain.
Methods and results
Data obtained from three previously published experimental studies using trabecular tissue to provide contemporaneous nominal stress and strain data and calculate the contractance in 18 different scenarios with different loading conditions. Contractance varied in the differing loading conditions with values of 1.16 (low preload), 2.02 (high afterload) and 3.76 kJ/m3 (normal) in Study 1. Contractance varied between 0 with isometric loading and 2.14 kJ/m3 with an isotonic and moderate afterload. Increasing inotrope increased contractance to 4.7 kJ/m3.
Conclusion
We showed that calculating MASED was feasible and provided a measure of energy production (work done) per unit volume of myocardium during contraction. The new term for contractile function, contractance, can be defined and quantified by MASED. Contractance measures contractile function in differing preload, afterload and inotropic settings. The method of measuring contractance is transferable to assessment of global and regional systolic function.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 06 Sep 2022; epub ahead of print
MacIver DH, Scrase T, Zhang H
Int J Cardiol: 06 Sep 2022; epub ahead of print | PMID: 36084798
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Impact:
Abstract

Outcomes among heart transplant recipients following acute coronary syndrome: A Nationwide population based study.

Ram P, Shah S, Patel B, Osman M, ... Jaber W, Shah M
Background
For patients with refractory heart failure despite optimal medical therapy, orthotopic heart transplantation (OHT) remains the treatment of choice. Since transplanted hearts have variable cardiac denervation and acute coronary syndrome often presents as a silent myocardial infarction or with atypical symptoms, the true impact of ACS on outcomes within this population needs more study. The aim of this study is to evaluate in-hospital mortality in post-transplant patients with ACS.
Methods
Utilizing data from the 2002-15 Nationwide Inpatient Sample database, patients with a primary diagnosis of acute coronary syndrome among those with prior heart transplantation were included. A risk adjusted regression analysis was performed to assess if ACS post-OHT had an independent impact on the risk of in-hospital mortality. A 2:1 propensity matching was used to match ACS patients with and without OHT, respectively to assess differences in mortality.
Results
A total of 3,224,073 patients with a primary diagnosis of acute coronary syndrome were included, of which 842 (0.03%) were heart-transplant recipients. The type of ACS: NSTEMI (76.0% vs 74.5%; p = 0.32) and STEMI (24.8% vs 26.7%; p = 0.21) between heart transplant and non-heart transplant patients was similar in both groups. Following ACS, patients with heart transplant were more likely to have accompanying shock of any etiology (15.6% vs 3.8%; p < 0.001) and cardiogenic shock (11.2% vs 2.6%; p < 0.001) compared to those with native hearts. OHT patients also had significantly higher in-hospital mortality (14.3% vs. 3.7%; p < 0.001) that remain significant following regression analysis (aOR 3.6, 95% CI 2.8-4.5; p < 0.001) irrespective of the presence of cardiogenic shock compared to native hearts. This relationship remained consistent following propensity matching where patients with OHT had significantly higher in-hospital mortality (13.5% vs. 7%; p < 0.001).
Conclusions
ACS following OHT was more likely to have accompanying cardiogenic shock. ACS in the setting of prior OHT remained a strong independent predictor of higher mortality as compared to native hearts.

Copyright © 2022 Elsevier Ireland Ltd. All rights reserved.

Int J Cardiol: 05 Sep 2022; epub ahead of print
Ram P, Shah S, Patel B, Osman M, ... Jaber W, Shah M
Int J Cardiol: 05 Sep 2022; epub ahead of print | PMID: 36075461
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Impact:
Abstract

Biomarkers in Takayasu arteritis.

Wen D, Feng L, Du X, Dong JZ, Ma CS
Takayasu arteritis (TA) is a rare large vasculitis with unknown etiology, which affects the aorta and its primary branches, as well as the pulmonary and coronary arteries. Cellular and humoral immunity, chronic inflammation, and genetic factors are involved into TA pathogenesis. Several biomarkers, such as MMPs, TIMPs, cytokines, cell adhesion molecules, autoantibodies, complements, PTX3, sRAGE, NT-proBNP, 8-isoPGF2α, NO2-, acute-phase and immunology-related proteins, thrombogenicity markers, ghrelin leptin and adipokines, endothelial damage and repair factors, genetic markers etc., related to the pathogenesis could be observed in patients with TA. These biomarkers have revealed great values in early diagnosis, evaluating disease activity, guiding clinical treatment options, and thus demonstrated significant clinical application values in TA. The combination of biomarkers assay and imaging examination may detect TA more accurately. The aim of this review is to systemically observe the clinical significance of these biomarkers in TA.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 03 Sep 2022; epub ahead of print
Wen D, Feng L, Du X, Dong JZ, Ma CS
Int J Cardiol: 03 Sep 2022; epub ahead of print | PMID: 36067923
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Impact:
Abstract

Prediction of congestive state in acute and chronic heart failure: The association between NT-proBNP and left atrial strain and its prognostic value.

Pastore MC, Mandoli GE, Stefanini A, Ghionzoli N, ... Mondillo S, Cameli M
Background
The relief of congestion is crucial to improve heart failure (HF) patient\'s quality of life and prognosis. N-terminal-pro-brain natriuretic peptide (NT-proBNP) is a well-known marker of congestion, although with limited specificity. Peak atrial longitudinal strain (PALS) by speckle tracking echocardiography (STE) is an index of intracardiac pressure and HF prognosis. We aimed to determine the association between NT-proBNP and PALS and its prognostic implications in patients with HF.
Methods
Patients hospitalized for de-novo or recurrent HF and outpatients with chronic HF were included in this retrospective study. Patients with missing data, previous cardiac surgery, non-feasible STE were excluded. Clinical, laboratory and echocardiographic data were collected. STE was performed on echocardiographic records. Primary endpoint was a combination of all-cause death and HF hospitalization.
Results
Overall, 388 patients were included (172 acute HF, 216 chronic HF, mean age = 65 ± 12 years, 37% female). Mean LV ejection fraction = 31 ± 9%. Global PALS showed a significant inverse correlation with NT-proBNP in acute and chronic HF (all p < 0.001). During a median follow-up of 4 years, 180 patients reached the combined endpoint. NT-proBNP (AUC = 0.87) and global PALS (AUC = 0.82) were good predictors of the combined endpoint. Global PALS was the only independent predictor of the combined endpoint. Optimal risk stratification for the composite endpoint was provided combining PALS ≤15% and NTproBNP ≥874.5 ng/l.
Conclusions
Global PALS is associated with NT-proBNP in acute and chronic HF and may be used as additional index of congestion to optimize therapeutic management. The combination of global PALS and NT-proBNP could enhance the prognostic stratification of HF.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 03 Sep 2022; epub ahead of print
Pastore MC, Mandoli GE, Stefanini A, Ghionzoli N, ... Mondillo S, Cameli M
Int J Cardiol: 03 Sep 2022; epub ahead of print | PMID: 36067924
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Impact:
Abstract

MicroRNA-29b regulates pyroptosis involving calcific aortic valve disease through the STAT3/SOCS1 pathway.

Fang M, Li B, Li X, Wang Y, Zhuang Y
Background
CAVD (calcific aortic valve disease) involves an inflammatory response similar to pyroptosis; therefore, we speculated that the progression of pyroptosis might be involved in the pathogenesis of CAVD.
Methods
We first investigated the expression of pyroptosis related genes in human CAVD, non-CAVD control and AS (calcific aortic stenosis) tissues. We further confirmed these genes by using CAVD cell and mouse models. Finally, we explored the functional molecular mechanism in the cell model.
Results
Our recent studies found that miR-29b plays an important role in CAVD, and we wanted to further address whether miR-29b is a key factor in the progression of pyroptosis related to CAVD. In this study, we found NLRP3 was highly expressed in CAVD patients and models. In contrast, SOCS1, a suppressor of NLRP3, showed reduced expression in CAVD. Furthermore, we found that ASC, Caspase-1, IL-1β, Cleaved IL-18 and p-JAK2 were all upregulated in the tissues of CAVD patients, suggesting the likelihood of activation of the inflammasome. Then, we found that miR-29b participated in the NLRP3-regulated CAVD pathway through its target gene STAT3 (signal transducer and activator of transcription 3). Finally, we found that a miR-29b inhibitor could mitigate the increases in osteogenic differentiation and pyroptosis and that SOCS1 showed negative regulation of osteogenic differentiation and pyroptosis in CAVD.
Conclusion
These findings suggested NLRP3 inflammasome-related genes are highly expressed in CAVD, and miR-29b reverses osteoblastic differentiation of aortic valve interstitial cells by regulating pyroptosis and inhibiting inflammation via the STAT3/SOCS1 pathway.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 02 Sep 2022; epub ahead of print
Fang M, Li B, Li X, Wang Y, Zhuang Y
Int J Cardiol: 02 Sep 2022; epub ahead of print | PMID: 36064035
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Abstract

Changes of left ventricular remodeling due to increased afterload in patients with essential hypertension.

Hamada M, Ogimoto A, Otani T, Ohshima K, ... Tasaka T, Ikeda S
Background
It is unclear whether afterload mismatch occurs during the initial stage of essential hypertension (EHT). Additionally, critical left ventricular hypertrophy (LVH) between preserved and reduced systolic functions in hypertension is also unclear. Thus, we aimed to clarify these points.
Methods
Forty-five normal control subjects (NCS) and 140 EHT patients participated. EHT patients were subdivided into three groups: group I, without LVH (n = 37); group II, with LVH (n = 80); and group III, with LVH and LV heart failure (LVHF) (n = 23). Routine electrocardiographic and echocardiographic parameters, V5R/V6R ratio, relative wall thickness (RWT), LV mass (LVM) index, and peak systolic wall stress (PSWS) were measured.
Results
In group I, LV systolic functions were preserved despite the increase of PSWS. In group II, LVH advanced, but LV systolic functions remained normal. A negative T-wave was observed in 69% of group II and 100% of group III. A significant correlation between RWT and LVM index was seen in NCS and groups I and II (r2 = 0.545, P < 0.0001) but not in group III. Afterload mismatch occurred in group III due to the decrease in V5R/V6R ratio, the increase of LV end-diastolic dimension, and the LV systolic dysfunctions, which are caused by exhaustion of preload reserve. The boundary of the LVM index between groups II and III was approximately 180 g/m2.
Conclusion
Afterload mismatch did not occur in group I, but it was observed in group III due to the exhaustion of preload reserve. (246).

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 02 Sep 2022; epub ahead of print
Hamada M, Ogimoto A, Otani T, Ohshima K, ... Tasaka T, Ikeda S
Int J Cardiol: 02 Sep 2022; epub ahead of print | PMID: 36064037
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Abstract

Sex-related differences among young adults with heart failure in Sweden.

Basic C, Rosengren A, Dahlström U, Edner M, ... Zverkova-Sandström T, Schaufelberger M
Background
Differences between the sexes among the non-elderly with heart failure (HF) have been insufficiently evaluated. This study aims to investigate sex-related differences in early-onset HF.
Methods
Patients aged 18 to 54 years who were registered from 2003 to 2014 in the Swedish Heart Failure Register were included. Each patient was matched with two controls from the Swedish Total Population Register. Data on comorbidities and outcomes were obtained through the National Patient Register and Cause of Death Register.
Results
We identified 3752 patients and 7425 controls. Of the patients, 971 (25.9%) were women and 2781 (74.1%) were men with a mean (standard deviation) age of 44.9 (8.4) and 46.4 (7.3) years, respectively. Men had more hypertension and ischemic heart disease, whereas women had more congenital heart disease and obesity. During the median follow-up of 4.87 years, 26.5 and 24.7 per 1000 person-years male and female patients died, compared with 3.61 and 2.01 per 1000 person-years male and female controls, respectively. The adjusted hazard ratios for all-cause mortality, compared with controls, were 4.77 (3.78-6.01) in men and 7.84 (4.85-12.7) in women (p for sex difference = 0.11). When HF was diagnosed at 30, 35, 40, and 45 years, women and men lost up to 24.6 and 24.2, 24.4 and 20.9, 20.5 and 18.3, and 20.7 and 16.5 years of life, respectively.
Conclusion
Long-term mortality was similar between the sexes. Women lost more years of life than men.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 01 Sep 2022; 362:97-103
Basic C, Rosengren A, Dahlström U, Edner M, ... Zverkova-Sandström T, Schaufelberger M
Int J Cardiol: 01 Sep 2022; 362:97-103 | PMID: 35490786
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Abstract

A systematic cohort review of pheochromocytoma-induced typical versus atypical Takotsubo cardiomyopathy.

Aw A, de Jong MC, Varghese S, Lee J, Parameswaran R
Background
A rare presentation of pheochromocytoma (PCC) is catecholamine-induced-cardiomyopathy, or Takotsubo cardiomyopathy (TCM). PCC-induced TCM(PCC-TCM) can present as a typical or atypical type, based on the location of cardiac wall motion abnormalities. In this review, we sought to assess features and outcomes for PCC-TCM, and to compare typical and atypical subtypes.
Methods
A search was conducted on two databases (PubMed and Embase) for case series or reports on PCC-TCM from 2006 to 2020.
Results
One-hundred-and-two papers with a total of 104 cases of PCC-TCM were retrieved: 67(64.4%) typical and 37(35.6%) atypical subtypes. Overall median age was 50[range:23-86] years, the atypical group about a decade younger(p < 0.001). A female preponderance was seen for either subtype (~75%). The most common presentations were chest pain(n = 60;58%), dyspnoea(n = 46;44%), and headache(n = 41;39.4%). Those with atypical subtype more often presented with fluid overload (typical:3% versus atypical:60%); acute pulmonary oedema (35% versus 60%); and cardiogenic shock (22% versus 43%) (all p < 0.05). Six patients (6%) died pre-operatively (typical:8% versus atypical:3%; p = 0.32). Non-fatal pre-operative complications occurred more among those with atypical TCM(p < 0.001), specifically cardiac arrest (typical:5% versus atypical:32%) and respiratory failure (9% versus 24%; both p < 0.05). Overall, 98 underwent surgery, majority undergoing laparoscopic adrenalectomy (81%); similar among the subtypes(p = 0.71). No robust data was provided on short-term outcomes, although two patients suffered from post-operative complications.
Conclusion
Although quite similar in presentation to either standalone TCM or PCC, PCC-TCM seems to be associated with a higher degree of morbidity and mortality. The atypical PCC-TCM subgroup seems to have a more severe course with possibly a poorer outcome. Further research is needed to make more reliable inferences.

Copyright © 2022 Elsevier Ireland Ltd. All rights reserved.

Int J Cardiol: 30 Aug 2022; epub ahead of print
Aw A, de Jong MC, Varghese S, Lee J, Parameswaran R
Int J Cardiol: 30 Aug 2022; epub ahead of print | PMID: 36055473
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Abstract

The role of anemia on admission in acute coronary syndrome - An umbrella review of systematic reviews and meta-analyses.

Jung C, Rezar R, Wischmann P, Masyuk M, ... Kelm M, Wernly B
Introduction
The role of erythrocytes in the acute coronary syndrome (ACS) is complex. The aim of this review in terms of PICO (P: patients; I: intervention; C: comparison; O: outcome) was to summarize systematic reviews in patients (P) with acute coronary syndrome, evaluating the effects of (I) 1) iron deficiency, 2) administration of an erythropoiesis-stimulating agent (ESA), 3) anemia on admission, 4) red blood cell transfusion, 5) a restrictive transfusion strategy in comparison (C) to 1) no iron deficiency, 2) no ESA 3) no anemia on admission, 4) no red blood cell transfusion, 5) a liberal transfusion strategy on mortality (O).
Methods
We used AMSTAR2 to assess the methodological quality of systematic reviews and grade the available research. The primary endpoint was all-cause mortality.
Results
Using the data from 2,787,005 patients, the following conditions were associated with worse outcome in patients with ACS: anemia on admission (RR 2.08 95%CI 1.70-2.55) and transfusion (1.93 95%CI 1.12-3.34) of red blood cells. A liberal transfusion (RR 0.86 95%CI 0.70-1-05), administration of ESA (RR 0.55 95%CI 0.22-1.33) and iron deficiency (OR 1.24 95%CI 0.12-13.13) were not associated with altered all-cause mortality.
Conclusion
Patients suffering from ACS and anemia on admission are at particular risk for adverse outcome. There is evidence of associations between adverse outcomes and receiving red blood cell transfusions.

Copyright © 2022 Elsevier Ireland Ltd. All rights reserved.

Int J Cardiol: 30 Aug 2022; epub ahead of print
Jung C, Rezar R, Wischmann P, Masyuk M, ... Kelm M, Wernly B
Int J Cardiol: 30 Aug 2022; epub ahead of print | PMID: 36055474
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Abstract

Hospital-associated disability and hospitalization costs for acute heart failure stratified by body mass index- insight from the JROAD/JROAD-DPC database.

Ogawa M, Yoshida N, Nakai M, Kanaoka K, ... Izawa KP, Hirata KI
Background
The impact of body mass index (BMI) on hospital mortality in patients with acute heart failure has been well documented in Asian populations. However, the relationship between BMI, hospital-associated disability (HAD), and hospitalization costs in patients with heart failure is poorly understood. This study aimed to explore the impact of BMI on HAD and hospitalization costs for acute heart failure in Japan.
Methods
From April 2012 to March 2020, the Japanese Registry of All Cardiac and Vascular Disease Diagnosis Procedure Combination (JROAD-DPC) database was used to identify patients with acute heart failure. All patients were categorized into five groups according to the World Health Organization Asian BMI criteria. The hospitalization costs and HAD were evaluated.
Results
Among the 238,160 eligible patients, 15.7% were underweight, 42.2% were normal, 16.7% were overweight, 19.3% were obese I, and 6.0% were obese II, according to BMI. The prevalence of HAD was 7.43% in the total cohort, and the risk of HAD increased with a lower BMI. Restricted cubic spline analysis showed a U-shaped relationship between BMI and hospitalization costs for all ages. Furthermore, developing HAD was associated with greater costs compared with non-HAD, regardless of BMI category.
Conclusions
We found that the lower the BMI, the higher the incidence of HAD. A U-shaped association was confirmed between BMI and hospitalization costs, indicating that hospitalization costs increased for both lower and higher BMI regardless of age. BMI could be an important and informative risk stratification tool for functional outcomes and economic burdens.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 24 Aug 2022; epub ahead of print
Ogawa M, Yoshida N, Nakai M, Kanaoka K, ... Izawa KP, Hirata KI
Int J Cardiol: 24 Aug 2022; epub ahead of print | PMID: 36029847
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Abstract

Short-term mortality differs between men and women according to the presence of previous cardiovascular disease: Insights from a nationwide STEMI cohort.

González-Del-Hoyo M, Rodríguez-Leor O, Cid-Álvarez AB, de Prado AP, ... Rossello X, Working Group on the Infarct Code of the Interventional Cardiology Association of the Spanish Society of Cardiology (Grupo de Trabajo de Código Infarto de la Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología)
Background
Sex and prior cardiovascular disease (CVD) are known independent prognostic factors following an ST-elevation myocardial infarction (STEMI). We aimed to examine whether the association between sex and 30-day mortality differ according to the presence of previous CVD in STEMI patients.
Methods
Prospective, observational, multicentre registry of consecutive patients managed in 17 STEMI networks in Spain (83 centres), between April and June 2019. Unadjusted and adjusted logistic regression models assessed the association of 30-day mortality with sex and prior CVD status, as well as their interaction.
Results
Among 4366 patients (mean age 63.7 ± 13.0 years; 78% male), there were 337 (8.1%) deaths within the first 30 days. There was an association between crude 30-day mortality and sex (women 10.4% vs. men 7.4%, p = 0.003), and prior CVD (CVD 13.7% vs non-CVD 6.8%, p < 0.001). After adjustment for potential confounding, neither sex nor prior CVD were apparently associated with mortality. Nevertheless, we found a significant sex-CVD interaction (p-interaction = 0.006), since women were at lower risk than men in the subset of patients with prior CVD (OR = 0.30, 95%CI = 0.12-0.80) but not in those without CVD (OR = 1.17, 95%CI = 0.79-1.74).
Conclusions
Women as well as patients with prior CVD have an increased crude risk of 30-day mortality. However, sex-related differences in short term mortality are modulated by the interaction with CVD in STEMI patients. Compared to men, women had a similar prognosis in the subset of patients without CVD, whereas they were associated with a lower risk of mortality among those with prior CVD after adjusting for other prognostic factors.

Copyright © 2022 Elsevier B.V. All rights reserved.

Int J Cardiol: 24 Aug 2022; epub ahead of print
González-Del-Hoyo M, Rodríguez-Leor O, Cid-Álvarez AB, de Prado AP, ... Rossello X, Working Group on the Infarct Code of the Interventional Cardiology Association of the Spanish Society of Cardiology (Grupo de Trabajo de Código Infarto de la Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología)
Int J Cardiol: 24 Aug 2022; epub ahead of print | PMID: 36030132
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Abstract

Utility of P-wave abnormalities for distinguishing embolic stroke from non-embolic stroke.

Iwakawa H, Terata K, Kato R, Kaimori R, ... Sato W, Watanabe H
Background
Our aim was to analyze the incidence of P-wave abnormalities in embolic and non-embolic strokes, and evaluate its clinical usefulness for predicting stroke etiology.
Methods
We included 376 consecutive patients hospitalized for acute ischemic stroke from January 2015 to September 2021. Among the patients in sinus rhythm at admission, 31 had ischemic stroke due to atrial fibrillation (AF)-related embolism, 59 had embolic stroke of unknown source (ESUS), and 143 had non-embolic stroke. P-wave abnormalities were defined as 1. P-wave axis abnormality (PWAA); 2. P-wave terminal force in V1 (PTFV1) ≤ -4000 μV*ms; 3. advanced inter-atrial block (A-IAB).
Results
The prevalence of each type of abnormality was consistently lower in patients with non-embolic stroke than in those with AF-related embolism (AF-related vs. ESUS vs. non-embolic; PWAA, 45% vs. 20% vs. 14%; PTFV1, 36% vs. 37% vs. 15%; and A-IAB, 55% vs. 31% vs. 13%, respectively). The identification of at least one type of P-wave abnormality improved the sensitivity compared to using a single abnormality parameter (sensitivity 72%, specificity 62%), while at least two types of abnormality had low sensitivity, but high specificity (sensitivity 29%, specificity 95%). Multivariate regression analysis revealed that identification of at least one type of P-wave abnormality was independently associated with embolic stroke (odds ratio 3.11, 95%CI 1.46-6.63).
Conclusions
The incidence of each type of P-wave abnormality was significantly lower in patients with non-embolic stroke. A combination of PWAA, PTFV1, and A-IAB parameters could be useful for distinguishing embolic from non-embolic stroke.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 23 Aug 2022; epub ahead of print
Iwakawa H, Terata K, Kato R, Kaimori R, ... Sato W, Watanabe H
Int J Cardiol: 23 Aug 2022; epub ahead of print | PMID: 36028092
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Abstract

Association of left ventricular flow energetics with remodeling after myocardial infarction: New hemodynamic insights for left ventricular remodeling.

Demirkiran A, van der Geest RJ, Hopman LHGA, Robbers LFHJ, ... Plein S, Garg P
Background
Myocardial infarction leads to complex changes in left ventricular (LV) hemodynamics. It remains unknown how four-dimensional acute changes in LV-cavity blood flow kinetic energy affects LV-remodeling.
Methods and results
In total, 69 revascularised ST-segment elevation myocardial infarction (STEMI) patients were enrolled. All patients underwent cardiovascular magnetic resonance (CMR) examination within 2 days of the index event and at 3-month. CMR examination included cine, late gadolinium enhancement, and whole-heart four-dimensional flow acquisitions. LV volume-function, infarct size (indexed to body surface area), microvascular obstruction, mitral inflow, and blood flow KEi (kinetic energy indexed to end-diastolic volume) characteristics were obtained. Adverse LV-remodeling was defined and categorized according to increase in LV end-diastolic volume of at least 10%, 15%, and 20%. Twenty-four patients (35%) developed at least 10%, 17 patients (25%) at least 15%, 11 patients (16%) at least 20% LV-remodeling. Demographics and clinical history were comparable between patients with/without LV-remodeling. In univariable regression-analysis, A-wave KEi was associated with at least 10%, 15%, and 20% LV-remodeling (p = 0.03, p = 0.02, p = 0.02, respectively), whereas infarct size only with at least 10% LV-remodeling (p = 0.02). In multivariable regression-analysis, A-wave KEi was identified as an independent marker for at least 10%, 15%, and 20% LV-remodeling (p = 0.09, p < 0.01, p < 0.01, respectively), yet infarct size only for at least 10% LV-remodeling (p = 0.03).
Conclusion
In patients with STEMI, LV hemodynamic assessment by LV blood flow kinetic energetics demonstrates a significant inverse association with adverse LV-remodeling. Late-diastolic LV blood flow kinetic energetics early after acute MI was independently associated with adverse LV-remodeling.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 22 Aug 2022; epub ahead of print
Demirkiran A, van der Geest RJ, Hopman LHGA, Robbers LFHJ, ... Plein S, Garg P
Int J Cardiol: 22 Aug 2022; epub ahead of print | PMID: 36007668
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Abstract

The prevalence of persistent bacteraemia in patients with a non-staphylococcal infective endocarditis, a retrospective cohort study.

van der Vaart TW, Stuifzand M, Boekholdt SM, Cramer MJ, ... Prins JM, van der Meer JTM
Background
Current guidelines on the management of infective endocarditis (IE) recommend follow-up blood cultures (FUBCs) to identify persistent bacteraemia, as this has prognostic value and guides treatment decisions. While persistent bacteraemia frequently occurs in Staphylococcus aureus bacteraemia and IE, its prevalence and impact in non-staphylococcal IE is largely unknown. We determined prevalence and prognostic value of persistent bacteraemia in non-staphylococcal IE.
Methods
We conducted a retrospective analysis of all patients diagnosed with definite non-staphylococcal endocarditis according to the modified Duke Criteria in two university hospital endocarditis registries We determined the prevalence and prognostic value of persistent bacteraemia.
Results
Of the included 159 patients 70 (44%) had prosthetic valve endocarditis (PVE). A median number of two [IQR 1-3] FUBCs were taken during the first week, with 134/159 (84%) having at least one FUBC in the first four days. Seven patients (4,4%) had persistent bacteraemia 48 h after start of antibiotic treatment: 5/70 patients (7.1%) with PVE and 2/89 (2.2%) with native valve endocarditis. Among 97 patients with streptococcal IE, nine patients with HACEK IE and six patients with Cutibacterium IE, no persistent bacteraemia was observed. Enterococcus faecalis was the causative microorganism in five patients with persistent bacteraemia, the other two had non-HACEK Gram-negative endocarditis.
Conclusion
Persistent bacteraemia in non-staphylococcal endocarditis was rare. It was more frequently observed in PVE and was restricted to more resilient microorganisms such as enterococci and non-HACEK Gram-negative bacteria. Routine collection of FUBCs in patients with streptococcal endocarditis has a low yield and may require re-evaluation.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 21 Aug 2022; epub ahead of print
van der Vaart TW, Stuifzand M, Boekholdt SM, Cramer MJ, ... Prins JM, van der Meer JTM
Int J Cardiol: 21 Aug 2022; epub ahead of print | PMID: 36002040
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Abstract

Cardiogenic shock related cardiovascular disease mortality trends in US population: Heart failure vs. acute myocardial infarction as contributing causes.

Ghajar A, Ordonez CP, Philips B, Pinzon PQ, ... Sabe M, Garan AR
Background
Observational and trial data have revealed significant improvement in cardiogenic shock (CS) mortality due to acute myocardial infarction (AMI) after introducing early coronary revascularization. Less is known about CS mortality due to heart failure (HF), which is increasingly recognized as a distinct entity from AMI-CS.
Methods and results
In this nationwide observational study, the CDC WONDER database was used to identify national trends in age-adjusted mortality rates (AAMR) due to CS (HF vs. AMI related) per 100,000 people aged 35-84. AAMR from AMI-CS decreased significantly from 1999 to 2009 (AAPC: -6.9% [95%CI -7.7, -6.1]) then stabilized from 2009 to 2020. By contrast, HF-CS associated AAMR rose steadily from 2009 to 2020 (AAPC: 13.3% [95%CI 11.4,15.2]). The mortality rate was almost twice as high in males compared to females in both AMI-CS and HF-CS throughout the study period. HF-CS mortality in the non-Hispanic Black population is increasing more quickly than that of the non-Hispanic White population (AAMR in 2020: 4.40 vs. 1.97 in 100,000). The AMI-CS mortality rate has been consistently higher in rural than urban areas (30% higher in 1999 and 28% higher in 2020).
Conclusions
These trends highlight the fact that HF-CS and AMI-CS represent distinct clinical entities. While mortality associated with AMI-CS has primarily declined over the last two decades, the mortality related to HF-CS has increased significantly, particularly over the last decade, and is increasing rapidly among individuals younger than 65. Accordingly, a dramatic change in the demographics of CS patients in modern intensive care units is expected.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 21 Aug 2022; epub ahead of print
Ghajar A, Ordonez CP, Philips B, Pinzon PQ, ... Sabe M, Garan AR
Int J Cardiol: 21 Aug 2022; epub ahead of print | PMID: 36002041
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Abstract

N(6)-methyladenosine modification: A vital role of programmed cell death in myocardial ischemia/reperfusion injury.

Wang J, Li Y, Zhang S
N(6)-methyladenosine (m6A) modification is closely associated with myocardial ischemia/reperfusion injury (MIRI). As the most common modification among RNA modifications, the reversible m6A modification is processed by methylase (\"writers\") and demethylase (\"erasers\"). The biological effects of RNA modified by m6A are regulated under the corresponding RNA binding proteins (RBPs) (\"readers\"). m6A modification regulates the whole process of RNA, including transcription, processing, splicing, nuclear export, stability, degradation, and translation. Programmed cell death (PCD) is a regulated mechanism that maintains the internal environment\'s stability. PCD plays an essential role in MIRI, including apoptosis, autophagy, pyroptosis, ferroptosis, and necroptosis. However, the relationship between PCD modified with m6A and MIRI is still not clear. This review summarizes the regulators of m6A modification and their bioeffects on PCD in MIRI.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 21 Aug 2022; epub ahead of print
Wang J, Li Y, Zhang S
Int J Cardiol: 21 Aug 2022; epub ahead of print | PMID: 36002042
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Abstract

The lncRNA MRPL20-AS1 is associated with severe OSAS and downregulated upon hypoxic injury of endothelial cells.

Zietzer A, Breitrück N, Düsing P, Böhle S, ... Jansen F, Jansen S
Introduction
Obstructive sleep apnea syndrome (OSAS) is the most common sleep disorder in humans. Although OSAS is clearly related to arterial hypertension, coronary artery disease, and heart failure, it remains unknown through which pathomechanisms OSAS influences cardiovascular health. Recent research has pinpointed long non-coding RNAs (lncRNA) as important molecular mediators of various cardiovascular pathologies. In this study, we have identified the lncRNA MRPL20-AS1 to be affected by OSAS in patients as well as by hypoxia in vitro.
Methods and results
A transcriptomic analysis was performed on peripheral blood from four patients with severe OSAS taken after one night of polygraphic assessment. We found that three lncRNAs were significantly dysregulated, of which MRPL20-AS1 was the most significant. In a larger cohort of 22 OSAS patients, MRPL20-AS1 was inversely correlated with the apnea-hypopnea index (AHI). This indicates that OSAS patients with higher AHI levels and therefore more severe OSAS had lower levels of MRPL20-AS1 in the blood. The results were recapitulated in vitro by subjecting endothelial cells to hypoxia. In these experiments, hypoxia led to a significant downregulation of MRPL20-AS1 in endothelial cells.
Conclusion
MRPL20-AS1 may serve as a useful tool to identify patients suffering from severe OSAS and further research should be done to evaluate the therapeutic potential of MRPL20-AS1 as a target to counteract the cardiovascular effects of OSAS.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 18 Aug 2022; epub ahead of print
Zietzer A, Breitrück N, Düsing P, Böhle S, ... Jansen F, Jansen S
Int J Cardiol: 18 Aug 2022; epub ahead of print | PMID: 35988669
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Impact:
Abstract

Visceral fat might impact left ventricular remodeling through changes in arterial stiffness in type 2 diabetes: A cross-sectional study.

Huang H, Jin J, Chen Y, Wang L, ... Chen Z, Xu L
Aims
Visceral fat (VF) influences left ventricular (LV) structure and diastolic function in type 2 diabetes (T2DM). However, there are limited data on the association among them based on different BMI levels as well as accounting for arterial stiffness. This study investigated the association of fat distribution, arterial stiffness, left ventricular (LV) structure and diastolic function in T2DM patients.
Materials and methods
This cross-sectional study comprised 905 patients. VF area (VFA) and subcutaneous fat area (SFA) were assessed by a dual bioelectrical impedance analyzer. Brachial-ankle pulse wave velocity (baPWV) was measured by a volume-plethysmographic apparatus and LV structure and diastolic function were echocardiography. Patients were divided into three groups based on BMI levels. Linear and logistic regression analysis were used to investigate the association.
Results
In multivariate linear regression, relative wall thickness (RWT) was negatively correlated with E/A in obese patients (β = -0.203, p = 0.004). LV mass/height2.7 was positively correlated with E/E\' in normal weight (β = 0.232, p = 0.002) and obese patients (β = 0.232, p = 0.008). In multivariate logistic regression, baPWV was an independent determinant of LV remodeling (LVRM) in normal weight (OR = 1.001; 95% CI, 1.000,1.002; P = 0.006), overweight (OR = 1.001; 95% CI, 1.000,1.002; P = 0.008) and obese groups (OR = 1.003; 95% CI, 1.001,1.004; P = 0.001), while VFA was correlated with arterial stiffness in normal weight (OR = 1.032; 95% CI, 1.017,1.047; P < 0.001) and overweight groups (OR = 1.011; 95% CI, 1.002,1.021; P = 0.015).
Conclusions
VF might impact LVRM through changes in baPWV in T2DM patients, thus influencing diastolic function.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 18 Aug 2022; epub ahead of print
Huang H, Jin J, Chen Y, Wang L, ... Chen Z, Xu L
Int J Cardiol: 18 Aug 2022; epub ahead of print | PMID: 35988671
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Impact:
Abstract

Impact of secondary prevention medical therapies on outcomes of patients suffering from Myocardial Infarction with NonObstructive Coronary Artery disease (MINOCA): A meta-analysis.

De Filippo O, Russo C, Manai R, Borzillo I, ... De Ferrari GM, D\'Ascenzo F
Aims
To assess the impact of secondary prevention medical therapies (statins, ACE-inhibitors/Angiotensin Receptor Blockers (ARB), beta-blockers (BB) and Dual Antiplatelet Therapy (DAPT)) on outcomes of patients with myocardial infarction with nonobstructive coronary artery disease (MINOCA).
Methods
Five adjusted observational studies encompassing 10,546 were included in this meta-analysis. All-cause death was the primary endpoint, while Major Adverse Cardiovascular Events (MACE) and acute myocardial infarction (AMI) were the secondary endpoints.
Results
After 24 months of follow up, statins (tested in 8093 patients) were associated with a reduced risk of all-cause death (HR 0.60:0.45-0.81, p 〈0,001), while ACE-inhibitors/ARB (on 9666 patients) were not. Aggregate data from two studies (n = 9720, 7719 on beta-blockers, 6423 on DAPT) indicated that beta-blockers and DAPT (median follow-up 34.1 and 15.7 months, respectively) were both associated with a significant reduction of all-cause death (HR0.81:0.66-0.99, p = 0.04, and HR0.73:0.55-0.98, p = 0.03, for beta-blockers and DAPT, respectively). Among the investigated therapies, only ACE-inhibitors/ARBs entailed a reduced risk of MACE (HR0.65:0.44-0.94, p = 0.02, all CI 95%) over 36.5 months (four studies, n = 10,150). None of the investigated therapies was associated with a reduced risk of AMI.
Conclusions
Data from adjusted observational studies suggest that beta-blockers, statins and DAPT are associated with a survival benefit among MINOCA patients. ACE-inhibitors/ARB entail a reduced risk of MACE while none of the investigated secondary prevention therapies is associated with a reduced risk of AMI. Randomized controlled trials are warranted to confirm these findings.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 17 Aug 2022; epub ahead of print
De Filippo O, Russo C, Manai R, Borzillo I, ... De Ferrari GM, D'Ascenzo F
Int J Cardiol: 17 Aug 2022; epub ahead of print | PMID: 35987312
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Impact:
Abstract

Nicorandil attenuates ventricular dysfunction and organ injury after cardiopulmonary bypass.

Peng YW, Major T, Deatrick KB, Mohammed A, Jeakle M, Charpie JR
Background
Nicorandil, an adenosine triphosphate-sensitive potassium channel agonist and nitric oxide donor, is a coronary vasodilator used to treat ischemia-induced chest pain, but it\'s potential cardioprotective benefits during open heart surgery have not been thoroughly investigated. The study objective was to assess the impact of nicorandil on postoperative ventricular dysfunction and end-organ injury in an established experimental model of open-heart surgery with cardiopulmonary bypass (CPB) and cardioplegic arrest. We hypothesized that nicorandil would attenuate myocardial ischemia-reperfusion (IR) injury, preserve ventricular function, and reduce end-organ injury.
Methods
Rabbits were cannulated for CPB, followed by 60 min of aortic cross-clamp (ACC) with cold cardioplegic arrest, and 120 min of recovery after ACC removal. Nicorandil (or normal saline vehicle) was given intravenously 5 min before ACC and continued throughout the recovery period. Left ventricular developed pressure (LVDP), systolic contractility (LV + dP/dt), and diastolic relaxation (LV -dP/dt) were continuously recorded, and blood and tissue samples were collected for measurement of oxidant stress (OS), inflammation, apoptosis, and organ injury.
Results
Nicorandil significantly attenuated IR-induced LV dysfunction compared to saline control (R-120: LV + dP/dt: 1596 ± 397 vs. 514 ± 269 mmHg/s, p = 0.010; LV -dP/dt: -1524 ± 432 vs. -432 ± 243 mmHg/s, p < 0.001; LVDP: 55 ± 11 vs. 22 ± 5 mmHg, p = 0.046). Furthermore, nicorandil inhibited IR-induced increases in OS, inflammation, apoptosis, and organ injury.
Conclusions
Nicorandil exhibits myocardial protection by attenuation of IR-induced LV dysfunction associated with OS, inflammation, apoptosis, and organ injury. Nicorandil should be explored further as a potential therapeutic strategy for limiting global IR injury during open-heart surgery in humans.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 17 Aug 2022; epub ahead of print
Peng YW, Major T, Deatrick KB, Mohammed A, Jeakle M, Charpie JR
Int J Cardiol: 17 Aug 2022; epub ahead of print | PMID: 35987313
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Impact:
Abstract

Hemodynamic effects of balloon pulmonary angioplasty for the treatment of total and subtotal pulmonary artery occlusions in inoperable chronic thromboembolic pulmonary hypertension.

Stępniewski J, Magoń W, Waligóra M, Jonas K, ... Podolec P, Kopeć G
Background
Balloon pulmonary angioplasty (BPA) has become a therapeutic option for inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Despite significant improvement in the technique, treatment of subtotal (STO) and total (TO) pulmonary artery occlusions with BPA may pose risk, but the efficacy is less known.
Aim
We aimed to evaluate the safety and efficacy of BPA in STO/TO.
Methods
We included consecutive patients with inoperable CTEPH, who underwent BPA treatment. To evaluate the efficacy and safety we grouped all BPA sessions into these in which recanalization of at least one STO or TO was performed and into those without. The primary efficacy outcome was a decrease of pulmonary vascular resistance (PVR) after BPA sessions with STO/TO recanalization as compared to those without.
Results
We analysed 169 BPA sessions in 50 CTEPH patients. Out of a total number of 831 lesions subjected for BPA, 169 were classified as STOs or TOs [123 (15,6%) and 39 (4,7%) respectively]. At least one STO/TO recanalization was successfully performed during 90 BPA sessions. Three (2,3%) STOs and 8 (20,5%) TOs were not recanalized despite repeated attempts. Recanalization of at least one STO/TO at the level of segmental pulmonary artery was associated with a significant PVR improvement as compared to subsegmental-only STO/TO recanalizations or no recanalizations (-126 ± 192 vs -38 ± 135 dyn·s·cm - 5, p = 0.007). The rate of complications was similar in STO/TO and non-STO/TO lesions (4.1% vs 2.4%, p = 0.22).
Conclusions
The use of BPA for the recanalization of subtotal and total PA occlusions is safe and feasible. Recanalization of segmental occlusive lesions leads to a significant improvement in PVR as compared to dilatation of nonocclusive ones.

Copyright © 2022 Elsevier B.V. All rights reserved.

Int J Cardiol: 15 Aug 2022; 361:71-76
Stępniewski J, Magoń W, Waligóra M, Jonas K, ... Podolec P, Kopeć G
Int J Cardiol: 15 Aug 2022; 361:71-76 | PMID: 35577168
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Impact:
Abstract

Association of body mass index and prognosis in patients with HFpEF: A dose-response meta-analysis.

Li S, Zheng Y, Huang Y, He W, Liu X, Zhu W
Background
Although agreements regarding the negative effects of obesity on the development of heart failure with preserved ejection fraction (HFpEF) have been reached, the relationship between body mass index (BMI) and adverse outcomes in HFpEF patients are still debatable. Therefore, we conducted the dose-response meta-analysis to investigate this relationship.
Methods
We searched the PubMed and Embase databases up to February 2022 for studies that evaluated the association between BMI and prognostic outcomes in patients with HFpEF. A cubic spline random-effects model was used to fit the potential dose-response curve. The effect estimates were expressed as adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).
Results
A total of 11 studies involving 69,273 patients with HFpEF were included. The summary HR for all-cause mortality was 0.90 (95% CI, 0.84-0.95) per 5 units increase in BMI, but the association was U-shaped (Pnonlinear < 0.01) with the nadir of risk at a BMI of 32-34 kg/m2. The summary HR for HF hospitalization was 1.12 (95% CI, 1.05-1.19) with a significant positive linear association (Pnonlinear = 0.54).
Conclusions
For patients with HFpEF, there was a positive linear association of BMI with HF hospitalization, while a U-shaped relationship between BMI and all-cause mortality was observed with the lowest event rate at a BMI of 32-34 kg/m2.

Copyright © 2022 Elsevier B.V. All rights reserved.

Int J Cardiol: 15 Aug 2022; 361:40-46
Li S, Zheng Y, Huang Y, He W, Liu X, Zhu W
Int J Cardiol: 15 Aug 2022; 361:40-46 | PMID: 35568057
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Impact:
Abstract

The CNIC-Polypill reduces recurrent major cardiovascular events in real-life secondary prevention patients in Spain: The NEPTUNO study.

González-Juanatey JR, Cordero A, Castellano JM, Masana L, ... Sicras-Mainar A, Fuster V
Background
To evaluate the effectiveness of a cardiovascular polypill including aspirin, ramipril and atorvastatin (CNIC-Polypill), on the incidence of recurrent major cardiovascular events (MACE) and risk factor control in patients with established atherosclerotic cardiovascular disease (ASCVD) vs different pharmacological therapeutic strategies.
Methods
Retrospective, observational study using data from electronic-health records. Patients were distributed into 4 different cohorts: CNIC-Polypill (case cohort) vs 3 control cohorts: same monocomponents taken separately (Monocomponents), equipotent drugs (Equipotent) and other drugs not included in the previous cohorts (Other therapies). Patients were followed for 2 years or until MACE or death.
Results
After propensity score matching, a total of 6456 patients (1614 patients per cohort) were analysed. After 2 years, the risk of recurrent MACE was lower in the CNIC-Polypill cohort compared to the control groups (22%; p = 0.017, 25%; p = 0.002, 27%; p = 0.001, higher in the Monocomponents, Equipotent and Other therapies cohorts, respectively). The incremental proportion of patients who achieved blood pressure (BP) and low-density lipoprotein cholesterol (LDLc) control from baseline was higher in the CNIC-Polypill cohort vs control cohorts (BP controlled patients: +12.5% vs + 6.3%; p < 0.05, +2.2%; p < 0.01, +2.4%; p < 0.01, LDLc controlled patients: +10.3% vs + 4.9%; p < 0.001, +5.7%; p < 0.001, +4.9%; p < 0.001, respectively). Medication persistence was higher in patients treated with the CNIC-Polypill (72.1% vs 62.2%, 60.0% and 54.2%, respectively; p < 0.001) at study end.
Conclusions
In secondary prevention patients, compared with control groups, treatment with the CNIC-Polypill was associated with significant reductions in the accumulated incidence of recurrent MACE, improved BP and LDLc control rates, and increased medication persistence.

Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.

Int J Cardiol: 15 Aug 2022; 361:116-123
González-Juanatey JR, Cordero A, Castellano JM, Masana L, ... Sicras-Mainar A, Fuster V
Int J Cardiol: 15 Aug 2022; 361:116-123 | PMID: 35569611
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Impact:
Abstract

Burden of influenza in adults with cardiac arrest admissions in Australia.

Moa A, Tan T, Wei J, Hutchinson D, MacIntyre CR
Background
Cardiac arrest is the least preventable burden of cardiovascular disease, as treatment depends on timely resuscitation. The incidence of sudden cardiac arrest (SCA) is high, contributing 10-20% of cardiovascular mortality globally. The influenza vaccine reduces the risk of acute cardiovascular events. Little is known about the relationship of influenza infection to cardiac arrest.
Methods
This study aimed to determine the estimated rate of SCA hospitalisations attributable to influenza in Australian adults. A generalised-additive statistical model was applied in the study. Weekly counts of laboratory-confirmed influenza notifications were used as independent variables in the model.
Results
Our estimates showed that the yearly rate of SCA hospitalisations varied, and a significant association with influenza was observed in some years in older adults aged 65 years and over. On average, the annual estimated SCA hospitalisations rate due to influenza in adults aged 50-64 years and ≥ 65 years were 0.7 (95%CI: 0.4, 1.1) and 5.3 (95%CI: 4.4, 6.2) per 100,000 population, respectively.
Conclusion
The association between influenza and SCA is evident in adults and the disease burden is significant in older people. Prevention of influenza by vaccination may reduce SCA.

Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.

Int J Cardiol: 15 Aug 2022; 361:109-115
Moa A, Tan T, Wei J, Hutchinson D, MacIntyre CR
Int J Cardiol: 15 Aug 2022; 361:109-115 | PMID: 35490787
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Impact:
Abstract

Tissue Doppler echocardiography and outcome in arrhythmogenic right ventricular cardiomyopathy.

Hosseini S, Erhart L, Anwer S, Heiniger PS, ... Saguner AM, Tanner FC
Aims
This study aimed at investigating whether tissue Doppler imaging (TDI) is associated with adverse events in arrhythmogenic right ventricular cardiomyopathy (ARVC).
Methods and results
Transthoracic echocardiography was performed in 72 patients with definite (n = 63) or borderline (n = 9) ARVC diagnosed according to the 2010 Task Force Criteria and included in the prospective Zurich ARVC registry. Myocardial peak systolic tissue velocity (S\') was measured by TDI at lateral tricuspid (tricuspid S\'), medial mitral (septal S\'), and lateral mitral anulus (lateral S\'). Association of echocardiographic parameters with outcome was assessed by univariable Cox regression. During a median follow-up of 4.9 ± 2.6 years, 6 (8.3%) patients died of cardiovascular cause or received heart transplantation and 21 (29.2%) patients developed sustained ventricular arrhythmia. Tricuspid, septal, and lateral S\' were lower in patients who died (p = 0.001; p < 0.001; p = 0.008; respectively), while tricuspid and septal S\' were lower in those with ventricular arrhythmia (p = 0.001; p = 0.008; respectively). There was a significant association of tricuspid, septal, and lateral S\' with mortality (HR = 1.61, p = 0.011; HR = 2.15, p = 0.007; HR = 1.67, p = 0.017; respectively), while tricuspid and septal S\' were associated with ventricular arrhythmia (HR = 1.20, p = 0.022; HR = 1.37, p = 0.004; respectively). Kaplan-Meier analyses demonstrated a higher freedom from mortality with tricuspid S\' >8 cm/s (p = 0.001) and from ventricular arrhythmia with S\' >10.5 cm/s (p = 0.021).
Conclusions
This study demonstrates that TDI provides information on the ARVC phenotype, is associated with adverse events in ARVC patients, and differentiates between patients with and without adverse events.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 12 Aug 2022; epub ahead of print
Hosseini S, Erhart L, Anwer S, Heiniger PS, ... Saguner AM, Tanner FC
Int J Cardiol: 12 Aug 2022; epub ahead of print | PMID: 35970442
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Impact:
Abstract

Association between kaolin-induced maximum amplitude and slow-flow/no-reflow in ST elevation myocardial infarction patients treated with primary percutaneous coronary intervention.

Li Q, Xie E, Tu Y, Wu Y, ... Gao Y, Jingang Z
Background
ST-segment elevation myocardial infarction (STEMI) patients with a high thrombus burden have a relatively high slow-flow/no-reflow risk. However, the association between kaolin-induced maximum amplitude (MAthrombin) and slow-flow/no-reflow has been scarcely explored.
Methods
STEMI patients treated with primary percutaneous coronary intervention (PCI) were retrospectively enrolled from January 2015 to December 2019 at China-Japan Friendship Hospital. MAthrombin levels were measured using thromboelastography before the PCI procedure. The patients were divided into two groups according to thrombolysis in myocardial infarction (TIMI) flow grade after primary PCI: the normal flow group (TIMI flow grade = 3) and slow-flow/no-reflow (TIMI flow grade ≤ 2). The logistic regression model and restricted cubic spline regression (RCS) were used to analyze the predictive value of MAthrombin for slow-flow/no-reflow. All patients were followed up after discharge and observed the adverse cardiovascular events between the two groups.
Results
A total of 690 patients were enrolled, with 108(15.7%) having slow-flow/no-reflow. The multivariate logistic regression model analysis showed that MAthrombin level was an independent risk factor for slow-flow/no-reflow. The RCS analysis showed a nonlinear relationship between MAthrombin levels and slow-flow/no-reflow. The cut-off value of MAthrombin levels for predicting slow-flow/no-reflow was 68 mm. During a median follow-up time of 4.4 years, slow-flow/no-reflow (hazard ratio 1.93, 95% confidence interval 1.27-2.93, P = 0.002) and MAthrombin levels (hazard ratio 1.06, 95% confidence interval 1.03-1.08, P < 0.001) were independent risk factors for predicting the long-term of adverse clinical cardiovascular events.
Conclusion
MAthrombin was an independent risk for predicting slow-flow/ no-reflow in STEMI patients who underwent primary PCI.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 12 Aug 2022; epub ahead of print
Li Q, Xie E, Tu Y, Wu Y, ... Gao Y, Jingang Z
Int J Cardiol: 12 Aug 2022; epub ahead of print | PMID: 35970443
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Impact:
Abstract

Preprocedural coronary computed tomography angiography in chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS-CTO registry.

Simsek B, Jaffer FA, Kostantinis S, Karacsonyi J, ... Burke MN, Brilakis ES
Background
Preprocedural coronary computed tomography angiography (CCTA) can be useful in procedural planning for chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Methods
We examined the clinical, angiographic and procedural characteristics and outcomes of cases with vs. without preprocedural CCTA in PROGRESS-CTO (NCT02061436). Multivariable logistic regression was used to adjust for confounding factors.
Results
Of 7034 CTO PCI cases, preprocedural CCTA was used in 375 (5.3%) with increasing frequency over time. Patients with preprocedural CCTA had a higher prevalence of prior coronary artery bypass graft surgery (39% vs. 27%, p < 0.001) and angiographically unfavorable characteristics including higher prevalence of proximal cap ambiguity (52% vs. 33%, p < 0.001) and moderate/severe calcification (59% vs. 41%, p < 0.001) compared with those without CCTA. CCTA helped resolve proximal cap ambiguity in 27%, identified significant calcium not seen on diagnostic angiography in 18%, changed estimated CTO length by >5 mm in 10%, and was performed as part of initial coronary artery disease work up in 19%. CCTA cases had higher J-CTO (2.6 ± 1.2 vs. 2.3 ± 1.3, p < 0.001) and PROGRESS-CTO (1.3 ± 1.0 vs. 1.2 ± 1.0 p = 0.027) scores. After adjusting for potential confounders, cases with preprocedural CCTA had similar technical success (odds ratio [OR]: 1.18, 95% confidence interval [CI], 0.83-1.67) and incidence of major adverse cardiovascular events (OR: 1.47, 95% CI, 0.72-3.00).
Conclusion
Preprocedural CCTA was used in ~5% of CTO PCI cases. While CCTA may help with procedural planning, especially in complex cases, technical success and MACE were similar with or without CCTA.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 11 Aug 2022; epub ahead of print
Simsek B, Jaffer FA, Kostantinis S, Karacsonyi J, ... Burke MN, Brilakis ES
Int J Cardiol: 11 Aug 2022; epub ahead of print | PMID: 35964847
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Impact:
Abstract

Cardiovascular prevention in the worksite: Where are we?

Biffi A, Fernando F, Palermi S, Sirico F, ... D\'Ascenzi F, Niebauer J
The current guidelines of the European Society of Cardiology on cardiovascular (CV) prevention highlighted the importance of implementing coordinated set of action, including worksite, aimed at eliminating or minimizing the impact of CV disease and their related disabilities. Workplace wellness programs tend to focus on modifiable risk factors of non-communicable disease, such as nutrition, physical activity, and smoking cessation. However, nowadays, corporate wellness programs are still rare and incomplete, and usually received limited attention. This represents a big public health issue since company health and wellness interventions may provide an important opportunity to identify and manage CV risk. Given the increasing of employees\' average age, a progressive shifting of retirement age and an increased number of chronic diseases, these preventive programs will increasingly represent key factors of both employee\'s health and economic strategies of companies in the near future.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 11 Aug 2022; epub ahead of print
Biffi A, Fernando F, Palermi S, Sirico F, ... D'Ascenzi F, Niebauer J
Int J Cardiol: 11 Aug 2022; epub ahead of print | PMID: 35964848
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Impact:
Abstract

Mobile app-based symptom-rhythm correlation assessment in patients with persistent atrial fibrillation.

Hermans ANL, Gawalko M, Slegers DPJ, Andelfinger N, ... Hendriks JM, Linz D
Background
The assessment of symptom-rhythm correlation (SRC) in patients with persistent atrial fibrillation (AF) is challenging. Therefore, we performed a novel mobile app-based approach to assess SRC in persistent AF.
Methods
Consecutive persistent AF patients planned for electrical cardioversion (ECV) used a mobile app to record a 60-s photoplethysmogram (PPG) and report symptoms once daily and in case of symptoms for four weeks prior and three weeks after ECV. Within each patient, SRC was quantified by the SRC-index defined as the sum of symptomatic AF recordings and asymptomatic non-AF recordings divided by the sum of all recordings.
Results
Of 88 patients (33% women, age 68 ± 9 years) included, 78% reported any symptoms during recordings. The overall SRC-index was 0.61 (0.44-0.79). The study population was divided into SRC-index tertiles: low (<0.47), medium (0.47-0.73) and high (≥0.73). Patients within the low (vs high) SRC-index tertile had more often heart failure and diabetes mellitus (both 24.1% vs 6.9%). Extrasystoles occurred in 19% of all symptomatic non-AF PPG recordings. Within each patient, PPG recordings with the highest (vs lowest) tertile of pulse rates conferred an increased risk for symptomatic AF recordings (odds ratio [OR] 1.26, 95% coincidence interval [CI] 1.04-1.52) and symptomatic non-AF recordings (OR 2.93, 95% CI 2.16-3.97). Pulse variability was not associated with reported symptoms.
Conclusions
In patients with persistent AF, SRC is relatively low. Pulse rate is the main determinant of reported symptoms. Further studies are required to verify whether integrating mobile app-based SRC assessment in current workflows can improve AF management.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 10 Aug 2022; epub ahead of print
Hermans ANL, Gawalko M, Slegers DPJ, Andelfinger N, ... Hendriks JM, Linz D
Int J Cardiol: 10 Aug 2022; epub ahead of print | PMID: 35963443
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Impact:
Abstract

Multimorbidity and combined interventions for patients with coronary heart disease in Chinese population: Latent class analysis of a multi-center study.

Chen Y, Wu J, Tang Y, Li Z, ... Lu Y, Cai J
Background:
and aims
This study aimed to explore the profile of multimorbidity phenotype clusters and their discrepancy in mortality and the efficiency of combined interventions on blood pressure, glucose and lipid in each cluster.
Methods
Fine and Gray competing risk regression models and Kaplan-Meier curves were used to assess the association between multimorbidity and mortality and rehospitalization. Fine and Gray competing risk regression models and subgroup analyses were used to estimate the relations between combined and mortality.
Results
Three distinct multimorbidity clusters were observed: Class 1 named severe class, Class 2 termed moderate class, and Class 3 named mild class. Competing risk regression models revealed that patients in Class 1 have the greatest burden of mortality and rehospitalization compared to Class 3 after confounder adjustment, with HRs 1.43 (95% CI 1.30-1.56, P < 0.001) and 2.97 (95% CI 2.74-3.21, P < 0.001), respectively. The patients in Class 2 have modest risk of mortality and rehospitalization compared to Class 3 after confounder adjustment, with HRs 1.41 (95% CI 1.30-1.52, P < 0.001) and 2.39 (95% CI 2.23-2.56, P < 0.001), respectively. Furthermore, we found that combined interventions on blood pressure, glucose and lipid simultaneously could further benefit on survival compared to each individual intervention or two in combine.
Conclusions
This study found that multimorbidity among patients with CHD was common and increased the risks of death and rehospitalization. Three multimorbidity clusters that were significantly associated with death and rehospitalization were identified. Simultaneous intervention on blood pressure, glucose and lipid level may further benefit CHD patient in survival.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 10 Aug 2022; epub ahead of print
Chen Y, Wu J, Tang Y, Li Z, ... Lu Y, Cai J
Int J Cardiol: 10 Aug 2022; epub ahead of print | PMID: 35963444
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Impact:
Abstract

The prognostic value of right ventricular ejection fraction by cardiovascular magnetic resonance in heart failure: A systematic review and meta-analysis.

Papanastasiou CA, Bazmpani MA, Kokkinidis DG, Zegkos T, ... Kramer CM, Karamitsos TD
Background
Cardiac magnetic resonance (CMR) is considered the gold standard for the assessment of right ventricular ejection fraction (RVEF). Previous studies have suggested that RVEF may be a predictor of adverse outcomes in heart failure (HF). In this study, we aimed to systematically review the prognostic value of RVEF, evaluated by CMR, across the spectrum of left ventricular systolic function in patients with HF.
Methods
Electronic databases were searched for studies investigating the prognostic value of RVEF in HF, irrespective of left ventricular ejection fraction (LVEF). A random-effects meta-analysis was conducted for mortality and HF hospitalization. Subgroup analyses were also performed based on the presence of reduced (<50%) or preserved LVEF (≥50%).
Results
In total, 46 studies enrolling 14,344 patients were included. In the pooled analyses, impaired RVEF was a powerful predictor of mortality (HR: 1.26, 95% CI: 1.18-1.33, I2: 13%, per 10% decrease in RVEF) and death or HF hospitalization (HR: 1.31, 95% Cl: 1.2-1.42, I2: 27%, per 10% decrease in RVEF). A decrease in RVEF was strongly associated with increased risk of mortality or hospitalization both in HF with reduced EF (HR: 1.24, 95% CI: 1.13-1.36, I2: 2%, per 10% decrease in RVEF) and in HF with preserved EF (HR: 1.24, 95% CI: 1.09-1.40, I2: 0%, per 10% decrease in RVEF).
Conclusion
Impaired RVEF on CMR strongly predicts adverse outcomes in patients with HF regardless of LVEF. RV systolic function should be carefully evaluated in these patients. Prospero Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021256967.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 09 Aug 2022; epub ahead of print
Papanastasiou CA, Bazmpani MA, Kokkinidis DG, Zegkos T, ... Kramer CM, Karamitsos TD
Int J Cardiol: 09 Aug 2022; epub ahead of print | PMID: 35961612
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Impact:
Abstract

Genetic admixture and cardiovascular disease risk in postmenopausal Hispanic women.

Zuercher MD, Harvey DJ, Au LE, Shadyab AH, ... Seldin MF, Garcia L
Background
Hispanics are a heterogeneous population with differences in the prevalence of cardiovascular disease (CVD) and its related risk factors among ethnic sub-groups. This study evaluated the association of genetic admixture and CVD in self-identified Hispanic women from the Women\'s Health Initiative (WHI).
Methods
Data came from the WHI Observational Study and the Clinical Trial Components conducted among postmenopausal women. The CVD outcomes included coronary heart disease (CHD) and stroke. The proportions of European (EUR), sub-Saharan African (AFR), and Amerindian (AMI) admixture were estimated using 92 ancestry-informative markers. Cox regression models were used to assess the relationship between genetic admixture and CVD adjusting for age, lifestyle risk factors, known risk factors, and neighborhood socioeconomic status.
Results
Among 5195 participants EUR ancestry was associated with a lower CHD risk after adjusting for age (HR 0.41, p = 0.02), and in the fully adjusted model (HR 0.40, p = 0.03). AFR ancestry was associated with a higher CHD risk after adjusting for age (HR 2.91, p = 0.03), but it only showed a trend in in the fully adjusted model (HR 2.46, p = 0.10). AMI ancestry was not statistically significantly associated with CHD and none of the genetic admixture proportions were statistically significantly associated with stroke (p > 0.05).
Conclusion
EUR ancestry was associated with a lower risk of CHD in Hispanic women. This highlights the need to account for genetic admixture in future CVD studies to consider different heritage groups to understand the role that genetic, neighborhood socioeconomic status, and environmental factors contribute to CVD health disparities in Hispanic women.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 09 Aug 2022; epub ahead of print
Zuercher MD, Harvey DJ, Au LE, Shadyab AH, ... Seldin MF, Garcia L
Int J Cardiol: 09 Aug 2022; epub ahead of print | PMID: 35961613
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Impact:
Abstract

Long-term outcome of combined catheter ablation and left atrial appendage closure in atrial fibrillation patients.

Chen M, Sun J, Wang QS, Zhang PP, ... Lu Q, Li YG
Background
The combined procedure of catheter ablation and left atrial appendage closure (LAAC) aims to simultaneously control the heart rhythm and reduce the risk of strokes in patients with atrial fibrillation (AF). The study aims to evaluate the procedural safety and long-term outcome of the combined procedure in a large patient cohort.
Methods
Clinical data of AF patients who underwent the combined procedure was retrospectively analyzed. Procedural and imaging follow-up parameters were compared between the transesophageal echocardiography-guided standard process and fluoroscopy-guided modified process, and between the single-seal WATCHMAN and dual-seal LACBES devices. Long-term outcomes included all-cause mortality, thromboembolic events, major bleeding, and recurrence of atrial tachyarrhythmias.
Results
A total of 1114 patients were included. The rates of procedure-related major complications were comparable between the standard and modified processes (3.7% vs. 2.2%, p = 0.219), except for a higher incidence of respiratory depression in standard process group (0.9% vs 0%, p = 0.037), and between WATCHMAN and LACBES devices (2.4% vs. 3.3%, p = 0.535). The follow-up imaging evaluation revealed a high rate of satisfactory seals (99.7%) and a low rate of device related thrombus (1.9%), which were similar between two process groups and devices. The follow-up of over 1960 patient-years revealed low rates of mortality, thromboembolism, and nonprocedural major bleeding (1.8, 3.2, and 0.9 per 100 patient-years, respectively). Recurrent atrial tachyarrhythmias was observed in 23.9% patients.
Conclusions
The results supported the safety and long-term efficacy of the combined procedure of catheter ablation and LAAC. Fluoroscopy-guided LAAC device implantation may be considered in experienced centers.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 08 Aug 2022; epub ahead of print
Chen M, Sun J, Wang QS, Zhang PP, ... Lu Q, Li YG
Int J Cardiol: 08 Aug 2022; epub ahead of print | PMID: 35952939
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Abstract

Early flattening of the oxygen pulse during the cardiopulmonary exercise test in asymptomatic adults and its association with cardiovascular risk factors.

de Almeida VR, di Paschoale Ostolin TLV, de Barros Gonze B, de Almeida FR, ... Arantes RL, Dourado VZ
Background
Individuals with cardiovascular exercise limitations present oxygen pulse morphology with early flattening (plateau) during the cardiopulmonary exercise test (CPET). Although this oxygen pulse response is well known in cardiac patients, these changes\' prevalence and clinical relevance in asymptomatic individuals are not known. We aimed to quantify the proportion of asymptomatic adults with an early flattening of the oxygen pulse and investigate its association with classical cardiovascular risk factors.
Methods
We carried out a cross-sectional study with a sample of 824 adults aged between 18 and 80 years. We assessed anthropometry, body composition, and cardiovascular risk. In addition, we obtained cardiorespiratory and metabolic responses during a ramp protocol treadmill CPET.
Results
The prevalence of early flattening of the oxygen pulse was 36.8%. These participants were predominantly females, older, less educated, with a higher body mass and percentage of fat and a lower percentage of lean body mass. After a multinominal multiple logistic regression analysis, we identified female sex (odds ratio, 5.46: 95% confidence interval, 3.73-7.99), low education (2.24: 1.47-3.42), dyslipidemia (1.67: 1.14-2.45), smoking (1.64: 1.00-2.69), and physical inactivity (1.39: 1.02-1.96) as the leading independent predictors of the early flattening of oxygen pulse.
Conclusion
The early flattening of oxygen pulse is common in asymptomatic adults and is highly determined by modifiable cardiovascular risk factors. These results suggest that identifying the early flattening of oxygen pulse may be helpful in the prevention of cardiovascular diseases.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 06 Aug 2022; epub ahead of print
de Almeida VR, di Paschoale Ostolin TLV, de Barros Gonze B, de Almeida FR, ... Arantes RL, Dourado VZ
Int J Cardiol: 06 Aug 2022; epub ahead of print | PMID: 35944764
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Impact:
Abstract

Activation of GLP-1 receptor signalling by sacubitril/valsartan: Implications for patients with poor glycaemic control.

Mahtani K, MMath BPB, Brian Wang MA, Barron A
Sacubitril/valsartan is a first-in-class Angiotensin Receptor-Neprilysin inhibitor (ARNi) to be approved for the treatment of heart failure with reduced ejection fraction (HFrEF). The combination tablet has become a mainstay of treatment in the management of heart failure (HF) due to its composite inhibition of the neurohumoral system. There is growing support to show that sacubitril/valsartan may enhance glycaemic control through the augmentation of neprilysin substrates - in particular, glucagon-like peptide 1 (GLP-1). Given that HF and Diabetes Mellitus (DM) frequently coexist, with 44% of patients hospitalised with heart failure also having diabetes as a co-morbidity, it is plausible that sacubitril/valsartan may represent a novel way to address glucose intolerance in HF. However, the role of neprilysin in the degradation of GLP-1 raises important clinical considerations such as the risk of hypoglycaemia and potential drug-drug interactions in patients with and without concurrent DM. We review the current body of research addressing the effect of neprilysin inhibition on GLP-1 receptor signalling and discuss the implications for treatment of HF and DM.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 06 Aug 2022; epub ahead of print
Mahtani K, MMath BPB, Brian Wang MA, Barron A
Int J Cardiol: 06 Aug 2022; epub ahead of print | PMID: 35944765
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Abstract

Geographic disparity in 10-year mortality after coronary artery revascularization in the SYNTAXES trial.

Kageyama S, Serruys PW, Garg S, Ninomiya K, ... Onuma Y, SYNTAX Extended Survival Investigators
Aims
To investigate geographic disparity in long-term mortality following revascularization in patients with complex coronary artery disease (CAD).
Methods and results
The SYNTAXES trial randomized 1800 patients with three-vessel and/or left main CAD to percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and assessed their survival at 10 years. Patients were stratified according to the region of recruitment: North America (N-A, n = 245), Eastern Europe (E-E, n = 189), Northern Europe (N-E, n = 425), Southern Europe (S-E, n = 263), and Western Europe (W-E, n = 678), which also served as the reference group. Compared to W-E, patients were younger in E-E (62 vs 65 years, p < 0.001), and less frequently male in N-A (65.3% vs 79.6%, p < 0.001). Diabetes (16.0% vs 25.4%, p < 0.001) and peripheral vascular disease (6.8% vs 10.9%, p = 0.025) were less frequent in N-E than W-E. Ejection fraction was highest in W-E (62% vs 56%, p < 0.001). Compared to W-E, the mean anatomic SYNTAX score was higher in S-E (29 vs 31, p = 0.008) and lower in N-A (26, p < 0.001). Crude ten-year mortality was similar in N-A (31.6%), and W-E (30.7%), and significantly lower in E-E (22.5%, p = 0.041), N-E (21.9%, p = 0.003) and S-E (22.0%, p = 0.014). Compared to W-E, adjusted mortality in N-E (HR 0.85, p = 0.019) and S-E (HR 0.72, p = 0.043) remain significantly lower after adjustment for pre- and peri-procedural factors, but no significant interaction (Pinteraction = 0.728) between region and modality of revascularization was seen.
Conclusion
In the era of globalization, knowledge, and understanding of geographic disparity are of paramount importance for the correct interpretation of global studies.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 06 Aug 2022; epub ahead of print
Kageyama S, Serruys PW, Garg S, Ninomiya K, ... Onuma Y, SYNTAX Extended Survival Investigators
Int J Cardiol: 06 Aug 2022; epub ahead of print | PMID: 35944766
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Impact:
Abstract

Sodium nitroprusside in acute heart failure: A multicenter historic cohort study.

Garatti L, Frea S, Bocchino PP, Angelini F, ... De Ferrari GM, Morici N
Aims
Despite evidence of hemodynamic benefit of sodium nitroprusside (SNP) treatment for acute heart failure (AHF), there are limited data about its efficacy and safety. This study aimed to assess the effectiveness and safety of SNP treatment, to explore the impact of N-terminal pro-B natriuretic peptide (NT-proBNP) reduction on clinical endpoints and to identify possible predictors of clinical response.
Methods and results
Multicenter retrospective cohort study of 200 patients consecutively admitted for AHF in 2 Italian Centers. Primary endpoint was the reduction of NT-proBNP levels ≥25% from baseline values within 48 h from the onset of SNP infusion. Secondary and safety endpoints included all-cause mortality, rehospitalization for HF at 1, 3 and 6 months, length of hospital stay (LOS) and severe hypotension. 131 (66%) patients experienced a NT-proBNP reduction ≥25% within 48 h from treatment onset, irrespective of initial systolic blood pressure (SBP). Left ventricular end diastolic diameter (LVEDD) was the only independent predictor of treatment efficacy. Patients who achieved the primary endpoint (i.e., \'responders\') had lower LOS (median 15 [IQR:10-27] vs 19 [IQR:12-35] days, p-value = 0.033) and a lower incidence of all-cause mortality and rehospitalization for HF at 1 and 3 months compared to \"non responders\" (p-value <0.050). Severe hypotension was observed in 10 (5%) patients, without any adverse clinical consequence.
Conclusion
SNP is a safe and effective treatment of AHF, particularly in patients with dilated left ventricle. Reduced NT-proBNP levels in response to SNP is associated to shorter LOS and lower risk of 1- and 3-month re-hospitalizations for HF.
Clinical trial registration
http://www.
Clinicaltrials
gov. Unique identifier: NCT05027360.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 06 Aug 2022; epub ahead of print
Garatti L, Frea S, Bocchino PP, Angelini F, ... De Ferrari GM, Morici N
Int J Cardiol: 06 Aug 2022; epub ahead of print | PMID: 35944767
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Abstract

TIMI flow and myocardial blushing after rescue PCI and cardiac magnetic resonance: Results from the Myocardial Salvage After Rescue Angioplasty: Evaluation by Magnetic Resonance (SAVE-ME) study.

Moroni F, Azzalini L, Caixeta A, Oliveira TP, Ybarra LF
Introduction
Thrombolysis is currently reserved for ST-elevation myocardial infarction (STEMI) patients who cannot access timely percutaneous coronary intervention (PCI). In case of failed thrombolysis, rescue PCI is a viable option. Substantial data concerning the outcomes in terms of infarct size and myocardial function after rescue PCI are lacking.
Methods
Forty patients treated with rescue PCI underwent serial contrast-enhanced cardiac magnetic resonance imaging (CMR) at 1 week, 3 months and 6 months from the index STEMI. Angiographic images were reviewed to assess Thrombolysis in Myocardial Infarction (TIMI) blood flow and TIMI Myocardial Blush Grade (TMBG) in the infarct related artery after PCI.
Results
Patients with lower TMBG at the end of procedure, but not patients with worse TIMI flow, had lower left ventricular ejection fraction (LVEF) and higher volume of late gadolinium enhancement (LGE) on baseline CMR (44 ± 13% vs 52 ± 9%, p = 0.026, and 41 ± 21 ml vs 26 ± 12, p = 0.030, respectively). Patients with lower TMBG remained with significantly lower LVEF at 6 months follow up (48 ± 16% vs 59 ± 14, p = 0.049).
Conclusion
TMBG after rescue PCI is associated with reduced LVEF and increased LGE burden. As TMBG is a known marker of microvascular damage after STEMI, novel strategies aimed at improving microvascular function in the setting of rescue PCI are needed to improve the outcomes in this patient population.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 06 Aug 2022; epub ahead of print
Moroni F, Azzalini L, Caixeta A, Oliveira TP, Ybarra LF
Int J Cardiol: 06 Aug 2022; epub ahead of print | PMID: 35944769
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Abstract

Serum glypican-4 is associated with the 10-year clinical outcome of patients with peripheral artery disease.

Muendlein A, Heinzle C, Leiherer A, Geiger K, ... Saely CH, Drexel H
Background
Patients with peripheral artery disease (PAD) are at increased risk of cardiovascular events and mortality compared with non-PAD populations. Blood based biomarkers may improve clinical risk assessment. Recently, we found significant associations of serum glypican-4 (GPC4) with cardiovascular events and mortality in coronary angiography patients. The impact of serum GPC4 on the clinical outcome in PAD patients is unknown and has been addressed in a prospective cohort study.
Methods
We measured GPC4 levels using an enzyme-linked immunosorbent assay in 295 PAD patients. The primary endpoint was major adverse cardiovascular events (MACE); we further investigated vascular mortality, and all-cause mortality over 10 years of follow-up.
Results
Serum GPC4 levels were positively linked with age, low kidney function, C-reactive protein (CRP), and the use of cardiovascular medications. During the 10-year follow-up period, MACE, vascular mortality, and all-cause mortality occurred in 43.1%, 33.4%, and 45.4%, respectively, of the patients. High serum GPC4 was significantly associated with all three endpoints (each log-rank P-value <0.001). In Cox regression analysis serum GPC4 significantly predicted MACE, vascular mortality, and all-cause mortality independently from traditional risk factors including age, sex, T2DM, hypertension, low kidney function, severity of PAD, smoking, and CRP, with adjusted hazard ratios [95% confidence interval] for one standard deviation change of serum GPC4 of 1.38 [1.06-1.80], 1.84 [1.28-2.64], and 1.94 [1.51-2.51], respectively.
Conclusion
We conclude that serum GPC4 is a predictor of the 10-year clinical outcome in patients with PAD.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 06 Aug 2022; epub ahead of print
Muendlein A, Heinzle C, Leiherer A, Geiger K, ... Saely CH, Drexel H
Int J Cardiol: 06 Aug 2022; epub ahead of print | PMID: 35944770
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Impact:
Abstract

Randomized controlled trial between conventional versus sutureless bioprostheses for aortic valve replacement: Impact of mini and full sternotomy access at 1-year follow-up.

Fischlein T, Caporali E, Folliguet T, Kappert U, ... García-Puente J, Lorusso R
Background
The present study is a sub-analysis of the multicenter, randomized PERSIST-AVR trial (PERceval Sutureless Implant versus Standard Aortic Valve Replacement) comparing the in-hospital and 1-year results of sutureless versus conventional stented bioprostheses in isolated surgical aortic valve replacement (SAVR) within two different surgical approaches: mini-sternotomy (MS) and full-sternotomy (FS).
Methods
A total of 819 patients (per-protocol population) underwent preoperative randomization to sutureless or stented biological valve at 47 centers worldwide. Sub-analysis on isolated SAVR was performed. Results were compared between sutureless and stented within the two different surgical approaches.
Results
285 patients were implanted with Perceval (67% in MS) and 293 with stented valves (65% in MS). Sutureless group showed significantly reduced surgical times both in FS and MS. In-hospital results show no differences between Perceval and stented valves in FS, while a lower incidence of new-onset of atrial fibrillation (3.7% vs 10.8%) with Perceval in MS. After 1-year, use of sutureless valve showed a significant reduction of MACCE (5.2% vs 10.8%), stroke rate (1.0% vs 5.4%), new-onset of atrial fibrillation (4.2% vs 11.4%) and re-hospitalizations (21.8 days vs 47.6 days), compared to stented valves but presented higher rate of pacemaker implantation (11% vs 1.6%).
Conclusions
Sutureless bioprosthesis showed significantly reduced procedural times during isolated SAVR in both surgical approaches. Patients with sutureless valves and MS access showed also better 1-year outcome regarding MACCEs, stroke, re-hospitalization and new-onset atrial fibrillation, but presented a higher rate of permanent pacemaker implantation compared to patients with stented bioprosthesis.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 06 Aug 2022; epub ahead of print
Fischlein T, Caporali E, Folliguet T, Kappert U, ... García-Puente J, Lorusso R
Int J Cardiol: 06 Aug 2022; epub ahead of print | PMID: 35944771
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Impact:
Abstract

Association among myocardial injury and mortality in Influenza: A prospective cohort study.

Biasco L, Valotta A, Klersy C, Valgimigli M, ... Senatore G, Pedrazzini GB
Background
Myocardial injury (MINJ) is a well-recognized prognostic marker in different acute cardio-respiratory illnesses, nonetheless, its relevance in Influenza remains poorly defined. Our aim was to assess incidence, correlates, short and mid-term prognostic role of MINJ in Influenza.
Methods
Hospitalized patients (pts) with laboratory confirmed Influenza A or B underwent highly sensitive cardiac T Troponin (hs-cTnT) measurement at admission in four regional Swiss hospitals during the 2018-2019 epidemic. MINJ was defined as hs-cTnT >14 ng/L. Clinical, laboratory and outcome data were prospectively collected. The primary endpoint was mortality at 28 days while the composite of mortality, admission to intensive care unit (ICU) or need for mechanical ventilation at 28-days and mortality at 30-months were set as secondary endpoints.
Results
The presence of MINJ was assessed within 48 h from admission in 145 consecutive hospitalized pts., being evident in 94 (65.5%) pts. and associated with older age, higher C-reactive protein levels, renal impairment or chronic obstructive pulmonary disease. At a 28-days follow-up, 7 deaths (4.8%) occurred, all in patients with MINJ at admission (log-rank p = 0.048). MINJ was strongly associated with occurrence of death, ICU admission or mechanical ventilation (OR 5.74, 95% CI 1.28-53.29; p = 0.015). After a median follow-up of 32.7 months (IQR 32.2-33.4), 15 (10.3%) deaths occurred, all among pts. with MINJ at index hospitalization leading to a higher mortality at follow-up among patients with MINJ (log-rank p = 0.003).
Conclusions
MINJ is common in patients hospitalized for Influenza and is able to stratify the risk of short-term adverse events and mid-term mortality.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 06 Aug 2022; epub ahead of print
Biasco L, Valotta A, Klersy C, Valgimigli M, ... Senatore G, Pedrazzini GB
Int J Cardiol: 06 Aug 2022; epub ahead of print | PMID: 35944772
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Abstract

Cardiac telerehabilitation with long-term follow-up reduces GlycA and improves lipoprotein particle profile: A randomised controlled trial.

Dalli-Peydro E, Gisbert-Criado R, Amigó N, Sanz-Sevilla N, Cosín-Sales J
Background
A 10-month strategy of cardiac telerehabilitation (CTR) improved outcomes over a standard centre-based cardiac rehabilitation (CBCR), as recently published. We hypothesised that prolonged telerehabilitation could also improve proinflammatory status and lipoprotein particle composition.
Methods
A randomised controlled trial compared a prolonged CTR program with CBCR in post-ACS patients. Patient\'s age was 18-72 years with low-risk criteria. Blood samples were drawn at baseline, at 4- and 10-months follow-up. Advanced lipoprotein characterization was performed using the NMR-based Liposcale test. Signals from glycoproteins (GlycA and GlycB) were also assessed.
Results
The final analysis included 31 patients in the CTR group and 25 patients in the CBCR group. GlycA decreased in the CTR group (p = 0,007). LDL particle number (LDL-P) increase in both groups, but it was at the expense of small-sized LDL in the CBCR group (p = 0.012). Triglycerides in intermediate-density lipoprotein (IDL-TG) increased only in the CBCR group (p = 0.043). The triglyceride-to-HDL (TG/HDL) ratio decreased only in the CTR group (p = 0.006). The TG/HDL ratio was correlated with GlycA (Spearman\'s correlation coefficient: 0.558, p < 0.001) but not with CRP (p = 0.101).
Conclusions
Our results showed that a 10-month CTR program reduced GlycA levels, the TG/HDL ratio and avoided unfavourable long-term changes in lipoprotein particle composition. Registration at ClinicalTrials.gov. NCT number: 04942977.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 06 Aug 2022; epub ahead of print
Dalli-Peydro E, Gisbert-Criado R, Amigó N, Sanz-Sevilla N, Cosín-Sales J
Int J Cardiol: 06 Aug 2022; epub ahead of print | PMID: 35944773
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Impact:
Abstract

Safety and usefulness of left ventricular endomyocardial biopsy in new- onset acute heart failure requiring mechanical support by an Impella® device.

Tschöpe C, Nelki V, Trippel TD, Klingel K, Abawi D, Alogna A
Background
In patients with de novo acute heart failure (AHF) requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO), endomyocardial biopsy (EMB) has been recently shown to be feasible and a helpful method to clarify differential diagnoses, including acute myocarditis. This study aimed to evaluate the feasibility and safety of EMB in patients with a left ventricular (LV) implanted Impella® device.
Methods and results
This retrospective, single-center study involves 22 cardiogenic shock patients [SCAI shock stage: C (91%)] requiring mechanical circulatory support (MCS) either by Impella® axial pumps [20 patients (91%)] alone or in combination with VA-ECMO [2 patients (9%)] between December 2017 and January 2022. Coronary artery disease (CAD) or severe valvular heart were excluded. The study\'s primary endpoint was to verify the safety of EMB during MCS. Furthermore, histopathological analysis of the EMB samples was described. 30 LV-EMB procedures were performed. No major complications were reported (death, sustained ventricular tachycardia, need for cardiopulmonary resuscitation, cardiac tamponade, stroke, major bleeding). In 14 patients (64%), EMB-derived histology/immunohistology led to the definitive diagnosis of acute myocarditis.
Conclusions
EMB can be safely performed in patients suffering from cardiogenic shock requiring an Impella®-based MCS without the risk of major complications. In about 50% of the patients, relevant inflammatory heart disease could be detected, which required a change in treatment decisions.

Copyright © 2022 Elsevier Ireland Ltd. All rights reserved.

Int J Cardiol: 06 Aug 2022; epub ahead of print
Tschöpe C, Nelki V, Trippel TD, Klingel K, Abawi D, Alogna A
Int J Cardiol: 06 Aug 2022; epub ahead of print | PMID: 35944774
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Impact:
Abstract

Empagliflozin inhibits macrophage inflammation through AMPK signaling pathway and plays an anti-atherosclerosis role.

Fu J, Xu H, Wu F, Tu Q, ... Xie H, Cao Z
Objective
In recent years, some authoritative clinical studies have found that SGLT2 inhibitor can reduce cardiovascular risk in patients with diabetes, which may imply that SGLT2 inhibitor can play a role beyond lowering blood glucose. In this study, we explored the effect of empagliflozin on vascular atherosclerosis after removing the effect of diabetes.
Methods
The interaction between SGLT2 inhibitor and the AMPK(Adenosine 5\'-monophosphate-activated protein kinase) signal pathway to attenuate atherosclerosis was studied in both spontaneously atherosclerotic mice in vivo and oxidized low-density lipoprotein(ox-LDL) induced macrophage inflammation model in vitro. In vivo experiment the aorta tree and aortic valve area were stained with oil red, and the level of inflammatory factors in the diseased tissue was evaluated by immunohistochemistry. Meanwhile, serum was collected to detect the levels of inflammatory factors. In vitro experiment, the RAW264.7 cell line was selected and ox-LDL was used to induce the release of proinflammatory factors, and different doses of empagliflozin were added. The phagocytosis of macrophages to ox-LDL density lipoprotein, and the expression of inflammatory factors at the protein and RNA levels were measured.
Results
Empagliflozin reduced the area of atherosclerotic plaque and macrophage infiltration in atherosclerotic plaques, decreased the expression of inflammatory factors in local plaque tissues and serum of APOE-/- mice fed with high-fat diet. Empagliflozin can improve the protein expression level of p-AMPK affected by ox-LDL in cell and reduce the gene expression level of inflammatory factors and protein expression level of NF-κB, thus playing an anti-atherosclerosis role.
Conclusions
Empagliflozin improves energy metabolism and reduces the expression of inflammatory factors by activating AMPK. As empagliflozin inhibits atherosclerosis progression, it may be of use in prevention of cardiovascular diseases.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 02 Aug 2022; epub ahead of print
Fu J, Xu H, Wu F, Tu Q, ... Xie H, Cao Z
Int J Cardiol: 02 Aug 2022; epub ahead of print | PMID: 35931206
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Impact:
Abstract

Myocardial infarction with non-obstructive coronary arteries in hypertrophic cardiomyopathy vs Fabry disease.

Graziani F, Lillo R, Biagini E, Limongelli G, ... Olivotto I, Crea F
Background
Little is known about prevalence and predictors of myocardial infarction with non-obstructive coronary arteries (MINOCA) in Fabry disease (FD) and hypertrophic cardiomyopathy (HCM). We assessed and compared the prevalence and predictors of MINOCA in a large cohort of HCM and FD patients.
Methods
In this multicenter, retrospective study we enrolled 2870 adult patients with HCM and 267 with FD. The only exclusion criterion was documented obstructive coronary artery disease. MINOCA was defined according to guidelines. For each patient we collected clinical, ECG and echocardiographic data recorded at initial evaluation.
Results
Overall, 36 patients had MINOCA during a follow-up period of 4.5 ± 11.2 years, MINOCA occurred in 16 patients with HCM (0.5%) and 20 patients with FD (7.5%; p < 0.001). The difference between the 2 groups was highly significant, also after adjustment for the main clinical, ECG and echocardiographic variables (OR 6.12;95%CI:2.80-13.3;p < 0.001). In the FD population MINOCA occurred in 17 out of 96 patients with left ventricle hypertrophy (LVH, 17.7%) and in 3 out of 171 patients without LVH (1.7%; OR 12.0;95%CI 3.43-42.3;p < 0.001). At multivariable analysis, voltage criteria for LVH at ECG (OR 7.3;95%CI 1.93-27.7;p = 0.003) and maximal LV wall thickness at echocardiography (OR 1.15; 95%CI 1.05-1.27;p = 0.002) maintained an independent association with MINOCA. No major significant differences were found in clinical, ECG and echocardiographic findings between HCM patients with or without MINOCA.
Conclusions
MINOCA was rare in HCM patients, and 6-fold more frequent in FD patients. MINOCA may be considered a red flag for FD and aid in the differential diagnosis from HCM.

Copyright © 2022 Elsevier Ireland Ltd. All rights reserved.

Int J Cardiol: 02 Aug 2022; epub ahead of print
Graziani F, Lillo R, Biagini E, Limongelli G, ... Olivotto I, Crea F
Int J Cardiol: 02 Aug 2022; epub ahead of print | PMID: 35931207
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Impact:
Abstract

How does protocolization improve outcomes in cardiogenic shock due to end-stage heart failure?

Lim HS
Background
Protocolized team-based care has been shown to improve outcomes in cardiogenic shock (CS) in patients with end-stage heart failure (ESHF). This study tested the hypothesis that protocolized care improves survival by reducing multi-organ dysfunction prior to orthotopic heart transplantation (OHT) or durable left ventricular assist device (LVAD).
Methods
We developed a protocolized Recognize/rescue-Optimization-Stabilization-Exit/de-Escalation (ROSE) framework for CS due to ESHF. Six-month survival pre-ROSE (2014-2018) and post-ROSE (2018-2021) were compared. The Sequential Organ Failure Assessment (SOFA) score was calculated as a measure of multi-organ dysfunction pre-MCS and pre-\"Exit\" therapy (OHT, LVAD or recovery).
Results
101 consecutive patients with CS due to ESHF who were deteriorating on inotropes (INTERMACS 1 or 2) were included (63 in Pre-ROSE and 38 in Post-ROSE). The proportions of patients who died on support (26 (41%) vs 11 (29%), p = 0.213) or bridged to \"Exit\" therapy were comparable between Pre- and Post-ROSE: OHT (28 (44%) vs 21 (55%), p = 0.292); durable LVAD (8 (13%) vs 5 (13%), p = 0.947); or recovery (1 (2%) vs 1 (3%), p = 0.715). SOFA score prior to \"Exit\" therapy was higher Pre-ROSE compared to Post-ROSE (4 (2-7) vs 2 (1-5), p = 0.012). Six-month survival from initial MCS (71% vs 41%, p = 0.004) and in patients who underwent \"Exit\" therapy (100% vs 71%, p = 0.001) were higher Post-ROSE vs Pre-ROSE, respectively. Higher pre-\"Exit\" SOFA score was associated with 6-month survival. None of the patients with Pre-\"Exit\" SOFA score ≥ 9 survived at 6 months.
Conclusion
Protocolization of CS care in ESHF improved six-month survival by improving multi-organ dysfunction (SOFA score) prior to OHT and LVAD implant.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 02 Aug 2022; epub ahead of print
Lim HS
Int J Cardiol: 02 Aug 2022; epub ahead of print | PMID: 35931208
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Impact:
Abstract

Global warming, renal function and heart failure over 20 years.

Aimo A, Lupon J, Spitaleri G, Domingo M, ... Emdin M, Bayes-Genis A
Background
The impact of increasing temperatures on renal function in heart failure (HF) outpatients has never been specifically analyzed.
Methods
We retrieved creatinine and estimated glomerular filtration rate (eGFR) values of all HF outpatients followed at a HF clinic and temperature data from 2002 to 2021. For each patient and each year we averaged values of creatinine, eGFR and monthly temperatures during summer and the rest of the year.
Results
The study cohort included 2167 HF patients undergoing 25,865 elective visits, with a median of 14 visits for each patient (interquartile range 7-23). At the first visit, patients (70% men) had an age of 67 ± 13 years, and a left ventricular ejection fraction of 35 ± 14%. Creatinine was 1.25 ± 0.51 mg/dL, and eGFR was 65 ± 25 mL/min/1.73 m2. When pooling together all average values of creatinine and eGFR measured during summer or in the rest of the year, creatinine was significantly higher in summer (difference 0.04, 95% confidence interval [CI] 0.04 to 0.05, p < 0.001), and eGFR was slightly lower (difference - 2.0, 95% CI -2.3 to -1.8, p < 0.001). Temperature rise during summer increased from 2002 to 2021. The absolute (Δ) and percent (Δ%) elevation in temperature during summer displayed independent associations with Δ and Δ% creatinine and eGFR after adjusting for age, sex, plasma creatinine, and HF therapies.
Conclusions
The magnitude of temperature elevation during summer has increased over 20 years. This elevation correlates with the decline in renal function during summer. This might be an example of how global warming is affecting human health.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 01 Aug 2022; epub ahead of print
Aimo A, Lupon J, Spitaleri G, Domingo M, ... Emdin M, Bayes-Genis A
Int J Cardiol: 01 Aug 2022; epub ahead of print | PMID: 35926642
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Abstract

Cardiac function in childhood cancer survivors treated with vincristine: Echocardiographic results from the DCCSS LATER 2 CARD study.

Merkx R, Feijen ELAM, Leerink JM, de Baat EC, ... Kapusta L, Dutch LATER Study Group
Background
Anthracyclines and radiotherapy involving the heart region are cardiotoxic, but the potential cardiotoxicity of vincristine remains unknown. We assessed cardiac function in vincristine-treated >5-year childhood cancer survivors (CCS).
Methods and results
We cross-sectionally compared echocardiograms of 101 vincristine-treated CCS (median age 35 years [range: 17-53], median vincristine dose 63 mg/m2) from the national Dutch Childhood Cancer Survivor Study, LATER cohort, to 101 age- and sex-matched controls. CCS treated with anthracyclines, radiotherapy involving the heart region, cyclophosphamide or ifosfamide were excluded. Twelve CCS (14%) versus four controls (4%; p 0.034) had a decreased left ventricular ejection fraction (LVEF; men <52%, women <54%). Mean LVEF was 58.4% versus 59.7% (p 0.050). Global longitudinal strain (GLS) was abnormal in nineteen (24%) CCS versus eight controls (9%; p 0.011). Mean GLS was 19.0% versus 20.1% (p 0.001). No ≥grade 2 diastolic dysfunction was detected. In multivariable logistic regression analysis CCS had higher risk of abnormal GLS (OR 3.55, p 0.012), but not abnormal LVEF (OR 3.07, p 0.065), than controls. Blood pressure and smoking history contributed to variation in LVEF, whereas obesity and diastolic blood pressure contributed to variation in GLS. Cumulative vincristine dose was not associated with either abnormal LVEF or abnormal GLS in multivariable models corrected for age and sex (OR per 50 mg/m2: 0.88, p 0.85 and 1.14, p 0.82, respectively).
Conclusions
Vincristine-treated long-term CCS showed an abnormal GLS more frequently than controls. Their risk for future clinical cardiac events and the role of risk factor modification should be further elucidated.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 01 Aug 2022; epub ahead of print
Merkx R, Feijen ELAM, Leerink JM, de Baat EC, ... Kapusta L, Dutch LATER Study Group
Int J Cardiol: 01 Aug 2022; epub ahead of print | PMID: 35926643
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Abstract

Sex-related differences in clinical outcomes among patients with myocardial infarction with nonobstructive coronary artery disease: A systematic review and meta-analysis.

Chaudhary R, Bashline M, Novelli EM, Bliden KP, ... Gurbel PA, Pacella JJ
Background
Among patients who present with acute myocardial infarction (MI), 2-6% are found to have non-obstructive coronary arteries (NOCA). Patients with MINOCA are more commonly women and present at a younger age (51-59 years). The influence of sex on adverse event rates remains unclear.
Methods
PubMed, MEDLINE, CENTRAL (Cochrane Central Register of Controlled Trials), EMBASE, EBSCO, Web of Science and CINAHL databases were searched for trials comparing gender differences in clinical outcomes among patients with MINOCA from inception through April 10, 2022. The primary endpoint of the study was composite major adverse clinical events (MACE) including all-cause mortality, non-fatal MI, stroke, and cardiovascular readmissions, and secondary endpoints were the individual components of the MACE.
Results
Seven studies with a total of 28,671 MINOCA patients were included (n = 11,249 men and n = 17,422 women) over a mean follow-up of 2 years. Women had more MACE than men (10.1% vs. 9.1%, OR 1.15, 1.04-1.23, I2 = 44.7%). Among secondary endpoints, only the incidence of stroke was higher in women (3.5% vs. 2.2%, OR 1.3, 1.01-1.68, I2 = 0%). All-cause mortality, non-fatal MI, and cardiovascular readmissions were not significantly different between the two groups.
Conclusions
We hypothesize that small vessel disease associated with MINOCA drives MACE in women and the diminishing influence of estrogen, hypercoagulability and underprescribing could contribute to the differences sex-related outcomes.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 01 Aug 2022; epub ahead of print
Chaudhary R, Bashline M, Novelli EM, Bliden KP, ... Gurbel PA, Pacella JJ
Int J Cardiol: 01 Aug 2022; epub ahead of print | PMID: 35926644
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Abstract

Echocardiographic assessment of COVID19 sequelae in survivors with elevated cardiac biomarkers.

Ródenas-Alesina E, Rodríguez-Palomares J, Bach-Oller M, Jordán P, ... Bañeras J, Ferreira-González I
Aims
We sought to determine, using advanced echocardiography, the prevalence and type of cardiovascular sequelae after COVID19 infection with marked elevation of cardiovascular biomarkers (CVB), and their prognostic implications.
Methods
All patients admitted from March 1st to May 25th, 2020 to a tertiary referral hospital were included. Those with cardiovascular diseases or dead during admission were excluded. Patients with hs-TnI > 45 ng/L, NT-proBNP>300 pg/mL, and D-dimer >8000 ng/mL were matched with COVID controls (three biomarkers within the normal range) based on intensive care requirements and age, and separately analyzed.
Results
From 2025 patients, 80 patients with significantly elevated CVB and 29 controls were finally included. No differences in baseline characteristics were observed among groups, but elevated CVB patients were sicker. Follow-up echocardiograms showed no differences among groups regarding LVEF and only slight differences between groups within the normal range. Hs-TnI patients had lower myocardial work and longitudinal strain. The presence of an abnormal echocardiogram was more frequent in the elevated CVB group compared to controls (23.8 vs 10.3%, P = 0.123) but mainly associated with mild abnormalities in deformation parameters. Management did not change in any case and no major cardiovascular events except deep vein thrombosis occurred after a median follow-up of 7 months.
Conclusion
Minimal abnormalities in cardiac structure and function are observed in COVID19 survivors without previous cardiovascular diseases who presented a significant CVB rise at admission, with no impact on patient management or short-term prognosis. These results do not support a routine screening program after discharge in this population.

Copyright © 2022 Elsevier B.V. All rights reserved.

Int J Cardiol: 01 Aug 2022; 360:104-110
Ródenas-Alesina E, Rodríguez-Palomares J, Bach-Oller M, Jordán P, ... Bañeras J, Ferreira-González I
Int J Cardiol: 01 Aug 2022; 360:104-110 | PMID: 35490788
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This program is still in alpha version.