Journal: Prog Cardiovasc Dis

Sorted by: date / impact
Abstract

Inspiratory muscle weakness in cardiovascular diseases: Implications for cardiac rehabilitation.

Smith JR, Taylor BJ
Exercise limitation is a cardinal manifestation of many cardiovascular diseases (CVD) and is associated with poor prognosis. It is increasingly well understood that exercise-based cardiac rehabilitation (CR) is an intervention that portends favorable clinical outcomes, including improvements in exercise capacity. The etiology of exercise limitation in CVD is multifactorial but is typically governed by terminal sensations of pain, fatigue, and/or breathlessness. A known but perhaps underestimated complication of CVD that contributes to breathlessness and exercise intolerance in such patients is inspiratory muscle dysfunction. For example, inspiratory muscle dysfunction, which encompasses a loss in muscle mass and/or pressure generating capacity, occurs in up to ~40% of patients with chronic heart failure and is associated with breathlessness, exertional intolerance, and worse survival in this patient population. In this review, we define inspiratory muscle weakness, detail its prevalence in a range of CVDs, and discuss how inspiratory weakness impacts physiological function and clinical outcomes in patients with CVD often referred to CR. We also evaluate the available evidence addressing effects of exercise-based CR with and without concurrent specific inspiratory muscle training (IMT) on inspiratory muscle function, general physiological function, and clinical outcomes in patients with CVD. Finally, we consider whether the assessment of global respiratory muscle function should become standard as part of the patient intake assessment for phase II CR programs, giving practical guidance on the implementation of such measures as well as IMT as part of phase II CR.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 20 Oct 2021; epub ahead of print
Smith JR, Taylor BJ
Prog Cardiovasc Dis: 20 Oct 2021; epub ahead of print | PMID: 34688670
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Transcatheter valve-in-valve implantation in degenerated surgical aortic and mitral bioprosthesis: Current state and future perspectives.

Alperi A, Garcia S, Rodés-Cabau J
The use of bioprosthetic valves for treating patients with severe valve disease has increased over the last 2 decades, and, as a consequence, a growing number of patients with failing surgical bioprosthesis is expected in the near future. In this setting, valve-in-valve (ViV) transcatheter aortic/mitral valve replacement (TAVR and TMVR) has emerged as an alternative to redo surgery. Despite the increasing experience in ViV procedures, the development of these techniques faces several specific challenges, mainly related to the unique anatomical and physiological characteristics presented in ViV-TAVR/TMVR. Subsequently, various approaches have been proposed to overcome ViV-related complications and pitfalls. A growing body of evidence is currently available concerning early- and long-term clinical outcomes of patients undergoing ViV-TAVR/TMVR. These data should be comprehensively evaluated by the Heart Team in the decision-making process involving patients with failing surgical bioprostheses. In this review, we aimed to delineate the technical challenges and risks associated with ViV-TAVR and ViV-TMVR, provide an updated overview of the main clinical results, and summarize the future perspectives of this evolving field.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 20 Oct 2021; epub ahead of print
Alperi A, Garcia S, Rodés-Cabau J
Prog Cardiovasc Dis: 20 Oct 2021; epub ahead of print | PMID: 34688669
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

The evolving role of cardiac imaging in patients with myocardial infarction and non-obstructive coronary arteries.

Montone RA, Jang IK, Beltrame JF, Sicari R, ... Bucciarelli-Ducci C, Crea F
Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) represents a heterogeneous clinical conundrum accounting for about 6%-8% of all acute MI who are referred for coronary angiography. Current guidelines and consensus documents recommend that these patients are appropriately diagnosed, uncovering the causes of MINOCA, so that specific therapies can be prescribed. Indeed, there are a variety of causes that can result in this clinical condition, and for this reason diagnostic cardiac imaging has an emerging critical role in the assessment of patients with suspected or confirmed MINOCA. In last years, different cardiac imaging techniques have been evaluated in this context, and the comprehension of their strengths and limitations is of the utmost importance for their effective use in clinical practice. Moreover, recent evidence is clearly suggesting that a multimodality cardiac imaging approach, combining different techniques, seems to be crucial for a proper management of MINOCA. However, great variability still exists in clinical practice in the management of patients with suspected MINOCA, also depending on the availability of diagnostic tools and local expertise. Herein, we review the current knowledge supporting the use of different cardiac imaging techniques in patients with MINOCA, underscoring the importance of a comprehensive multimodality cardiac imaging approach and proposing a practical diagnostic algorithm to properly identify and treat the specific causes of MINOCA, in order to improve prognosis and the quality of life in these patients.

Copyright © 2018. Published by Elsevier Inc.

Prog Cardiovasc Dis: 29 Sep 2021; epub ahead of print
Montone RA, Jang IK, Beltrame JF, Sicari R, ... Bucciarelli-Ducci C, Crea F
Prog Cardiovasc Dis: 29 Sep 2021; epub ahead of print | PMID: 34600948
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Cardiorespiratory optimal point during exercise testing and sudden cardiac death: A prospective cohort study.

Laukkanen JA, Savonen K, Hupin D, Araújo CGS, Kunutsor SK
Background
Cardiorespiratory optimal point (COP) during exercise, a potentially useful submaximal cardiopulmonary exercise testing (CPET) variable, may be an independent risk factor for cardiovascular disease outcomes. However, the relationship of COP with risk of sudden cardiac death (SCD) has not been previously investigated. We sought to evaluate the association between COP during exercise and SCD risk and determine whether COP improves SCD risk prediction.
Methods
COP, the minimum value of the ventilatory equivalent for oxygen (VE/VO2) in a given minute of a CPET, was ascertained in 2190 men who underwent clinical exercise testing. Hazard ratios (HRs) (95% confidence intervals [CIs]) and measures of risk discrimination for SCD were calculated.
Results
A total of 240 SCDs death occurred during a median follow-up of 28.8 years. COP was linearly associated with SCD in a dose-response manner. In a multivariable model comprising several established and emerging CVD risk factors, the HR (95% CI) for SCD was 2.51 (1.36-4.62) per standard deviation increase in COP. This was minimally attenuated to 2.36 (1.27-4.37) on further adjustment for high sensitivity C-reactive protein. The association did not vary importantly in several relevant clinical subgroups. Addition of COP to a SCD risk score was associated with a C-index change of 0.0086 (0.0005 to 0.0167; p = .038) and difference in -2 log likelihood (p = .017).
Conclusions
COP during exercise is strongly, inversely and independently associated with SCD in a graded fashion. COP during exercise may potentially be used for the prediction of the long-term risk for SCD beyond established CVD risk factors.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 28 Sep 2021; epub ahead of print
Laukkanen JA, Savonen K, Hupin D, Araújo CGS, Kunutsor SK
Prog Cardiovasc Dis: 28 Sep 2021; epub ahead of print | PMID: 34597617
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Lower muscular strength is associated with smaller left and right chambers and lower cardiac mass in the general population - The Sedentary\'s Heart The Study of Health in Pomerania (SHIP).

Markus MRP, Ittermann T, Kim S, Schipf S, ... Steinhagen-Thiessen E, Dörr M
Background
The cardiac muscle has the ability to adapt to different loading conditions. We analyzed the associations of the age-related decreasing handgrip strength (HGS), a marker of muscular fitness, on cardiac structure and function in a community-based sample.
Methods
We performed cross-sectional analyses of 4646 subjects (2554 women; 55.0%) aged 20 to 93 years from two independent cohorts of the Study of Health in Pomerania (SHIP-2 and SHIP-TREND-0). We analyzed the associations of HGS with structural and functional left and right ventricular (LV and RV) and left atrial (LA) parameters as determined by echocardiography and magnetic resonance imaging (MRI) as well with log-transformed NT-proBNP values using multivariable-adjusted linear regression models.
Results
MRI data showed that a 1 kg lower HGS was associated with a 0.40 mL (95% confidence interval: 0.26 to 0.54; p < 0.001) lower LV end-diastolic volume, a 0.011 mm (0.005 to 0.018; p = 0.001) lower LV wall-thickness, a 0.59 g (0.43 to 0.75; p < 0.001) lower LV mass, a 0.58 mL/beat (0.43 to 0.74; p < 0.001) lower LV stroke volume, a 0.03 L/min (0.02 to 0.04; p < 0.001) lower LV cardiac output, a 0.48 mL (0.27 to 0.68; p < 0.001) lower LA end-diastolic volume, and a 1.02 mL (0.71 to 1.32) lower RV end-diastolic volume. Similar findings were observed for echocardiographic parameters. Moreover, lower HGS was associated with higher echocardiographic LV diastolic stiffness and NT-proBNP levels.
Conclusions
In this large population-based sample, lower muscular fitness as assessed by HGS was associated with lower LV wall thickness and mass as well as with smaller chamber size, stroke volume and cardiac output of the LV, LA and RV. Moreover, HGS was inversely related to LV diastolic stiffness and NT-proBNP values. These outcomes might demonstrate the effects of an aging-related decrease in physical activity and lower muscular fitness on the heart - \"the sedentary\'s heart\".

Copyright © 2018. Published by Elsevier Inc.

Prog Cardiovasc Dis: 21 Sep 2021; epub ahead of print
Markus MRP, Ittermann T, Kim S, Schipf S, ... Steinhagen-Thiessen E, Dörr M
Prog Cardiovasc Dis: 21 Sep 2021; epub ahead of print | PMID: 34562438
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Cardiac MRI shows an association of lower cardiorespiratory fitness with decreased myocardial mass and higher cardiac stiffness in the general population - The sedentary\'s heart: The Study of Health in Pomerania (SHIP).

Markus MRP, Ittermann T, Drzyzga CJ, Bahls M, ... Felix SB, Dörr M
Background
The heart has the capacity to adapt to different demands. The pathophysiological mechanisms involved with sedentarism are not fundamentally the opposite of those related with physical activity and regular exercise. We investigated the impact of lower cardiorespiratory fitness (CRF) on heart\'s plasticity and function in a population-based setting.
Methods
We used data from 1165 participants (539 women; 46.3%) aged 21-81 years from two independent cohorts of the Study of Health in Pomerania (SHIP-2 and SHIP-TREND-0). We analyzed the cross-sectional associations of peak oxygen uptake (VO2peak), determined by symptom-limited cardiopulmonary exercise testing, with structural and functional left ventricular (LV) and left atrial (LA) parameters determined by magnetic resonance imaging (MRI) using multivariable- adjusted linear regression models.
Results
A1 L/min lower VO2peak was associated with a 10.5 g (95% confidence interval: 8.00 to 12.9; p < 0.001) lower LV mass, a 14.8 mL (10.9 to 18.6; p < 0.001) lower LV end-diastolic volume, a 0.29 mm (0.19 to 0.40; p < 0.001) lower LV wall-thickness, a 8.85 mL/beat (6.53 to 11.2; p < 0.001) lower LV stroke volume, a 0.42 L/min (0.25 to 0.60; p < 0.001) lower LV cardiac output and a 7.51 mL (3.88 to 11.1; p < 0.001) lower LA end-diastolic volume. Moreover, there were no associations with a concentric or eccentric remodeling and LV and LA ejection fraction.
Conclusions
Lower CRF was associated with a smaller heart, LV wall-thickness and mass, LV and LA stroke volume and cardiac output. Conversely, there was no association with LA and LV ejection fraction. Our cross-sectional observations are consistent with cardiac adaptations reflecting reduced volume loading demands of a sedentary lifestyle - \"the sedentary\'s heart\".

Copyright © 2018. Published by Elsevier Inc.

Prog Cardiovasc Dis: 15 Sep 2021; epub ahead of print
Markus MRP, Ittermann T, Drzyzga CJ, Bahls M, ... Felix SB, Dörr M
Prog Cardiovasc Dis: 15 Sep 2021; epub ahead of print | PMID: 34537204
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Exercise heart rate reserve and recovery as risk factors for sudden cardiac death.

Kurl S, Jae SY, Voutilainen A, Hagnäs M, Laukkanen JA
Background
Little is known if heart rate responses during and after exercise test may be associated with the risk of sudden cardiac death (SCD). Our aim was to determine if exercise heart rate reserve and recovery, providing non-invasive indices, may predict SCD risk in general male population.
Methods
We evaluated the impact of delayed heart rate reserve and slow heart rate recovery and the risk of SCD in the Kuopio Ischemic Heart Disease prospective cohort study of randomly selected 1967 men aged 42-61 years at recruitment. Heart rate reserve was calculated as the difference between the maximal attained heart rate and resting heart rate, whereas heart rate recovery was defined as maximal heart rate minus the heart rate measured at 2 min of recovery, on a symptom-limited cardiopulmonary exercise testing.
Results
During a median follow-up interval of 25 years, 209 events of SCD occurred. The age and examination adjusted relative hazards of SCD were in the lowest third of heart rate reserve 3.86 (95% confidence interval (CI) 2.56-5.80, p < 0.001) and the lowest third of heart rate recovery 2.86 (95% CI 1.95-4.20, p < 0.001) as compared to men in the highest third of heart rate reserve and heart rate recovery, respectively. After adjusting for potential confounders, the respective relative hazards were 1.96 (95% CI 1.24-3.12) and 1.75 (95% CI 1.16-2.64). Each unit increment (1 beat/min) in heart rate reserve and heart rate recovery decreased the incidence of SCD by 1-2%.
Conclusions
Delayed exercise heart rate reserve and slow heart rate recovery predicted the risk of SCD, suggesting that heart rate responses may be associated with an increased risk for SCD in general population.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 14 Sep 2021; epub ahead of print
Kurl S, Jae SY, Voutilainen A, Hagnäs M, Laukkanen JA
Prog Cardiovasc Dis: 14 Sep 2021; epub ahead of print | PMID: 34536445
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

The role of eicosapentaenoic acid in reducing important cardiovascular events, including coronary revascularization.

Bhatt RD, Libby P, Verma S, Mason RP, Bhatt DL
The omega-3 fatty acid eicosapentaenoic acid has an important role in human health. The Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT) examined the prescription omega-3 fatty acid icosapent ethyl (IPE) in patients with established cardiovascular disease (CVD) or with diabetes plus additional CVD risk factors. The trial found a large reduction in CVD events, including significant reductions in CVD death, myocardial infarction, stroke, coronary revascularization, and hospitalization for unstable angina. These results led to the regulatory approval of IPE in a population similar to REDUCE-IT participants in the United States, Canada, United Kingdom, and the European Union. Moreover, multiple international guidelines have endorsed the use of IPE in such individuals. A secondary analysis of REDUCE-IT examined the endpoint of coronary artery revascularization. This analysis showed a significant reduction not only in coronary revascularization overall but also in elective, urgent, and emergent coronary revascularization. Additionally, IPE significantly reduced the need for both percutaneous coronary intervention and for coronary artery bypass graft surgery. Coronary imaging studies have demonstrated significant decreases in rates of plaque progression with IPE, with significant effects within 6-9 months. In parallel, experimental findings corroborate several effects of IPE that provide mechanisms that could contribute to the profound reductions in multiple types of ischemic events, including percutaneous and surgical coronary revascularization. Future trials should explore potential benefits of initiation of IPE at the time of revascularization in broader populations, potentially in conjunction with loading doses.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 19 Aug 2021; epub ahead of print
Bhatt RD, Libby P, Verma S, Mason RP, Bhatt DL
Prog Cardiovasc Dis: 19 Aug 2021; epub ahead of print | PMID: 34419485
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) guidelines for management of dyslipidemia and cardiovascular disease risk reduction: Putting evidence in context.

Al Rifai M, Blumenthal RS, Stone NJ, Schofield RS, ... Grundy S, Virani SS
Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortality in the United States (U.S.) and incurs significant cost to the healthcare system. Management of cholesterol remains central for ASCVD prevention and has been the focus of multiple national guidelines. In this review, we compare the American Heart Association (AHA)/American College of Cardiology (ACC) and the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) Cholesterol guidelines. We review the evidence base that was used to generate recommendations focusing on 4 distinct themes: 1) the threshold of absolute 10-year ASCVD risk to start a clinician-patient discussion for the initiation of statin therapy in primary prevention patients; 2) the utility of coronary artery calcium score to guide clinician-patient risk discussion pertaining to the initiation of statin therapy for primary ASCVD prevention; 3) the use of moderate versus high-intensity statin therapy in patients with established ASCVD; and 4) the utility of ordering lipid panels after initiation or intensification of lipid lowering therapy to document efficacy and monitor adherence to lipid lowering therapy. We discuss why the VA/DoD and AHA/ACC may have reached different conclusions on these key issues.

Published by Elsevier Inc.

Prog Cardiovasc Dis: 07 Aug 2021; epub ahead of print
Al Rifai M, Blumenthal RS, Stone NJ, Schofield RS, ... Grundy S, Virani SS
Prog Cardiovasc Dis: 07 Aug 2021; epub ahead of print | PMID: 34371083
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:

This program is still in alpha version.