Topic: General Cardiology

Abstract
<div><h4>Angiotensin-converting enzyme 2 in human plasma and lung tissue.</h4><i>Xie J, Huang QF, Zhang Z, Dong Y, ... Wang X, Wang JG</i><br /><b>Purpose</b><br />We investigated plasma angiotensin-converting enzyme 2 (ACE2) concentration in a population sample and the ACE2 expression quantitated with the diaminobenzidine mean intensity in the lung tissue in patients who underwent lung surgery.<br /><b>Materials and methods</b><br />The study participants were recruited from a residential area in the suburb of Shanghai for the plasma ACE2 concentration study (<i>n</i> = 503) and the lung tissue samples were randomly selected from the storage in Ruijin Hospital (80 men and 78 age-matched women).<br /><b>Results</b><br />In analyses adjusted for covariables, men had a significantly higher plasma ACE2 concentration (1.21 <i>vs</i>. 0.98 ng/mL, <i>p</i> = 0.027) and the mean intensity of ACE2 in the lung tissue (55.1 <i>vs</i>. 53.9 a.u., <i>p</i> = 0.037) than women. With age increasing, plasma ACE2 concentration decreased (<i>p</i> = 0.001), while the mean intensity of ACE2 in the lung tissue tended to increase (<i>p</i> = 0.087). Plasma ACE2 concentration was higher in hypertension than normotension, especially treated hypertension (1.23 <i>vs</i>. 0.98 ng/mL, <i>p</i> = 0.029 <i>vs</i>. normotension), with no significant difference between users of RAS inhibitors and other classes of antihypertensive drugs (<i>p</i> = 0.64). There was no significance of the mean intensity of ACE2 in the lung tissue between patients taking and those not taking RAS inhibitors (<i>p</i> = 0.14). Neither plasma ACE2 concentration nor the mean intensity of ACE2 in the lung tissue differed between normoglycemia and diabetes (<i>p</i> ≥ 0.20).<br /><b>Conclusion</b><br />ACE2 in the plasma and lung tissue showed divergent changes according to several major characteristics of patients.Plain language summary <b>What is the context?</b> • The primary physiological function of ACE2 is the degradation of angiotensin I and II to angiotensin 1-9 and 1-7, respectively. • ACE2 was found to behave as a mediator of the severe acute respiratory syndrome coronavirus (SARS) infection. • There is little research on ACE2 in humans, especially in the lung tissue. • In the present report, we investigated plasma ACE2 concentration and the ACE2 expression quantitated with the diaminobenzidine mean intensity in the lung tissue respectively in two study populations. <b>What is new?</b> • Our study investigated both circulating and tissue ACE2 in human subjects. The main findings were: • In men as well as women, plasma ACE2 concentration was higher in younger than older participants, whereas the mean intensity of ACE2 in the lung tissue increase with age increasing. • Compared with normotension, hypertensive patients had higher plasma ACE2 concentration but similar mean intensity of ACE2 in the lung tissue. • Neither plasma ACE2 concentration nor lung tissue ACE2 expression significantly differed between users of RAS inhibitors and other classes of antihypertensive drugs. <b>What is the impact?</b> • ACE2 in the plasma and lung tissue showed divergent changes according to several major characteristics, such as sex, age, and treated and untreated hypertension. • A major implication is that plasma ACE2 concentration might not be an appropriate surrogate for the ACE2 expression in the lung tissue, and hence not a good predictor of SARS-COV-2 infection or fatality.<br /><br /><br /><br /><small>Blood Pressure: 01 Dec 2023; 32:6-15</small></div>
Xie J, Huang QF, Zhang Z, Dong Y, ... Wang X, Wang JG
Blood Pressure: 01 Dec 2023; 32:6-15 | PMID: 36495008
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<div><h4>Blood pressure responses are dependent on call type and related to hypertension status in firefighters.</h4><i>Rynne PJ, Derella CC, McMorrow C, Dickinson RL, ... Carty M, Feairheller DL</i><br /><b>Background</b><br />Impaired cardiovascular health is a concern for firefighters, with over 50% of line-of-duty deaths having cardiac causes. Many firefighters have hypertension and <25% have their blood pressure (BP) controlled. The alarm response could be an unidentified cardiac risk, but interestingly, the BP response to different calls and on-the-job activity is unknown.<br /><b>Purpose</b><br />We aimed to measure the physiological stress resulting from different call types (fire, medical) and job activity (riding apparatus, pre-alert alarms) through ambulatory BP (ABP) monitoring in a population of firefighters.<br /><b>Materials and methods</b><br />During 111 12-h work shifts firefighters wore an ABP monitor. BP was measured at 30-min intervals and manual measurements were prompted when the pager went off or whenever they felt stress.<br /><b>Results</b><br />Firefighters were hypertensive (124.3 ± 9.9/78.1 ± 6.7 mmHg), overweight (30.2 ± 4.6 kg/m<sup>2</sup>), middle-aged (40.5 ± 12.6 years) and experienced (17.3 ± 11.7 years). We calculated an average 11% increase in systolic and 10.5% increase in diastolic BP with alarm. Systolic BP (141.9 ± 13.2 mmHg) and diastolic BP (84.9 ± 11.1 mmHg) and the BP surges were higher while firefighters were responding to medical calls compared to fire calls. Between BP groups we found that medical call systolic BP (<i>p</i> = .001, <i>d</i> = 1.2), diastolic BP (<i>p</i> = .017, <i>d</i> = 0.87), and fire call systolic BP (<i>p</i> = .03, <i>d</i> = 0.51) levels were higher in the hypertensive firefighters.<br /><b>Conclusion</b><br />This is the first report of BP surge responses to alarms and to occupational activities in firefighters, and medical calls elicited the largest overall responses.PLAIN LANGUAGE SUMMARYCardiovascular disease and impaired cardiovascular health are substantially more prevalent in firefighters, with over 50% of line-of-duty deaths being cardiac related.Many firefighters are diagnosed with high blood pressure (hypertension), which is known to increase the risk of heart attacks, strokes, heart disease, and other serious health complications.Upon stress, our body enacts the \'fight or flight\' response where sympathetic nervous system activity triggers an immediate increase in heart rate and blood pressure. This response can be dangerous when surges reach extreme levels due to underlying impaired cardiovascular function. It is known that alarm sounds trigger a stress response.Firefighters respond to different alarms while on the job, each indicating different call types, such as a house fire or a medical emergency. Due to the prevalence of impaired cardiovascular health in firefighters, the physical stress resulting from these alerts is cause for concern.The blood pressure surge response to different call types and job activities in healthy and hypertensive firefighters had not been measured before this study.Through the ambulatory blood pressure monitoring of 111 on-duty firefighters, this study discovered that medical calls caused the greatest blood pressure and heart rate surge.Also, firefighters with hypertension experienced a greater blood pressure surge in response to alarms than their non-hypertensive co-workers.<br /><br /><br /><br /><small>Blood Pressure: 01 Dec 2023; 32:2161997</small></div>
Rynne PJ, Derella CC, McMorrow C, Dickinson RL, ... Carty M, Feairheller DL
Blood Pressure: 01 Dec 2023; 32:2161997 | PMID: 36597210
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<div><h4>Current practice of blood pressure measurement in Germany: a nationwide questionnaire-based survey in medical practices.</h4><i>Beger C, Mayerböck A, Klein K, Karg T, ... Randerath O, Limbourg FP</i><br /><b>Purpose</b><br />Discrepancies exist between guideline recommendations and real-world practice of blood pressure (BP) measurements. The aim of this study was to assess, with a nationwide, questionnaire-based survey, the current practice of BP measurement and associated BP values in German medical practices.<br /><b>Material and methods</b><br />A nationwide survey in German medical practices was performed in the period from 10 May 2021 to 15 August 2021. The questionnaire was divided into five sections. The current office BP (OBP) values as well as the current drug therapy were recorded. In addition, the implementation of office BP (OBP) and home BP monitoring (HBPM) was queried. For analysis, questionnaires were scanned and automatically digitised.<br /><b>Results</b><br />A total of 7049 questionnaires were analysed, the majority of which came from general practitioners (66%) and internal medicine practices (34%). The average OBP (SD) was 140.0 (18)/82.7 (11) mmHg. 40.8% of treated patients had OBP in the controlled range, with monotherapy (34.7%) or dual combination therapy (38.2%) prescribed in most cases. OBP was taken from a single measurement in 66.3% of cases, and in 21.8% from 23 measurements. OBP was mostly measured after a rest period (87.1%) and in a separate room (80.4%). HBPM was performed in 62.3% of patients; however, in 24.9% of the participants HBP measurements were recorded once a week or less.<br /><b>Conclusion</b><br />In this nationwide survey in German medical practices, BP control remains at below 50%, while monotherapy is prescribed in around one third of patients. Moreover, office measurements and HBPM are often not performed according to current guideline recommendations.<br /><br /><br /><br /><small>Blood Pressure: 01 Dec 2023; 32:2165901</small></div>
Beger C, Mayerböck A, Klein K, Karg T, ... Randerath O, Limbourg FP
Blood Pressure: 01 Dec 2023; 32:2165901 | PMID: 36637453
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<div><h4>Ambulatory blood pressure monitoring in treated patients with hypertension in the COVID-19 pandemic - The study of European society of hypertension (ESH ABPM COVID-19 study).</h4><i>Wojciechowska W, Rajzer M, Weber T, Prejbisz A, ... Kreutz R, Januszewicz A</i><br /><b>Purpose</b><br />The coronavirus disease 2019 (COVID-19) pandemic and the subsequent lockdown profoundly affected almost all aspects of daily life including health services worldwide. The established risk factors for increased blood pressure (BP) and hypertension may also demonstrate significant changes during the pandemic. This study aims to determine the impact of the COVID-19 pandemic on BP control and BP phenotypes as assessed with 24-hour ambulatory BP monitoring (ABPM).<br /><b>Materials and methods</b><br />This is a multi-centre, observational, retrospective and comparative study involving Excellence Centres of the European Society of Hypertension across Europe. Along with clinical data and office BP, ABPM recordings will be collected in adult patients with treated arterial hypertension. There will be two groups in the study: Group 1 will consist of participants who have undergone two ABPM recordings - the second one occurring during the COVID-19 pandemic, i.e. after March 2020, and the first one 9-15 months prior to the second. Participants in Group 2 will have two repeated ABPM recordings - both performed before the pandemic within a similar 9-15 month interval between the recordings. Within each group, we will analyse and compare BP variables and phenotypes (including averaged daytime and night-time BP, BP variability, dipper and non-dipper status, white-coat and masked hypertension) between the two respective ABPM recordings and compare these changes between the two groups. The target sample size will amount to least 590 participants in each of the study groups, which means a total of at least 2360 ABPM recordings overall.<br /><b>Expected outcomes</b><br />As a result, we expect to identify the impact of a COVID-19 pandemic on blood pressure control and the quality of medical care in order to develop the strategy to control cardiovascular risk factors during unpredictable global events.<br /><br /><br /><br /><small>Blood Pressure: 01 Dec 2023; 32:2161998</small></div>
Wojciechowska W, Rajzer M, Weber T, Prejbisz A, ... Kreutz R, Januszewicz A
Blood Pressure: 01 Dec 2023; 32:2161998 | PMID: 36694963
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<div><h4>Urine sodium excretion is related to extracellular water volume but not to blood pressure in 510 normotensive and never-treated hypertensive subjects.</h4><i>Taurio J, Koskela J, Sinisalo M, Tikkakoski A, ... Nevalainen P, Pörsti I</i><br /><b>Purpose</b><br />High sodium intake is an accepted risk factor for hypertension, while low Na<sup>+</sup> intake has also been associated with increased risk of cardiovascular events. In this cross-sectional study, we examined the association of 24-h urinary Na<sup>+</sup> excretion with haemodynamics and volume status.<br /><b>Materials and methods</b><br />Haemodynamics were recorded in 510 normotensive and never-treated hypertensive subjects using whole-body impedance cardiography and tonometric radial artery pulse wave analysis. The results were examined in sex-specific tertiles of 24-h Na<sup>+</sup> excretion, and comparisons between normotensive and hypertensive participants were also performed. Regression analysis was used to investigate factors associated with volume status. The findings were additionally compared to 28 patients with primary aldosteronism.<br /><b>Results</b><br />The mean values of 24-h urinary Na<sup>+</sup> excretion in tertiles of the 510 participants were 94, 148 and 218 mmol, respectively. Average tertile age (43.4-44.7 years), office blood pressure and pulse wave velocity were corresponding in the tertiles. Plasma electrolytes, lipids, vitamin D metabolites, parathyroid hormone, renin activity, aldosterone, creatinine and insulin sensitivity did not differ in the tertiles. In supine laboratory recordings, there were no differences in aortic systolic and diastolic blood pressure, heart rate, cardiac output and systemic vascular resistance. Extracellular water volume was higher in the highest versus lowest tertile of Na<sup>+</sup> excretion. In regression analysis, body surface area and 24-h Na<sup>+</sup> excretion were independent explanatory variables for extracellular water volume. No differences in urine Na<sup>+</sup> excretion and extracellular water volume were found between normotensive and hypertensive participants. When compared with the 510 participants, patients with primary aldosteronism had 6.0% excess in extracellular water (<i>p</i> = .003), and 24-h Na<sup>+</sup> excretion was not related with extracellular water volume.<br /><b>Conclusion</b><br />In the absence of mineralocorticoid excess, Na<sup>+</sup> intake, as evaluated from 24-h Na<sup>+</sup> excretion, predominantly influences extracellular water volume without a clear effect on blood pressure.<br /><br /><br /><br /><small>Blood Pressure: 01 Dec 2023; 32:2170869</small></div>
Taurio J, Koskela J, Sinisalo M, Tikkakoski A, ... Nevalainen P, Pörsti I
Blood Pressure: 01 Dec 2023; 32:2170869 | PMID: 36708156
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<div><h4>Isolated systolic or diastolic hypertension and mortality risk in young adults using the 2017 American College of Cardiology/American Heart Association blood pressure guideline: a longitudinal cohort study.</h4><i>Bo Y, Yu T, Guo C, Chang LY, ... Tam T, Lao XQ</i><br /><b>Background</b><br />Little is known regarding the health effects of different hypertension phenotypes including isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic and diastolic hypertension (SDH) defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline among young adults. We conducted this longitudinal study using time-varying analyses to evaluate the relationship between cardiovascular/all-natural mortality risk and different hypertension phenotypes in young adults.<br /><b>Methods</b><br />A total of 284 597 young adults (aged 18-39 years) were recruited between 1996 and 2016. Participants were classified into eight mutually exclusive BP groups: normal blood pressure (BP), elevated BP, stage 1 IDH, stage 1 ISH, stage 1 SDH, stage 2 IDH, stage 2 ISH, and stage 2 SDH. The outcomes were cardiovascular and all-natural mortality.<br /><b>Results</b><br />After a median follow-up of 15.8 years, 2341 all-natural deaths with 442 cardiovascular deaths were observed. When compared with individuals with normal BP, the multivariable adjusted hazard ratios (95% confidence interval) of cardiovascular mortality was 1.39 (1.01-1.93) for elevated BP, 2.00 (1.45-2.77) for stage 1 IDH, 1.66 (1.08-2.56) for stage 1 ISH, 3.08 (2.13-4.45) for stage 1 SDH, 2.85 (1.76-4.62) for stage 2 IDH, 4.30 (2.96-6.25) for stage 2 ISH, and 6.93 (4.99-9.61) for stage 2 SDH, respectively. In consideration to all-natural mortality, similar results were observed for stage 1 SDH, stage 2 ISH, and stage 2 SDH; but not for elevated BP, stage 1 IDH, stage 1 ISH, and stage 2 IDH.<br /><b>Conclusion</b><br />Young adults with stage 1 or stage 2 ISH, IDH, and SDH are at increased risk of cardiovascular death than those with normal BP. Regardless of BP stage, SDH was associated with a higher cardiovascular mortality risk than IDH and ISH.<br /><br />Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.<br /><br /><small>J Hypertens: 01 Mar 2023; 41:271-279</small></div>
Abstract
<div><h4>Effect of intravenous antihypertensives on outcomes of severe hypertension in hospitalized patients without acute target organ damage.</h4><i>Ghazi L, Li F, Simonov M, Yamamoto Y, ... Peixoto AJ, Wilson FP</i><br /><b>Background</b><br />Treatment of severe inpatient hypertension (HTN) that develops during hospitalization is not informed by guidelines. Intravenous (i.v.) antihypertensives are used to manage severe HTN even in the absence of acute target organ damage; however they may result in unpredictable blood pressure (BP) reduction and cardiovascular events. Our goal was to assess the association between i.v. antihypertensives and clinical outcomes in this population.<br /><b>Methods</b><br />This is a multihospital retrospective study of adults admitted for reasons other than HTN who develop severe HTN during hospitalization without acute target end organ damage. We defined severe HTN as BP elevation of systolic >180 or diastolic >110 mmHg. Treatment was defined as receiving i.v. antihypertensives within 3 h of BP elevation. We used overlap propensity score weighted Cox models to study the association between treatment and clinical outcomes during index hospitalization.<br /><b>Results</b><br />Of 224 265 unique, nonintensive care unit hospitalizations, 20 383 (9%) developed severe HTN, of which 5% received i.v. antihypertensives and 79% were untreated within 3 h of severe BP elevation. In the overlap propensity weighted population, patients who received i.v. antihypertensives were more likely to develop myocardial injury (5.9% in treated versus 3.6% in untreated; hazard ratio [HR]: 1.6 [1.13, 2.24]). Treatment was not associated with increased risk of stroke (HR: 0.7 [0.3, 1.62]), acute kidney injury (HR: 0.97 [0.81, 1.17]), or death (HR: 0.86 [0.49, 1.51]).<br /><b>Conclusions</b><br />Intravenous antihypertensives were associated with increased risk of myocardial injury in patients who develop severe HTN during hospitalization. These results suggest that i.v. antihypertensives should be used with caution in patients without acute target organ damage.<br /><br />Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.<br /><br /><small>J Hypertens: 01 Mar 2023; 41:288-294</small></div>
Ghazi L, Li F, Simonov M, Yamamoto Y, ... Peixoto AJ, Wilson FP
J Hypertens: 01 Mar 2023; 41:288-294 | PMID: 36583354
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<div><h4>Effect of finerenone on ambulatory blood pressure in chronic kidney disease in type 2 diabetes.</h4><i>Agarwal R, Ruilope LM, Ruiz-Hurtado G, Haller H, ... Joseph A, Bakris GL</i><br /><b>Objective</b><br />Finerenone is a selective nonsteroidal mineralocorticoid receptor antagonist with a short half-life. Its effects on cardiorenal outcomes were thought to be mediated primarily via nonhemodynamic pathways, but office blood pressure (BP) measurements were insufficient to fully assess hemodynamic effects. This analysis assessed the effects of finerenone on 24-h ambulatory BP in patients with chronic kidney disease and type 2 diabetes.<br /><b>Methods</b><br />ARTS-DN (NCT01874431) was a phase 2b trial that randomized 823 patients with type 2 diabetes and chronic kidney disease, with urine albumin-to-creatinine ratio ≥30 mg/g and estimated glomerular filtration rate of 30-90 ml/min per 1.73 m2 to placebo or finerenone (1.25-20 mg once daily in the morning) administered over 90 days. Ambulatory BP monitoring (ABPM) over 24 h was performed in a subset of 240 patients at screening, Day 60, and Day 90.<br /><b>Results</b><br />Placebo-adjusted change in 24-h ABPM systolic BP (SBP) at Day 90 was -8.3 mmHg (95% confidence interval [CI], -16.6 to 0.1) for finerenone 10 mg (n = 27), -11.2 mmHg (95% CI, -18.8 to -3.6) for finerenone 15 mg (n = 34), and -9.9 mmHg (95% CI, -17.7 to -2.0) for finerenone 20 mg (n = 31). Mean daytime and night-time SBP recordings were similarly reduced and finerenone did not increase the incidence of SBP dipping. Finerenone produced a persistent reduction in SBP over the entire 24-h interval.<br /><b>Conclusions</b><br />Finerenone reduced 24-h, daytime, and night-time SBP. Despite a short half-life, changes in BP were persistent over 24 h with once-daily dosing in the morning.<br /><br />Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.<br /><br /><small>J Hypertens: 01 Mar 2023; 41:295-302</small></div>
Agarwal R, Ruilope LM, Ruiz-Hurtado G, Haller H, ... Joseph A, Bakris GL
J Hypertens: 01 Mar 2023; 41:295-302 | PMID: 36583355
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<div><h4>Time of blood pressure in target range in acute ischemic stroke.</h4><i>Kakaletsis N, Ntaios G, Milionis H, Protogerou AD, ... Doumas M, Savopoulos C</i><br /><b>Objective</b><br />The purpose of this study was to investigate the association of blood pressure (BP) time-in-target range (TTR) derived from 24-h ambulatory BP monitoring (ABPM) during the acute phase of ischemic stroke (AIS), with the severity of stroke and its predictive value for the 3 months outcome.<br /><b>Methods</b><br />A total of 228 AIS patients (prospective multicenter follow-up study) underwent ABPM every 20 min within 48 h from stroke onset using an automated oscillometric device. Clinical and laboratory findings were recorded. Mean BP parameters, BP variability and TTR for SBP (90-140 mmHg), DBP (60-90 mmHg), and mean arterial pressure (MAP) were calculated. Endpoints were death and disability/death at 3 months.<br /><b>Results</b><br />A total of 14 942 BP measurements were recorded (∼66 per AIS patient) within 72 h of stroke onset. Patient\'s 24-h TTR was 34.7 ± 29.9, 64.3 ± 24.2, and 55.3 ± 29.4% for SBP, DBP and MAP, respectively. In patients without prior hypertension, TTR was lower as stroke severity increased for both DBP (P = 0.031) and MAP (P = 0.016). In 175 patients without prior disability, increase in TTR of DBP and MAP associated significantly with a decreased risk of disability/death (hazard ratio 0.96, 95% CI 0.95-0.99, P = 0.007 and hazard ratio 0.97, 95% CI 0.96-0.99, P = 0.007). TTR of SBP in 130-180 mmHg and 110-160 mmHg ranges seems to be related with mortality and disability outcomes, respectively.<br /><b>Conclusion</b><br />TTR can be included for a more detailed description of BP course, according to stroke severity, and for the evaluation of BP predictive role, in addition to mean BP values, derived from ABPM during the acute phase of AIS.<br /><b>Clinical trial registrationurl</b><br />http://www.clinicaltrials.gov. Unique identifier: NCT01915862.<br /><br />Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.<br /><br /><small>J Hypertens: 01 Mar 2023; 41:303-309</small></div>
Kakaletsis N, Ntaios G, Milionis H, Protogerou AD, ... Doumas M, Savopoulos C
J Hypertens: 01 Mar 2023; 41:303-309 | PMID: 36583356
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<div><h4>Unmasking left ventricular systolic dysfunction in masked hypertension: looking at myocardial strain. A review and meta-analysis.</h4><i>Cuspidi C, Gherbesi E, Faggiano A, Sala C, Grassi G, Tadic M</i><br /><b>Background:</b><br/>and aim</b><br />A growing body of evidence supports the view that masked hypertension (MH) (i.e. normal office and elevated out-of-office BP) is a blood pressure (BP) phenotype associated with increased risk of subclinical organ damage, cardiovascular disease and death as compared to true normotension. Whether left ventricular (LV) systolic function is impaired in individuals with MH is still a poorly defined topic. Therefore, we aimed to provide a new piece of information on LV systolic dysfunction in the untreated MH setting, focusing on speckle tracking echocardiography (STE) studies investigating LV global longitudinal strain (GLS), a more sensitive index of systolic function than conventional LV ejection fraction (LVEF).<br /><b>Methods</b><br />A computerized search was performed using Pub-Med, OVID, EMBASE and Cochrane library databases from inception until June 30, 2022. Full articles reporting data on LV GLS in MH, as assessed by ambulatory BP monitoring (ABPM), and normotensive controls were considered suitable for the purposes of review and meta-analysis.<br /><b>Results</b><br />A total of 329 untreated individuals with MH and 376 normotensive controls were included in six studies. While pooled average LVEF was not different between groups [64.5 ± 1.5 and 64.5 ± 1.3%, respectively, standard means difference (SMD): -0.002 ± 0.08, confidence interval (CI): 0.15/-0.15, P = 0.98), LV GLS was worse in MH patients than in normotensive counterparts (-18.5 ± 0.70 vs. -20.0 ± 0.34%, SMD: 0.68 ± 0.28, CI: 0.12/1.24, P < 0.01).<br /><b>Conclusions</b><br />Our findings suggest that early changes in LV systolic function not detectable by conventional echocardiography in the MH setting can be unmasked by STE and that its implementation of STE in current practice may improve the detection of subclinical organ damage of adverse prognostic significance.<br /><br />Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.<br /><br /><small>J Hypertens: 01 Mar 2023; 41:344-350</small></div>
Cuspidi C, Gherbesi E, Faggiano A, Sala C, Grassi G, Tadic M
J Hypertens: 01 Mar 2023; 41:344-350 | PMID: 36583359
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<div><h4>Redefining \"low risk\": Outcomes of surgical aortic valve replacement in low-risk patients in the transcatheter aortic valve replacement era.</h4><i>Johnston DR, Mahboubi R, Soltesz EG, Artis AS, ... Svensson LG, Cleveland Clinic Aortic Valve Center Collaborators</i><br /><b>Objectives</b><br />Guidelines suggest aortic valve replacement (AVR) for low-risk asymptomatic patients. Indications for transcatheter AVR now include low-risk patients, making it imperative to understand state-of-the-art surgical AVR (SAVR) in this population. Therefore, we compared SAVR outcomes in low-risk patients with those expected from Society of Thoracic Surgeons (STS) models and assessed their intermediate-term survival.<br /><b>Methods</b><br />From January 2005 to January 2017, 3493 isolated SAVRs were performed in 3474 patients with STS predicted risk of mortality <4%. Observed operative mortality and composite major morbidity or mortality were compared with STS-expected outcomes according to calendar year of surgery. Logistic regression analysis was used to identify risk factors for these outcomes. Patients were followed for time-related mortality.<br /><b>Results</b><br />With 15 observed operative deaths (0.43%) compared with 55 expected (1.6%), the observed:expected ratio was 0.27 for mortality (95% confidence interval [CI], 0.14-0.42), stroke 0.65 (95% CI, 0.41-0.89), and reoperation 0.50 (95% CI, 0.42-0.60). Major morbidity or mortality steadily declined, with probabilities of 8.6%, 6.7%, and 5.2% in 2006, 2011, and 2016, respectively, while STS-expected risk remained at approximately 12%. Mitral valve regurgitation, ventricular hypertrophy, pulmonary, renal, and hepatic failure, coronary artery disease, and earlier surgery date were residual risk factors. Survival was 98%, 91%, and 82% at 1, 5, and 9 years, respectively, superior to that predicted for the US age-race-sex-matched population.<br /><b>Conclusions</b><br />STS risk models overestimate contemporary SAVR risk at a high-volume center, supporting efforts to create a more agile quality assessment program. SAVR in low-risk patients provides durable survival benefit, supporting early surgery and providing a benchmark for transcatheter AVR.<br /><br />Copyright © 2021 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Thorac Cardiovasc Surg: 01 Feb 2023; 165:591-604.e3</small></div>
Johnston DR, Mahboubi R, Soltesz EG, Artis AS, ... Svensson LG, Cleveland Clinic Aortic Valve Center Collaborators
J Thorac Cardiovasc Surg: 01 Feb 2023; 165:591-604.e3 | PMID: 36635021
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<div><h4>Infective Endocarditis After Transcatheter Aortic Valve Replacement: JACC State-of-the-Art Review.</h4><i>Del Val D, Panagides V, Mestres CA, Miró JM, Rodés-Cabau J</i><br /><AbstractText>Infective endocarditis (IE) is a rare but serious complication following transcatheter aortic valve replacement (TAVR). Despite substantial improvements in the TAVR procedure (less invasive) and its expansion to younger and healthier patients, the incidence of IE after TAVR remains stable, with incidence rates similar to those reported after surgical aortic valve replacement. Although IE after TAVR is recognized as a subtype of prosthetic valve endocarditis, this condition represents a particularly challenging scenario given its unique clinical and microbiological profile, the high incidence of IE-related complications, the uncertain role of cardiac surgery, and the dismal prognosis in most patients with TAVR-IE. The number of TAVR procedures is expected to grow exponentially in the coming years, increasing the number of patients at risk of developing this life-threatening complication. Therefore, a detailed understanding of this disease and its complications will be essential to improve clinical outcomes.</AbstractText><br /><br />Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 31 Jan 2023; 81:394-412</small></div>
Del Val D, Panagides V, Mestres CA, Miró JM, Rodés-Cabau J
J Am Coll Cardiol: 31 Jan 2023; 81:394-412 | PMID: 36697140
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<div><h4>Long-term outcomes of perioperative myocardial infarction/injury after non-cardiac surgery.</h4><i>Puelacher C, Gualandro DM, Glarner N, Lurati Buse G, ... Mueller C, BASEL-PMI Investigators </i><br /><b>Aims</b><br />Perioperative myocardial infarction/injury (PMI) following non-cardiac surgery is a frequent cardiac complication. Better understanding of the underlying aetiologies and outcomes is urgently needed.<br /><b>Methods and results</b><br />Aetiologies of PMIs detected within an active surveillance and response programme were centrally adjudicated by two independent physicians based on all information obtained during clinically indicated PMI work-up including cardiac imaging among consecutive high-risk patients undergoing major non-cardiac surgery in a prospective multicentre study. PMI aetiologies were hierarchically classified into \'extra-cardiac\' if caused by a primarily extra-cardiac disease such as severe sepsis or pulmonary embolism; and \'cardiac\', further subtyped into type 1 myocardial infarction (T1MI), tachyarrhythmia, acute heart failure (AHF), or likely type 2 myocardial infarction (lT2MI). Major adverse cardiac events (MACEs) including acute myocardial infarction, AHF (both only from day 3 to avoid inclusion bias), life-threatening arrhythmia, and cardiovascular death as well as all-cause death were assessed during 1-year follow-up. Among 7754 patients (age 45-98 years, 45% women), PMI occurred in 1016 (13.1%). At least one MACE occurred in 684/7754 patients (8.8%) and 818/7754 patients died (10.5%) within 1 year. Outcomes differed starkly according to aetiology: in patients with extra-cardiac PMI, T1MI, tachyarrhythmia, AHF, and lT2MI 51%, 41%, 57%, 64%, and 25% had MACE, and 38%, 27%, 40%, 49%, and 17% patients died within 1 year, respectively, compared to 7% and 9% in patients without PMI. These associations persisted in multivariable analysis.<br /><b>Conclusion</b><br />At 1 year, most PMI aetiologies have unacceptably high rates of MACE and all-cause death, highlighting the urgent need for more intensive treatments.<br /><b>Study registration</b><br />https://clinicaltrials.gov/ct2/show/NCT02573532.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur Heart J: 27 Jan 2023; epub ahead of print</small></div>
Puelacher C, Gualandro DM, Glarner N, Lurati Buse G, ... Mueller C, BASEL-PMI Investigators
Eur Heart J: 27 Jan 2023; epub ahead of print | PMID: 36705050
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<div><h4>Meta-Analysis on the Safety and Efficacy of Transradial Approach in Chronic Total Occlusion Percutaneous Coronary Intervention.</h4><i>Nguyen DV, Nguyen QN, Pham HM, Le TX, Nguyen HTT</i><br /><AbstractText>The aim of this study was to compare the efficacy and safety of transradial approach (TRA) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with the efficacy and safety of transfemoral approach (TFA). We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies (OS) reporting the outcomes of TRA versus TFA in CTO PCI. The primary end point was procedural success. Secondary end points included access-site complications, in-hospital adverse events, procedural efficacy outcomes, and 30-day all-cause mortality. A total of 28,754 CTO PCI cases from 19 studies were included (2 RCTs and 17 OS). The pooled mean J-CTO score is 2.3. The main analysis showed a trend toward a higher success rate for TRA (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.00 to 1.38), but this was not the case in the secondary analysis, which included only RCTs and OS with moderate risk of bias (OR 0.99, 95% CI 0.81 to 1.22). TRA was associated with significant reductions in access-site complications (OR 0.33, 95% CI 0.24 to 0.45) and major bleeding (OR 0.34, 95% CI 0.20 to 0.59), and a similar risk of other in-hospital adverse events and 30-day mortality (p >0.05) to that of TFA. Moreover, there was less fluoroscopy time (minutes) and contrast volume use (ml) in the transradial CTO PCI (mean difference: -6.19 [-10.98 to -1.40] and -22.14[-34.56 to -9.72], respectively). In conclusion, the transradial PCI in appropriate CTO lesions was associated with a lower incidence of access-site complications/major bleeding than was TFA and a similar other periprocedural complications rate, without compromising procedural success.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 27 Jan 2023; epub ahead of print</small></div>
Nguyen DV, Nguyen QN, Pham HM, Le TX, Nguyen HTT
Am J Cardiol: 27 Jan 2023; epub ahead of print | PMID: 36710142
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<div><h4>Redo-Transcatheter Aortic Valve Implantation Using the SAPIEN 3/Ultra Transcatheter Heart Valves-Expert Consensus on Procedural Planning and Techniques.</h4><i>Tarantini G, Delgado V, de Backer O, Sathananthan J, ... Blackman D, Parma R</i><br /><AbstractText>Recent guidelines on valvular heart disease in Europe and the United States have expanded the indications for transcatheter aortic valve implantation (TAVI) to younger patients and those at lower surgical risk with severe symptomatic aortic stenosis. Consequently, the number of TAVI procedures will significantly increase worldwide. Patients with longer life expectancies will outlive their transcatheter heart valves (THVs) and require established treatment strategies for re-intervention. Current data have shown encouraging outcomes, including low mortality, with redo-TAVI; in contrast, surgical explantation of THVs is associated with high mortality. Redo-TAVI, therefore, is likely to be the treatment of choice for THV failure. The expected increase in the number of redo-TAVIs stands in contrast to the current lack of evidence on how this procedure should be planned and performed, including the risks and pitfalls operators need to consider. Preliminary reports stress the importance of preprocedural planning, understanding of THV skirt and leaflet characteristics, and implantation guidelines specific to different THVs. Currently, SAPIEN 3/Ultra is the only THV approved in Europe and the United States for redo-TAVI. Therefore, we gathered a panel of experts in TAVI procedures with the aim of providing operative guidance on redo-TAVI, using the SAPIEN 3/Ultra THV. This consensus article presents a step-by-step approach encompassing clinical, anatomical, and technical aspects in preprocedural planning, procedural techniques, and postprocedural care. In conclusion, the recommendations aim to improve the feasibility, safety, and long-term outcomes of redo-TAVI, including the durability of implanted THVs.</AbstractText><br /><br />Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 27 Jan 2023; epub ahead of print</small></div>
Tarantini G, Delgado V, de Backer O, Sathananthan J, ... Blackman D, Parma R
Am J Cardiol: 27 Jan 2023; epub ahead of print | PMID: 36710143
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<div><h4>Systolic reverse flow derived from 4D flow cardiovascular magnetic resonance in bicuspid aortic valve is associated with aortic dilation and aortic valve stenosis: a cross sectional study in 655 subjects.</h4><i>Weiss EK, Jarvis K, Maroun A, Malaisrie SC, ... Rigsby CK, Markl M</i><br /><b>Background</b><br />Bicuspid aortic valve (BAV) disease is associated with increased risk of aortopathy. In addition to current intervention guidelines, BAV mediated changes in aortic 3D hemodynamics have been considered as risk stratification measures. We aimed to evaluate the association of 4D flow cardiovascular magnetic resonance (CMR) derived voxel-wise aortic reverse flow with aortic dilation and to investigate the role of aortic valve regurgitation (AR) and stenosis (AS) on reverse flow in systole and diastole.<br /><b>Methods</b><br />510 patients with BAV (52 ± 14 years) and 120 patients with trileaflet aortic valve (TAV) (61 ± 11 years) and mid-ascending aorta diameter (MAAD) > 35 mm who underwent CMR including 4D flow CMR were retrospectively included. An age and sex-matched healthy control cohort (n = 25, 49 ± 12 years) was selected. Voxel-wise reverse flow was calculated in the aorta and quantified by the mean reverse flow in the ascending aorta (AAo) during systole and diastole.<br /><b>Results</b><br />BAV patients without AS and AR demonstrated significantly increased systolic and diastolic reverse flow (222% and 13% increases respectively, p < 0.01) compared to healthy controls and also had significantly increased systolic reverse flow compared to TAV patients with aortic dilation (79% increase, p < 0.01). In patients with isolated AR, systolic and diastolic AAo reverse flow increased significantly with AR severity (c = - 83.2 and c = - 205.6, p < 0.001). In patients with isolated AS, AS severity was associated with an increase in both systolic (c = - 253.1, p < 0.001) and diastolic (c = - 87.0, p = 0.02) AAo reverse flow. Right and left/right and non-coronary fusion phenotype showed elevated systolic reverse flow (> 17% increase, p < 0.01). Right and non-coronary fusion phenotype showed decreased diastolic reverse flow (> 27% decrease, p < 0.01). MAAD was an independent predictor of systolic (p < 0.001), but not diastolic, reverse flow (p > 0.1).<br /><b>Conclusion</b><br />4D flow CMR derived reverse flow associated with BAV was successfully captured even in the absence of AR or AS and in comparison to TAV patients with aortic dilation. Diastolic AAo reverse flow increased with AR severity while AS severity strongly correlated with increased systolic reverse flow in the AAo. Additionally, increasing MAAD was independently associated with increasing systolic AAo reverse flow. Thus, systolic AAo reverse flow may be a valuable metric for evaluating disease severity in future longitudinal outcome studies.<br /><br />© 2023. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 26 Jan 2023; 25:3</small></div>
Abstract
<div><h4>Cardiac Resynchronization Therapy Improves Outcomes in Patients With Intraventricular Conduction Delay But Not Right Bundle Branch Block: A Patient-Level Meta-Analysis of Randomized Controlled Trials.</h4><i>Friedman DJ, Al-Khatib SM, Dalgaard F, Fudim M, ... Inoue LYT, Sanders GD</i><br /><b>Background</b><br />Benefit from cardiac resynchronization therapy (CRT) varies by QRS characteristics; individual randomized trials are underpowered to assess benefit for relatively small subgroups.<br /><b>Methods</b><br />The authors analyzed patient-level data from pivotal CRT trials (MIRACLE [Multicenter InSync Randomized Clinical Evaluation], MIRACLE-ICD [Multicenter InSync ICD Randomized Clinical Evaluation], MIRACLE-ICD II [Multicenter InSync ICD Randomized Clinical Evaluation II], REVERSE [Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction], RAFT [Resynchronization-Defibrillation for Ambulatory Heart Failure], BLOCK-HF [Biventricular Versus Right Ventricular Pacing in Heart Failure Patients with Atrioventricular Block], COMPANION [Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure], and MADIT-CRT [Multicenter Automatic Defibrillator Implantation Trial - Cardiac Resynchronization Therapy]) using Bayesian Hierarchical Weibull survival regression models to assess CRT benefit by QRS morphology (left bundle branch block [LBBB], n=4549; right bundle branch block [RBBB], n=691; and intraventricular conduction delay [IVCD], n=1024) and duration (with 150-ms partition). The continuous relationship between QRS duration and CRT benefit was also examined within subgroups defined by QRS morphology. The primary end point was time to heart failure hospitalization (HFH) or death; a secondary end point was time to all-cause death.<br /><b>Results</b><br />Of 6264 patients included, 25% were women, the median age was 66 [interquartile range, 58 to 73] years, and 61% received CRT (with or without an implantable cardioverter defibrillator). CRT was associated with an overall lower risk of HFH or death (hazard ratio [HR], 0.73 [credible interval (CrI), 0.65 to 0.84]), and in subgroups of patients with QRS ≥150 ms and either LBBB (HR, 0.56 [CrI, 0.48 to 0.66]) or IVCD (HR, 0.59 [CrI, 0.39 to 0.89]), but not RBBB (HR 0.97 [CrI, 0.68 to 1.34]; <i>P</i><sub>interaction</sub> <0.001). No significant association for CRT with HFH or death was observed when QRS was <150 ms (regardless of QRS morphology) or in the presence of RBBB. Similar relationships were observed for all-cause death.<br /><b>Conclusions</b><br />CRT is associated with reduced HFH or death in patients with QRS ≥150 ms and LBBB or IVCD, but not for those with RBBB. Aggregating RBBB and IVCD into a single \"non-LBBB\" category when selecting patients for CRT should be reconsidered.<br /><b>Registration</b><br />URL: https://www.<br /><b>Clinicaltrials</b><br />gov; Unique identifiers: NCT00271154, NCT00251251, NCT00267098, and NCT00180271.<br /><br /><br /><br /><small>Circulation: 26 Jan 2023; epub ahead of print</small></div>
Friedman DJ, Al-Khatib SM, Dalgaard F, Fudim M, ... Inoue LYT, Sanders GD
Circulation: 26 Jan 2023; epub ahead of print | PMID: 36700426
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<div><h4>Placental syndromes and long-term risk of hypertension.</h4><i>Fraser A, Catov JM</i><br /><AbstractText>Higher blood pressure prior to pregnancy is associated with increased risk of placental abruption, hypertension and preeclampsia, preterm delivery and fetal growth restriction. These conditions are jointly termed placental syndromes as they are characterised by impaired placentation and early placental vascularization. Placental syndromes are associated with an increased maternal risk of progression to hypertension and cardiovascular disease (CVD) in later life. Women affected by both a clinical placental syndrome and with evidence of placental maternal vascular malperfusion (MVM) have a particularly high risk of hypertension and CVD. Yet whether placental impairment and clinical syndromes are causes or consequences of higher blood pressure in women remains unclear. In this review, we address the relationship between blood pressure and maternal health in pregnancy. We conclude that there is a pressing need for studies with a range of detailed measures of cardiac and vascular structure and function taken before, during and after pregnancy to solve the \'chicken and egg\' puzzle of women\'s blood pressure and pregnancy health, and to inform effective precision medicine prevention and treatment of both placental syndromes and chronic hypertension in women.</AbstractText><br /><br />© 2023. The Author(s).<br /><br /><small>J Hum Hypertens: 26 Jan 2023; epub ahead of print</small></div>
Fraser A, Catov JM
J Hum Hypertens: 26 Jan 2023; epub ahead of print | PMID: 36702879
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<div><h4>Risk and trajectory of premature ischaemic cardiovascular disease in women with a history of pre-eclampsia: a nationwide register-based study.</h4><i>Hallum S, Basit S, Kamper-Jørgensen M, Sehested TSG, Boyd HA</i><br /><b>Aims</b><br />Pre-eclampsia increases women\'s lifetime risk of cardiovascular disease (CVD). Little is known about the trajectory of CVD after pre-eclampsia, limiting the usefulness of this knowledge for informing screening, prevention, and interventions. We investigated when the risk of CVD increases after pre-eclampsia and how the risk changes over time since pregnancy.<br /><b>Methods and results</b><br />This register-based study included 1 157 666 women with >1 pregnancy between 1978 and 2017. Cumulative incidences of acute myocardial infarction (AMI) and ischaemic stroke were estimated, as well as hazard ratios (HRs) by attained age and time since delivery. Up to 2% [95% confidence interval (CI): 1.46-2.82%] of women with pre-eclampsia in their first pregnancy had an AMI or stroke within two decades of delivery, compared with up to 1.2% (95% CI: 1.08-1.30%) of pre-eclampsia-free women; differences in cumulative incidences were evident 7 years after delivery. Ten years after delivery, women with pre-eclampsia had four- and three-fold higher rates of AMI (HR = 4.16, 95% CI: 3.16-5.49) and stroke (HR = 2.59, 95% CI 2.04-3.28) than women without pre-eclampsia; rates remained doubled >20 years later. Women with pre-eclampsia aged 30-39 years had five-fold and three-fold higher rates of AMI (HR = 4.88, 95% CI 3.55-6.71) and stroke (HR = 2.56, 95% CI 1.95-3.36) than women of similar age without pre-eclampsia.<br /><b>Conclusions</b><br />Women with a history of pre-eclampsia have high rates of AMI and stroke at early ages and within a decade after delivery. The findings suggest that pre-eclampsia history could be useful in identifying women at increased risk of CVD and that targeted interventions should be initiated soon after delivery.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 26 Jan 2023; epub ahead of print</small></div>
Hallum S, Basit S, Kamper-Jørgensen M, Sehested TSG, Boyd HA
Eur J Prev Cardiol: 26 Jan 2023; epub ahead of print | PMID: 36702629
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<div><h4>Impact of Achieving Blood Pressure Targets and High Time in Therapeutic Range on Clinical Outcomes in Patients With Atrial Fibrillation Adherent to the Atrial Fibrillation Better Care Pathway: A Report From the COOL-AF Registry.</h4><i>Krittayaphong R, Winijkul A, Methavigul K, Lip GYH</i><br /><AbstractText><br /><b>Background:</b><br/>We aimed to determine the effect of integrating Atrial Fibrillation Better Care pathway compliance in relation to achievement of systolic blood pressure (SBP) targets and good control of time in therapeutic range (TTR) on clinical outcomes in patients with atrial fibrillation. Methods and Results We prospectively enrolled patients with nonvalvular atrial fibrillation  from 27 hospitals in Thailand. All clinical outcomes were recorded. Main outcomes were the composite of all-cause death or ischemic stroke/systemic embolism (SSE), as well as secondary outcomes of all-cause death, SSE, major bleeding, intracranial hemorrhage, and heart failure. An SBP of 120 to 140 mm Hg was considered good blood pressure control. Target TTR was a TTR ≥65%. A total of 3405 patients were studied (mean age 67.8 years, 41.8% female). Full ABC pathway compliance was evident in 42.7%. For blood pressure control, 41.9% had SBP within target, whereas 35.9% of those on warfarin had TTR within target. The incidence rates of all-cause death/SSE, all-cause death, SSE, major bleeding, intracranial hemorrhage, and heart failure were 5.29, 4.21, 1.51, 2.25, 0.78, and 2.84 per 100 person-years respectively. Adjusted hazard ratios and 95% CI of Atrial Fibrillation Better Care pathway compliance for all-cause death/SSE, all-cause death, and heart failure were 0.76 (0.62-0.94), 0.79 (0.62-0.99), and 0.69 (0.51-0.94), respectively, compared with noncompliance. Patients with Atrial Fibrillation Better Care compliance and SBP within target had a better outcome or TTR within target had better outcomes. <br /><b>Conclusions:</b><br/>In COOL-AF (Cohort of Antithrombotic Use and Optimal International Normalized Ratio Level in Patients With Non-Valvular Atrial Fibrillation in Thailand), a multicenter nationwide prospective cohort of patients with atrial fibrillation, achieving SBP within target and TTR ≥ 65% has added value to Atrial Fibrillation Better Care pathway compliance in the reduction of adverse clinical outcomes in patients with atrial fibrillation.</AbstractText><br /><br /><br /><br /><small>J Am Heart Assoc: 25 Jan 2023:e028463; epub ahead of print</small></div>
Abstract
<div><h4>Prognostic Impact of Cardiac Diastolic Function and Coronary Microvascular Function on Cardiovascular Death.</h4><i>Hong D, Lee SH, Shin D, Choi KH, ... Gwon HC, Lee JM</i><br /><AbstractText><br /><b>Background:</b><br/>Coronary microvascular dysfunction (CMD) has been considered as a possible cause of cardiac diastolic dysfunction. The current study evaluated the association between cardiac diastolic dysfunction and CMD, and their prognostic implications in patients without significant left ventricular systolic dysfunction and epicardial coronary stenosis. Methods and Results A total of 330 patients without left ventricular systolic dysfunction (ejection fraction ≥50%) and significant epicardial coronary stenosis (fractional flow reserve >0.80) were analyzed. Cardiac diastolic dysfunction was defined by echocardiographic parameters (early diastolic transmitral flow velocity/early diastolic mitral annular velocity, e\' velocity, tricuspid regurgitation velocity, and left atrial volume index). Overt CMD was defined as coronary flow reserve <2.0 and index of microcirculatory resistance ≥25 U. The primary end point was cardiovascular death or admission for heart failure during 5 years of follow-up. In patients without left ventricular systolic dysfunction and significant epicardial coronary stenosis, prevalence of cardiac diastolic dysfunction and overt CMD was 25.5% and 11.2%, respectively. Overt CMD was independently associated with cardiac diastolic dysfunction (adjusted odds ratio, 3.440 [95% CI, 1.599-7.401]; <i>P</i>=0.002). Patients with cardiac diastolic dysfunction showed significantly higher risk of the primary outcome than those without (adjusted hazard ratio [HR], 2.996 [95% CI, 1.888-4.755]; <i>P</i><0.001). Patients with overt CMD also showed significantly higher risk of the primary outcome than those without (adjusted HR, 2.939 [95% CI, 1.642-5.261]; <i>P</i><0.001). Presence of overt CMD was associated with significantly increased risk of cardiovascular death among the patients with cardiac diastolic dysfunction (43.8% versus 14.5%; <i>P</i>=0.006) but not in patients without cardiac diastolic dysfunction (interaction <i>P</i><0.001). Inclusion of overt CMD into the model with cardiac diastolic dysfunction significantly improved predictive ability for cardiovascular death or heart failure admission (conconrdance index, 0.719 versus 0.737; <i>P</i> for comparison=0.034). <br /><b>Conclusions:</b><br/>There was significant association between the presence of cardiac diastolic dysfunction and overt CMD. Both cardiac diastolic dysfunction and overt CMD were associated with increased risk of cardiovascular death or admission for heart failure. Integration of overt CMD into cardiac diastolic dysfunction showed improvement of the risk stratification in patients without significant left ventricular systolic dysfunction and epicardial coronary stenosis. Registration DIAST-CMD (Prognostic Impact of Cardiac Diastolic Function and Coronary Microvascular Function) registry; Unique identifier: NCT05058833.</AbstractText><br /><br /><br /><br /><small>J Am Heart Assoc: 25 Jan 2023:e027690; epub ahead of print</small></div>
Hong D, Lee SH, Shin D, Choi KH, ... Gwon HC, Lee JM
J Am Heart Assoc: 25 Jan 2023:e027690; epub ahead of print | PMID: 36695307
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<div><h4>Association of Rurality With Risk of Heart Failure.</h4><i>Turecamo SE, Xu M, Dixon D, Powell-Wiley TM, ... Lipworth L, Roger VL</i><br /><b>Importance</b><br />Rural populations experience an increased burden of heart failure (HF) mortality compared with urban populations. Whether HF incidence is greater among rural individuals is less known. Additionally, the intersection between racial and rural health inequities is understudied.<br /><b>Objective</b><br />To determine whether rurality is associated with increased risk of HF, independent of cardiovascular (CV) disease and socioeconomic status (SES), and whether rurality-associated HF risk varies by race and sex.<br /><b>Design, setting, and participants</b><br />This prospective cohort study analyzed data for Black and White participants of the Southern Community Cohort Study (SCCS) without HF at enrollment who receive care via Centers for Medicare & Medicaid Services (CMS). The SCCS is a population-based cohort of low-income, underserved participants from 12 states across the southeastern United States. Participants were enrolled between 2002 and 2009 and followed up until December 31, 2016. Data were analyzed from October 2021 to November 2022.<br /><b>Exposures</b><br />Rurality as defined by Rural-Urban Commuting Area codes at the census-tract level.<br /><b>Main outcomes and measures</b><br />Heart failure was defined using diagnosis codes via CMS linkage through 2016. Incidence of HF was calculated by person-years of follow-up and age-standardized. Sequentially adjusted Cox proportional hazards regression models tested the association between rurality and incident HF.<br /><b>Results</b><br />Among 27 115 participants, the median (IQR) age was 54 years (47-65), 18 647 (68.8%) were Black, and 8468 (32.3%) were White; 5556 participants (20%) resided in rural areas. Over a median 13-year follow-up, age-adjusted HF incidence was 29.6 (95% CI, 28.9-30.5) per 1000 person-years for urban participants and 36.5 (95% CI, 34.9-38.3) per 1000 person-years for rural participants (P < .001). After adjustment for demographic information, CV risk factors, health behaviors, and SES, rural participants had a 19% greater risk of incident HF (hazard ratio [HR], 1.19; 95% CI, 1.13-1.26) compared with their urban counterparts. The rurality-associated risk of HF varied across race and sex and was greatest among Black men (HR, 1.34; 95% CI, 1.19-1.51), followed by White women (HR, 1.22; 95% CI, 1.07-1.39) and Black women (HR, 1.18; 95% CI, 1.08-1.28). Among White men, rurality was not associated with greater risk of incident HF (HR, 0.97; 95% CI, 0.81-1.16).<br /><br /><b>Conclusions:</b><br/>and relevance</b><br />Among predominantly low-income individuals in the southeastern United States, rurality was associated with an increased risk of HF among women and Black men, which persisted after adjustment for CV risk factors and SES. This inequity points to a need for additional emphasis on primary prevention of HF among rural populations.<br /><br /><br /><br /><small>JAMA Cardiol: 25 Jan 2023; epub ahead of print</small></div>
Turecamo SE, Xu M, Dixon D, Powell-Wiley TM, ... Lipworth L, Roger VL
JAMA Cardiol: 25 Jan 2023; epub ahead of print | PMID: 36696094
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<div><h4>Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association.</h4><i>Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, ... Martin SS, American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee</i><br /><b>Background</b><br />The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).<br /><b>Methods</b><br />The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year\'s worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year\'s edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.<br /><b>Results</b><br />Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.<br /><b>Conclusions</b><br />The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.<br /><br /><br /><br /><small>Circulation: 25 Jan 2023; epub ahead of print</small></div>
Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, ... Martin SS, American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee
Circulation: 25 Jan 2023; epub ahead of print | PMID: 36695182
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<div><h4>Hypertension and Cardiovascular Disease Risk Among Individuals With Versus Without HIV.</h4><i>Siddiqui M, Hannon L, Wang Z, Blair J, ... Overton ET, Muntner P</i><br /><b>Background</b><br />A high proportion of individuals with HIV have hypertension, and the incidence of cardiovascular disease (CVD) is high in individuals with HIV.<br /><b>Methods</b><br />We determined if the association between hypertension and CVD, including acute myocardial infarction (AMI), stroke, and heart failure, differs between individuals with and without HIV. We analyzed data for 108 980 adults with HIV matched (1:4) to 435 920 adults without HIV in 2011 to 2019 from the Marketscan database, which includes US adults with health insurance. The primary outcome, incident CVD, defined by an AMI, stroke or heart failure, was identified using validated claims-based algorithms.<br /><b>Results</b><br />Over a median follow-up of 2.3 years, there were 4027 CVD events, including 2345 AMI, 1153 stroke, and 684 heart failure events. After multivariable adjustment, the hazard ratio for CVD associated with hypertension was 1.56 (95% CI, 1.44-1.69) among individuals without HIV and 1.73 (95% CI, 1.52-1.96) among individuals with HIV (<i>P</i> value for interaction=0.159). The multivariable-adjusted hazard ratio for AMI associated with hypertension was 1.35 (95% CI, 1.22-1.51) among individuals without HIV and 1.70 (95% CI, 1.44-2.01) among individuals with HIV (<i>P</i> value for interaction=0.017). Hypertension was associated with stroke and heart failure among individuals without and with HIV with no evidence of effect modification (<i>P</i> value for interaction >0.40).<br /><b>Conclusions</b><br />Hypertension was associated with increased CVD, AMI, stroke, and heart failure risk among individuals with and without HIV, with a stronger association for AMI among individuals with versus without HIV. This study emphasizes the high CVD risk associated with hypertension among individuals with HIV.<br /><br /><br /><br /><small>Hypertension: 25 Jan 2023; epub ahead of print</small></div>
Siddiqui M, Hannon L, Wang Z, Blair J, ... Overton ET, Muntner P
Hypertension: 25 Jan 2023; epub ahead of print | PMID: 36695187
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<div><h4>Body Composition and Risk of Vascular-Metabolic Mortality Risk in 113 000 Mexican Men and Women Without Prior Chronic Disease.</h4><i>Gnatiuc Friedrichs L, Wade R, Alegre-Díaz J, Ramirez-Reyes R, ... Kuri-Morales P, Tapia-Conyer R</i><br /><AbstractText><br /><b>Background:</b><br/>Body-mass index is the sum of fat mass index (FMI) and lean mass index (LMI), which vary by age, sex, and impact on disease outcomes. We investigated the separate and joint relevance of FMI and LMI with vascular-metabolic causes of death in Mexican adults. Methods and Results A total of 113 025 adults aged 35 to 74 years and free from diabetes or other chronic diseases when recruited into the Mexico City Prospective Study were followed for 19 years. Cox models estimated sex-specific death rate ratios from vascular-metabolic causes after adjustment for confounders and exclusion of the first 5 years of follow-up. To account for the strong correlation between FMI and LMI, additional models estimated rate ratios associated with \"residual FMI\" and \"residual LMI\" (ie, the residuals from linear regression analyses of FMI on LMI, or vice versa). In both sexes, higher FMI and LMI were associated with higher risks of vascular-metabolic mortality. For a given (ie, fixed) level of LMI, the rate ratio (95% CI) for vascular-metabolic mortality per 1 kg/m<sup>2</sup> higher residual FMI strengthened and was higher in women (1.52 [1.38-1.68]) than in men (1.19 [1.13-1.25]). By contrast, for a given level of FMI, higher residual LMI was inversely associated with vascular-metabolic mortality (rate ratio per 1 kg/m<sup>2</sup> 0.67 [0.56-0.80] in women and 0.94 [0.90-0.98] in men). <br /><b>Conclusions:</b><br/>In this study, higher residual FMI was more strongly associated with vascular-metabolic mortality in women than in men. Conversely, higher residual LMI was inversely associated with vascular-metabolic mortality, particularly in women.</AbstractText><br /><br /><br /><br /><small>J Am Heart Assoc: 25 Jan 2023:e028263; epub ahead of print</small></div>
Gnatiuc Friedrichs L, Wade R, Alegre-Díaz J, Ramirez-Reyes R, ... Kuri-Morales P, Tapia-Conyer R
J Am Heart Assoc: 25 Jan 2023:e028263; epub ahead of print | PMID: 36695315
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<div><h4>Differential Associations of Cystatin C Versus Creatinine-Based Kidney Function With Risks of Cardiovascular Event and Mortality Among South Asian Individuals in the UK Biobank.</h4><i>Chen DC, Lees JS, Lu K, Scherzer R, ... Shlipak MG, Estrella MM</i><br /><AbstractText><br /><b>Background:</b><br/>South Asian individuals have increased cardiovascular disease and mortality risks. Reliance on creatinine- rather than cystatin C-based estimated glomerular filtration rate (eGFRcys) may underestimate the cardiovascular disease risk associated with chronic kidney disease. Methods and Results Among 7738 South Asian UK BioBank participants without prevalent heart failure (HF) or atherosclerotic cardiovascular disease, we investigated associations of 4 eGFRcys and creatinine-based estimated glomerular filtration rate categories (<45, 45-59, 60-89, and ≥90 mL/min per 1.73 m<sup>2</sup>) with risks of all-cause mortality, incident HF, and incident atherosclerotic cardiovascular disease. The mean age was 53±8 years; 4085 (53%) were women. Compared with creatinine, cystatin C identified triple the number of participants with estimated glomerular filtration <45 (n=35 versus n=113) and 6 times the number with estimated glomerular filtration 45 to 59 (n=80 versus n=481). After multivariable adjustment, the eGFRcys 45 to 59 category was associated with higher risks of mortality (hazard ratio [HR], 2.38 [95% CI, 1.55-3.65]) and incident HF (sub-HR [sHR], 1.87 [95% CI, 1.09-3.22]) versus the eGFRcys ≥90 category; the creatinine-based estimated glomerular filtration rate 45 to 59 category had no significant associations with outcomes. Of the 7623 participants with creatinine-based estimated glomerular filtration rate ≥60, 498 (6.5%) were reclassified into eGFRcys <60 categories. Participants who were reclassified as having eGFRcys <45 had higher risks of mortality (HR, 4.88 [95% CI, 2.56-9.31]), incident HF (sHR, 4.96 [95% CI, 2.21-11.16]), and incident atherosclerotic cardiovascular disease (sHR, 2.29 [95% CI, 1.14-4.61]) versus those with eGFRcys ≥90; those reclassified as having eGFRcys 45 to 59 had double the mortality risk (HR, 2.25 [95% CI, 1.45-3.51]). <br /><b>Conclusions:</b><br/>Among South Asian individuals, cystatin C identified a high-risk chronic kidney disease population that was not detected by creatinine and enhanced estimated glomerular filtration rate-based risk stratification for mortality, incident HF, and incident atherosclerotic cardiovascular disease.</AbstractText><br /><br /><br /><br /><small>J Am Heart Assoc: 25 Jan 2023:e027079; epub ahead of print</small></div>
Chen DC, Lees JS, Lu K, Scherzer R, ... Shlipak MG, Estrella MM
J Am Heart Assoc: 25 Jan 2023:e027079; epub ahead of print | PMID: 36695320
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<div><h4>Improving representativeness in trials: a call to action from the Global Cardiovascular Clinical Trialists Forum.</h4><i>Filbey L, Zhu JW, D\'Angelo F, Thabane L, ... Zannad F, Van Spall HGC</i><br /><AbstractText>Participants enrolled in cardiovascular disease (CVD) randomized controlled trials are not often representative of the population living with the disease. Older adults, children, women, Black, Indigenous and People of Color, and people living in low- and middle-income countries are typically under-enrolled in trials relative to disease distribution. Treatment effect estimates of CVD therapies have been largely derived from trial evidence generated in White men without complex comorbidities, limiting the generalizability of evidence. This review highlights barriers and facilitators of trial enrollment, temporal trends, and the rationale for representativeness. It proposes strategies to increase representativeness in CVD trials, including trial designs that minimize the research burden on participants, inclusive recruitment practices and eligibility criteria, diversification of clinical trial leadership, and research capacity-building in under-represented regions. Implementation of such strategies could generate better and more generalizable evidence to reduce knowledge gaps and position the cardiovascular trial enterprise as a vehicle to counter existing healthcare inequalities.</AbstractText><br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur Heart J: 25 Jan 2023; epub ahead of print</small></div>
Filbey L, Zhu JW, D'Angelo F, Thabane L, ... Zannad F, Van Spall HGC
Eur Heart J: 25 Jan 2023; epub ahead of print | PMID: 36702610
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<div><h4>Long-Term Visit-to-Visit Glycemic Variability as a Predictor of Major Adverse Limb and Cardiovascular Events in Patients With Diabetes.</h4><i>Hsu JC, Yang YY, Chuang SL, Huang KC, Lee JK, Lin LY</i><br /><AbstractText><br /><b>Background:</b><br/>Peripheral arterial disease (PAD) is a severe complication in patients with type 2 diabetes. Glycemic variability (GV) is associated with increased risks of developing microvascular and macrovascular diseases. However, few studies have focused on the association between GV and PAD. Methods and Results This cohort study used a database maintained by the National Taiwan University Hospital, a tertiary medical center in Taiwan. For each individual, GV parameters were calculated, including fasting glucose coefficient of variability (FGCV) and hemoglobin A1c variability score (HVS). Multivariate Cox regression models were constructed to estimate the relationships between GV parameters and composite scores for major adverse limb events (MALEs) and major adverse cardiovascular events (MACEs). Between 2014 and 2019, a total of 45 436 adult patients with prevalent type 2 diabetes were enrolled for analysis, and GV was assessed during a median follow-up of 64.4 months. The average number of visits and time periods were 13.38 and 157.87 days for the HVS group and 14.27 and 146.59 days for the FGCV group, respectively. The incidence rates for cardiac mortality, PAD, and critical limb ischemia (CLI) were 5.38, 20.11, and 2.41 per 1000 person-years in the FGCV group and 5.35, 20.32, and 2.50 per 1000 person-years in HVS group, respectively. In the Cox regression model with full adjustment, the highest FGCV quartile was associated with significantly increased risks of MALEs (hazard ratio [HR], 1.57 [95% CI, 1.40-1.76]; <i>P</i><0.001) and MACEs (HR, 1.40 [95% CI, 1.25-1.56]; <i>P</i><0.001). Similarly, the highest HVS quartile was associated with significantly increased risks of MALEs (HR, 1.44 [95% CI, 1.28-1.62]; <i>P</i><0.001) and MACEs (HR, 1.28 [95% CI, 1.14-1.43]; <i>P</i><0.001). The highest FGCV and HVS quartiles were both associated with the development of PAD and CLI (FGCV: PAD [HR, 1.57; <i>P</i><0.001], CLI [HR, 2.19; <i>P</i><0.001]; HVS: PAD [HR, 1.44; <i>P</i><0.001], CLI [HR, 1.67; <i>P</i>=0.003]). The Kaplan-Meier analysis showed significantly higher risks of MALEs and MACEs with increasing GV magnitude (log-rank <i>P</i><0.001). <br /><b>Conclusions:</b><br/>Among individuals with diabetes, increased GV is independently associated with the development of MALEs, including PAD and CLI, and MACEs. The benefit of maintaining stable glycemic levels for improving clinical outcomes warrants further studies.</AbstractText><br /><br /><br /><br /><small>J Am Heart Assoc: 25 Jan 2023:e025438; epub ahead of print</small></div>
Hsu JC, Yang YY, Chuang SL, Huang KC, Lee JK, Lin LY
J Am Heart Assoc: 25 Jan 2023:e025438; epub ahead of print | PMID: 36695326
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<div><h4>Radiotherapy-induced Malfunctions of Cardiac Implantable Electronic Devices: a Meta-analysis.</h4><i>Xu B, Wang Y, Tse G, Chen J, ... Korantzopoulos P, Liu T</i><br /><b>Background</b><br />Radiation therapy (RT) may pose acute and long-term risks for patients with cardiac implantable electronic devices (CIEDs), including pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs).<br /><b>Objective</b><br />We conducted a systematic review and meta-analysis to examine the association between RT and PMs/ ICDs malfunctions in cancer patients.<br /><b>Methods</b><br />We searched the literature using the PubMed, the Cochrane clinical trials database, and the Web of Science and Embase, for relative publications until April 2022. Of the 550 initially identified studies, 17 retrospective observational studies including 2,454 patients were finally analyzed.<br /><b>Results</b><br />The meta-analysis showed that RT was associated with an increased risk of ICDs malfunctions (OR 2.75, 95%CI 1.74-4.33). Five studies were included in the subgroup analysis regarding photon beam energy showing that radiation induced CIEDs failure was more likely to occur in ICDs when beam energy was ≥10MV (OR 5.28, 95%CI 2.14-13.03). Neutron-generating RT significantly increased the risk of CIEDs malfunctions (OR 3.97, 95%CI 1.70-9.26), especially the risk of reset (OR 5.79, 95%CI 2.37-14.12, p=0.0001). We did not find significant differences in the risk of CIEDs failure between chest RT and other RT sites (OR 1.09, 95%CI 0.63-1.88).<br /><b>Conclusion</b><br />Our meta-analysis suggests that ICDs are more likely to be affected by RT than PMs. These adverse events, especially reset, in cancer patients were associated with neutron-generating RT and beam energy ≥10MV. Given the increasing requirement for RT in several cancer patients as well as the increasing implantation rates of CIEDs, a better risk stratification is needed in this setting.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 25 Jan 2023; epub ahead of print</small></div>
Xu B, Wang Y, Tse G, Chen J, ... Korantzopoulos P, Liu T
Heart Rhythm: 25 Jan 2023; epub ahead of print | PMID: 36708909
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<div><h4>Left atrial late gadolinium enhancement in patients with ischaemic stroke.</h4><i>Larsen BS, Bertelsen L, Christensen H, Hadad R, ... Vejlstrup N, Sajadieh A</i><br /><b>Aims</b><br />To evaluate the extent of left atrial (LA) fibrosis in patients with a recent stroke without atrial fibrillation and controls without established cardiovascular disease.<br /><b>Methods and results</b><br />This prospectively designed study used cardiac magnetic resonance to detect LA late gadolinium enhancement as a proxy for LA fibrosis. Between 2019 and 2021, we consecutively included 100 patients free of atrial fibrillation with recent ischaemic stroke (<30 days) and 50 age- and sex-matched controls. LA fibrosis assessment was achieved in 78 patients and 45 controls. Blinded to the cardiac magnetic resonance results, strokes were adjudicated according to modified Trial of Org 10172 in Acute Stroke Treatment classification as undetermined aetiology (n = 42) or as attributable to large- or small-vessel disease (n = 36). Patients with stroke had a larger extent of LA fibrosis [6.9%, interquartile range (IQR) 3.6-15.4%] than matched controls (4.2%, IQR 2.3-7.5%; P = 0.007). No differences in LA fibrosis were observed between patients with stroke of undetermined aetiology and those with large- or small-vessel disease (6.6%, IQR 3.8-16.0% vs. 6.9%, IQR 3.4-14.6%; P = 0.73).<br /><b>Conclusion</b><br />LA fibrosis was more extensive in patients with stroke than in age- and sex-matched controls. A similar extent of LA fibrosis was observed in patients with stroke of undetermined aetiology and stroke classified as attributable to large- or small-vessel disease. Our findings suggest that LA structural abnormality is more frequent in patients with stroke than in controls independent of aetiological classification.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur Heart J Cardiovasc Imaging: 24 Jan 2023; epub ahead of print</small></div>
Larsen BS, Bertelsen L, Christensen H, Hadad R, ... Vejlstrup N, Sajadieh A
Eur Heart J Cardiovasc Imaging: 24 Jan 2023; epub ahead of print | PMID: 36691845
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<div><h4>Apolipoprotein Proteomics for Residual Lipid-Related Risk in Coronary Heart Disease.</h4><i>Clarke R, Von Ende A, Schmidt L, Yin X, ... Mayr M, PROCARDIS Consortium</i><br /><b>Background</b><br />Recognition of the importance of conventional lipid measures and the advent of novel lipid-lowering medications have prompted the need for more comprehensive lipid panels to guide use of emerging treatments for the prevention of coronary heart disease (CHD). This report assessed the relevance of 13 apolipoproteins measured using a single mass-spectrometry assay for risk of CHD in the PROCARDIS case-control study of CHD (941 cases/975 controls).<br /><b>Methods</b><br />The associations of apolipoproteins with CHD were assessed after adjustment for established risk factors and correction for statin use. Apolipoproteins were grouped into 4 lipid-related classes [lipoprotein(a), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides] and their associations with CHD were adjusted for established CHD risk factors and conventional lipids. Analyses of these apolipoproteins in a subset of the ASCOT trial (Anglo-Scandinavian Cardiac Outcomes Trial) were used to assess their within-person variability and to estimate a correction for statin use. The findings in the PROCARDIS study were compared with those for incident cardiovascular disease in the Bruneck prospective study (n=688), including new measurements of Apo(a).<br /><b>Results</b><br />Triglyceride-carrying ApoC1, ApoC3, and ApoE (apolipoproteins) were most strongly associated with the risk of CHD (2- to 3-fold higher odds ratios for top versus bottom quintile) independent of conventional lipid measures. Likewise, ApoB was independently associated with a 2-fold higher odds ratios of CHD. Lipoprotein(a) was measured using peptides from the Apo(a)-kringle repeat and Apo(a)-constant regions, but neither of these associations differed from the association with conventionally measured lipoprotein(a). Among HDL-related apolipoproteins, ApoA4 and ApoM were inversely related to CHD, independent of conventional lipid measures. The disease associations with all apolipoproteins were directionally consistent in the PROCARDIS and Bruneck studies, with the exception of ApoM.<br /><b>Conclusions</b><br />Apolipoproteins were associated with CHD independent of conventional risk factors and lipids, suggesting apolipoproteins could help to identify patients with residual lipid-related risk and guide personalized approaches to CHD risk reduction.<br /><br /><br /><br /><small>Circ Res: 24 Jan 2023; epub ahead of print</small></div>
Clarke R, Von Ende A, Schmidt L, Yin X, ... Mayr M, PROCARDIS Consortium
Circ Res: 24 Jan 2023; epub ahead of print | PMID: 36691918
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<div><h4>Major cardiovascular events and subsequent risk of kidney failure with replacement therapy: a CKD Prognosis Consortium study.</h4><i>Mark PB, Carrero JJ, Matsushita K, Sang Y, ... Visseren FLJ, Stengel B</i><br /><b>Aims</b><br />Chronic kidney disease (CKD) increases risk of cardiovascular disease (CVD). Less is known about how CVD associates with future risk of kidney failure with replacement therapy (KFRT).<br /><b>Methods and results</b><br />The study included 25 903 761 individuals from the CKD Prognosis Consortium with known baseline estimated glomerular filtration rate (eGFR) and evaluated the impact of prevalent and incident coronary heart disease (CHD), stroke, heart failure (HF), and atrial fibrillation (AF) events as time-varying exposures on KFRT outcomes. Mean age was 53 (standard deviation 17) years and mean eGFR was 89 mL/min/1.73 m2, 15% had diabetes and 8.4% had urinary albumin-to-creatinine ratio (ACR) available (median 13 mg/g); 9.5% had prevalent CHD, 3.2% prior stroke, 3.3% HF, and 4.4% prior AF. During follow-up, there were 269 142 CHD, 311 021 stroke, 712 556 HF, and 605 596 AF incident events and 101 044 (0.4%) patients experienced KFRT. Both prevalent and incident CVD were associated with subsequent KFRT with adjusted hazard ratios (HRs) of 3.1 [95% confidence interval (CI): 2.9-3.3], 2.0 (1.9-2.1), 4.5 (4.2-4.9), 2.8 (2.7-3.1) after incident CHD, stroke, HF and AF, respectively. HRs were highest in first 3 months post-CVD incidence declining to baseline after 3 years. Incident HF hospitalizations showed the strongest association with KFRT [HR 46 (95% CI: 43-50) within 3 months] after adjustment for other CVD subtype incidence.<br /><b>Conclusion</b><br />Incident CVD events strongly and independently associate with future KFRT risk, most notably after HF, then CHD, stroke, and AF. Optimal strategies for addressing the dramatic risk of KFRT following CVD events are needed.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur Heart J: 24 Jan 2023; epub ahead of print</small></div>
Mark PB, Carrero JJ, Matsushita K, Sang Y, ... Visseren FLJ, Stengel B
Eur Heart J: 24 Jan 2023; epub ahead of print | PMID: 36691956
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<div><h4>Cost-effectiveness analysis of cardiac implantable electronic devices with reactive atrial-based antitachycardia pacing.</h4><i>Noda T, Ueda N, Tanaka Y, Ishiguro Y, ... Myung JE, Kusano K</i><br /><b>Aims</b><br />Reactive atrial-based anti-tachycardia pacing (rATP) in pacemakers (PMs) and cardiac resynchronization therapy defibrillators (CRT-Ds) has been reported to prevent progression of atrial fibrillation, and this reduced progression is expected to decrease the risk of complications such as stroke and heart failure (HF). This study aimed to assess the cost-effectiveness of rATP in PMs and CRT-Ds in the Japanese public health insurance system.<br /><b>Methods and results</b><br />We developed a Markov model comprising five states: bradycardia, post-stroke, mild HF, severe HF, and death. For devices with rATP and control devices without rATP, we compared the incremental cost-effectiveness ratio (ICER) from the payer\'s perspective. Costs were estimated from healthcare resource utilisation data in a Japanese claims database. We evaluated model uncertainty by analysing two scenarios for each device. The ICER was 763 729 JPY/QALY (5616 EUR/QALY) for PMs and 1,393 280 JPY/QALY (10 245 EUR/QALY) for CRT-Ds. In all scenarios, ICERs were below 5 million JPY/QALY (36 765 EUR/QALY), supporting robustness of the results.<br /><b>Conclusion</b><br />According to a willingness to pay threshold of 5 million JPY/QALY, the devices with rATP were cost-effective compared with control devices without rATP, showing that the higher reimbursement price of the functional categories with rATP is justified from a healthcare economic perspective.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Europace: 24 Jan 2023; epub ahead of print</small></div>
Noda T, Ueda N, Tanaka Y, Ishiguro Y, ... Myung JE, Kusano K
Europace: 24 Jan 2023; epub ahead of print | PMID: 36691793
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<div><h4>The worsening effect of anemia on left ventricular function and global strain in type 2 diabetes mellitus patients: a 3.0 T CMR feature tracking study.</h4><i>Qian WL, Xu R, Shi R, Li Y, ... Jiang L, Yang ZG</i><br /><b>Objective</b><br />To explore the additive effects of anemia on left ventricular (LV) global strains in patients with type 2 diabetes mellitus (T2DM) with or without anemia via cardiac magnetic resonance (CMR) feature tracking technology.<br /><b>Materials and methods</b><br />236 T2DM patients with or without anemia and 67 controls who underwent CMR examination were retrospectively enrolled. LV function parameters, LV global radial peak strain (GRPS), longitudinal peak strain (GLPS), and circumferential peak strain (GCPS) were used to analyze the function and global strain of the heart. One-way analysis of variance and the chi-square test were used for intergroup analysis. Multivariable linear regression analysis was performed for the two T2DM groups to explore factors associated with LV global strains.<br /><b>Results</b><br />The T2DM group with anemia was oldest and had a lowest hemoglobin (Hb) concentration, lowest estimated glomerular filtration rate, highest LV end-systolic volume index, highest end-diastolic volume index and highest LV mass index than the control group and T2DM without anemia group (all P ≤ 0.001). Besides, The LV global peak strains in all three directions worsened successively from the control group to the T2DM without anemia group to the T2DM with anemia group (all p < 0.001). Among all clinical indices, the decrease in Hb was independently associated with the worsening in GRPS (β = 0.237, p = 0.001), GCPS (β = 0.326, p < 0.001), and GLPS (β = 0.265, p < 0.001).<br /><b>Conclusion</b><br />Anemia has additive deleterious effects on LV function and LV global strains in patients with T2DM. Regular detection and early intervention of anemia might be beneficial for T2DM patients.<br /><br />© 2023. The Author(s).<br /><br /><small>Cardiovasc Diabetol: 24 Jan 2023; 22:15</small></div>
Qian WL, Xu R, Shi R, Li Y, ... Jiang L, Yang ZG
Cardiovasc Diabetol: 24 Jan 2023; 22:15 | PMID: 36694151
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<div><h4>Association of Frailty Status on the Causes and Outcomes of Patients Admitted With Cardiovascular Disease.</h4><i>Sokhal BS, Matetić A, Rashid M, Protheroe J, ... Mallen C, Mamas MA</i><br /><AbstractText>Data are limited about the contemporary association between frailty and the causes and outcomes of patients admitted with cardiovascular diseases (CVD). Using the US National Inpatient Sample, CVD admissions of interest (acute myocardial infarction, ischemic stroke, atrial fibrillation (AF), heart failure, pulmonary embolism, cardiac arrest, and hemorrhagic stroke) were stratified by Hospital Frailty Risk Score (HFRS). Logistic regression was used to determine adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of in-hospital mortality among different groups with frailty. The study included 9,317,398 hospitalizations. Of these, 5,573,033 (59.8%) had a low HFRS (<5); 3,422,700 (36.7%) had an intermediate HFRS (5 to 15); and 321,665 (3.5%) had a high HFRS (>15). Ischemic stroke was the most common admission for the groups with high risk (75.4%), whereas acute myocardial infarction was the most common admission for the group with low risk (36.9%). Compared with the group with low risk, patients with high risk had increased mortality across the most CVD admissions, except in patients admitted for cardiac arrest and hemorrhagic stroke (p <0.001). The strongest association with all-cause mortality was shown among patients with high risk admitted for AF (aOR 6.75, 95% CI 6.51 to 7.00, and aOR 17.69, 95% CI 16.08 to 19.45) compared with their counterparts with low risk. In conclusion, patients with CVD admissions have varying frailty risk according to cardiovascular cause of admission, with ischemic stroke being the most common among groups with frailty and high risk. Increased frailty is associated with all-cause mortality in patients with most CVD admissions, except for cardiac arrest and hemorrhagic stroke, with the strongest association seen in patients admitted with AF.</AbstractText><br /><br />Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 24 Jan 2023; 192:7-15</small></div>
Sokhal BS, Matetić A, Rashid M, Protheroe J, ... Mallen C, Mamas MA
Am J Cardiol: 24 Jan 2023; 192:7-15 | PMID: 36702048
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<div><h4>Association of Depression and Poor Mental Health With Cardiovascular Disease and Suboptimal Cardiovascular Health Among Young Adults in the United States.</h4><i>Kwapong YA, Boakye E, Khan SS, Honigberg MC, ... Blaha MJ, Sharma G</i><br /><AbstractText><br /><b>Background:</b><br/>Depression is a nontraditional risk factor for cardiovascular disease (CVD). Data on the association of depression and poor mental health with CVD and suboptimal cardiovascular health (CVH) among young adults are limited. Methods and Results We used data from 593 616 young adults (aged 18-49 years) from the 2017 to 2020 Behavioral Risk Factor Surveillance System, a nationally representative survey of noninstitutionalized US adults. Exposures were self-reported depression and poor mental health days (PMHDs; categorized as 0, 1-13, and 14-30 days of poor mental health in the past 30 days). Outcomes were self-reported CVD (composite of myocardial infarction, angina, or stroke) and suboptimal CVH (≥2 cardiovascular risk factors: hypertension, hypercholesterolemia, overweight/obesity, smoking, diabetes, physical inactivity, and inadequate fruit and vegetable intake). Using logistic regression, we investigated the association of depression and PMHDs with CVD and suboptimal CVH, adjusting for sociodemographic factors (and cardiovascular risk factors for the CVD outcome). Of the 593 616 participants (mean age, 34.7±9.0 years), the weighted prevalence of depression was 19.6% (95% CI, 19.4-19.8), and the weighted prevalence of CVD was 2.5% (95% CI, 2.4-2.6). People with depression had higher odds of CVD than those without depression (odds ratio [OR], 2.32 [95% CI, 2.13-2.51]). There was a graded association of PMHDs with CVD. Compared with individuals with 0 PMHDs, the odds of CVD in those with 1 to 13 PMHDs and 14 to 30 PHMDs were 1.48 (95% CI, 1.34-1.62) and 2.29 (95% CI, 2.08-2.51), respectively, after adjusting for sociodemographic and cardiovascular risk factors. The associations did not differ significantly by sex or urban/rural status. Individuals with depression had higher odds of suboptimal CVH (OR, 1.79 [95% CI, 1.65-1.95]) compared with those without depression, with a similar graded relationship between PMHDs and suboptimal CVH. <br /><b>Conclusions:</b><br/>Depression and poor mental health are associated with premature CVD and suboptimal CVH among young adults. Although this association is likely bidirectional, prioritizing mental health may help reduce CVD risk and improve CVH in young adults.</AbstractText><br /><br /><br /><br /><small>J Am Heart Assoc: 23 Jan 2023:e028332; epub ahead of print</small></div>
Kwapong YA, Boakye E, Khan SS, Honigberg MC, ... Blaha MJ, Sharma G
J Am Heart Assoc: 23 Jan 2023:e028332; epub ahead of print | PMID: 36688365
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<div><h4>Diastolic Blood Pressure and Intensive Blood Pressure Control on Cognitive Outcomes: Insights From the SPRINT MIND Trial.</h4><i>Jiang C, Li S, Wang Y, Lai Y, ... Anderson CS, Ma C</i><br /><b>Background</b><br />The potential benefits or harms of intensive systolic blood pressure (BP) control on cognitive function and cerebral blood flow in individuals with low diastolic blood pressure (DBP) remain unclear.<br /><b>Methods</b><br />We conducted a post hoc analysis of the SPRINT MIND (Systolic Blood Pressure Intervention Trial Memory and Cognition in Decreased Hypertension) that randomly assigned hypertensive participants to an intensive (<120 mm Hg; n=4278) or standard (<140 mm Hg; n=4385) systolic blood pressure target. We evaluated the effects of BP intervention on cognitive outcomes and cerebral blood flow across baseline DBP quartiles.<br /><b>Results</b><br />Participants in the intensive group had a lower incidence rate of probable dementia or mild cognitive impairment than those in the standard group, regardless of DBP quartiles. The hazard ratio of intensive versus standard target for probable dementia or mild cognitive impairment was 0.91 (95% CI, 0.73-1.12) in the lowest DBP quartile and 0.70 (95% CI, 0.48-1.02) in the highest DBP quartile, respectively, with an interaction <i>P</i> value of 0.24. Similar results were found for probable dementia (interaction <i>P</i>=0.06) and mild cognitive impairment (interaction <i>P</i>=0.80). The effect of intensive treatment on cerebral blood flow was not modified by baseline DBP either (interaction <i>P</i>=0.25). Even among participants within the lowest DBP quartile, intensive versus standard BP treatment resulted in an increasing trend of annualized change in cerebral blood flow (+0.26 [95% CI, -0.72 to 1.24] mL/[100 g·min]).<br /><b>Conclusions</b><br />Intensive BP control did not appear to have a detrimental effect on cognitive outcomes and cerebral perfusion in patients with low baseline DBP.<br /><b>Registration</b><br />URL: https://www.<br /><b>Clinicaltrials</b><br />gov; Unique identifier: NCT01206062.<br /><br /><br /><br /><small>Hypertension: 23 Jan 2023; epub ahead of print</small></div>
Jiang C, Li S, Wang Y, Lai Y, ... Anderson CS, Ma C
Hypertension: 23 Jan 2023; epub ahead of print | PMID: 36688305
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<div><h4>Surgical Management and Mechanical Circulatory Support in High-Risk Pulmonary Embolisms: Historical Context, Current Status, and Future Directions: A Scientific Statement From the American Heart Association.</h4><i>Goldberg JB, Giri J, Kobayashi T, Ruel M, ... American Heart Association Council on Cardiovascular Surgery and Anesthesia; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Lifestyle and Cardiometabolic Health; and Council on Peripheral Vascular Disease</i><br /><AbstractText>Acute pulmonary embolism is the third leading cause of cardiovascular death, with most pulmonary embolism-related mortality associated with acute right ventricular failure. Although there has recently been increased clinical attention to acute pulmonary embolism with the adoption of multidisciplinary pulmonary embolism response teams, mortality of patients with pulmonary embolism who present with hemodynamic compromise remains high when current guideline-directed therapy is followed. Because historical data and practice patterns affect current consensus treatment recommendations, surgical embolectomy has largely been relegated to patients who have contraindications to other treatments or when other treatment modalities fail. Despite a selection bias toward patients with greater illness, a growing body of literature describes the safety and efficacy of the surgical management of acute pulmonary embolism, especially in the hemodynamically compromised population. The purpose of this document is to describe modern techniques, strategies, and outcomes of surgical embolectomy and venoarterial extracorporeal membrane oxygenation and to suggest strategies to better understand the role of surgery in the management of pulmonary embolisms.</AbstractText><br /><br /><br /><br /><small>Circulation: 23 Jan 2023; epub ahead of print</small></div>
Goldberg JB, Giri J, Kobayashi T, Ruel M, ... American Heart Association Council on Cardiovascular Surgery and Anesthesia; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Lifestyle and Cardiometabolic Health; and Council on Peripheral Vascular Disease
Circulation: 23 Jan 2023; epub ahead of print | PMID: 36688837
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<div><h4>Diagnosis of coronary artery disease in patients with type 2 diabetes mellitus based on computed tomography and pericoronary adipose tissue radiomics: a retrospective cross-sectional study.</h4><i>Dong X, Li N, Zhu C, Wang Y, ... Wang W, Zhang T</i><br /><b>Background</b><br />Patients with type 2 diabetes mellitus (T2DM) are highly susceptible to cardiovascular disease, and coronary artery disease (CAD) is their leading cause of death. We aimed to assess whether computed tomography (CT) based imaging parameters and radiomic features of pericoronary adipose tissue (PCAT) can improve the diagnostic efficacy of whether patients with T2DM have developed CAD.<br /><b>Methods</b><br />We retrospectively recruited 229 patients with T2DM but no CAD history (146 were diagnosed with CAD at this visit and 83 were not). We collected clinical information and extracted imaging manifestations from CT images and 93 radiomic features of PCAT from all patients. All patients were randomly divided into training and test groups at a ratio of 7:3. Four models were constructed, encapsulating clinical factors (Model 1), clinical factors and imaging indices (Model 2), clinical factors and Radscore (Model 3), and all together (Model 4), to identify patients with CAD. Receiver operating characteristic curves and decision curve analysis were plotted to evaluate the model performance and pairwise model comparisons were performed via the DeLong test to demonstrate the additive value of different factors.<br /><b>Results</b><br />In the test set, the areas under the curve (AUCs) of Model 2 and Model 4 were 0.930 and 0.929, respectively, with higher recognition effectiveness compared to the other two models (each p < 0.001). Of these models, Model 2 had higher diagnostic efficacy for CAD than Model 1 (p < 0.001, 95% CI [0.129-0.350]). However, Model 4 did not improve the effectiveness of the identification of CAD compared to Model 2 (p = 0.776); similarly, the AUC did not significantly differ between Model 3 (AUC = 0.693) and Model 1 (AUC = 0.691, p = 0.382). Overall, Model 2 was rated better for the diagnosis of CAD in patients with T2DM.<br /><b>Conclusions</b><br />A comprehensive diagnostic model combining patient clinical risk factors with CT-based imaging parameters has superior efficacy in diagnosing the occurrence of CAD in patients with T2DM.<br /><br />© 2023. The Author(s).<br /><br /><small>Cardiovasc Diabetol: 23 Jan 2023; 22:14</small></div>
Abstract
<div><h4>Nursing Home Admission Following Transcatheter Aortic Valve Replacement: A Danish Nationwide Cohort Study.</h4><i>Strange JE, Sindet-Pedersen C, Holt A, Andersen MP, ... Olesen JB, Fosbøl EL</i><br /><b>Background</b><br />Loss of autonomy associated with nursing home admission (NHA) is a concern for patients. Yet the incidence of NHA after transcatheter aortic valve replacement (TAVR) is unknown.<br /><b>Objectives</b><br />The aim of this study was to investigate the incidence and factors associated with NHA following TAVR compared with the general population.<br /><b>Methods</b><br />Through Danish registries, patients alive at discharge after TAVR were identified from January 2014 to October 2021. Patients were matched 1:5 on sex, age, and calendar year to the general population. The 3-year cumulative incidence and 95% CI of NHA were estimated using the Aalen-Johansen estimator, accounting for the competing risk for death. Through multivariate cause-specific Cox regression models, factors associated with NHA were examined.<br /><b>Results</b><br />In total, 5,312 TAVR patients were matched to 26,560 control subjects with a median age of 81 years and 56.1% males. Comorbidity burden was higher for TAVR patients. The 3-year cumulative incidence of NHA was 6.3% (95% CI: 5.5%-7.1%) for TAVR patients compared with 5.8% (95% CI: 5.4%-6.1%) for the general population. For TAVR patients >85 years of age, the cumulative incidence of NHA was 11.6% (95% CI: 9.5%-13.8%), and the risk for death was 23.3% (95% CI: 20.4%-26.2%). Factors associated with NHA were increasing age, frailty, living alone, and atrial fibrillation.<br /><b>Conclusions</b><br />TAVR was not associated with an increased incidence of NHA compared with the general population. Despite the increased incidence of NHA for TAVR patients >85 years of age, approximately 2 in 3 patients were still alive and not admitted to nursing homes 3 years after TAVR.<br /><br />Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.<br /><br /><small>JACC Cardiovasc Interv: 23 Jan 2023; 16:179-188</small></div>
Strange JE, Sindet-Pedersen C, Holt A, Andersen MP, ... Olesen JB, Fosbøl EL
JACC Cardiovasc Interv: 23 Jan 2023; 16:179-188 | PMID: 36697154
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<div><h4>Transient vs In-Hospital Persistent Acute Kidney Injury in Patients With Acute Coronary Syndrome.</h4><i>Landi A, Branca M, Leonardi S, Frigoli E, ... Valgimigli M, MATRIX Investigators</i><br /><b>Background</b><br />The occurrence of acute kidney injury (AKI) among patients with acute coronary syndrome (ACS) undergoing invasive management is associated with worse outcomes. However, the prognostic implications of transient or in-hospital persistent AKI may differ.<br /><b>Objectives</b><br />The aim of this study was to evaluate the prognostic implications of transient or in-hospital persistent AKI in patients with ACS.<br /><b>Methods</b><br />In the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox) trial, 203 subjects were excluded because of incomplete information or end-stage renal disease, with a study population of 8,201 patients. Transient and persistent AKI were defined as renal dysfunction no longer or still fulfilling the AKI criteria (>0.5 mg/dL or a relative >25% increase in creatinine) at discharge, respectively. Thirty-day coprimary outcomes were the out-of-hospital composite of death, myocardial infarction, or stroke (major adverse cardiovascular events [MACE]) and net adverse cardiovascular events (NACE), defined as the composite of MACE or Bleeding Academic Research Consortium type 3 or 5 bleeding.<br /><b>Results</b><br />Persistent and transient AKI occurred in 750 (9.1%) and 587 (7.2%) subjects, respectively. After multivariable adjustment, compared with patients without AKI, the risk for 30-day coprimary outcomes was higher in patients with persistent AKI (MACE: adjusted HR: 2.32; 95% CI: 1.48-3.64; P < 0.001; NACE: adjusted HR: 2.29; 95% CI: 1.48-3.52; P < 0.001), driven mainly by all-cause mortality (adjusted HR: 3.43; 95% CI: 2.03-5.82; P < 0.001), whereas transient AKI was not associated with higher rates of MACE or NACE. Results remained consistent when implementing the KDIGO (Kidney Disease Improving Global Outcomes) criteria.<br /><b>Conclusions</b><br />Among patients with ACS undergoing invasive management, in-hospital persistent but not transient AKI was associated with higher risk for 30-day MACE and NACE. (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox [MATRIX]; NCT01433627).<br /><br />Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>JACC Cardiovasc Interv: 23 Jan 2023; 16:193-205</small></div>
Landi A, Branca M, Leonardi S, Frigoli E, ... Valgimigli M, MATRIX Investigators
JACC Cardiovasc Interv: 23 Jan 2023; 16:193-205 | PMID: 36697156
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<div><h4>Diagnostic test accuracy of life-threatening electrocardiographic findings (ST-elevation myocardial infarction equivalents) for acute coronary syndrome after out-of-hospital cardiac arrest without ST-segment elevation.</h4><i>Yoshimura S, Kiguchi T, Irisawa T, Yamada T, ... Kitamura T, Iwami T</i><br /><b>Aim</b><br />Life-threatening electrocardiographic (ECG) findings aid in the diagnosis of acute coronary syndrome (ACS), which has not been well-evaluated in patients with out-of-hospital cardiac arrest (OHCA). This study aimed to evaluate the diagnostic test accuracy (DTA) of ST-elevation myocardial infarction (STEMI) equivalents following the return of spontaneous circulation (ROSC) in patients with OHCA to identify patients with ACS.<br /><b>Methods</b><br />Using the database of the Comprehensive Registry of In-Hospital Intensive Care for OHCA Survival study from 2012 to 2017, patients aged ≥ 18 years with non-traumatic OHCA and ventricular fibrillation or pulseless ventricular tachycardia on the arrival of emergency medical service personnel or arrival at the emergency department, who achieved ROSC, were included. Patients without ST-segment elevation or complete left bundle branch block on ECG and those who did not undergo ECG or coronary angiography, were excluded from the study. We evaluated the DTA of STEMI equivalents for the diagnosis of ACS: isolated T-wave inversion, ST-segment depression, Wellens\' signs, and ST-segment elevation in lead aVR.<br /><b>Results</b><br />Isolated T-wave inversion and Wellens\' signs had high specificity for ACS with 0.95 (95% confidence interval [CI], 0.87-0.99) and 0.92 (95% CI, 0.82-0.97), respectively, but their positive likelihood ratios were low, with a wide range of 95% CI: 1.89 (95% CI, 0.51-7.02) and 0.81 (95% CI, 0.25-2.68), respectively.<br /><b>Conclusion</b><br />The DTA of STEMI equivalents for the diagnosis of ACS was low among patients with OHCA. Further investigation considering the measurement timing of the ECG after ROSC is required.<br /><br />Copyright © 2023 Elsevier B.V. All rights reserved.<br /><br /><small>Resuscitation: 23 Jan 2023:109700; epub ahead of print</small></div>
Yoshimura S, Kiguchi T, Irisawa T, Yamada T, ... Kitamura T, Iwami T
Resuscitation: 23 Jan 2023:109700; epub ahead of print | PMID: 36702338
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<div><h4>Guedel oropharyngeal airway: The validation of facial landmark-distances to estimate sizing in children - visualisation by magnetic resonance imaging (GUEDEL-I): a prospective observational study.</h4><i>Nemeth M, Ernst M, Asendorf T, Wilmers S, ... Kunze-Szikszay N, Miller C</i><br /><b>Objective</b><br />To validate the ERC-recommended facial landmark-distance for oropharyngeal airway sizing in children.<br /><b>Methods</b><br />We conducted a prospective observational study in anaesthetised, spontaneously breathing children ≤12 years undergoing cranial MRI. Oropharyngeal airways were inserted following the distance from the maxillary incisors to the mandibular angle. Primary outcome was the rate of properly sized oropharyngeal airways on MRI, defined as the distal end positioned within 10mm from the epiglottis without contacting it. Secondary outcomes were the occurrence of tongue protrusion, oropharyngeal airways clinical efficacy, and related adverse events. Furthermore, we calculated probabilities for the estimation of proper size when considering five facial landmark-distances and optimal rules based on biometric parameters.<br /><b>Results</b><br />In 94 children with a mean (SD) age of 4.7 (±3) years, 47.9% [95%-CI 38%-57.9%] oropharyngeal airways were properly sized, while 23.4% [95%-CI 15.9%-33%] were undersized, and 28.7% [95%-CI 20.5%-38.7%] oversized. Tongue protrusion occurred in 59.1% [95%-CI 38.2%-77.2%] of undersized and 15.6% [95%-CI 7.6%-29.2%] of properly sized oropharyngeal airways. No oropharyngeal airway required replacement. Comparing probabilities for five landmark-distances, \"maxillary incisors to the angle of the mandible\" proved superior for proper sizing at 41.2% [95%-CI 32%-51.7%]. The best-fit formula was \"22.43+17.54 x log(weight[kg])\" with a probability of 61.7% [95%-CI 51.5%-70.9%].<br /><b>Conclusion</b><br />Although the facial landmark-distance \"maxillary incisors to the angle of the mandible\" does not reliably predict oropharyngeal airway size, no clinical problems have been encountered. Since it can be considered the least inaccurate facial landmark-distance, it can serve as an approximation, but the efficacy of oropharyngeal airways should be evaluated clinically.<br /><b>Registered clinical trial</b><br />German Clinical Trials Register; DRKS00025918.<br /><br />Copyright © 2023 Elsevier B.V. All rights reserved.<br /><br /><small>Resuscitation: 23 Jan 2023:109702; epub ahead of print</small></div>
Nemeth M, Ernst M, Asendorf T, Wilmers S, ... Kunze-Szikszay N, Miller C
Resuscitation: 23 Jan 2023:109702; epub ahead of print | PMID: 36702339
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<div><h4>Sex-specific aortic valve calcifications in patients undergoing transcatheter aortic valve implantation.</h4><i>Hokken TW, Veulemans V, Adrichem R, Ooms JF, ... Zeus T, Van Mieghem NM</i><br /><b>Aims</b><br />To study sex-specific differences in the amount and distribution of aortic valve calcification (AVC) and to correlate the AVC load with paravalvular leakage (PVL) post-transcatheter aortic valve intervention (TAVI).<br /><b>Methods and results</b><br />This registry included 1801 patients undergoing TAVI with a Sapien3 or Evolut valve in two tertiary care institutions. Exclusion criteria encompassed prior aortic valve replacement, suboptimal multidetector computed tomography (MDCT) quality, and suboptimal transthoracic echocardiography images. Calcium content and distribution were derived from MDCT. In this study, the median age was 81.7 (25th-75th percentile 77.5-85.3) and 54% male. Men, compared to women, were significantly younger [81.2 (25th-75th percentile 76.5-84.5) vs. 82.4 (78.2-85.9), P ≤ 0.01] and had a larger annulus area [512 mm2 (25th-75th percentile 463-570) vs. 405 mm2 (365-454), P < 0.01] and higher Agatston score [2567 (25th-75th percentile 1657-3913) vs. 1615 (25th-75th percentile 905-2484), P < 0.01]. In total, 1104 patients (61%) had none-trace PVL, 648 (36%) mild PVL, and 49 (3%) moderate PVL post-TAVI. There was no difference in the occurrence of moderate PVL between men and women (3% vs. 3%, P = 0.63). Cut-off values for the Agatston score as predictor for moderate PVL based on the receiver-operating characteristic curve were 4070 (sensitivity 0.73, specificity 0.79) for men and 2341 (sensitivity 0.74, specificity 0.73) for women.<br /><b>Conclusion</b><br />AVC is a strong predictor for moderate PVL post-TAVI. Although the AVC load in men is higher compared to women, there is no difference in the incidence of moderate PVL. Sex-specific Agatston score cut-offs to predict moderate PVL were almost double as high in men vs. women.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur Heart J Cardiovasc Imaging: 21 Jan 2023; epub ahead of print</small></div>
Hokken TW, Veulemans V, Adrichem R, Ooms JF, ... Zeus T, Van Mieghem NM
Eur Heart J Cardiovasc Imaging: 21 Jan 2023; epub ahead of print | PMID: 36680538
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<div><h4>Cardiovascular disease prevention and management in the COVID-19 era and beyond: An international perspective.</h4><i>Faghy MA, Yates J, Hills AP, Jayasinghe S, ... Dixit S, Ashton REM</i><br /><AbstractText>Despite some indicators of a localized curtailing of cardiovascular disease (CVD) prevalence, CVD remains one of the largest contributors to global morbidity and mortality. While the magnitude and impact of the coronavirus disease 2019 (COVID-19) pandemic have yet to be realized in its entirety, an unquestionable impact on global health and well-being is already clear. At a time when the global state of CVD is perilous, we provide a continental overview of prevalence data and initiatives that have positively influenced CVD outcomes. What is clear is that despite attempts to address the global burden of CVD, there remains a lack of collective thinking and approaches. Moving forward, a coordinated global infrastructure that, if developed with appropriate and relevant key stakeholders, could provide significant and longstanding benefits to public health and yield prominent and consistent policy resulting in impactful change. To achieve global impact, research priorities that address multi-disciplinary social, environmental, and clinical perspectives must be underpinned by unified approaches that maximize public health.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 21 Jan 2023; epub ahead of print</small></div>
Faghy MA, Yates J, Hills AP, Jayasinghe S, ... Dixit S, Ashton REM
Prog Cardiovasc Dis: 21 Jan 2023; epub ahead of print | PMID: 36693488
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<div><h4>Recognizing risk factors associated with poor outcomes among patients with COVID-19.</h4><i>Rodriguez-Miguelez P, Heefner A, Carbone S</i><br /><AbstractText>The coronavirus disease 2019 (COVID-19) pandemic has affected >610 million people globally, exerting major social, economic, and health impacts. Despite the large number of global casualities and severe symptomatology associated with COVID-19, a large number of individuals remain at elevated risk of infection and severe outcomes related to poor lifestyle behaviors and/or associated comorbidities. Beyond the well-known social distance and masking policies, maintaining an active lifestyle, minimizing the consumption of tobacco products, and maintaining an adequate nutrition status are some of the key factors that, in an affordable and accessible way, have the potential to improve health and minimize COVID-19 impact. In addition, bringing awareness of the higher risks and poor prognosis of COVID-19 when other conditions are present seems to be essential to protect those individuals with the highest risks.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 21 Jan 2023; epub ahead of print</small></div>
Rodriguez-Miguelez P, Heefner A, Carbone S
Prog Cardiovasc Dis: 21 Jan 2023; epub ahead of print | PMID: 36693489
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<div><h4>Long-term risk associated with clonal hematopoiesis in patients with severe aortic valve stenosis undergoing TAVR.</h4><i>Mas-Peiro S, Pergola G, Berkowitsch A, Meggendorfer M, ... Dimmeler S, Zeiher AM</i><br /><b>Background</b><br />Mutations in the clonal hematopoiesis of indeterminate potential (CHIP)-driver genes DNMT3A and TET2 have been previously shown to be associated with short-term prognosis in patients undergoing TAVR for aortic valve stenosis. We aimed to extend and characterize these findings on long-term outcome in a large cohort.<br /><b>Methods</b><br />A total of 453 consecutive patients undergoing TAVR were included in an up to 4-year follow-up study. Next-generation sequencing was used to identify DNMT3A- and/or TET2-CHIP-driver mutations. Primary endpoint was all-cause mortality. Since CHIP-driver mutations appear to be closely related to DNA methylation, results were also assessed in patients who never smoked, a factor known to interfere with DNA methylation.<br /><b>Results</b><br />DNMT3A-/TET2-CHIP-driver mutations were present in 32.4% of patients (DNMT3A n = 92, TET2 n = 71), and were more frequent in women (52.4% vs. 38.9%, p = 0.007) and older participants (83.3 vs. 82.2 years, p = 0.011), while clinical characteristics or blood-derived parameters did not differ. CHIP-driver mutations were associated with a significantly higher mortality up to 4 years after TAVR in both univariate (p = 0.031) and multivariate analyses (HR 1.429, 95%CI 1.014-2.013, p = 0.041). The difference was even more pronounced (p = 0.011) in never smokers. Compared to TET2 mutation carriers, patients with DNMT3A mutations had significantly less frequently concomitant coronary and peripheral artery disease.<br /><b>Conclusion</b><br />DNMT3A- and TET2-CHIP-driver mutations are associated with long-term mortality in patients with aortic valve stenosis even after a successful TAVR. The association is also present in never smokers, in whom no biasing effect from smoking on DNA methylation is to be expected.<br /><br />© 2023. The Author(s).<br /><br /><small>Clin Res Cardiol: 21 Jan 2023; epub ahead of print</small></div>
Mas-Peiro S, Pergola G, Berkowitsch A, Meggendorfer M, ... Dimmeler S, Zeiher AM
Clin Res Cardiol: 21 Jan 2023; epub ahead of print | PMID: 36680616
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<div><h4>The role of obesity-related cardiovascular remodelling in mediating incident cardiovascular outcomes: a population-based observational study.</h4><i>Szabo L, McCracken C, Cooper J, Rider OJ, ... Petersen SE, Raisi-Estabragh Z</i><br /><b>Aims</b><br />We examined associations of obesity with incident cardiovascular outcomes and cardiovascular magnetic resonance (CMR) phenotypes, integrating information from body mass index (BMI) and waist-to-hip ratio (WHR). Then, we used multiple mediation to define the role of obesity-related cardiac remodelling in driving obesity-outcome associations, independent of cardiometabolic diseases.<br /><b>Methods and results</b><br />In 491 606 UK Biobank participants, using Cox proportional hazard models, greater obesity (higher WHR, higher BMI) was linked to significantly greater risk of incident ischaemic heart disease, atrial fibrillation (AF), heart failure (HF), all-cause mortality, and cardiovascular disease (CVD) mortality. In combined stratification by BMI and WHR thresholds, elevated WHR was associated with greater risk of adverse outcomes at any BMI level. Individuals with overweight BMI but normal WHR had weaker disease associations. In the subset of participants with CMR (n = 31 107), using linear regression, greater obesity was associated with higher left ventricular (LV) mass, greater LV concentricity, poorer LV systolic function, lower myocardial native T1, larger left atrial (LA) volumes, poorer LA function, and lower aortic distensibility. Of note, higher BMI was linked to higher, whilst greater WHR was linked to lower LV end-diastolic volume (LVEDV). In Cox models, greater LVEDV and LV mass (LVM) were linked to increased risk of CVD, most importantly HF and an increased LA maximal volume was the key predictive measure of new-onset AF. In multiple mediation analyses, hypertension and adverse LV remodelling (higher LVM, greater concentricity) were major independent mediators of the obesity-outcome associations. Atrial remodelling and native T1 were additional mediators in the associations of obesity with AF and HF, respectively.<br /><b>Conclusions</b><br />We demonstrate associations of obesity with adverse cardiovascular phenotypes and their significant independent role in mediating obesity-outcome relationships. In addition, our findings support the integrated use of BMI and WHR to evaluate obesity-related cardiovascular risk.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur Heart J Cardiovasc Imaging: 20 Jan 2023; epub ahead of print</small></div>
Szabo L, McCracken C, Cooper J, Rider OJ, ... Petersen SE, Raisi-Estabragh Z
Eur Heart J Cardiovasc Imaging: 20 Jan 2023; epub ahead of print | PMID: 36660920
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<div><h4>Serum lipoprotein(a) and bioprosthetic aortic valve degeneration.</h4><i>Botezatu SB, Tzolos E, Kaiser Y, Cartlidge TRG, ... Zheng KH, Dweck MR</i><br /><b>Aims</b><br />Bioprosthetic aortic valve degeneration demonstrates pathological similarities to aortic stenosis. Lipoprotein(a) [Lp(a)] is a well-recognized risk factor for incident aortic stenosis and disease progression. The aim of this study is to investigate whether serum Lp(a) concentrations are associated with bioprosthetic aortic valve degeneration.<br /><b>Methods and results</b><br />In a post hoc analysis of a prospective multimodality imaging study (NCT02304276), serum Lp(a) concentrations, echocardiography, contrast-enhanced computed tomography (CT) angiography, and 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) were assessed in patients with bioprosthetic aortic valves. Patients were also followed up for 2 years with serial echocardiography. Serum Lp(a) concentrations [median 19.9 (8.4-76.4) mg/dL] were available in 97 participants (mean age 75 ± 7 years, 54% men). There were no baseline differences across the tertiles of serum Lp(a) concentrations for disease severity assessed by echocardiography [median peak aortic valve velocity: highest tertile 2.5 (2.3-2.9) m/s vs. lower tertiles 2.7 (2.4-3.0) m/s, P = 0.204], or valve degeneration on CT angiography (highest tertile n = 8 vs. lower tertiles n = 12, P = 0.552) and 18F-NaF PET (median tissue-to-background ratio: highest tertile 1.13 (1.05-1.41) vs. lower tertiles 1.17 (1.06-1.53), P = 0.889]. After 2 years of follow-up, there were no differences in annualized change in bioprosthetic hemodynamic progression [change in peak aortic valve velocity: highest tertile [0.0 (-0.1-0.2) m/s/year vs. lower tertiles 0.1 (0.0-0.2) m/s/year, P = 0.528] or the development of structural valve degeneration.<br /><b>Conclusion</b><br />Serum lipoprotein(a) concentrations do not appear to be a major determinant or mediator of bioprosthetic aortic valve degeneration.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur Heart J Cardiovasc Imaging: 20 Jan 2023; epub ahead of print</small></div>
Botezatu SB, Tzolos E, Kaiser Y, Cartlidge TRG, ... Zheng KH, Dweck MR
Eur Heart J Cardiovasc Imaging: 20 Jan 2023; epub ahead of print | PMID: 36662130
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<div><h4>Alternative polyadenylation regulation in cardiac development and cardiovascular disease.</h4><i>Cao J, Kuyumcu-Martinez MN</i><br /><AbstractText>Cleavage and polyadenylation of pre-mRNAs is a necessary step for gene expression and function. Majority of human genes exhibit multiple polyadenylation sites, which can be alternatively used to generate different mRNA isoforms from a single gene. Alternative polyadenylation (APA) of pre-mRNAs is important for proteome and transcriptome landscape. APA is tightly regulated during development and contributes to tissue-specific gene regulation. Mis-regulation of APA is linked to a wide range of pathological conditions. APA-mediated gene regulation in the heart is emerging as new area of research. Here, we will discuss the impact of APA on gene regulation during heart development and in cardiovascular diseases. First, we will briefly review how APA impacts gene regulation and discuss molecular mechanisms that control APA. Then, we will address APA regulation during heart development and its dysregulation in cardiovascular diseases. Finally, we will discuss pre-mRNA targeting strategies to correct aberrant APA patterns of essential genes for the treatment or prevention of cardiovascular diseases. The RNA field is blooming due to the advancements in RNA-based technologies. RNA-based vaccines and therapies are becoming the new line of effective and safe approaches for the treatment and prevention of human diseases. Overall, this review will be influential for understanding gene regulation at the RNA level via APA in the heart and will help design RNA-based tools for the treatment of cardiovascular diseases in the future.</AbstractText><br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Cardiovasc Res: 20 Jan 2023; epub ahead of print</small></div>
Cao J, Kuyumcu-Martinez MN
Cardiovasc Res: 20 Jan 2023; epub ahead of print | PMID: 36657944
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<div><h4>Lifestyle habits associated with cardiac conduction disease.</h4><i>Frimodt-Møller EK, Soliman EZ, Kizer JR, Vittinghoff E, ... Gottdiener JS, Marcus GM</i><br /><b>Aims</b><br />Cardiac conduction disease can lead to syncope, heart failure, and death. The only available therapy is pacemaker implantation, with no established prevention strategies. Research to identify modifiable risk factors has been scant.<br /><b>Methods and results</b><br />Data from the Cardiovascular Health Study, a population-based cohort study of adults ≥ 65 years with annual 12-lead electrocardiograms obtained over 10 years, were utilized to examine relationships between baseline characteristics, including lifestyle habits, and conduction disease. Of 5050 participants (mean age 73 ± 6 years; 52% women), prevalent conduction disease included 257 with first-degree atrioventricular block, 99 with left anterior fascicular block, 9 with left posterior fascicular block, 193 with right bundle branch block (BBB), 76 with left BBB, and 102 with intraventricular block at baseline. After multivariable adjustment, older age, male sex, a larger body mass index, hypertension, and coronary heart disease were associated with a higher prevalence of conduction disease, whereas White race and more physical activity were associated with a lower prevalence. Over a median follow-up on 7 (interquartile range 1-9) years, 1036 developed incident conduction disease. Older age, male sex, a larger BMI, and diabetes were each associated with incident conduction disease. Of lifestyle habits, more physical activity (hazard ratio 0.91, 95% confidence interval 0.84-0.98, P = 0.017) was associated with a reduced risk, while smoking and alcohol did not exhibit a significant association.<br /><b>Conclusion</b><br />While some difficult to control comorbidities were associated with conduction disease as expected, a readily modifiable lifestyle factor, physical activity, was associated with a lower risk.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur Heart J: 20 Jan 2023; epub ahead of print</small></div>
Frimodt-Møller EK, Soliman EZ, Kizer JR, Vittinghoff E, ... Gottdiener JS, Marcus GM
Eur Heart J: 20 Jan 2023; epub ahead of print | PMID: 36660815
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<div><h4>Transcatheter versus surgical aortic valve replacement in lower-risk and higher-risk patients: a meta-analysis of randomized trials.</h4><i>Ahmad Y, Howard JP, Arnold AD, Madhavan MV, ... Forrest JK, Leon MB</i><br /><b>Aims</b><br />Additional randomized clinical trial (RCT) data comparing transcatheter aortic valve implantation (TAVI) with surgical aortic valve replacement (SAVR) is available, including longer term follow-up. A meta-analysis comparing TAVI to SAVR was performed. A pragmatic risk classification was applied, partitioning lower-risk and higher-risk patients.<br /><b>Methods and results</b><br />The main endpoints were death, strokes, and the composite of death or disabling stroke, occurring at 1 year (early) or after 1 year (later). A random-effects meta-analysis was performed. Eight RCTs with 8698 patients were included. In lower-risk patients, at 1 year, the risk of death was lower after TAVI compared with SAVR [relative risk (RR) 0.67; 95% confidence interval (CI) 0.47 to 0.96, P = 0.031], as was death or disabling stroke (RR 0.68; 95% CI 0.50 to 0.92, P = 0.014). There were no differences in strokes. After 1 year, in lower-risk patients, there were no significant differences in all main outcomes. In higher-risk patients, there were no significant differences in main outcomes. New-onset atrial fibrillation, major bleeding, and acute kidney injury occurred less after TAVI; new pacemakers, vascular complications, and paravalvular leak occurred more after TAVI.<br /><b>Conclusion</b><br />In lower-risk patients, there was an early mortality reduction with TAVI, but no differences after later follow-up. There was also an early reduction in the composite of death or disabling stroke, with no difference at later follow-up. There were no significant differences for higher-risk patients. Informed therapy decisions may be more dependent on the temporality of events or secondary endpoints than the long-term occurrence of main clinical outcomes.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur Heart J: 20 Jan 2023; epub ahead of print</small></div>
Ahmad Y, Howard JP, Arnold AD, Madhavan MV, ... Forrest JK, Leon MB
Eur Heart J: 20 Jan 2023; epub ahead of print | PMID: 36660821
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<div><h4>Gender Differences in the Impact of Coronary Artery Disease and Complete Revascularization on Long-Term Outcomes After Transcatheter Aortic Valve Implantation.</h4><i>Minten L, Bennett J, Wissels P, McCutcheon K, Dubois C</i><br /><AbstractText>In this study, we compare gender-specific clinical outcomes. We show that outcomes among women after transcatheter aortic valve implantation are significantly influenced by co-existing coronary artery disease (CAD) and its complexity, whereas in men, this is less pronounced. Moreover, we identified a subgroup of women with complex CAD who are at particularly high risk for fatal cardiovascular events, even when compared with men with similar CAD.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 20 Jan 2023; 191:133-135</small></div>
Minten L, Bennett J, Wissels P, McCutcheon K, Dubois C
Am J Cardiol: 20 Jan 2023; 191:133-135 | PMID: 36682081
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<div><h4>The acute and chronic implications of the COVID-19 virus on the cardiovascular system in adults: A systematic review.</h4><i>Ashton RE, Philips BE, Faghy M</i><br /><AbstractText>Despite coronavirus disease 2019 (COVID-19) primarily being identified as a respiratory illness, some patients who seemingly recovered from initial infection, developed chronic multi-system complications such as cardiovascular (CV), pulmonary and neurological issues leading to multiple organ injuries. However, to date, there is a dearth of understanding of the acute and chronic implications of a COVID-19 infection on the CV system in adults. A systematic review of the literature was conducted according to PRISMA guidelines and prospectively registered via Prospero (ID: CRD42022360444). The MEDLINE Ovid, Cochrane Library and PubMed databases were searched from inception to August 2022. The search strategy keywords and MeSH terms used included: 1) COVID; 2) coronavirus; 3) long COVID; 4) cardiovascular; and 5) cardiovascular disease. Reference lists of all relevant systematic reviews identified were searched for additional studies. A total of 11,332 records were retrieved from database searches, of which 310 records were duplicates. A further 9887 were eliminated following screening of titles and abstracts. After full-text screening of 1135 articles, 9 manuscripts were included for review. The evidence of CV implications post-COVID-19 infection is clear, and this must be addressed with appropriate management strategies that recognise the acute and chronic nature of cardiac injury in COVID-19 patients. Efficacious management strategies will be needed to address long standing issues and morbidity.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 20 Jan 2023; epub ahead of print</small></div>
Ashton RE, Philips BE, Faghy M
Prog Cardiovasc Dis: 20 Jan 2023; epub ahead of print | PMID: 36690284
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<div><h4>Public policy for healthy living: How COVID-19 has changed the landscape.</h4><i>Whitsel LP, Ajenikoko F, Chase PJ, Johnson J, ... Radcliffe R, Faghy MA</i><br /><AbstractText>The coronavirus disease 2019 (COVID-19) pandemic had a transformational impact on public policy as governments played a leading role, working alongside and coordinating with business/industry, healthcare, public health, education, transportation, researchers, non-governmental organizations, philanthropy, and media/communications. This paper summarizes the impact of the pandemic on different areas of public policy affecting healthy living and cardiovascular health including prevention (i.e., nutrition, physical activity, air quality, tobacco use), risk factors for chronic disease (hypertension, diabetes, obesity, substance abuse), access to health care, care delivery and payment reform, telehealth and digital health, research, and employment policy. The paper underscores where public policy is evolving and where there are needs for future evidence base to inform policy development, and the intersections between the public and private sectors across the policy continuum. There is a continued need for global multi-sector coordination to optimize population health.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 20 Jan 2023; epub ahead of print</small></div>
Whitsel LP, Ajenikoko F, Chase PJ, Johnson J, ... Radcliffe R, Faghy MA
Prog Cardiovasc Dis: 20 Jan 2023; epub ahead of print | PMID: 36690285
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<div><h4>Cardiovascular services in Covid-19 - Impact of the pandemic and lessons learned.</h4><i>Josephson RA, Gillombardo CB</i><br /><AbstractText>The coronavirus disease 2019 (COVID-19) pandemic immediately and perhaps irrevocably impacted society at large, the provision of cardiovascular (CV) care, the function and staffing of hospitals, and CV clinicians. Initially many clinicians at all career stages rose to the challenges, and support and accolades were the initial societal response. Politicization of the public health response as well as widespread misinformation and disinformation all negatively impacted CV clinicians\' roles as well diminished and, in some cases, eliminated their public and self-esteem. Unabated stress, disrespect, and a likely lack of emotional and physical respite may all have contributed to the Great Resignation. Insights gained from review of the COVID-19 pandemic may help inform changes to foster system resiliency and prepare for an improved response to the inevitable next stressor.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 20 Jan 2023; epub ahead of print</small></div>
Josephson RA, Gillombardo CB
Prog Cardiovasc Dis: 20 Jan 2023; epub ahead of print | PMID: 36690286
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<div><h4>What has cardiac rehabilitation looked like in the COVID-19 pandemic: Lessons learned for the future.</h4><i>Ozemek C, Berry R, Bonikowske AR, German C, Gavic AM</i><br /><AbstractText>The global coronavirus disease 2019 (COVID-19) pandemic prompted widespread national shutdown, halting or dramatically reducing the delivery of non-essential outpatient services including cardiac rehabilitation (CR). Center-based CR services were closed for as few as two weeks to greater than one year and the uncertainty surrounding the duration of the lockdown phase prompted programs to consider programmatic adaptations that would allow for the safe and effective delivery of CR services. Among the actions taken to accommodate in person CR sessions included increasing the distance between exercise equipment and/or limiting the number of patients per session. Legislative approval of reimbursing telehealth or virtual services presented an opportunity to reach patients that may otherwise have not considered attending CR during or even before the pandemic. Additionally, the considerable range of symptoms and infection severity as well as the risk of developing long lasting, debilitating symptoms has complicated exercise recommendations. Important lessons from publications reporting findings from clinical settings have helped shape the way in which exercise is applied, with much more left to discover. The overarching aim of this paper is to review how programs adapted to the COVID-19 pandemic and identify lessons learned that have positively influenced the future of CR delivery.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 20 Jan 2023; epub ahead of print</small></div>
Ozemek C, Berry R, Bonikowske AR, German C, Gavic AM
Prog Cardiovasc Dis: 20 Jan 2023; epub ahead of print | PMID: 36690287
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<div><h4>Fibrin clot properties in cardiovascular disease: from basic mechanisms to clinical practice.</h4><i>Ząbczyk M, Ariëns RAS, Undas A</i><br /><AbstractText>Fibrinogen conversion into insoluble fibrin and formation of a stable clot is the final step of the coagulation cascade. Fibrin clot porosity and its susceptibility to plasmin-mediated lysis are the key fibrin measures, describing properties of clots prepared ex vivo from citrated plasma. Cardiovascular disease, referring to coronary heart disease, heart failure, stroke, and hypertension, has been shown to be associated with a formation of dense fibrin networks that are relatively resistant to lysis. Denser fibrin mesh characterized acute patients at the onset of myocardial infarction or ischemic stroke, while hypofibrinolysis has been identified as a persistent fibrin feature in patients following thrombotic events or in those with stable coronary artery disease. Traditional cardiovascular risk factors, such as smoking, diabetes mellitus, hyperlipidaemia, obesity, and hypertension have also been linked with unfavourably altered fibrin clot properties, while some lifestyle modifications and pharmacological treatment, in particular statins and anticoagulants, may improve fibrin structure and function. Prospective studies have suggested that prothrombotic fibrin clot phenotype can predict cardiovascular events in a short- and long-term follow-up. Mutations and splice variants of the fibrinogen molecule that have been proven to be associated with thrombophilia or increased cardiovascular risk, along with fibrinogen post-translational modifications, prothrombotic state, inflammation, platelet activation, and neutrophil extracellular traps formation contribute also to prothrombotic fibrin clot phenotype. Moreover, about 500 clot-bound proteins have been identified within plasma fibrin clots, including fibronectin, α2-antiplasmin, factor XIII, complement component C3, and histidine-rich glycoprotein. This review summarizes the current knowledge on the mechanisms underlying unfavourable fibrin clot properties and their implications in cardiovascular disease and its thromboembolic manifestations.</AbstractText><br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Cardiovasc Res: 20 Jan 2023; epub ahead of print</small></div>
Ząbczyk M, Ariëns RAS, Undas A
Cardiovasc Res: 20 Jan 2023; epub ahead of print | PMID: 36662542
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<div><h4>Employment Status at Time of Acute Myocardial Infarction and Risk of Death and Recurrent Acute Myocardial Infarction.</h4><i>Petersen JK, Shams-Eldin AN, Fosbøl EL, Rørth R, ... Køber L, Butt JH</i><br /><b>Background</b><br />Employment is important for physical and mental health and self-esteem and provides financial independence. However, little is known on the prognostic value of employment status prior to admission with acute myocardial infarction (MI).<br /><b>Methods and results</b><br />Using Danish nationwide registries, all patients between 18 and 60 years with a first-time MI admission (2010-2018) and alive at discharge were included. Rates of all-cause mortality and recurrent MI according to workforce attachment at the time of the event was compared using multivariable Cox regression. Of the 16,060 patients included in the study, 3,520 (21.9%) patients were not part of the workforce. Patients who were not part of the workforce were older (52 versus 51 years), less often men (63% versus 77%), less likely to have higher education, more often living alone (47% versus 29%), and more often had comorbidities, including heart failure, atrial fibrillation, hypertension, diabetes, chronic kidney disease, and chronic obstructive pulmonary disease. The absolute 5-year risk of death was 3.3% and 12.8% in the workforce and non-workforce group, respectively. The corresponding rates of recurrent MI were 7.5% and 10.9%, respectively. In adjusted analyses, not being part of the workforce was associated with a significantly higher rate of all-cause mortality (HR 2.39 ([95% CI, 2.01-2.83]) and recurrent MI (1.36 [1.18-1.57]).<br /><b>Conclusion</b><br />Among patients of working age who were admitted with MI and alive at discharge, not being part of the workforce was associated with a higher long-term rate of all-cause mortality and recurrent MI.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 19 Jan 2023; epub ahead of print</small></div>
Petersen JK, Shams-Eldin AN, Fosbøl EL, Rørth R, ... Køber L, Butt JH
Eur J Prev Cardiol: 19 Jan 2023; epub ahead of print | PMID: 36653331
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<div><h4>Aspirin or Low-Molecular-Weight Heparin for Thromboprophylaxis after a Fracture.</h4><i>Major Extremity Trauma Research Consortium (METRC), O\'Toole RV, Stein DM, O\'Hara NN, ... Marvel D, Castillo RC</i><br /><b>Background</b><br />Clinical guidelines recommend low-molecular-weight heparin for thromboprophylaxis in patients with fractures, but trials of its effectiveness as compared with aspirin are lacking.<br /><b>Methods</b><br />In this pragmatic, multicenter, randomized, noninferiority trial, we enrolled patients 18 years of age or older who had a fracture of an extremity (anywhere from hip to midfoot or shoulder to wrist) that had been treated operatively or who had any pelvic or acetabular fracture. Patients were randomly assigned to receive low-molecular-weight heparin (enoxaparin) at a dose of 30 mg twice daily or aspirin at a dose of 81 mg twice daily while they were in the hospital. After hospital discharge, the patients continued to receive thromboprophylaxis according to the clinical protocols of each hospital. The primary outcome was death from any cause at 90 days. Secondary outcomes were nonfatal pulmonary embolism, deep-vein thrombosis, and bleeding complications.<br /><b>Results</b><br />A total of 12,211 patients were randomly assigned to receive aspirin (6101 patients) or low-molecular-weight heparin (6110 patients). Patients had a mean (±SD) age of 44.6±17.8 years, 0.7% had a history of venous thromboembolism, and 2.5% had a history of cancer. Patients received a mean of 8.8±10.6 in-hospital thromboprophylaxis doses and were prescribed a median 21-day supply of thromboprophylaxis at discharge. Death occurred in 47 patients (0.78%) in the aspirin group and in 45 patients (0.73%) in the low-molecular-weight-heparin group (difference, 0.05 percentage points; 96.2% confidence interval, -0.27 to 0.38; P<0.001 for a noninferiority margin of 0.75 percentage points). Deep-vein thrombosis occurred in 2.51% of patients in the aspirin group and 1.71% in the low-molecular-weight-heparin group (difference, 0.80 percentage points; 95% CI, 0.28 to 1.31). The incidence of pulmonary embolism (1.49% in each group), bleeding complications, and other serious adverse events were similar in the two groups.<br /><b>Conclusions</b><br />In patients with extremity fractures that had been treated operatively or with any pelvic or acetabular fracture, thromboprophylaxis with aspirin was noninferior to low-molecular-weight heparin in preventing death and was associated with low incidences of deep-vein thrombosis and pulmonary embolism and low 90-day mortality. (Funded by the Patient-Centered Outcomes Research Institute; PREVENT CLOT ClinicalTrials.gov number, NCT02984384.).<br /><br />Copyright © 2023 Massachusetts Medical Society.<br /><br /><small>N Engl J Med: 19 Jan 2023; 388:203-213</small></div>
Major Extremity Trauma Research Consortium (METRC), O'Toole RV, Stein DM, O'Hara NN, ... Marvel D, Castillo RC
N Engl J Med: 19 Jan 2023; 388:203-213 | PMID: 36652352
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<div><h4>Psychosocial Functioning in Transgender Youth after 2 Years of Hormones.</h4><i>Chen D, Berona J, Chan YM, Ehrensaft D, ... Tishelman AC, Olson-Kennedy J</i><br /><b>Background</b><br />Limited prospective outcome data exist regarding transgender and nonbinary youth receiving gender-affirming hormones (GAH; testosterone or estradiol).<br /><b>Methods</b><br />We characterized the longitudinal course of psychosocial functioning during the 2 years after GAH initiation in a prospective cohort of transgender and nonbinary youth in the United States. Participants were enrolled in a four-site prospective, observational study of physical and psychosocial outcomes. Participants completed the Transgender Congruence Scale, the Beck Depression Inventory-II, the Revised Children\'s Manifest Anxiety Scale (Second Edition), and the Positive Affect and Life Satisfaction measures from the NIH (National Institutes of Health) Toolbox Emotion Battery at baseline and at 6, 12, 18, and 24 months after GAH initiation. We used latent growth curve modeling to examine individual trajectories of appearance congruence, depression, anxiety, positive affect, and life satisfaction over a period of 2 years. We also examined how initial levels of and rates of change in appearance congruence correlated with those of each psychosocial outcome.<br /><b>Results</b><br />A total of 315 transgender and nonbinary participants 12 to 20 years of age (mean [±SD], 16±1.9) were enrolled in the study. A total of 190 participants (60.3%) were transmasculine (i.e., persons designated female at birth who identify along the masculine spectrum), 185 (58.7%) were non-Latinx or non-Latine White, and 25 (7.9%) had received previous pubertal suppression treatment. During the study period, appearance congruence, positive affect, and life satisfaction increased, and depression and anxiety symptoms decreased. Increases in appearance congruence were associated with concurrent increases in positive affect and life satisfaction and decreases in depression and anxiety symptoms. The most common adverse event was suicidal ideation (in 11 participants [3.5%]); death by suicide occurred in 2 participants.<br /><b>Conclusions</b><br />In this 2-year study involving transgender and nonbinary youth, GAH improved appearance congruence and psychosocial functioning. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.).<br /><br />Copyright © 2023 Massachusetts Medical Society.<br /><br /><small>N Engl J Med: 19 Jan 2023; 388:240-250</small></div>
Chen D, Berona J, Chan YM, Ehrensaft D, ... Tishelman AC, Olson-Kennedy J
N Engl J Med: 19 Jan 2023; 388:240-250 | PMID: 36652355
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<div><h4>Association of COVID-19 with short- and long-term risk of cardiovascular disease and mortality: a prospective cohort in UK Biobank.</h4><i>Wan EYF, Mathur S, Zhang R, Yan VKC, ... Yiu KH, Wong ICK</i><br /><b>Aims</b><br />This study aims to evaluate the short- and long-term associations between COVID-19 and development of cardiovascular disease (CVD) outcomes and mortality in the general population.<br /><b>Methods and results</b><br />A prospective cohort of patients with COVID-19 infection between 16 March 2020 and 30 November 2020 was identified from UK Biobank, and followed for up to 18 months, until 31 August 2021. Based on age (within 5 years) and sex, each case was randomly matched with up to 10 participants without COVID-19 infection from two cohorts-a contemporary cohort between 16 March 2020 and 30 November 2020 and a historical cohort between 16 March 2018 and 30 November 2018. The characteristics between groups were further adjusted with propensity score-based marginal mean weighting through stratification. To determine the association of COVID-19 with CVD and mortality within 21 days of diagnosis (acute phase) and after this period (post-acute phase), Cox regression was employed. In the acute phase, patients with COVID-19 (n = 7584) were associated with a significantly higher short-term risk of CVD {hazard ratio (HR): 4.3 [95% confidence interval (CI): 2.6- 6.9]; HR: 5.0 (95% CI: 3.0-8.1)} and all-cause mortality [HR: 81.1 (95% CI: 58.5-112.4); HR: 67.5 (95% CI: 49.9-91.1)] than the contemporary (n = 75 790) and historical controls (n = 75 774), respectively. Regarding the post-acute phase, patients with COVID-19 (n = 7139) persisted with a significantly higher risk of CVD in the long-term [HR: 1.4 (95% CI: 1.2-1.8); HR: 1.3 (95% CI: 1.1- 1.6)] and all-cause mortality [HR: 5.0 (95% CI: 4.3-5.8); HR: 4.5 (95% CI: 3.9-5.2) compared to the contemporary (n = 71 296) and historical controls (n = 71 314), respectively.<br /><b>Conclusions</b><br />COVID-19 infection, including long-COVID, is associated with increased short- and long-term risks of CVD and mortality. Ongoing monitoring of signs and symptoms of developing these cardiovascular complications post diagnosis and up till at least a year post recovery may benefit infected patients, especially those with severe disease.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Cardiovasc Res: 19 Jan 2023; epub ahead of print</small></div>
Wan EYF, Mathur S, Zhang R, Yan VKC, ... Yiu KH, Wong ICK
Cardiovasc Res: 19 Jan 2023; epub ahead of print | PMID: 36652991
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<div><h4>The influence of renal disease on outcomes and cardiac remodeling following surgical mitral valve replacement.</h4><i>El-Andari R, Bozso SJ, Fialka NM, Kang JJH, ... Nagendran J, Nagendran J</i><br /><b>Objectives</b><br />Chronic kidney disease (CKD) is increasingly prevalent in patients undergoing mitral valve replacement (MVR). While CKD is known to result in suboptimal outcomes for patients with mitral valve disease, there is limited literature evaluating the long-term outcomes and cardiac remodeling of patients with CKD undergoing MVR. We present the first analysis coupling long-term outcomes of combined morbidity, mortality, and cardiac remodeling post-MVR in patients with CKD.<br /><b>Methods</b><br />Patients with varying degrees of CKD undergoing MVR from 2004 to 2018 were compared. Patients were grouped by estimated glomerular filtration rate (eGFR) > 90 mL/min/1.73m<sup>2</sup> (n = 109), 60-89 mL/min/1.73m<sup>2</sup> (450), 30-59 mL/min/1.73m<sup>2</sup> (449), < 30 mL/min/1.73m<sup>2</sup> (60). The primary outcome was mortality. Secondary outcomes included measures of postoperative morbidity and cardiac remodeling.<br /><b>Results</b><br />One-year mortality was significantly increased in patients with eGFR < 30 (p = 0.023). Mortality at 7 years was significantly increased in patients with eGFR < 30 mL/min/1.73m<sup>2</sup> (p < 0.001). Multivariable regression analysis of 7-year all-cause mortality indicated an eGFR of 15 mL/min/1.73m<sup>2</sup> (HR 4.03, 95% CI 2.54-6.40) and 30 mL/min/1.73m<sup>2</sup> (HR 2.17 95% CI 1.55-3.05) were predictive of increased mortality. Reduced eGFR predicted the development of postoperative sepsis (p = 0.002), but not other morbidities. Positive cardiac remodeling of the left ventricle, left atrium, and valve gradients were identified postoperatively for patients with eGFR > 30 mL/min/1.73m<sup>2</sup> while patients with eGFR < 30 mL/min/1.73m<sup>2</sup> did not experience the same changes.<br /><b>Conclusions</b><br />CKD is predictive of inferior clinical and echocardiographic outcomes in patients undergoing MVR and consequently requires careful preoperative consideration and planning. Further investigation into optimizing the postoperative outcomes of this patient population is necessary.<br /><br />© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.<br /><br /><small>Clin Res Cardiol: 19 Jan 2023; epub ahead of print</small></div>
El-Andari R, Bozso SJ, Fialka NM, Kang JJH, ... Nagendran J, Nagendran J
Clin Res Cardiol: 19 Jan 2023; epub ahead of print | PMID: 36656378
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<div><h4>Accumulated hypertension burden on atrial fibrillation risk in diabetes mellitus: a nationwide population study.</h4><i>Choi J, Lee SR, Choi EK, Lee H, ... Oh S, Lip GYH</i><br /><b>Background</b><br />Patients with diabetes mellitus have an increased risk of incident atrial fibrillation (AF). The effect of accumulated hypertension burden is a less well-known modifiable risk factor. We explored the relationship between accumulated hypertension burden and incident AF in these patients.<br /><b>Methods</b><br />We evaluated data for 526,384 patients with diabetes who underwent three consecutive health examinations, between 2009 and 2012, from the Korean National Health Insurance Service. Hypertension burden was calculated by assigning points to each stage of hypertension in each health examination: 1 for stage 1 hypertension (systolic blood pressure [SBP] 130-139 mmHg; diastolic blood pressure [DBP] 80-89 mmHg); 2 for stage 2 (SBP 140-159 mmHg and DBP 90-99 mmHg); and 3 for stage 3 (SBP ≥ 160 mmHg or DBP ≥ 100 mmHg). Patients were categorized into 10 hypertensive burden groups (0-9). Groups 1-9 were then clustered into 1-3, 4-6, and 7-9.<br /><b>Results</b><br />During a mean follow-up duration of 6.7 ± 1.7 years, AF was newly diagnosed in 18,561 (3.5%) patients. Compared to patients with hypertension burden 0, those with burden 1 to 9 showed a progressively increasing risk of incident AF: 6%, 11%, 16%, 24%, 28%, 41%, 46%, 57%, and 67% respectively. Clusters 1-3, 4-6, and 7-9 showed increased risks by 10%, 26%, and 45%, respectively, when compared to a hypertension burden of 0.<br /><b>Conclusions</b><br />Accumulated hypertension burden was associated with an increased risk of incident AF in patients with diabetes. Strict BP control should be emphasized for these patients.<br /><br />© 2023. The Author(s).<br /><br /><small>Cardiovasc Diabetol: 19 Jan 2023; 22:12</small></div>
Choi J, Lee SR, Choi EK, Lee H, ... Oh S, Lip GYH
Cardiovasc Diabetol: 19 Jan 2023; 22:12 | PMID: 36658574
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<div><h4>Cardiovascular complications in a diabetes prediction model using machine learning: a systematic review.</h4><i>Kee OT, Harun H, Mustafa N, Abdul Murad NA, ... Jaafar R, Abdullah N</i><br /><AbstractText>Prediction model has been the focus of studies since the last century in the diagnosis and prognosis of various diseases. With the advancement in computational technology, machine learning (ML) has become the widely used tool to develop a prediction model. This review is to investigate the current development of prediction model for the risk of cardiovascular disease (CVD) among type 2 diabetes (T2DM) patients using machine learning. A systematic search on Scopus and Web of Science (WoS) was conducted to look for relevant articles based on the research question. The risk of bias (ROB) for all articles were assessed based on the Prediction model Risk of Bias Assessment Tool (PROBAST) statement. Neural network with 76.6% precision, 88.06% sensitivity, and area under the curve (AUC) of 0.91 was found to be the most reliable algorithm in developing prediction model for cardiovascular disease among type 2 diabetes patients. The overall concern of applicability of all included studies is low. While two out of 10 studies were shown to have high ROB, another studies ROB are unknown due to the lack of information. The adherence to reporting standards was conducted based on the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) standard where the overall score is 53.75%. It is highly recommended that future model development should adhere to the PROBAST and TRIPOD assessment to reduce the risk of bias and ensure its applicability in clinical settings. Potential lipid peroxidation marker is also recommended in future cardiovascular disease prediction model to improve overall model applicability.</AbstractText><br /><br />© 2023. The Author(s).<br /><br /><small>Cardiovasc Diabetol: 19 Jan 2023; 22:13</small></div>
Kee OT, Harun H, Mustafa N, Abdul Murad NA, ... Jaafar R, Abdullah N
Cardiovasc Diabetol: 19 Jan 2023; 22:13 | PMID: 36658644
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<div><h4>Severe aortic stenosis management in heart valve centres compared with primary/secondary care centres.</h4><i>Rudolph TK, Messika-Zeitoun D, Frey N, Lutz M, ... Steeds RP, IMPULSE enhanced investigators</i><br /><b>Objective</b><br />Current guidelines recommend use of heart valve centres (HVCs) to deliver optimal quality of care for patients with valve disease but there is no evidence to support this. The hypothesis of this study is that patient care with severe aortic stenosis (AS) will differ in HVCs compared with satellite centres. We aimed to compare the treatment of patients with AS at HVCs (tertiary care hospitals with full access to AS interventions) to satellites (hospitals without such access).<br /><b>Methods</b><br /><i>IMPULSE enhanced</i> is a European, observational, prospective registry enrolling consecutive patients with newly diagnosed severe AS at four HVCs and 10 satellites. Clinical characteristics, interventions performed and outcomes up to 1 year by site-type were examined.<br /><b>Results</b><br />Among 790 patients, 594 were recruited in HVCs and 196 in satellites. At baseline, patients in HVCs had more severe valve disease (higher peak aortic velocity (4.3 vs 4.1 m/s; p=0.008)) and greater comorbidity (coronary artery disease (CAD) (44% vs 27%; p<0.001) prior myocardial infarction (MI) (11% vs 5.1%; p=0.011) and chronic pulmonary disease (17% vs 8.9%; p=0.007)) than those presenting in satellites. An aortic valve replacement was performed more often by month 3 in HVCs than satellites in the overall population (52.6% of vs 31.3%; p<0.001) and in symptomatic patients (66.7% vs 43.2%, p<0.001). One-year survival rate was higher for patients in HVCs than satellites (HR2.19; 95% CI 1.28 to 3.73 total population and 2.89 (95%CI 1.64 to 5.11) for symptomatic patients.<br /><b>Conclusions</b><br />Our data support the implementation of referral pathways that direct patients to HVCs performing both surgery and transcatheter interventions.<br /><b>Trial registration number</b><br />NCT03112629.<br /><br />© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.<br /><br /><small>Heart: 19 Jan 2023; epub ahead of print</small></div>
Rudolph TK, Messika-Zeitoun D, Frey N, Lutz M, ... Steeds RP, IMPULSE enhanced investigators
Heart: 19 Jan 2023; epub ahead of print | PMID: 36657962
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<div><h4>Cognitive-behavioural therapy reduces psychological distress in younger patients with cardiac disease: a randomized trial.</h4><i>Holdgaard A, Eckhardt-Hansen C, Lassen CF, Kjesbu IE, ... Prescott E, Rasmusen HK</i><br /><b>Aims</b><br />To test whether usual outpatient cardiac rehabilitation (CR) supplemented by a cognitive-behavioural therapy (CBT) intervention may reduce anxiety and depression compared with usual CR.<br /><b>Methods and results</b><br />In this multicentre randomized controlled trial, 147 cardiac patients (67% men, mean age 54 years, 92% with coronary artery disease) with psychological distress defined as a hospital anxiety and depression scale (HADS) anxiety or depression score ≥8 were randomized to five sessions of group CBT plus usual CR (intervention, n = 74) or CR alone (control, n = 73). Patients with severe distress or a psychiatric diagnosis were excluded. The intervention was delivered by cardiac nurses with CBT training and supervised by a psychologist. A reference, non-randomized group (background, n = 41) of consecutive patients without psychological distress receiving usual CR was included to explore the effect of time on HADS score. The primary outcome, total HADS score after 3 months, improved more in the intervention than in the control group [the mean total HADS score improved by 8.0 (standard deviation 5.6) vs. 4.1 (standard deviation 7.8), P < 0.001]. Significant between-group differences were maintained after 6 months. Compared with the control group, the intervention group also had greater adherence to CR (P = 0.003), more improvement in the heart-related quality of life (HeartQoL) at 6 months (P < 0.01), and a significant reduction in cardiac readmissions at 12 months (P < 0.01). The background group had no significant change in HADS score over time.<br /><b>Conclusion</b><br />Brief CBT provided by cardiac nurses in relation to CR reduced anxiety and depression scores, improved HeartQoL and adherence to CR, and reduced cardiovascular readmissions. The programme is simple and may be implemented by CR nurses.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur Heart J: 18 Jan 2023; epub ahead of print</small></div>
Holdgaard A, Eckhardt-Hansen C, Lassen CF, Kjesbu IE, ... Prescott E, Rasmusen HK
Eur Heart J: 18 Jan 2023; epub ahead of print | PMID: 36649937
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<div><h4>Sex differences and disparities in cardiovascular outcomes of COVID-19.</h4><i>Bugiardini R, Nava S, Caramori G, Yoon J, ... Zdravkovic M, Manfrini O</i><br /><b>Background</b><br />Previous analyses on sex differences in case fatality rates at population-level data had limited adjustment for key patient clinical characteristics thought to be associated with COVID-19 outcomes. We aimed to estimate the risk of specific organ dysfunctions and mortality in women and men.<br /><b>Methods and results</b><br />This retrospective cross-sectional study included 17 hospitals within 5 European countries participating in the International Survey of Acute Coronavirus Syndromes (ISACS) COVID-19(NCT05188612). Participants were individuals hospitalized with positive SARS-CoV-2 from March 2020 to February 2022. Risk-adjusted ratios(RR) of in-hospital mortality, acute respiratory failure(ARF), acute heart failure(AHF), and acute kidney injury(AKI) were calculated for women versus men. Estimates were evaluated by inverse probability of weighting and logistic regression models. The overall care cohort included 4,499 patients with COVID-19 associated hospitalizations. Of these, 1,524(33.9%) were admitted to ICU, and 1,117(24.8%) died during hospitalization. Compared with men, women were less likely to be admitted to ICU (RR:0.80; 95%CI: 0.71-0.91). In general wards (GW) and ICU cohorts, the adjusted women-to-men RRs for in-hospital mortality were of 1.13(95%CI: 0.90-1.42) and 0.86(95%CI: 0.70-1.05; pinteraction=0.04). Development of AHF, AKI and ARF was associated with increased mortality risk (ORs: 2.27; 95%CI; 1.73-2.98,3.85; 95%CI:3.21-4.63 and 3.95; 95%CI:3.04-5.14, respectively). The adjusted RRs for AKI and ARF were comparable among women and men regardless of intensity of care. By contrast, female sex was associated with higher odds for AHF in GW, but not in ICU (RRs:1.25; 95%CI0.94-1.67 versus 0.83; 95%CI:0.59-1.16, pinteraction=0.04).<br /><b>Conclusions</b><br />Women in GW were at increased risk of AHF and in-hospital mortality for COVID-19 compared with men. For patients receiving ICU care, fatal complications including AHF and mortality appeared to be independent of sex. Equitable access to COVID-19 ICU care is needed to minimize the unfavourable outcome of women presenting with COVID-19 related complications.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Cardiovasc Res: 18 Jan 2023; epub ahead of print</small></div>
Bugiardini R, Nava S, Caramori G, Yoon J, ... Zdravkovic M, Manfrini O
Cardiovasc Res: 18 Jan 2023; epub ahead of print | PMID: 36651866
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<div><h4>Association of Plasma High-Density Lipoprotein Cholesterol Level With Risk of Fractures in Healthy Older Adults.</h4><i>Hussain SM, Ebeling PR, Barker AL, Beilin LJ, Tonkin AM, McNeil JJ</i><br /><b>Importance</b><br />Increased levels of high-density lipoprotein cholesterol (HDL-C) have been associated with osteoporosis. Preclinical studies have reported that HDL-C reduces bone mineral density by reducing osteoblast number and function. However, the clinical significance of these findings is unclear.<br /><b>Objective</b><br />To determine whether higher HDL-C levels are predictive of an increased fracture risk in healthy older adults.<br /><b>Design, setting, and participants</b><br />This cohort study is a post hoc analysis of data from the Aspirin in Reducing Events in the Elderly (ASPREE) clinical trial and the ASPREE-Fracture substudy. ASPREE was a double-blind, randomized, placebo-controlled primary prevention trial of aspirin that recruited participants between 2010 and 2014. These comprised community-based older adults (16 703 Australians aged ≥70 years, 2411 US participants ≥65 years) without evident cardiovascular disease, dementia, physical disability, and life-limiting chronic illness. The ASPREE-Fracture substudy collected data on fractures reported postrandomization from Australian participants. Cox regression was used to calculate hazard ratio (HR) and 95% CI. Data analysis for this study was performed from April to August 2022.<br /><b>Exposure</b><br />Plasma HDL-C.<br /><b>Main outcomes and measures</b><br />Fractures included were confirmed by medical imaging and included both traumatic and minimal trauma fractures. Fractures were adjudicated by an expert review panel.<br /><b>Results</b><br />Of the 16 262 participants who had a plasma HDL-C measurement at baseline (8945 female participants [55%] and 7319 male [45%]), 1659 experienced at least 1 fracture over a median (IQR) of 4.0 years (0.02-7.0 years). In a fully adjusted model, each 1-SD increment in HDL-C level was associated with a 14% higher risk of fractures (HR, 1.14; 95% CI, 1.08-1.20). The results remained similar when these analyses were stratified by sex. Sensitivity and stratified analyses demonstrated that these associations persisted when the analyses were repeated to include only (1) minimal trauma fractures, (2) participants not taking osteoporosis medications, (3) participants who were never smokers and reported that they did not drink alcohol, and (4) participants who walked outside for less than 30 minutes per day and reported no participation in moderate/vigorous physical activity and to examine only (5) statin use. No association was observed between non-HDL-C levels and fractures.<br /><br /><b>Conclusions:</b><br/>and relevance</b><br />This study suggests that higher levels of HDL-C are associated with an increased fracture risk. This association was independent of common risk factors for fractures.<br /><br /><br /><br /><small>JAMA Cardiol: 18 Jan 2023; epub ahead of print</small></div>
Hussain SM, Ebeling PR, Barker AL, Beilin LJ, Tonkin AM, McNeil JJ
JAMA Cardiol: 18 Jan 2023; epub ahead of print | PMID: 36652261
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<div><h4>Combining European and U.S. risk prediction models with polygenic risk scores to refine cardiovascular prevention: the CoLaus|PsyCoLaus Study.</h4><i>de La Harpe R, Thorball CW, Redin C, Fournier S, ... Fellay J, Vaucher J</i><br /><b>Background</b><br />Polygenic risk score (PRS) have potential to improve individual atherosclerotic cardiovascular disease (ASCVD) risk assessment.<br /><b>Aims</b><br />To determine whether a PRS combined with two clinical risk scores, the Systematic COronary Risk Evaluation 2 (SCORE2) and the Pooled Cohort Equation (PCE), improves prediction of ASCVD.<br /><b>Methods</b><br />Using a population-based European prospective cohort, with 6733 participants at baseline (2003-2006), the PRS presenting the best predictive accuracy was combined with SCORE2 and PCE to assess their joint performances for predicting ASCVD Discrimination, calibration, Cox proportional hazard regression and net reclassification index were assessed.<br /><b>Results</b><br />4,218 subjects (53% women; median age, 53.4 years), with 363 prevalent and incident ASCVD, were used to compare four PRSs. The metaGRS_CAD PRS presented the best predictive capacity (AUROC=0.77) and was used in the following analyses. 3,383 subjects (median follow-up of 14.4 years), with 190 first incident ASCVD, were employed to test ASCVD risk prediction. The changes in C statistic between SCORE2 and PCE models and those combining metaGRS_CAD with SCORE2 and PCE were 0.008 (95% CI, -0.00008-0.02, P =0.05), and 0.007 (95% CI, 0.005-0.01, P=0.03), respectively.Reclassification was improved for people at clinically-determined intermediate-risk for both clinical scores (NRI of 9.6% (95% CI, 0.3-18.8) and 12.0% (95%CI, 1.5-22.6) for SCORE2 and PCE, respectively).<br /><b>Conclusion</b><br />Combining a PRS with clinical risk scores significantly improved the reclassification of risk for incident ASCVD for subjects in the clinically-determined intermediate-risk category. Introducing PRSs in clinical practice may refine cardiovascular prevention for subgroups of patients in whom prevention strategies are uncertain.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 18 Jan 2023; epub ahead of print</small></div>
de La Harpe R, Thorball CW, Redin C, Fournier S, ... Fellay J, Vaucher J
Eur J Prev Cardiol: 18 Jan 2023; epub ahead of print | PMID: 36652418
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<div><h4>Adverse cardiovascular and metabolic perturbations among older women: \'fat-craving\' hearts.</h4><i>Ho JS, Wong JJ, Gao F, Wee HN, ... Kovalik JP, Koh AS</i><br /><b>Background</b><br />Despite known sex-based differences in cardiovascular aging, differences in aging biology are poorly understood. We hypothesize that circulating metabolites studied cross-sectionally with cardiac aging may be associated with cardiovascular changes that distinguish cardiac aging in women.<br /><b>Methods</b><br />A population-based cohort of community men and women without cardiovascular disease from Singapore underwent detailed clinical and echocardiography examinations. Cross-sectional associations between cardiac functional characteristics and metabolomics profiles were examined.<br /><b>Results</b><br />Five hundred sixty-seven adults (48.9% women) participated. Women were younger (72 ± 4.4 years vs 73 ± 4.3 years, p = 0.022), had lower diastolic blood pressures (71 ± 11.0 mmHg vs 76 ± 11.2 mmHg, p < 0.0001, and less likely to have diabetes mellitus (18.0% vs 27.6%, p = 0.013) and smoking (3.8% vs 34.5%, p < 0.001). Body mass indices were similar (24 ± 3.8 kg/m<sup>2</sup> vs 24 ± 3.4 kg/m<sup>2</sup>, p = 0.29), but women had smaller waist circumferences (81 ± 10.1 cm vs 85 ± 9.2 cm, p < 0.001). Women had a significantly higher E/e\' ratios (10.9 ± 3.4 vs 9.9 ± 3.3, p = 0.007) and mitral A peak (0.86 ± 0.2 m/s vs 0.79 ± 0.2 m/s, p < 0.001) than men. Among women, lower E/e\' ratio was associated with higher levels of C16 (OR 1.019, 95%CI 1.002-1.036, p = 0.029), C16:1 (OR 1.06, 95%CI 1.006-1.118, p = 0.028), serine (OR 1.019, 95%CI 1.002-1.036, p = 0.025), and histidine (OR 1.045, 95%CI 1.013-1.078, p = 0.006). Lower mitral A peak was associated with higher levels of histidine (OR 1.039, 95%CI 1.009-1.070, p = 0.011), isoleucine (OR 1.013, 95%CI 1.004-1.021, p = 0.004), and C20 (OR 1.341, 95%CI 1.067-1.684, p = 0.012).<br /><b>Conclusion</b><br />Impairments in diastolic functions were more frequent among older women compared to men, despite lower prevalence of vascular risk factors and preserved cardiac structure. Cardiac aging in women correlated with metabolites involved in fatty acid oxidation and tricyclic acid cycle fuelling.<br /><br />© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.<br /><br /><small>Clin Res Cardiol: 18 Jan 2023; epub ahead of print</small></div>
Ho JS, Wong JJ, Gao F, Wee HN, ... Kovalik JP, Koh AS
Clin Res Cardiol: 18 Jan 2023; epub ahead of print | PMID: 36651997
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<div><h4>Effects of Mavacamten on Measures of Cardiopulmonary Exercise Testing Beyond Peak Oxygen Consumption: A Secondary Analysis of the EXPLORER-HCM Randomized Trial.</h4><i>Wheeler MT, Olivotto I, Elliott PM, Saberi S, ... Oreziak A, Myers J</i><br /><b>Importance</b><br />Mavacamten, a cardiac myosin inhibitor, improved peak oxygen uptake (pVO2) in patients with symptomatic obstructive hypertrophic cardiomyopathy (HCM) in the EXPLORER-HCM study. However, the full extent of mavacamten\'s effects on exercise performance remains unclear.<br /><b>Objective</b><br />To investigate the effect of mavacamten on exercise physiology using cardiopulmonary exercise testing (CPET).<br /><b>Design, setting, and participants</b><br />Exploratory analyses of the data from the EXPLORER-HCM study, a randomized, double-blind, placebo-controlled, phase 3 trial that was conducted in 68 cardiovascular centers in 13 countries. In total, 251 patients with symptomatic obstructive HCM were enrolled.<br /><b>Interventions</b><br />Patients were randomly assigned in a 1:1 ratio to mavacamten or placebo.<br /><b>Main outcomes and measures</b><br />The following prespecified exploratory cardiovascular and performance parameters were assessed with a standardized treadmill or bicycle ergometer test protocol at baseline and week 30: carbon dioxide output (VCO2), minute ventilation (VE), peak VE/VCO2 ratio, ventilatory efficiency (VE/VCO2 slope), peak respiratory exchange ratio (RER), peak circulatory power, ventilatory power, ventilatory threshold, peak metabolic equivalents (METs), peak exercise time, partial pressure of end-tidal carbon dioxide (PETCO2), and VO2/workload slope.<br /><b>Results</b><br />Two hundred fifty-one patients were enrolled. The mean (SD) age was 58.5 (11.9) years and 59% of patients were male. There were significant improvements with mavacamten vs placebo in the following peak-exercise CPET parameters: peak VE/VCO2 ratio (least squares [LS] mean difference, -2.2; 95% CI, -3.05 to -1.26; P < .001), peak METs (LS mean difference, 0.4; 95% CI, 0.17-0.60; P < .001), peak circulatory power (LS mean difference, 372.9 mL/kg/min × mm Hg; 95% CI, 153.12-592.61; P = .001), and peak PETCO2 (LS mean difference, 2.0 mm Hg; 95% CI, 1.12-2.79; P < .001). Mavacamten also improved peak exercise time compared with placebo (LS mean difference, 0.7 minutes; 95% CI, 0.13-1.24; P = .02). There was a significant improvement in nonpeak-exercise CPET parameters, such as VE/VCO2 slope (LS mean difference, -2.6; 95% CI, -3.58 to -1.52; P < .001) and ventilatory power (LS mean difference, 0.6 mm Hg; 95% CI, 0.29-0.90; P < .001) favoring mavacamten vs placebo.<br /><br /><b>Conclusions:</b><br/>and relevance</b><br />Mavacamten improved a range of CPET parameters beyond pVO2, indicating consistent and broad benefits on maximal exercise capacity. Although improvements in peak-exercise CPET parameters are clinically meaningful, the favorable effects of mavacamten on submaximal exertional tolerance provide further insights into the beneficial impact of mavacamten in patients with obstructive HCM.<br /><b>Trial registration</b><br />ClinicalTrials.gov Identifier: NCT03470545.<br /><br /><br /><br /><small>JAMA Cardiol: 18 Jan 2023; epub ahead of print</small></div>
Wheeler MT, Olivotto I, Elliott PM, Saberi S, ... Oreziak A, Myers J
JAMA Cardiol: 18 Jan 2023; epub ahead of print | PMID: 36652223
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<div><h4>Comparison of Echocardiographic and Catheter Mean Gradient to Assess Stenosis After Transcatheter Aortic Valve Implantation.</h4><i>DeSa TB, Tecson KM, Lander SR, Stoler RC, ... Henry AC, Grayburn PA</i><br /><AbstractText>Discordance exists between Doppler-derived and left heart catheterization (LHC)-derived mean gradient (MG) in transcatheter aortic valve implantation (TAVI). We compared echocardiographic parameters of prosthetic valve stenosis and LHC-derived MG in new TAVIs. In a retrospective, single-center study, intraoperative transesophageal echocardiogram (TEE)-derived MG, LHC-derived MG, and acceleration time (AT) were obtained before and after TAVI in 362 patients. Discharge MG, AT, and Doppler velocity index (DVI) using transthoracic echocardiogram (TTE) were also obtained. MG ≥10 mm Hg was defined as abnormal. During native valve assessment with pre-TAVI TEE and pre-TAVI LHC, Pearson correlation coefficient revealed a nearly perfect linear relation between both methods\' MGs (r = 0.97, p <0.0001). Intraoperatively, after TAVI, Spearman correlation coefficient revealed a weak-to-moderate relation between post-TAVI TEE and LHC MGs (r = 0.33, p <0.0001). Significant differences were observed in categorizations between post-TAVI TEE MG and post-TAVI AT (McNemar test p = 0.0003) and between post-TAVI TEE MG and post-TAVI LHC MG (signed-rank test p <0.0001), with TEE MG more likely to misclassify a patient as abnormal. At discharge, 30% of patients had abnormal TTE MG, whereas 0% and 0.8% of patients had abnormal DVI and AT, respectively. Discharge TTE MG was not associated with death or hospitalization for heart failure at a median follow-up of 862 days. Post-TAVI Doppler-derived MG by intraoperative TEE was higher than LHC, despite being virtually identical before implantation. At discharge, patients were more likely to be classified as abnormal using MG than DVI and AT. Elevated MG at discharge was not associated with death or hospitalization for heart failure.</AbstractText><br /><br />Copyright © 2022 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 18 Jan 2023; 191:110-118</small></div>
DeSa TB, Tecson KM, Lander SR, Stoler RC, ... Henry AC, Grayburn PA
Am J Cardiol: 18 Jan 2023; 191:110-118 | PMID: 36669380
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<div><h4>Dual or single antiplatelet therapy after coronary surgery for acute coronary syndrome (TACSI trial): Rationale and design of an investigator-initiated, prospective, multinational, registry-based randomized clinical trial.</h4><i>Malm CJ, Alfredsson J, Erlinge D, Gudbjartsson T, ... Tønnessen T, Jeppsson A</i><br /><AbstractText>The TACSI trial (ClinicalTrials.gov Identifier: NCT03560310) tests the hypothesis that one-year treatment with dual antiplatelet therapy (DAPT) with acetylsalicylic acid (ASA) and ticagrelor is superior to only ASA after isolated coronary artery bypass grafting (CABG) in patients with acute coronary syndrome. The TACSI trial is an investor-initiated pragmatic, prospective, multinational, multicenter, open-label, registry-based randomized trial with 1:1 randomization to DAPT with ASA and ticagrelor or ASA only, in patients undergoing first isolated CABG, with a planned enrollment of 2200 patients at Nordic cardiac surgery centers. The primary efficacy endpoint is a composite of time to all cause death, myocardial infarction, stroke, or new coronary revascularization within 12 months after randomization. The primary safety endpoint is time to hospitalization due to major bleeding. Secondary efficacy endpoints include time to the individual components of the primary endpoint, cardiovascular death and rehospitalization due to cardiovascular causes. High-quality health-care registries are used to assess primary and secondary endpoints. The patients will be followed for 10 years. The TACSI trial will give important information useful for guiding the antiplatelet strategy in acute coronary syndrome patients treated with CABG.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Am Heart J: 18 Jan 2023; epub ahead of print</small></div>
Abstract
<div><h4>Recurrent venous thromboembolism and bleeding with extended anticoagulation: the VTE-PREDICT risk score.</h4><i>de Winter MA, Büller HR, Carrier M, Cohen AT, ... Nijkeuter M, VTE-PREDICT study group </i><br /><b>Aims</b><br />Deciding to stop or continue anticoagulation for venous thromboembolism (VTE) after initial treatment is challenging, as individual risks of recurrence and bleeding are heterogeneous. The present study aimed to develop and externally validate models for predicting 5-year risks of recurrence and bleeding in patients with VTE without cancer who completed at least 3 months of initial treatment, which can be used to estimate individual absolute benefits and harms of extended anticoagulation.<br /><b>Methods and results</b><br />Competing risk-adjusted models were derived to predict recurrent VTE and clinically relevant bleeding (non-major and major) using 14 readily available patient characteristics. The models were derived from combined individual patient data from the Bleeding Risk Study, Hokusai-VTE, PREFER-VTE, RE-MEDY, and RE-SONATE (n = 15,141, 220 recurrences, 189 bleeding events). External validity was assessed in the Danish VTE cohort, EINSTEIN-CHOICE, GARFIELD-VTE, MEGA, and Tromsø studies (n = 59 257, 2283 recurrences, 3335 bleeding events). Absolute treatment effects were estimated by combining the models with hazard ratios from trials and meta-analyses. External validation in different settings showed agreement between predicted and observed risks up to 5 years, with C-statistics ranging from 0.48-0.71 (recurrence) and 0.61-0.68 (bleeding). In the Danish VTE cohort, 5-year risks ranged from 4% to 19% for recurrent VTE and 1% -19% for bleeding.<br /><b>Conclusion</b><br />The VTE-PREDICT risk score can be applied to estimate the effect of extended anticoagulant treatment for individual patients with VTE and to support shared decision-making.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur Heart J: 17 Jan 2023; epub ahead of print</small></div>
de Winter MA, Büller HR, Carrier M, Cohen AT, ... Nijkeuter M, VTE-PREDICT study group
Eur Heart J: 17 Jan 2023; epub ahead of print | PMID: 36648242
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<div><h4>A New Era in Cardiac Rehabilitation Delivery: Research Gaps, Questions, Strategies, and Priorities.</h4><i>Beatty AL, Beckie TM, Dodson J, Goldstein CM, ... Wu WC, Franklin BA</i><br /><AbstractText>Cardiac rehabilitation (CR) is a guideline-recommended, multidisciplinary program of exercise training, risk factor management, and psychosocial counseling for people with cardiovascular disease (CVD) that is beneficial but underused and with substantial disparities in referral, access, and participation. The emergence of new virtual and remote delivery models has the potential to improve access to and participation in CR and ultimately improve outcomes for people with CVD. Although data suggest that new delivery models for CR have safety and efficacy similar to traditional in-person CR, questions remain regarding which participants are most likely to benefit from these models, how and where such programs should be delivered, and their effect on outcomes in diverse populations. In this review, we describe important gaps in evidence, identify relevant research questions, and propose strategies for addressing them. We highlight 4 research priorities: (1) including diverse populations in all CR research; (2) leveraging implementation methodologies to enhance equitable delivery of CR; (3) clarifying which populations are most likely to benefit from virtual and remote CR; and (4) comparing traditional in-person CR with virtual and remote CR in diverse populations using multicenter studies of important clinical, psychosocial, and cost-effectiveness outcomes that are relevant to patients, caregivers, providers, health systems, and payors. By framing these important questions, we hope to advance toward a goal of delivering high-quality CR to as many people as possible to improve outcomes in those with CVD.</AbstractText><br /><br /><br /><br /><small>Circulation: 17 Jan 2023; 147:254-266</small></div>
Beatty AL, Beckie TM, Dodson J, Goldstein CM, ... Wu WC, Franklin BA
Circulation: 17 Jan 2023; 147:254-266 | PMID: 36649394
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<div><h4>Elevated LDL Triglycerides and Atherosclerotic Risk.</h4><i>Balling M, Afzal S, Davey Smith G, Varbo A, ... Kamstrup PR, Nordestgaard BG</i><br /><b>Background</b><br />It is unclear whether elevated low-density lipoprotein (LDL) triglycerides are associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD).<br /><b>Objectives</b><br />This study tested the hypothesis that elevated LDL triglycerides are associated with an increased risk of ASCVD and of each ASCVD component individually.<br /><b>Methods</b><br />The study investigators used the Copenhagen General Population Study, which measured LDL triglycerides in 38,081 individuals with a direct automated assay (direct LDL triglycerides) and in another 30,208 individuals with nuclear magnetic resonance (NMR) spectroscopy (NMR LDL triglycerides). Meta-analyses aggregated the present findings with previously reported results.<br /><b>Results</b><br />During a median follow-up of 3.0 and 9.2 years, respectively, 872 and 5,766 individuals in the 2 cohorts received a diagnosis of ASCVD. Per 0.1 mmol/L (9 mg/dL) higher direct LDL triglycerides, HRs were 1.26 (95% CI: 1.17-1.35) for ASCVD, 1.27 (95% CI: 1.16-1.39) for ischemic heart disease, 1.28 (95% CI: 1.11-1.48) for myocardial infarction, 1.22 (95% CI: 1.08-1.38) for ischemic stroke, and 1.38 (95% CI: 1.21-1.58) for peripheral artery disease. Corresponding HRs for NMR LDL triglycerides were 1.26 (95% CI: 1.20-1.33), 1.33 (95% CI: 1.25-1.41), 1.41 (95% CI: 1.31-1.52), 1.13 (95% CI: 1.05-1.23), and 1.26 (95% CI: 1.10-1.43), respectively. The foregoing results were not entirely statistically explained by apolipoprotein B levels. In meta-analyses for the highest quartile vs the lowest quartile of LDL triglycerides, random-effects risk ratios were 1.50 (95% CI: 1.35-1.66) for ASCVD (4 studies; 71,526 individuals; 8,576 events), 1.62 (95% CI: 1.37-1.93) for ischemic heart disease (6 studies; 107,538 individuals; 9,734 events), 1.30 (95% CI: 1.13-1.49) for ischemic stroke (4 studies; 78,026 individuals; 4,273 events), and 1.53 (95% CI: 1.29-1.81) for peripheral artery disease (4 studies; 107,511 individuals; 1,848 events).<br /><b>Conclusions</b><br />Elevated LDL triglycerides were robustly associated with an increased risk of ASCVD and of each ASCVD component individually in 2 prospective cohort studies and in meta-analyses of previous and present studies combined.<br /><br />Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 17 Jan 2023; 81:136-152</small></div>
Balling M, Afzal S, Davey Smith G, Varbo A, ... Kamstrup PR, Nordestgaard BG
J Am Coll Cardiol: 17 Jan 2023; 81:136-152 | PMID: 36631208
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<div><h4>Trajectory and correlates of pulmonary congestion by lung ultrasound in patients with acute myocardial infarction: Insights from PARADISE-MI.</h4><i>Platz E, Claggett B, Jering KS, Kovacs A, ... Pfeffer MA, Shah A</i><br /><b>Background</b><br />PARADISE-MI examined the efficacy of sacubitril/valsartan in acute myocardial infarction (AMI) complicated by reduced left ventricular ejection fraction (LVEF), pulmonary congestion or both. We sought to assess the trajectory of pulmonary congestion using lung ultrasound (LUS) and its association with cardiac structure and function in a prespecified substudy.<br /><b>Methods</b><br />Patients without prior heart failure (HF) underwent 8-zone LUS and echocardiography at baseline (±2 days of randomization) and after 8 months. B-lines were quantified offline, blinded to treatment, clinical findings, timepoint and outcomes.<br /><b>Results</b><br />Among 152 patients (median age 65, 32% women, mean LVEF 41%), B-lines were detectable in 87% at baseline (median B-line count: 4 [IQR 2-8]). Among 115 patients with LUS data at baseline and follow-up, B-lines decreased significantly from baseline (mean ± SD: -1.6 ± 7.3; p=0.018). The proportion of patients without pulmonary congestion at follow-up was significantly higher in those with fewer B-lines at baseline. Adjusted for baseline, B-lines at follow-up were on average 6 (95% CI: 3, 9) higher in patients who experienced an intercurrent HF event vs. those who did not (p=0.001). A greater number of B-lines at baseline was associated with larger left atrial size, higher E/e\' and E/A ratios, greater degree of mitral regurgitation, worse right ventricular systolic function, and higher tricuspid regurgitation velocity (p trend <0.05 for all).<br /><b>Conclusions</b><br />In this AMI cohort, B-lines, indicating pulmonary congestion, were common at baseline and, on average, decreased significantly from baseline to follow-up. Worse pulmonary congestion was associated with prognostically important echocardiographic markers.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur Heart J Acute Cardiovasc Care: 17 Jan 2023; epub ahead of print</small></div>
Platz E, Claggett B, Jering KS, Kovacs A, ... Pfeffer MA, Shah A
Eur Heart J Acute Cardiovasc Care: 17 Jan 2023; epub ahead of print | PMID: 36649251
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<div><h4>Ticagrelor With or Without Aspirin in High-Risk Patients With Anemia Undergoing Percutaneous Coronary Intervention: a subgroup analysis of the TWILIGHT trial.</h4><i>Spirito A, Kastrati A, Cao D, Baber U, ... Pocock S, Mehran R</i><br /><b>Aim</b><br />The aim of this study was to assess the effect of ticagrelor monotherapy among high-risk patients with anemia undergoing percutaneous coronary intervention (PCI).<br /><b>Methods and results</b><br />In the TWILIGHT trial (Ticagrelor With Aspirin or Alone in High-Risk Patients after Coronary Intervention), after 3 months of ticagrelor plus aspirin, high-risk patients were maintained on ticagrelor and randomized to aspirin or placebo for 1 year. Anemia was defined as hemoglobin <13 g/dL for men and <12 g/dL for women. The primary endpoint was Bleeding Academic Research Consortium (BARC) 2, 3, or 5 bleeding. The key secondary endpoint was a composite of all-cause death, myocardial infarction, or stroke.Out of 6 828 patients, 1 329 (19.5%) had anemia and were more likely to have comorbidities, multivessel disease, and to experience bleeding or ischemic complications than non-anemic patients. Among anemic patients, BARC 2, 3, or 5 bleeding occurred less frequently with ticagrelor monotherapy than with ticagrelor plus aspirin (6.4% vs. 10.7%; HR 0.60; 95% CI 0.41 to 0.88; p = 0.009); the rate of the key secondary endpoint was similar in the two arms (5.2% vs. 4.8%; HR 1.07; 95% CI 0.66 to 1.74; p = 0.779). These effects were consistent in patients without anemia (interaction p-value 0.671 and 0.835, respectively).<br /><b>Conclusions</b><br />In high-risk patients undergoing PCI, ticagrelor monotherapy after 3 months of ticagrelor-based DAPT was associated with a reduced risk of clinically relevant bleeding without any increase in ischemic events irrespective of anemia status. (TWILIGHT: NCT02270242).<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur Heart J Cardiovasc Pharmacother: 17 Jan 2023; epub ahead of print</small></div>
Spirito A, Kastrati A, Cao D, Baber U, ... Pocock S, Mehran R
Eur Heart J Cardiovasc Pharmacother: 17 Jan 2023; epub ahead of print | PMID: 36649694
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<div><h4>Multi-Marker Risk Assessment in Patients Hospitalized with COVID-19: Results from the American Heart Association COVID-19 Cardiovascular Disease Registry.</h4><i>Bhatt AS, Daniels LB, de Lemos J, Goodrich E, Bohula EA, Morrow DA</i><br /><b>Background</b><br />The pathobiology of inflammation, thrombosis, and myocardial injury associated with SARS-CoV2 may be assessed by circulating biomarkers. However, their relative prognostic importance has been incompletely described.<br /><b>Methods</b><br />We analyzed data from patients hospitalized with COVID-19 from 1/2020 to 4/2021 at 122 US hospitals in the AHA COVID-19 Cardiovascular (CV) Disease Registry. Patients with data for D-dimer, C-reactive protein (CRP), ferritin, natriuretic peptides [NP], or cardiac troponin (cTn) at admission were included. cTn quintiles were indexed to the assay-specific 99<sup>th</sup>%ile reference limits. Using multivariable logistic regression, we assessed the association between each biomarker by quintile [Q] and odds of in-hospital death and a cardiovascular and thrombotic composite.<br /><b>Results</b><br />Of 32,636 registry patients, 26,424 (81%) had admission values for ≥1 of the key biomarkers, of which 4527 (17%) had admission values for all five biomarkers. Each biomarker revealed a significant gradient for in-hospital mortality from Q1-Q5: D-dimer 14%-35%, CRP 11%-32%, ferritin 11%-30%, cTn 13%-43%, and NPs 7%-35% (p<sub>trend</sub> for each <0.001). After adjustment for other biomarkers and clinical variables, Q5 for NPs (OR:4.67, 95% CI: 3.05-7.14) retained the greatest relative odds for death; cTn (OR:2.68, 95% CI: 2.00-3.59) and NPs (OR:7.14, 95% CI: 4.92-10.37) were associated with the greatest odds of the CV composite. Q5 for D-dimer were associated with the highest risk of thrombotic events (OR: 9.02, 95% CI: 5.36-15.18).<br /><b>Conclusions</b><br />Among patients hospitalized with COVID-19, cTn and NPs identified patients at high risk for an in-hospital adverse cardiovascular outcome, while elevations in D-dimer identified patients at risk for thrombotic complications.<br /><br />Copyright © 2023 Elsevier Ltd. All rights reserved.<br /><br /><small>Am Heart J: 17 Jan 2023; epub ahead of print</small></div>
Bhatt AS, Daniels LB, de Lemos J, Goodrich E, Bohula EA, Morrow DA
Am Heart J: 17 Jan 2023; epub ahead of print | PMID: 36669711
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<div><h4>Acute heart failure after non-cardiac surgery: incidence, phenotypes, determinants and outcomes.</h4><i>Gualandro DM, Puelacher C, Chew MS, Andersson H, ... Mueller C, BASEL-PMI Investigators</i><br /><b>Aims</b><br />Primary acute heart failure (AHF) is a common cause of hospitalization. AHF may also develop postoperatively (pAHF). The aim of this study was to assess the incidence, phenotypes, determinants and outcomes of pAHF following non-cardiac surgery.<br /><b>Methods and results</b><br />9,164 consecutive high-risk patients undergoing 11,262 non-cardiac inpatient surgeries were prospectively included. The incidence, phenotypes, determinants and outcome of pAHF, centrally adjudicated by independent cardiologists, was determined. The incidence of pAHF was 2.5% (95% confidence interval [CI] 2.2-2.8%). 51% of pAHF occurred in patients without known HF (de novo pAHF), and 49% in patients with chronic HF. Among patients with chronic HF, 10% developed pAHF, and among patients without a history of HF, 1.5% developed pAHF. Chronic HF, diabetes, urgent/emergent surgery, atrial fibrillation, cardiac troponin elevations above the 99<sup>Th</sup> percentile, chronic obstructive pulmonary disease, anemia, peripheral artery disease, coronary artery disease, and age , , , were independent predictors of pAHF in the logistic regression model. Patients with pAHF had significantly higher all-cause mortality (44% vs. 11%, p<.001) and AHF readmission (15% vs. 2%, p< .001) within one year than patients without pAHF. After cox regression analysis, pAHF was an independent predictor of all-cause mortality (adjusted hazard ratio [aHR] 1.7 [95%CI 1.3-2.2]; P<.001) and AHF readmission (aHR 2.3 [95%CI 1.5-3.7]; P<.001). Findings were confirmed in an external validation cohort using a prospective multicenter cohort of 1250 patients (incidence of pAHF 2.4% [95%CI, 1.6-3.3%]).<br /><b>Conclusions</b><br />pAHF frequently developed following non-cardiac surgery, being de novo in half of cases, and associated with a very high mortality.<br /><br />This article is protected by copyright. All rights reserved.<br /><br /><small>Eur J Heart Fail: 16 Jan 2023; epub ahead of print</small></div>
Gualandro DM, Puelacher C, Chew MS, Andersson H, ... Mueller C, BASEL-PMI Investigators
Eur J Heart Fail: 16 Jan 2023; epub ahead of print | PMID: 36644890
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<div><h4>Relationship of arterial stiffness and central hemodynamics with cardiovascular risk in hypertension.</h4><i>Jin L, Chen J, Zhang M, Sha L, ... Li Z, Liu L</i><br /><b>Background</b><br />Hypertension is becoming a serious public health problem and non-invasive estimation of central hemodynamics and artery stiffness have been identified as important predictors of cardiovascular disease.<br /><b>Methods</b><br />The study included 4,311 participants, both sex, aged between 20 and 79 years. Arterial velocity pulse index, arterial pressure volume index (AVI, API, the index of artery stiffness), central systolic blood pressure, central artery pulse pressure (CSBP, CAPP, estimated via oscillometric blood pressure monitor) and 10-year risk score of cardiovascular disease in China (China-PAR) and Framingham cardiovascular risk score (FCVRS) were assessed at baseline. Regression model was performed to identify factors associated with high cardiovascular disease risk stratification. The relationships between CSBP, CAPP and China-PAR, FCVRS were analyzed by restrictive cubic spline functions.<br /><b>Results</b><br />The uncontrolled hypertension group showed the highest values of AVI, API, CSBP and CAPP. In the regression analysis, CAPP and hypertension subtypes were identified as significant predictors of high cardiovascular risk stratification, and CAPP was strongly correlated with API in this cohort. Finally, CSBP and CAPP showed significant J-shaped relationships with China-PAR and FCVRS.<br /><b>Conclusion</b><br />Subjects with uncontrolled hypertension present with elevated values of CAPP, CSBP, API, AVI, China-PAR and FCVRS score. CAPP was independently associated with high cardiovascular risk stratification, and there was a significant J-shaped relationship with China-PAR and FCVRS that may identify people with higher cardiovascular risk.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Am J Hypertens: 16 Jan 2023; epub ahead of print</small></div>
Jin L, Chen J, Zhang M, Sha L, ... Li Z, Liu L
Am J Hypertens: 16 Jan 2023; epub ahead of print | PMID: 36645322
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<div><h4>Long-Term Outcomes and Duration of Dual Antiplatelet Therapy After Coronary Intervention With Second-Generation Drug-Eluting Stents: The Veterans Affairs Extended DAPT Study.</h4><i>Kinlay S, Young MM, Sherrod R, Gagnon DR</i><br /><AbstractText><br /><b>Background:</b><br/>Recent guidelines on dual antiplatelet therapy (DAPT) duration after percutaneous coronary intervention (PCI) balance the subsequent risks of major bleeding with ischemic events. Although generally favoring shorter DAPT duration with second-generation drug-eluting stents, the effects on long-term outcomes in the wider population are uncertain. Methods and Results We tracked all patients having PCI with second-generation drug-eluting stents in the Veterans Affairs Healthcare System between 2006 and 2016 for death, myocardial infarction, stroke, and major bleeding up to 13 years. We compared these outcomes with 4 DAPT durations of 1 to 5, 6 to 9, 10 to 12, and 13 to 18 months after the index PCI using hazard ratios (HRs) and 95% CIs from Cox proportional hazards models adjusted by inverse probability weighting. A total of 40 882 subjects with PCI were followed up for a median of 4.3 (25%-75%: 2.4-6.5) years. DAPT discontinuation was rare early after PCI (5.8% at 1-5 months and 6.3% at 6-9 months) but increased (19% and 44%) >9 months. The risk of cardiovascular and noncardiovascular death was higher (HR, 2.03-3.41) with DAPT discontinuation <9 months, likely reflecting premature cessation from factors related to early death. DAPT discontinuation after 9 months following PCI was associated with lower risks of death (HR, 0.93 [95% CI, 0.88-0.99]), cardiac death (HR, 0.79 [95% CI, 0.70-0.90]), myocardial infarction (HR, 0.75 [95% CI, 0.69-0.82]), and major bleeding (HR, 0.82 [95% CI, 0.74-0.91]). Results were similar with an index PCI for an acute coronary syndrome. <br /><b>Conclusions:</b><br/>Stopping DAPT after 9 months is associated with lower long-term risks of adverse ischemic and bleeding events and supports recent guidelines of shorter duration DAPT after PCI with second-generation drug-eluting stents.</AbstractText><br /><br /><br /><br /><small>J Am Heart Assoc: 16 Jan 2023:e027055; epub ahead of print</small></div>
Kinlay S, Young MM, Sherrod R, Gagnon DR
J Am Heart Assoc: 16 Jan 2023:e027055; epub ahead of print | PMID: 36645075
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<div><h4>Heart-Brain Team Approach of Acute Myocardial Infarction Complicating Acute Stroke: Characteristics of Guideline-Recommended Coronary Revascularization and Antithrombotic Therapy and Cardiovascular and Bleeding Outcomes.</h4><i>Suzuki T, Kataoka Y, Shiozawa M, Morris K, ... Tsujita K, Noguchi T</i><br /><AbstractText><br /><b>Background:</b><br/>Acute myocardial infarction (AMI) infrequently occurs after acute stroke. The Heart-brain team approach has a potential to appropriately manage this poststroke cardiovascular complication. However, clinical outcomes of AMI complicating acute stroke (AMI-CAS) with the heart-brain team approach have not been characterized. The current study investigated cardiovascular outcomes in patients with AMI-CAS managed by a heart-brain team. Methods and Results We retrospectively analyzed 2390 patients with AMI at our institute (January 1, 2007-September 30, 2020). AMI-CAS was defined as the occurrence of AMI within 14 days after acute stroke. Major adverse cerebral/cardiovascular events (cardiac-cause death, nonfatal myocardial infarction, and nonfatal stroke) and major bleeding events were compared in subjects with  AMI-CAS and those without acute stroke. AMI-CAS was identified in 1.6% of the subjects. Most AMI-CASs (37/39=94.9%) presented ischemic stroke. Median duration of AMI from the onset of acute stroke was 2 days. Patients with AMI-CAS less frequently received primary percutaneous coronary intervention (43.6% versus 84.7%; <i>P</i><0.001) and dual-antiplatelet therapy (38.5% versus 85.7%; <i>P</i><0.001), and 33.3% of them did not receive any antithrombotic agents (versus 1.3%; <i>P</i><0.001). During the observational period (median, 2.4 years [interquartile range, 1.1-4.4 years]), patients with AMI-CAS exhibited a greater likelihood of experiencing major adverse cerebral/cardiovascular events (hazard ratio [HR], 3.47 [95% CI, 1.99-6.05]; <i>P</i><0.001) and major bleeding events (HR, 3.30 [95% CI, 1.34-8.10]; <i>P</i>=0.009). These relationships still existed even after adjusting for clinical characteristics and medication use (major adverse cerebral/cardiovascular event: HR, 1.87 [95% CI, 1.02-3.42]; <i>P</i>=0.04; major bleeding: HR, 2.67 [95% CI, 1.03-6.93]; <i>P</i>=0.04). <br /><b>Conclusions:</b><br/>Under the heart-brain team approach, AMI-CAS was still a challenging disease, reflected by less adoption of primary percutaneous coronary intervention and antithrombotic therapies, with substantially elevated cardiovascular and major bleeding risks. Our findings underscore the need for a further refined approach to mitigate their ischemic/bleeding risks.</AbstractText><br /><br /><br /><br /><small>J Am Heart Assoc: 16 Jan 2023:e8140; epub ahead of print</small></div>
Suzuki T, Kataoka Y, Shiozawa M, Morris K, ... Tsujita K, Noguchi T
J Am Heart Assoc: 16 Jan 2023:e8140; epub ahead of print | PMID: 36645078
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<div><h4>Large-Scale Metabolomics and the Incidence of Cardiovascular Disease.</h4><i>Lind L, Fall T, Ärnlöv J, Elmståhl S, Sundström J</i><br /><AbstractText><br /><b>Background:</b><br/>The study aimed to show the relationship between a large number of circulating metabolites and subsequent cardiovascular disease (CVD) and subclinical markers of CVD in the general population. Methods and Results In 2278 individuals free from CVD in the EpiHealth study (aged 45-75 years, mean age 61 years, 50% women), 790 annotated nonxenobiotic metabolites were measured by mass spectroscopy (Metabolon). The same metabolites were measured in the PIVUS (Prospective Investigation of Vasculature in Uppsala Seniors) study (n=603, all aged 80 years, 50% women), in which cardiac and carotid artery pathologies were evaluated by ultrasound. During a median follow-up of 8.6 years, 107 individuals experienced a CVD (fatal or nonfatal myocardial infarction, stroke, or heart failure) in EpiHealth. Using a false discovery rate of 0.05 for age- and sex-adjusted analyses and <i>P</i><0.05 for adjustment for traditional CVD risk factors, 37 metabolites were significantly related to incident CVD. These metabolites belonged to multiple biochemical classes, such as amino acids, lipids, and nucleotides. Top findings were dimethylglycine and N-acetylmethionine. A lasso selection of 5 metabolites improved discrimination when added on top of traditional CVD risk factors (+4.0%, <i>P</i>=0.0054). Thirty-five of the 37 metabolites were related to subclinical markers of CVD evaluated in the PIVUS study. The metabolite 1-carboxyethyltyrosine was associated with left atrial diameter as well as inversely related to both ejection fraction and the echogenicity of the carotid artery. <br /><b>Conclusions:</b><br/>Several metabolites were discovered to be associated with future CVD, as well as with subclinical markers of CVD. A selection of metabolites improved discrimination when added on top of CVD risk factors.</AbstractText><br /><br /><br /><br /><small>J Am Heart Assoc: 16 Jan 2023:e026885; epub ahead of print</small></div>
Lind L, Fall T, Ärnlöv J, Elmståhl S, Sundström J
J Am Heart Assoc: 16 Jan 2023:e026885; epub ahead of print | PMID: 36645074
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<div><h4>Effect of BMI on patients undergoing transcatheter aortic valve implantation: A systematic review and meta-analysis.</h4><i>Gupta R, Mahmoudi E, Behnoush AH, Khalaji A, ... Lavie CJ, Patel NC</i><br /><b>Background</b><br />The relationship of body mass index (BMI) and an \"obesity paradox\" with cardiovascular risk prediction is controversial. This systematic review and meta-analysis aims to compare the associations of different BMI ranges on transcatheter aortic valve implantation (TAVI) outcomes.<br /><b>Methods</b><br />International databases, including PubMed, the Web of Science, and the Cochrane Library, were systematically searched for observational and randomized controlled trial studies investigating TAVI outcomes in any of the four BMI categories: underweight, normal weight, overweight, and obese with one of the predefined outcomes. Primary outcomes were in-hospital, 30-day, and long-term all-cause mortality. Random-effects meta-analysis was performed to calculate the odds ratio (OR) or standardized mean differences (SMD) with 95% confidence interval (CI) for each paired comparison between two of the BMI categories.<br /><b>Results</b><br />A total of 38 studies were included in our analysis, investigating 99,829 patients undergoing TAVI. There was a trend toward higher comorbidities such as hypertension, diabetes, and dyslipidemia in overweight patients and individuals with obesity. Compared with normal-weight, patients with obesity had a lower rate of 30-day mortality (OR 0.42, 95% CI 0.25-0.72, p < 0.01), paravalvular aortic regurgitation (OR 0.63, 95% CI 0.44-0.91, p = 0.01), 1-year mortality (OR 0.48, 95% CI 0.24-0.96, p = 0.04), and long-term mortality (OR 0.69, 95% CI 0.51-0.94, p = 0.02). However, acute kidney injury (OR 1.16, 95% CI 1.04-1.30, p = 0.01) and permanent pacemaker implantation (OR 1.25, 95% CI 1.05-1.50, p = 0.01) odds were higher in patients with obesity. Noteworthy, major vascular complications were significantly higher in underweight patients in comparison with normal weight cases (OR 1.62, 95% CI 1.07-2.46, p = 0.02). In terms of left ventricular ejection fraction (LVEF), patients with obesity had higher post-operative LVEF compared to normal-weight individuals (SMD 0.12, 95% CI 0.02-0.22, p = 0.02).<br /><b>Conclusion</b><br />Our results suggest the presence of the \"obesity paradox\" in TAVI outcomes with higher BMI ranges being associated with lower short- and long-term mortality. BMI can be utilized for risk prediction of patients undergoing TAVI.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 16 Jan 2023; epub ahead of print</small></div>
Gupta R, Mahmoudi E, Behnoush AH, Khalaji A, ... Lavie CJ, Patel NC
Prog Cardiovasc Dis: 16 Jan 2023; epub ahead of print | PMID: 36657654
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<div><h4>Antithrombotic Therapy and Cardiovascular Outcomes After Transcatheter Aortic Valve Implantation in Patients Without Indications for Chronic Oral Anticoagulation: A systematic review and network meta-analysis of randomized controlled trials.</h4><i>Guedeney P, Roule V, Mesnier J, Chapelle C, ... Montalescot G, Collet JP</i><br /><b>Aims</b><br />As the antithrombotic regimen which may best prevent ischemic complications along with the lowest bleeding risk offset following transcatheter aortic valve implantation (TAVI) remains unclear, we aimed to compare the safety and efficacy of antithrombotic regimens in patients without having an indication for chronic oral anticoagulation.<br /><b>Methods and results</b><br />We conducted a Prospero-registered (CRD42021247924) systematic review and network meta-analysis of randomized controlled trials evaluating post-TAVI antithrombotic regimens up to April 2022. We estimated the relative risk (RR) and 95% confidence intervals (95%CI) using a random-effects model in a frequentist pairwise and network metanalytic approach. We included 7 studies comprising of 4 006 patients with a mean weighted follow-up of 12.9 months. Risk of all-cause death was significantly reduced with dual antiplatelet therapy (DAPT) compared to low-dose rivaroxaban + 3-month single antiplatelet therapy (SAPT) (RR 0.60, 95%CI 0.41-0.88) while no significant reduction was observed with SAPT versus DAPT (RR 1.02 95%CI 0.67-1.58) and SAPT and DAPT compared to apixaban or edoxaban (RR:0.60 95%CI:0.32-1.14 and RR:0.59 95%CI 0.34-1.02, respectively). SAPT was associated with a significant reduction of life-threatening, disabling, or major bleeding compared to DAPT (RR 0.45 95%CI 0.29-0.70), apixaban or edoxaban alone (RR 0.45, 95%CI 0.25-0.79) and low-dose rivaroxaban + 3-month SAPT (RR 0.30, 95%CI 0.16-0.57). There were no differences between the various regimens with respect to myocardial infarction, stroke, or systemic embolism.<br /><b>Conclusion</b><br />Following TAVI in patients without an indication for chronic oral anticoagulant, SAPT more than halved the risk of bleeding compared to DAPT and direct oral anticoagulant-based regimens without significant ischemic offset.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur Heart J Cardiovasc Pharmacother: 14 Jan 2023; epub ahead of print</small></div>
Guedeney P, Roule V, Mesnier J, Chapelle C, ... Montalescot G, Collet JP
Eur Heart J Cardiovasc Pharmacother: 14 Jan 2023; epub ahead of print | PMID: 36640149
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<div><h4>Trans-fatty acid blood levels of industrial but not natural origin are associated with cardiovascular risk factors in patients with HFpEF: a secondary analysis of the Aldo-DHF trial.</h4><i>Lechner K, Bock M, von Schacky C, Scherr J, ... Duvinage A, Edelmann F</i><br /><b>Background</b><br />Industrially processed trans-fatty acids (IP-TFA) have been linked to altered lipoprotein metabolism, inflammation and increased NT-proBNP. In patients with heart failure with preserved ejection fraction (HFpEF), associations of TFA blood levels with patient characteristics are unknown.<br /><b>Methods</b><br />This is a secondary analysis of the Aldo-DHF-RCT. From 422 patients, individual blood TFA were analyzed at baseline in n = 404 using the HS-Omega-3-Index<sup>®</sup> methodology. Patient characteristics were: 67 ± 8 years, 53% female, NYHA II/III (87/13%), ejection fraction ≥ 50%, E/e\' 7.1 ± 1.5; NT-proBNP 158 ng/L (IQR 82-298). A principal component analysis was conducted but not used for further analysis as cumulative variance for the first two PCs was low. Spearman\'s correlation coefficients as well as linear regression analyses, using sex and age as covariates, were used to describe associations of whole blood TFA with metabolic phenotype, functional capacity, echocardiographic markers for LVDF and neurohumoral activation at baseline and after 12 months.<br /><b>Results</b><br />Blood levels of the naturally occurring TFA C16:1n-7t were inversely associated with dyslipidemia, body mass index/truncal adiposity, surrogate markers for non-alcoholic fatty liver disease and inflammation at baseline/12 months. Conversely, IP-TFA C18:1n9t, C18:2n6tt and C18:2n6tc were positively associated with dyslipidemia and isomer C18:2n6ct with dysglycemia. C18:2n6tt and C18:2n6ct were inversely associated with submaximal aerobic capacity at baseline/12 months. No significant association was found between TFA and cardiac function.<br /><b>Conclusions</b><br />In HFpEF patients, higher blood levels of IP-TFA, but not naturally occurring TFA, were associated with dyslipidemia, dysglycemia and lower functional capacity. Blood TFAs, in particular C16:1n-7t, warrant further investigation as prognostic markers in HFpEF. Higher blood levels of industrially processed TFA, but not of the naturally occurring TFA C16:1n-7t, are associated with a higher risk cardiometabolic phenotype and prognostic of lower aerobic capacity in patients with HFpEF.<br /><br />© 2023. The Author(s).<br /><br /><small>Clin Res Cardiol: 14 Jan 2023; epub ahead of print</small></div>
Lechner K, Bock M, von Schacky C, Scherr J, ... Duvinage A, Edelmann F
Clin Res Cardiol: 14 Jan 2023; epub ahead of print | PMID: 36640187
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<div><h4>Benefit of treatment based on indapamide mostly combined with perindopril on mortality and cardiovascular outcomes: a pooled analysis of four trials.</h4><i>Chalmers J, Mourad JJ, Brzozowska-Villatte R, De Champvallins M, Mancia G</i><br /><b>Objective</b><br />The aim of this study was to assess the reduction in all-cause death and cardiovascular outcomes associated with the administration of the thiazide-like diuretic indapamide monotherapy or in combination with perindopril as a blood pressure lowering drug in randomized controlled trials (RCTs).<br /><b>Method</b><br />Aggregate data from four published RCTs conducted versus matching placebo were pooled: PATS, a 2-year study (indapamide), and PROGRESS, a 4-year study (indapamide and perindopril), both in patients with a history of stroke or transient ischemic attack; ADVANCE, a 4-year study in patients with type 2 diabetes and cardiovascular risk factor (single-pill combination perindopril/indapamide) and HYVET, a 2-year study in very elderly hypertensive individuals (indapamide and an option of perindopril). The pooled effect (fixed and random) estimate (hazard ratio) was reported with corresponding 95% confidence intervals and P values. Treatment discontinuations were also analysed to assess the net benefit of the treatment.<br /><b>Results</b><br />The population involved 24 194 patients (active: 12 113, placebo: 12 081). The fixed-effects meta-analysis of the three mortality endpoints found low statistical heterogeneity (I2 = 0). Statistically significant risk reductions in the indapamide with or without perindopril-treated patients as compared to placebo were observed for all-cause death (-15%), cardiovascular death (-21%), fatal stroke (-36%) and all strokes (-27%). Other cardiovascular outcomes were improved (risk reduction, 22 to 36%). As expected, discontinuation rates for safety (two studies) were higher in the active group (6.4 vs. 3.9%), while they were similar when discontinuation for any reason is concerned (18.4 vs. 18.0%).<br /><b>Conclusion</b><br />Across medium to high cardiovascular risk population, long-term indapamide, mostly combined with perindopril-based treatment, provided evidence of benefit on mortality and morbidity.<br /><br />Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.<br /><br /><small>J Hypertens: 13 Jan 2023; epub ahead of print</small></div>
Chalmers J, Mourad JJ, Brzozowska-Villatte R, De Champvallins M, Mancia G
J Hypertens: 13 Jan 2023; epub ahead of print | PMID: 36633311
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<div><h4>Left atrial reservoir strain as a novel predictor of new-onset atrial fibrillation in light-chain-type cardiac amyloidosis.</h4><i>Choi YJ, Kim D, Rhee TM, Lee HJ, ... Choi JO, Kim HK</i><br /><b>Aims</b><br />To investigate whether left arterial reservoir strain (LASr) could predict new-onset atrial fibrillation (NOAF) in patients with light-chain-type cardiac amyloidosis (ALCA).<br /><b>Methods and results</b><br />This study enrolled 427 patients with CA from two tertiary centres between 2005 and 2019. LASr was measured using a vendor-independent analysis programme. The primary outcome was NOAF. A total of 287 patients with ALCA were included [median age 63.0 (56.0-70.0) years, 53.3% male]. The median LASr was 13.9% (10.5-20.8%). During the median follow-up of 0.85 years, AF occurred in 34 patients (11.8%). In the receiver operating characteristics curve analysis, the optimal cut-off of LASr for predicting NOAF was 14.4%. Patients with LASr ≤14.4% had a higher risk of NOAF than those with LASr >14.4% (18.1% vs. 5.1%, P < 0.010). In the multivariate analysis adjusting for confounding factors, including left arterial volume index and left ventricular global longitudinal strain (LV-GLS), higher LASr (%) was independently associated with lower risk for NOAF [adjusted hazard ratio (aHR): 0.936, 95% confidence interval (95% CI): 0.879-0.997, P = 0.039]. Furthermore, LASr ≤14.4% was an independent predictor for NOAF (aHR: 3.370, 95% CI: 1.337-8.492, P = 0.010). This remained true after accounting for all-cause death as a competing risk. Compared with Model 1 (LV-GLS) and Model 2 (LV-GLS plus LAVI), Model 3, including LASr showed a better reclassification ability for predicting NOAF (net reclassification index = 0.735, P < 0.001 compared with Model 1; net reclassification index = 0.514, P = 0.003 compared with Model 2).<br /><b>Conclusion</b><br />LASr was an independent predictor of NOAF in patients with ALCA.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur Heart J Cardiovasc Imaging: 13 Jan 2023; epub ahead of print</small></div>
Choi YJ, Kim D, Rhee TM, Lee HJ, ... Choi JO, Kim HK
Eur Heart J Cardiovasc Imaging: 13 Jan 2023; epub ahead of print | PMID: 36637873
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