bluuebunny/crossref_metadata_2025 huggingface dataset:
The ‘diamond’ approach to personalized drug treatment of heart failure with reduced ejection fraction
Authors: Gan Hongbo , Tang Heng , Huang Yujie , Wang Dan , Pu Peng , Zuo Zhong
Published: September 2021

Heart failure (HF) is a complex clinical syndrome with symptoms and signs due to cardiac dysfunction, leading to high hospitalization and morbidity. HF treatment has rapidly developed in recent decades, and breakthroughs have been made. Although conventional neurohormonal blockade therapies, including β-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and mineralocorticoid receptor antagonists (MRAs), significantly improve the prognosis of patients with heart failure with reduced ejection fraction (HFrEF), mortality and rehospitalization remain high. Therefore, new therapies are needed. Previous studies demonstrated that ivabradine, angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 (SGLT2) inhibitor, vericiguat, and omecamtiv mecarbil (OM) are beneficial for HFrEF. However, there is a lack of systematic review of the most optimal manner to use under various clinical conditions. This review summarizes the current knowledge regarding these therapies to give suggestions regarding clinical use timing, application scope, and optimal therapies under various conditions. Most importantly, we propose the HF diamond approach to express the necessity of conjunction of therapies. Different from the current guidelines, we suggest to use the diamond approach in an early and comprehensive manner at the beginning of ventricular remodeling in HFrEF to prevent further deterioration of HF and maximize the prognosis of patients.
Progress on developing an effective below-the-knee drug-coated balloon
Authors: Khoury Rym El , Brodmann Marianne , Schneider Peter A.
Published: September 2021

Infrapopliteal atherosclerotic disease continues to present the greatest conundrum for effective endovascular therapies. To date, conventional angioplasty has been fraught with early restenosis and recoil in these complex, long, calcified, and occlusive lesions. The success of metallic drug-eluting stents in coronary arteries has not carried over to below-the-knee arteries. Initial promise in paclitaxel-coated balloons has not been demonstrated in large randomized clinical trials. Furthermore, the potential association between paclitaxel and mortality continues to generate tremendous controversy. The goal of this review article is to discuss the evolution and challenges of drug-coated balloon (DCB) science, present the clinical results of currently available tibial DCBs, and introduce new horizons in DCB technology.
Long-term management of Takotsubo syndrome: a not-so-benign condition
Authors: Sclafani Matteo , Arcari Luca , Russo Domitilla , Tini Giacomo , Limite Luca Rosario , Cacciotti Luca , Volpe Massimo , Autore Camillo , Musumeci Maria Beatrice
Published: September 2021

Takotsubo syndrome (TTS) is an intriguing clinical entity, characterized by usually transient and reversible abnormalities of the left ventricular systolic function, mimicking the myocardial infarction with non-obstructive coronary arteries. TTS was initially regarded as a benign condition, however recent studies have unveiled adverse outcomes in the short- and long-term, with rates of morbidity and mortality comparable to those experienced after an acute myocardial infarction. Given the usual transient nature of TTS, this is an unexpected finding. Moreover, long-term mortality seems to be mainly driven by non-cardiovascular causes. The uncertain long-term prognosis of TTS warrants a comprehensive outpatient follow-up after the acute event, although there are currently no robust data indicating its modality and timing. The aim of the present review is to summarize recent available evidence regarding long-term prognosis in TTS. Moreover methods, timing and findings of the long-term management of TTS will be discussed.
A scoping review of exercise-based cardiac rehabilitation for patients with aortic dissection
Authors: Feng Danni , Ke Jian , Huang Sufang , Lang Xiaorong
Published: September 2021

Our objective was to provide evidence for exercise-based cardiac rehabilitation (ECR) for patients with aortic dissection (AD), so as to better improve the prognosis of patients and improve the quality of life (QoL) after discharge. The database PubMed, Embase, MEDLINE, Web of Science, Cochrane Library, WanFang Chinese database, ZhiWang Chinese database, Chinese Clinical Trials Registry from establishment of each database until February 2021 were included. A total of 1684 records were found by searching the database and clinical trial registry, 178 duplicate records were deleted, and 11 records met the inclusion criteria according to the screening process. We can conclude that ECR for patients with AD can effectively reduce complications and shorten the course of the disease. In addition, it is very safe because there are no serious adverse events occurring. Further research should be developed from three aspects, including the development of systematic evaluation indicators and standardized clinical exercise rehabilitation pathway, more randomized controlled trials, and the development of individualized exercise program so as to help patients with AD better improve the prognosis and QoL.
Peritoneal dialysis in heart failure: focus on kidney and ventricular dysfunction
Authors: Morales Ronald O. , Barbosa Francesc , Farre Nuria
Published: September 2021

Heart failure is a significant health problem worldwide. Despite all the new therapies available nowadays, many patients will reach advanced stages of the disease. Diuretic resistance, kidney dysfunction, and refractory congestion, all highly prevalent in advanced heart failure, frequently complicate the situation, making it more challenging to manage. Ultrafiltration through hemodialysis or peritoneal dialysis can be alternative options to treat fluid overload. Peritoneal dialysis has gained increased interest in the last decades due to several benefits such as functional class improvement, reduction in hospital admissions, improvement in quality of life, and even a reduction in mortality shown by numerous cohort studies. However, the majority of the studies were observational and with a limited number of patients. In addition, the optimal timing for the initiation of this type of therapy and the subgroup of patients who would benefit the most from it is unknown. Hence, randomized controlled trials in this subject are urgently needed. We aim to review the contemporary evidence of peritoneal dialysis in patients with heart failure and diuretic resistance across the spectrum of ventricular dysfunction and degree of renal dysfunction.
Management of antithrombotic therapy in patients with atrial fibrillation and acute coronary syndromes
Authors: Pop Călin , Țînț Diana , Petris Antoniu
Published: September 2021

If atrial fibrillation (AF) and acute coronary syndrome (ACS) coexist, they should be treated with combined antithrombotic therapy. To reduce the risk of bleeding while maintaining the desired antithrombotic effect, choices should be made for each patient according to the balance between the bleeding and the thrombotic risk. There are many ways to select the type and dose of the oral anticoagulant (OAC) and P2Y12 inhibitors. As a rule of thumb, aspirin and P2Y12 inhibitors should be recommended to all patients. The duration of this combination therapy is a matter of debate; available data promote an initial period of one to four weeks of triple antithrombotic association with aspirin and P2Y12 inhibitors (clopidogrel in the absence of high ischaemic risk) and preferable direct oral anticoagulants (DOACs). On discontinuing aspirin, double therapy with P2Y12 inhibitors and a DOAC provides similar efficacy and superior safety for many patients on ACS medical or interventional treatment, especially if the risk of bleeding is high and that of thrombosis is low. Further studies are needed to clarify the concerns for a slight augmentation in the number of ischaemic cases (myocardial infarction and stent thrombosis) with double antithrombotic regimen in patients at high ischaemic risk.
The relevance of specific heart failure outpatient programs in the COVID era: an appropriate model for every disease
Authors: Beltrami Matteo , Bartolini Simone , Milli Massimo , Palazzuoli Alberto
Published: September 2021

Heart Failure (HF) is characterized by an elevated readmission rate, with almost 50% of events occurring after the first episode over the first 6 months of the post-discharge period. In this context, the vulnerable phase represents the period when patients elapse from a sub-acute to a more stabilized chronic phase. The lack of an accurate approach for each HF subtype is probably the main cause of the inconclusive data in reducing the trend of recurrent hospitalizations. Most care programs are based on the main diagnosis and the HF stages, but a model focused on the specific HF etiology is lacking. The HF clinic route based on the HF etiology and the underlying diseases responsible for HF could become an interesting approach, compared with the traditional programs, mainly based on non-specific HF subtypes and New York Heart Association class, rather than on detailed etiologic and epidemiological data. This type of care may reduce the 30-day readmission rates for HF, increase the use of evidence-based therapies, prevent the exacerbation of each comorbidity, improve patient compliance, and decrease the use of resources. For all these reasons, we propose a dedicated outpatient HF program with a daily practice scenario that could improve the early identification of symptom progression and the quality-of-life evaluation, facilitate the access to diagnostic and laboratory tools and improve the utilization of financial resources, together with optimal medical titration and management.
Current evidence in the diagnosis and management of cardiogenic shock complicating acute coronary syndrome
Authors: Kaddoura Rasha , Elbdri Salah
Published: September 2021

Cardiogenic shock (CS) is a hemodynamically complex and highly morbid syndrome characterized by circulatory collapse and inadequate end-organ perfusion due to impaired cardiac output. It is usually associated with multiorgan failure and death. Mortality rate is still high despite advancement in treatment. CS has been conceptualised as a vicious cycle of injury and decompensation, both cardiac and systemic. Interrupting the vicious cycle and restoring the hemodynamic stability is a fundamental treatment of CS. Acute coronary syndrome (ACS) is the most frequent cause of CS. Early coronary revascularization is a cornerstone therapy that reduces mortality in patients with ACS complicated by CS. Early diagnosis of CS accompanied with invasive hemodynamics, helps in identification of CS phenotype, classification of CS severity, stratification of risk and prognostication. This can guide a tailored and optimized therapeutic approach. Inotropes and vasopressors are considered the first-line pharmacological option for hemodynamic instability. The current availability of the mechanical circulatory support devices has broadened the therapeutic choices for hemodynamic support. To date there is no pharmacological or nonpharmacological intervention for CS that showed a mortality benefit. The clinical practices in CS management remain inconsistent. Herein, this review discusses the current evidence in the diagnosis and management of CS complicating ACS, and features the changes in CS definition and classification.
Role of transthoracic echocardiogram in acute heart failure
Authors: Fitzsimons Sarah , Doughty Robert N
Published: September 2021

Acute Heart Failure (AHF) is an increasingly common condition with a poor prognosis. In contrast to CHF where advances in medical therapy and devices has led to significant improvement in morbidity and mortality, the prognosis for AHF has not changed significantly in the last few decades despite efforts to find effective treatment. There are multiple factors that contribute to the high mortality and morbidity of AHF; it can be a diagnostic challenge, determining whether decongestion has been achieved can be difficult, and persisting congestion is commonly present at discharge contributing to early decompensation and rehospitalisation. Transthoracic echocardiogram (TTE) is a unique imaging modality that is non-invasive, can be done at the bedside, in real time during procedures, is affordable and easy to access both in community and inpatient settings. Small hand held ‘point of care’ scans are increasingly available and being used as an adjunct to improve clinical examination. Consequently, the use of echocardiography to improve outcomes for patients with cardiac disease continues to evolve. In chronic heart failure TTE has established roles in the quantification of HF phenotype, and determination of treatment initiation, escalation and success. However, the role of echocardiogram in AHF is not as well established with society guidelines relying on expert consensus for their recommendations. Use of TTE at all stages of AHF has potential to reduce morbidity and mortality. This review discusses the evidence for use of TTE to improve the diagnosis, prognosis and management of AHF.
Pathophysiological mechanisms and clinical evidence of relationship between Nonalcoholic fatty liver disease (NAFLD) and cardiovascular disease
Authors: Galiero Raffaele , Caturano Alfredo , Vetrano Erica , Cesaro Arturo , Rinaldi Luca , Salvatore Teresa , Marfella Raffaele , Sardu Celestino , Moscarella Elisabetta , Gragnano Felice , Calabrò Paolo , Sasso Ferdinando Carlo
Published: September 2021

Evidence suggests a close connection between Nonalcoholic Fatty Liver Disease (NAFLD) and increased cardiovascular (CV) risk. Several cross-sectional studies report that NAFLD is related to preclinical atherosclerotic damage, and to coronary, cerebral and peripheral vascular events. Similar results have been showed by prospective studies and also by meta-analyzes on observational studies. The pathophysiological mechanisms of NAFLD are related to insulin resistance, which causes a dysfunction in adipokine production, especially adiponectin, from adipose tissue. A proinflammatory state and an increase in oxidative stress, due to increased reacting oxygen species (ROS) formation with consequent oxidation of free fatty acids and increased de novo lipogenesis with accumulation of triglycerides, are observed. These mechanisms may have an impact on atherosclerotic plaque formation and progression, and they can lead to increased cardiovascular risk in subjects with NAFLD. This review extensively discusses and comments current and developing NAFLD therapies and their possible impact on cardiovascular outcome.
Non-ST segment elevation myocardial infarction in the elderly
Authors: Jiménez-Méndez César , Díez-Villanueva Pablo , Alfonso Fernando
Published: September 2021

Ischemic heart disease constitutes the leading cause of death in Western countries. The general incidence of acute coronary syndromes (ACS), especially non-ST segment elevation myocardial infarction (NSTEMI), is growing. Advanced age is both a strong risk factor for ACS and an independent predictor of poorer clinical outcomes. Management of this entity is often complex in the elderly, while special attention should be focused on comorbidities and geriatric conditions. This article aims to review clinical presentation, identification and management of NSTEMI in the elderly population.
Trimethylamine N-oxide—a marker for atherosclerotic vascular disease
Authors: Xie Guinan , Yan An , Lin Peng , Wang Yi , Guo Liping
Published: September 2021

As a potential causative factor in various cardiovascular diseases, the gut microbe-generated metabolite trimethylamine N-oxide (TMAO) has courted considerable research interest as a potential biomarker. TMAO is a small molecule considered to be beneficial for the health of deep-water animals due to its ability to protect proteins against hydrostatic pressure stress. However, it may cause deleterious effects in humans as mounting evidence suggests that TMAO may enhance atherosclerosis, independent of traditional risk factors. This may be mediated by its capacity to enhance inflammation, platelet activation and thrombosis, and inhibit reverse cholesterol transport. In humans, circulating levels of TMAO have been found to be associated with increased risk of developing atherosclerotic diseases such as carotid atherosclerosis, coronary atherosclerotic heart disease, stroke, and peripheral arteriosclerosis. This review aims to discuss the current role of TMAO in the atherosclerosis process, using animal models and clinical studies, with special attention to determining whether TMAO could be used as a marker for monitoring severity and prognosis in atherosclerosis and to evaluate evidence for its role as a mediator in the pathogenesis of atherosclerotic vascular disease.
The blooming intersection of subfatin and metabolic syndrome
Authors: Huang Shenglei , Cao Lei , Cheng Hongwei , Li Dongliang , Li Yi , Wu Zhixian
Published: September 2021

Metabolic Syndrome (MS) remains the leading cause of mortality and morbidity globally. Adipose tissue releases adipokines that play key roles in metabolic and cardio-cerebro-vascular homeostasis. Subfatin, induced after exercise or upon cold exposure in adipose tissue, is a novel secreted protein homologous to Metrn, a neutrophic factor with angiogenic properties. The protein was proved to be of great significance in the browning of white adipose tissue (BWT) and insulin resistance (IR). It affected insulin sensitivity at least via its local autocrine/paracrine action through AMP-activated protein kinase (AMPK) or peroxisome proliferator-activated receptor δ (PPAR-δ) dependent signaling. Subfatin blocked the release of inflammatory mediators, improved intracellular insulin signal transduction and reversed IR. It also improved glucose tolerance and played a key role in metabolism and cardiovascular and cerebrovascular homeostasis. It was reported that the level of serum subfatin was significantly correlated with the occurrence and severity of coronary heart disease, which might be a new target for the treatment of coronary heart disease. In addition, exercise increased the level of subfatin in circulation and adipose tissue, promoted energy consumption, improved glucose and lipid metabolism, increased the heat production of brown fat, and strengthened the anti-inflammatory mechanism. Given its role in metabolic disorders, subfatin is considered as a candidate biomarker of MS. However, the clinical significance of subfatin remains largely unclear. The purpose of this article is to review the research on the effect of subfatin on MS in recent years.
Dyslipidemia in pediatrician’s practice
Authors: Burlutskaya Alla V. , Tril Victoria E. , Polischuk Lily V. , Pokrovskii Vladimir M.
Published: September 2021

Atherosclerosis ranks first among cardiovascular system diseases. It is the “disease of the century”, and more than 50% of people with circulatory pathology die of it. The clinical manifestation of atherosclerosis is observed at the middle and older ages, but it is known that the pathological process develops much earlier. There has been a clear trend in theoretical and practical cardiology in recent years to study the earliest atherogenic markers. Epidemiological, clinical, and morphological studies have proved the presence in children and adolescents of sexual, endogenous, exogenous, primary, and potentiating risk factors contributing to an early formation of a pathogenic foundation for atherosclerotic cardiovascular diseases. Disorders of lipid metabolism – dyslipidemias are attributed to the most significant risk factor for atherosclerotic cardiovascular diseases. The DLP prevalence in the pediatric population is extremely high. According to the results of conducted global studies, lipid metabolism disorders occur in more than 70% of children and adolescents. It causes the need for timely diagnostic, therapeutic and preventive measures. The need to extrapolate the risk factor concept to childhood age is justified by several reasons, the main of which include the broadest spread of atherosclerosis that has become a global pandemic, genetic determinism, and low variability of the lipid spectrum of blood serum: the levels of lipids and lipoproteins discovered in childhood are stable throughout life and have an independent prognostic value. That is why the most practical significance is inherent to the study of lipid and lipoprotein metabolism, starting in the early periods of lipid and lipoprotein ontogenesis. Since risk factors can be identified at the preclinical stage of the atherosclerotic process, dyslipidemia phenotyping will facilitate identifying children and adolescents at risk of developing cardiovascular pathologies in the future. The study objective is to examine the pathophysiological aspects of lipid and lipoprotein metabolism and examine DLP epidemiology – as the leading atherosclerotic cardiovascular disease risk factor in children and adolescents, DLP classification, modern approaches to DLP diagnosis and management.
Apple or apple polyphenol consumption improves cardiovascular disease risk factors: a systematic review and meta-analysis
Authors: Zhu Xiaoqing , Xu Guanhua , Jin Wangyan , Gu Yingying , Huang Xuhua , Ge Lidan
Published: September 2021

Many fruits and vegetables have been found to have a protective effect against cardiovascular diseases. We conducted a systematic review and meta-analysis to determine the relationship between apple or apple polyphenol intake and cardiovascular disease risk. The PubMed, Embase, Cochrane, and Web of Science databases were searched up to August 4, 2020. Studies that had an intervention time of >1 week; used apple or apple polyphenols as the intervention; were designed as a randomized controlled trial; and measured blood pressure, cholesterol, and blood glucose levels were included. The meta-analysis showed that the group with apple or apple polyphenol intake had significantly higher high-density lipoprotein levels (standardized mean difference [SMD] = 0.34, 95% confidence interval [CI] [0.01, 0.67], p = 0.0411, I2 = 77%, random-effects model) and significantly lower C-reactive protein levels (SMD = –0.43, 95% CI [–0.65, –0.20], p = 0.0002, I2 = 18%, fixed-effects model) than the control group, indicating that the intervention reduced the risk of cardiovascular diseases. Apple or apple polyphenol intake is associated with a reduced risk of cardiovascular diseases. These results are consistent with the old saying that eating an apple a day can help keep the doctors away.
Accurate and early detection of sleepiness, fatigue and stress levels in drivers through Heart Rate Variability parameters: a systematic review
Authors: Burlacu Alexandru , Brinza Crischentian , Brezulianu Adrian , Covic Adrian
Published: September 2021

Sleepiness, fatigue, and stress in drivers are the leading causes of car crashes. In the late two decades, there is an endeavor to monitor vital signs, stress levels, and fatigue using adapted sensors supported by technological advances. To the best of our knowledge, this systematic review is the first to investigate the role of HRV measurement for sleepiness, fatigue, and stress level monitoring in car drivers. A search was performed in PubMed, Embase, and Cochrane databases using prespecified keywords. Studies were considered for inclusion if they reported original data regarding the association between different HRV measurements and drivers’ sleepiness, fatigue, or stress levels. Of the retrieved 749 citations, 19 studies were finally included. The sensibility and specificity of HRV significantly varied across studies, respectively 47.1%–95% and 74.6%–98%. Accuracy was also different, ranging from 56.6% to 95%. Nevertheless, in real-world conditions, confounding factors could affect sympathovagal tone and HRV. Multiple HRV parameters measurement rather than one parameter approach seems to be the optimal strategy for evaluating the vigilance state in drivers that it would be possible to achieve a good performance. As all studies were observational, data should be confirmed in randomized controlled trials. In conclusion, HRV represents a potentially valuable marker for sleepiness, fatigue, and stress monitoring in car drivers. HRV measurements could be implemented in future clinical models and sensors to detect early sleepiness and fatigue and prevent car crashes. More studies with larger populations are needed to support this evidence.
A qualitative meta-synthesis of patients with heart failure perceived needs
Authors: Kyriakou Martha , Samara Anastasia , Philippou Katerina , Lakatamitou Ioanna , Lambrinou Ekaterini
Published: September 2021

Supportive care may have significant input into the treatment of patients with heart failure (HF). Support, understanding and being treated as a whole and unique person are vital for patients with HF. In order to develop a person-centred program, it is important to know patients’ needs from their perspectives. The aim of the current review and meta-synthesis was to explore the needs of patients with HF from their perspective. A qualitative review was conducted using the keywords: (“needs” OR “need”) AND (“heart failure”) AND (“qualitative”) in four databases. Pre-defined inclusion and exclusion criteria were set. The ‘Consolidated criteria for reporting qualitative studies’ item checklist was used to assess the research methodologies of the included studies. A “thematic synthesis” methodological approach was used: (1) Line by line coding of the findings from primary studies. (2) The resulting codes were organized into related areas thus building descriptive themes. (3) Analytical themes were developed. Eleven articles were included in the present review. The results from the meta-synthesis extracted five different categories covering patents’ needs: Self-management, palliative care, supportive care, social support and continuing person-centred care. The need for continuing empowerment and support to meet those needs was also identified, revealing the core theme: ‘Wind beneath my wings’. The meta-synthesis quotations highlighted the necessity for dynamic and interactive continuing person-centred care focusing on the ongoing patients’ needs through the HF trajectory. Giving more emphasis to the human dimension and holistic approach of patients with HF, along with cardiology medicine development might be a key factor in improving clinical outcomes and health related quality of life.
Intravenous morphine use in acute heart failure increases adverse outcomes: a meta-analysis
Authors: Lin Yaowang , Chen Yang , Yuan Jie , Pang Xinli , Liu Huadong , Dong Shaohong , Chen Qiuling
Published: September 2021

Intravenous morphine is a controversial treatment for acute heart failure (AHF). This study aimed to evaluate and compare the efficacy of intravenous morphine treatment vs. no morphine treatment in AHF patients. Relevant research conducted before June 2020 was retrieved from electronic databases. One unpublished study of our own was also included. Studies were eligible for inclusion if they compared AHF patients treated with intravenous morphine and patients who did not receive morphine. This meta-analysis included three propensity-matched cohorts and two retrospective analyses, involving a total of 149,967 patients (intravenous-morphine group, n = 22,072; no-morphine group, n = 127,895). There was a non-significant increase in the in-hospital mortality in the morphine group (combined odds ratio [OR] = 2.14, 95% confidence interval [CI]: 0.88–5.23, p = 0.095, I2 = 97.1%). However, subgroup analyse showed that the rate of in-hospital mortality with odds of 1.41 times more likely (95% CI: 1.11–1.80, p = 0.005, I2 = 0%) in those receiving vs. not receiving intravenous morphine. No significant correlation was found between intravenous morphine and invasive mechanical ventilation (OR = 2.19, 95% CI: 0.84–5.73, p = 0.10, I2 = 94.2%; subgroup analysis: OR = 2.24, 95% CI: 0.70–7.21, p = 0.176, I2 = 95.1%) or long-term mortality (hazard ratio = 1.15, 95% CI: 0.96–1.34, p = 0.335; I2 = 8.6%). The administration of intravenous morphine to patients with AHF may be related to in-hospital mortality, but not to invasive mechanical ventilation and long-term mortality.
Association of polymorphisms in endothelial dysfunction-related genes with susceptibility to essential hypertension in elderly Han population in Liaoning province, China
Authors: Ta Na , Liu Mengwei , Wang Yue , Zeng Fanxin , Nie Fangfang , Shang Mengke , Wang Xiaotong , Yang Yuetian , Liang Man , Wen Lu , Ou Lanxin , Yang Zhibin , Liu Wanyang , Liu Xiuping
Published: September 2021

Hypertension is a complex disease which is mainly influenced by genetic factors. Recently, genome-wide association study (GWAS) found three novel endothelial dysfunction-related sites: Vascular endothelial growth factor A (VEGFA) rs9472135, Faciogenital dysplasia 5 (FGD5) rs11128722, Zinc Finger C3HC-type Containing 1 (ZC3HC1) rs11556924. Endothelial dysfunction is one of the early events in pathophysiology of essential hypertension. To investigate the association of endothelial dysfunction-related genes with essential hypertension, we conducted a case-control study of 431 patients with hypertension and 345 controls. The polymorphisms were detected using Taqman Probe. The alleles and genotypes of ZC3HC1 rs11556924 and VEGFA rs9472135 were not statistically different between the two groups, while the allele of FGD5 rs11128722 was different [P = 0.045, OR = 1.265, 95% CI = (1.009–1.586)], especially in the male [P = 0.035, OR = 1.496, 95% CI = (1.037–2.158)]. Analyzing the different of genotype distribution of 3 SNPs in the two groups under different genetic models, the genotypes of FGD5 rs11128722 showed difference in male under dominant model [P = 0.049, OR = 1.610, 95% CI = (1.018–2.544)]. The polymorphism of FGD5 rs11128722 had a significant difference in Body Mass Index (BMI) among different genotypes; In the additive genetic model, BMI of GA genotype was higher than that of GG (P = 0.038); GA + AA was higher than GG in the dominant genetic model (P = 0.011). In our study, we found that the polymorphisms of VEGFA rs9472135 and ZC3HC1 rs11556924 may not significantly associated with the risk of essential hypertension, and FGD5 rs11128722 may increase the risk of it, especially in elderly men.
Cardiac rehabilitation in elderly myocardial infarction survivors: focus on circulatory power
Authors: Vilela Eduardo Matos , Ladeiras-Lopes Ricardo , João Ana , Torres Susana , Ribeiro José , Campos Lilibeth , Miranda Fátima , Nunes José Pedro , Teixeira Madalena , Fontes-Carvalho Ricardo
Published: September 2021

Exercise-based cardiac rehabilitation (EBCR) is paramount after an acute myocardial infarction (AMI). Older individuals have been reported as having a worse prognosis after an AMI, and some series have reported differences in the functional response to EBCR. The peak circulatory power (CP), a non-invasive parameter, has been described as a surrogate for the cardiac power, showing promising results as a comprehensive measure of the cardiovascular response. Whilst this, data concerning the impact of EBCR on CP, particularly among elderly individuals, remains elusive. To address this issue, an observational, retrospective study including all patients admitted due to an AMI who completed a phase II EBCR programme between 11/2012 and 4/2017, was conducted, with CP being analysed by a symptom-limited cardiopulmonary exercise test. A total of 379 patients, 30% aged ≥65 years-old, were included. CP significantly improved after the EBCR programme (in all patients, as well as in both subgroups). Older patients presented lower CP than their younger counterparts at the beginning and the end of the programme, while presenting smaller improvements (122 ± 540 vs 293 ± 638 mmHg mL/kg/min, p = 0.013). This was maintained after adjusting for several potential confounding factors. A contemporary ECBR programme was associated with significant improvements in CP among AMI patients. Though those aged ≥65 years-old presented smaller improvements in CP than younger individuals, these still presented significant increases in this parameter. These results highlight the importance of EBCR in this challenging higher risk group of patients.
Comparison of standard versus modified stenting technique for treatment of tapered coronary artery lesions
Authors: Ke Dan , He Xi , Lin Chaogui , Chen Lianglong
Published: September 2021

Tapered coronary artery lesions (TCALs) are often seen clinically, optimal stenting of TCALs remains challengeable. This study sought to compare clinical outcomes between the modified single stenting (MSS) and conventional overlapped stenting (COS) in treatment of TCALs. 150 patients were treated with MSS (MSS group), another 150 patients were matched with propensity score matching from 5055 patients treated with COS (COS group). Quantitative coronary angiography was performed to measure minimal lumen diameter (MLD), late lumen loss (LLL). The primary endpoint was immediate angiographic success, one-year cumulative major cardiac adverse events (MACEs) composing cardiac death, target vessel myocardial infarction (TVMI), target lesion/vessel revascularization (TLR/TVR) or stent thrombosis (ST). Post-procedural in-stent MLD (2.96 ± 0.34 versus 3.08 ± 0.33, P = 0.004) was smaller and diameter stenosis (11.7 ± 4.0% versus 9.0 ± 4.8%, P = 0.003) was higher in MSS group than COS group. At 1-year follow-up, in-stent MLD (2.76 ± 0.38 mm versus 2.65 ± 0.60 mm, P = 0.003) was reduced, LLL (0.20 ± 0.26 mm versus 0.42 ± 0.48 mm, P = 0.001), diameter stenosis (24.02 ± 20.94% versus 19.68 ± 11.75%, P = 0.028) and binary restenosis (18.7% versus 10.0%, P = 0.047) were increased in COS group. Angiographic success (96.7% versus 98.0%, P = 0.723) was similar between MSS group and COS group. At 1-year, the cumulative MACEs (12.0% versus 22.7%, P = 0.022) and TLR/TVR (10.0% versus 18.7%, P = 0.047) were reduced in MSS group as compared to COS group, there was no difference in cardiac death, TVMI and ST between the groups. Compared to conventional overlapped stenting, modified single stenting for TCALs is associated with similar angiographic success, fewer one-year cumulative MACEs and less treatment cost.
The antegrade reperfusion test avoids the risk of mitral regurgitation recurrence optimizing valve repair
Authors: Youssari Amir , Couetil Jean-Paul , Piscitelli Mariantonietta , Zerbib Céline , Brault-Meslin Ophélie , Singh Sanjeet Singh Avtaar , Nappi Francesco , Fiore Antonio
Published: September 2021

Saline injection into the left ventricle trough mitral valve (saline test) is the most commonly used intraoperative assessment method in mitral valve repair. However, potential discrepancies between the saline test findings and intraoperative transesophageal echocardiography results after the weaning of cardiopulmonary by-pass, remain significant. Here, we describe a new antegrade reperfusion test, reproducing intraoperatively, the physiologic conditions of loaded and beating heart for direct transatrial evaluation of valve tightness. The proposed test is performed by perfusing warm oxygenated blood into the aortic root under cross-clamping. From February 2016 to December 2018, 91 patients (mean age: 63 ± 11 years) underwent mitral valve repair for mitral regurgitation. In all of them, the classic saline test was completed with the newly proposed antegrade test. We report our results with this combined approach. Data were obtained from the medical records and our mitral valve repair database. In 32 (35.1%) patients, evident or undetectable minor regurgitation at the saline test were respectively unconfirmed or detected by the antegrade reperfusion test leading to their complete correction. In only three patients (3.2%) major discrepancies was present between the intraoperative evaluation and the post-pump transesophageal echocardiography. Two of them (2.1%) required a second cardiopulmonary bypass run to fix the residual regurgitation. The antegrade reperfusion test is a simple dynamic intraoperative approach mimicking the physiological conditions of ventricular systole for mitral valve repair evaluation. Combined with the classic saline test, it seems to be a valuable additional intraoperative tool, enabling a more predictable repair result.
Evaluation of the aortic velocity propagation, epicardial fat thickness, and carotid intima-media thickness in patients with subclinical hypothyroidism
Authors: Asoğlu Emin , Akbulut Tayyar , Doğan Zeki , Asoğlu Ramazan
Published: September 2021

Subclinical hypothyroidism (SH) is associated with hemodynamic and metabolic abnormalities that cause endothelial dysfunction and atherosclerotic cardiovascular diseases. Aortic velocity propagation (AVP), epicardial fat thickness (EFT), and carotid intima-media thickness (CIMT) may provide additional information in SH patients. This study aimed to evaluate thyroid stimulating hormone (TSH), AVP, EFT, and CIMT in SH patients, and determine the associations among these parameters. Eighty patients with SH and 43 euthyroid (EU) individuals were enrolled. Blood samples were collected to measure laboratory parameters. Patients were divided into two groups based on their TSH values (TSH ≥10 or TSH <10 mIU/L). AVP, EFT, and CIMT were measured and compared between the study groups. A multivariate linear regression model was used for analysis of the independent predictors of AVP (beta = –0.298; 95% confidence interval = –0.946 to –0.287; p < 0.001). AVP was significantly lower in SH patients than the control group (43.7 ± 12.5 and 62.6 ± 13.8, respectively; p < 0.001). EFT values were similar between the SH and control groups (0.7 ± 0.3 and 0.6 ± 0.2, respectively; p = 0.10). SH patients had higher CIMT values than the control group (0.8 ± 0.3 and 0.5 ± 0.2, respectively; p < 0.001). In the multivariate linear analysis, TSH was an independent predictor of AVP. AVP was lower and CIMT was higher in SH patients compared to EU individuals. The increased CIMT and decreased AVP levels were significantly associated with TSH levels in SH patients.
Validity of SOFA score as a prognostic tool for critically ill elderly patients with acute infective endocarditis
Authors: Lin Yaowang , Liu Feng , Gong Shuying , Liao Bihong , Liu Huadong , Yuan Jie , Yu Danqing , Qin Haiyan , Wu Meishan , Dong Shaohong
Published: September 2021

The prognostic value of the sequential organ failure assessment (SOFA) score for critically ill elderly patients with acute infective endocarditis (IE) remains unknown. From January 2015 to December 2019, 111 elderly (≥65 years) patients with acute IE were consecutively included and divided into a low SOFA (<6) group (n = 71) and a high SOFA (≥6) group (n = 40). Endpoints included in-hospital and long-term (12–36 month) mortality. A high SOFA score was related to higher incidence of in-hospital mortality (30.0%) with an area under the curve (AUC) of 0.796. In multivariate analysis, age [odds ratio (OR) = 2.21, 95% confidence intervals (CI), 1.16–6.79, p = 0.040], SOFA ≥6 (OR = 6.38, 95% CI, 1.80–16.89, p = 0.004) and surgical treatment (OR = 0.21, 95% CI, 0.05–0.80, p = 0.021) were predictive of in-hospital mortality. A Cox proportional-hazards model identified age [Hazard ratios (HR)= 2.85, 95% CI, 1.11–7.37, p = 0.031], diabetes mellitus (HR = 3.99, 95% CI, 1.35–11.80, p = 0.013), SOFA ≥6 (OR = 3.38, 95% CI, 1.26–9.08, p = 0.001) and surgical treatment (HR = 0.24, 95% CI, 0.08–0.68, p = 0.021) as predictors of long-term mortality. A high SOFA score predicts a poor outcome including in-hospital and long-term mortality in critically ill elderly patients with acute IE.
The comparison between the effects of aspirin and clopidogrel monotherapy on postoperative bleeding in diabetic patients after off-pump coronary artery bypass surgery
Authors: Altınay Levent , Çetin Erdem
Published: September 2021

There is limited data about the bleeding complication of antiplatelet therapy after coronary artery bypass graft (CABG) operations focused on diabetic patients. Herein, we aimed to evaluate the effects of aspirin and clopidogrel monotherapies on postoperative bleeding in these patients. A total of 165 diabetic patients who underwent isolated off-pump beating heart coronary artery bypass (OPCAB) operation were evaluated, 84 patients were included in this retrospective study. Patients were divided into groups according to the type of antiplatelet regime. Chest tube drainage amounts and the amount of blood product transfusions were evaluated. Acetylsalicylic acid (ASA) - group included 42 aspirin monotherapy and Clopidogrel - group included 42 clopidogrel monotherapy patients after propensity matching. The mean drainage amount in ASA - group was 670.24 ± 185.46 mL, in Clopidogrel - group was 921.43 ± 167.53 mL (p < 0.001). More packed red blood cell (PRBC) and fresh frozen plasma (FFP) units were needed in the Clopidogrel - group than in the ASA - group (2.05 ± 1.13 vs. 0.83 ± 0.93 units of PRBC, and 1.90 ± 0.58 vs. 1.05 ± 0.58 units of FFP, respectively, p < 0.001). In conclusion, clopidogrel had a stronger effect on bleeding in diabetic patients than aspirin after OPCAB surgery.
Echocardiographic and clinical outcomes of patients undergoing septal myectomy plus anterior mitral leaflet extension for hypertrophic cardiomyopathy
Authors: Fernandez Rafle , Nappi Francesco , Horvath Sofia A. , Guigui Sarah A. , Mihos Christos G.
Published: September 2021

Septal myectomy is indicated in patients with obstructive hypertrophic cardiomyopathy (HCM) and intractable symptoms. Concomitant mitral valve (MV) surgery is performed for abnormalities contributing to systolic anterior motion (SAM), or for SAM-mediated mitral regurgitation (MR) with or without left ventricular outflow tract (LVOT) obstruction. One MV repair technique is anterior mitral leaflet extension (AMLE) utilizing bovine pericardium, stiffening the leaflet and enhancing coaptation posteriorly. Fifteen HCM patients who underwent combined myectomy-AMLE for LVOT obstruction or moderate-to-severe MR between 2009 and 2020 were analyzed using detailed echocardiography. The mean age was 56.6 years and 67% were female. The average peak systolic LVOT gradient and MR grade measured 73.4 mmHg and 2.3, respectively. Indications for myectomy-AMLE were LVOT obstruction and moderate-to-severe MR in 67%, MR only in 20%, and LVOT obstruction only in 13%. There was no mortality observed, and median follow-up was 1.2 years. Two patients had follow-up grade 1 mitral SAM, one of whom also had mild LVOT obstruction. No recurrent MR was observed in 93%, and mild MR in 7%. Compared with preoperative measures, there was a decrease in follow-up LV ejection fraction (68.2 vs 56.3%, p = 0.02) and maximal septal wall thickness (25.5 vs 21.3 mm, p < 0.001), and an increase in the end-diastolic diameter (21.9 vs 24.8 mm/m2, p = 0.04). There was no change in global longitudinal strain (–12.1 vs –11.6%, p = 0.73) and peak LV twist (7.4 vs 7.3∘, p = 0.97). In conclusion, myectomy-AMLE is a viable treatment option for carefully selected symptomatic HCM patients with LVOT obstruction or moderate-to-severe MR.
The association between serum uric acid levels and 10-year cardiovascular disease incidence: results from the ATTICA prospective study
Authors: Katsiki Niki , Kouvari Matina , Panagiotakos Demosthenes B , Borghi Claudio , Chrysohoou Christina , Mikhailidis Dimitri P , Pitsavos Christos
Published: September 2021

Limited data suggests possible gender-specific association between serum uric acid (SUA) and cardiovascular disease (CVD) incidence. The aim of the present analysis was to evaluate the association between SUA levels and 10-year CVD incidence (2002–2012) in the ATTICA study participants. Overall, 1687 apparently healthy volunteers, with SUA measurements, residing in the greater metropolitan Athens area (Greece), were included. Multivariable Cox-regression models were used to estimate the hazard ratios for SUA in relation to 10-year CVD incidence. Receiver operating curve analysis was conducted to detect optimal SUA cut-off values. Participants in the 2nd and 3rd SUA tertile had 29 and 73% higher 10-year CVD incidence compared with those in the 1st tertile (p < 0.001). In gender-specific analysis, only in women SUA was independently associated with CVD incidence; women in the 3rd SUA tertile had 79% greater 10-year CVD event risk compared to their 1st tertile counterparts. Obese in the 3rd SUA tertile had 2-times higher CVD incidence compared to those in the 1st tertile. Similar findings were observed in metabolically healthy (vs. unhealthy) and metabolically healthy obese. SUA thresholds best predicting 10-year CVD incidence was 5.05 and 4.15 mg/dL (0.30 and 0.25 mmol/L) in men and women, respectively. In conclusion, increased SUA levels were independently related to 10-year CVD event rate in women, obese and metabolically healthy individuals. SUA could predict 10-year CVD incidence even at low levels. Further studies are warranted to identify SUA cut-off values that may improve the detection of individuals at higher CVD risk in clinical practice.
Predictive and prognostic value of v-set and transmembrane domain-containing 1 expression in monocytes for coronary artery disease
Authors: Wang Xiao-Fei , Xu Meng-Cheng , Mao Cheng-Yu , En Zhou , He Qing , Qu Xing-Qian , Fan Yu-Qi , Wang Chang-Qian , Zhang Jun-Feng
Published: September 2021

The aim of this study was to investigate the correlation between v-set and transmembrane domain-containing 1 (VSTM1) expression and incidence of major adverse cardiac events (MACE) in patients with coronary heart disease (CHD). A total of 310 patients were divided into a non-acute coronary syndrome (non-ACS) group (containing the stable angina group, and the asymptomatic coronary artery diseaseand other patients group) and an ACS group (containing unstable angina and acute myocardial infarction patients). Monocytic VSTM1 expression levels (assessed via average fluorescence intensity derived from antibody binding to VSTM1) in each group were detected and analyzed. The cut-off value of monocytic VSTM1 expression to predict the onset of ACS and MACE was confirmed. VSTM1 expression in monocytes from the ACS group was lower than that of the non-ACS group. The incidence of MACEs in the high VSTM1-expression group was much less than that of those in the low VSTM1 expression group at the 1 year follow-up stage. VSTM1 expression had an independent-inversed association with increased incidence of MACE and ACS. VSTM1 expression in monocytes may help to predict the occurrence of ACS in patients with CHD, and moreover it may provide the means to evaluate MACE prognosis during CHD patient follow-up.