Progress in cardiovascular diseases最新文献

{"title":"Advances in the management of heart failure","authors":"Gregg C. Fonarow","doi":"10.1016/j.pcad.2024.01.006","DOIUrl":"10.1016/j.pcad.2024.01.006","url":null,"abstract":"","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139503291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Update on obesity, the obesity paradox, and obesity management in heart failure","authors":"Pamela L. Alebna ,&nbsp;Anurag Mehta ,&nbsp;Amin Yehya ,&nbsp;Adrian daSilva-deAbreu ,&nbsp;Carl J. Lavie ,&nbsp;Salvatore Carbone","doi":"10.1016/j.pcad.2024.01.003","DOIUrl":"10.1016/j.pcad.2024.01.003","url":null,"abstract":"<div><p>Obesity is a major public health<span><span> challenge worldwide. It is costly, predisposes to many cardiovascular (CV) diseases (CVD), is increasing at an alarming rate, and disproportionately affects people of low-socioeconomic status. It has a myriad of deleterious effects on the body, particularly on the CV system. Obesity is a major risk factor for heart failure (HF) and highly prevalent in this population, particularly in those with HF with preserved ejection fraction<span> (HFpEF), to the extent that an obesity HFpEF<span> phenotype has been proposed in the literature. However, once HF is developed, an obesity paradox exists where those with obesity have better short- and mid-term survival than normal or underweight individuals, despite a greater risk for hospitalizations. It may be argued that excess energy reserve, younger patient population, higher tolerability of HF therapy and better nutritional status may account for at least part of the obesity paradox on survival. Furthermore, </span></span></span>body mass index<span> (BMI) may not be an accurate measure of body composition, especially in HF, where there is an excess volume status. BMI also fails to delineate fat-free mass and its components, which is a better predictor of functional capacity and cardiorespiratory fitness (CRF), which particularly is increasingly being recognized as a risk modifier in both healthy individuals and in persons with comorbidities, particularly in HF. Notably, when CRF is accounted for, the obesity paradox disappears, suggesting that improving CRF might represent a therapeutic target with greater importance than changes in body weight in the setting of HF.</span></span></p><p>In this narrative review, we discuss the current trends in obesity, the causal link between obesity and HF, an update on the obesity paradox, and a description of the major flaws of BMI in this population. We also present an overview of the latest in HF therapy, weight loss, CRF, and the application of these therapeutic approaches in patients with HF and concomitant obesity.</p></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139418802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The economics of heart failure care","authors":"Chen Wei ,&nbsp;Paul A. Heidenreich ,&nbsp;Alexander T. Sandhu","doi":"10.1016/j.pcad.2024.01.010","DOIUrl":"10.1016/j.pcad.2024.01.010","url":null,"abstract":"<div><p>Heart failure (HF) poses a significant economic burden in the US, with costs projected to reach $70 billion by 2030. Cost-effectiveness analyses play a pivotal role in assessing the economic value of HF therapies. In this review, we overview the cost-effectiveness of HF therapies and discuss ways to improve patient access. Based on current costs, guideline directed medical therapies for HF with reduced ejection fraction provide high economic value except for sodium-glucose cotransporter-2 inhibitors, which provide intermediate economic value. Combining therapy with the four pillars of medical therapy also has intermediate economic value, with incremental cost-effectiveness ratios ranging from $73,000 to $98,500/ quality adjusted life-years. High economic value procedures include cardiac resynchronization devices, implantable cardioverter-defibrillators, and coronary artery bypass surgery. In contrast, advanced HF therapies have previously demonstrated intermediate to low economic value, but newer data appear more favorable. Given the affordability challenges of HF therapies, additional efforts are needed to ensure optimal care for patients. The recent Inflation Reduction Act contains provisions to reform policy pertaining to drug price negotiation and out-of-pocket spending, as well as measures to increase access to existing programs, including the Medicare low-income subsidy. On a patient level, it is also important to encourage patient and physician awareness and discussions surrounding medical costs. Overall, a broad approach to improving available therapies and access to care is needed to reduce the growing clinical and economic morbidity of HF.</p></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139508590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The spectrum of post-myocardial infarction care: From acute ischemia to heart failure","authors":"Khawaja Hassan Akhtar ,&nbsp;Muhammad Shahzeb Khan ,&nbsp;Suzanne J. Baron ,&nbsp;Shelley Zieroth ,&nbsp;Jerry Estep ,&nbsp;Daniel Burkhoff ,&nbsp;Javed Butler ,&nbsp;Marat Fudim","doi":"10.1016/j.pcad.2024.01.017","DOIUrl":"10.1016/j.pcad.2024.01.017","url":null,"abstract":"<div><p><span>Heart failure (HF) is the leading cause of mortality in patients with </span>acute myocardial infarction<span><span> (AMI), with incidence ranging from 14% to 36% in patients admitted due to AMI. HF post-MI develops due to complex inter-play between macrovascular obstruction, microvascular dysfunction, myocardial stunning and remodeling, inflammation, and neuro-hormonal activation. </span>Cardiogenic shock<span> is an extreme presentation of HF post-MI and is associated with a high mortality. Early revascularization<span> is the only therapy shown to improve survival in patients with cardiogenic shock. Treatment of HF post-MI requires prompt recognition and timely introduction of guideline-directed therapies to improve mortality and morbidity. This article aims to provide an up-to-date review on the incidence and pathogenesis of HF post-MI, current strategies to prevent and treat onset of HF post-MI, promising therapeutic strategies, and knowledge gaps in the field.</span></span></span></p></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139499861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart failure with improved ejection fraction: Beyond diagnosis to trajectory analysis","authors":"Anthony V. Pensa ,&nbsp;Sadiya S. Khan ,&nbsp;Ravi V. Shah ,&nbsp;Jane E. Wilcox","doi":"10.1016/j.pcad.2024.01.014","DOIUrl":"10.1016/j.pcad.2024.01.014","url":null,"abstract":"<div><p>Left ventricular (LV) systolic dysfunction<span><span><span><span> represents a highly treatable cause of heart failure (HF). A substantial proportion of patients with HF with reduced ejection fraction (EF;HFrEF) demonstrate improvement in LV </span>systolic function (termed HF with improved EF [HFimpEF]), either spontaneously or when treated with guideline-directed medical therapy (GDMT). Although it is a relatively new HF classification, HFimpEF has emerged in recent years as an important and distinct clinical entity. Improvement in LVEF leads to decreased rates of mortality and adverse HF-related outcomes compared to patients with sustained LV systolic dysfunction (HFrEF). While numerous clinical and imaging factors have been associated with HFimpEF, identification of which patients do and do not improve requires further investigation. In addition, patients improve at different rates, and what determines the trajectory of HFimpEF patients after improvement is incompletely characterized. A proportion of patients maintain improvement in LV systolic function, while others experience a </span>recrudescence of systolic dysfunction, especially with GDMT discontinuation. In this review we discuss the contemporary guideline-recommended classification definition of HFimpEF, the </span>epidemiology of improvement in LV systolic function, and the clinical course of this unique patient population. We also offer evidence-based recommendations for the clinical management of HFimpEF and provide a roadmap for future directions in understanding and improving outcomes in the care of patients with HFimpEF.</span></p></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139508313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cover 2 (Masthead)","authors":"","doi":"10.1016/S0033-0620(23)00115-9","DOIUrl":"https://doi.org/10.1016/S0033-0620(23)00115-9","url":null,"abstract":"","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138472014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of untreated subclinical antibody-mediated rejection after heart transplantation","authors":"Jacinthe Boulet ,&nbsp;Jane Kelleher ,&nbsp;Mauro R.B. Wanderley Junior ,&nbsp;Anju Nohria ,&nbsp;Charlotte Andersson ,&nbsp;Miae Kim ,&nbsp;Mandeep R. Mehra","doi":"10.1016/j.pcad.2023.10.001","DOIUrl":"10.1016/j.pcad.2023.10.001","url":null,"abstract":"<div><p><span>Subclinical antibody-mediated rejection (AMR) is represented by histopathological and/or immunopathological manifestations in the absence of significant cardiac allograft<span><span> dysfunction. Treatment remains uncertain as there is a lack of data on asymptomatic </span>heart transplant (HT) recipients (HTR) with a positive </span></span>cardiac biopsy<span>. We sought to determine the impact of untreated subclinical biopsy-proven AMR, regardless of circulating donor-specific antigen (DSA) expression, when diagnosed on surveillance biopsies in the first year after HT. This retrospective case control study evaluated 260 HTR between May 2004 and February 2021. These comprised 231 controls and 29 patients with untreated subclinical AMR. The mortality event rate was higher in controls (2.63 events per 100 person-years) compared to the scAMR Group (1.71 events per 100 person-years), a difference that did not reach statistical significance (hazard ratio 0.66, CI: 0.18–2.36). The combined event rate of cardiac allograft vasculopathy<span> (CAV), graft dysfunction, or mortality was higher in the subclinical AMR group (5.60 events per 100 person-years) than in controls (3.89 events per 100 person-years) but did not reach statistical significance (hazard ratio 1.63, CI: 0.07–40.09). Our results suggest that subclinical AMR diagnosed in the first year after HT on surveillance biopsy is not associated with decreased survival. This may sway the management of subclinical AMR towards a more conservative approach in transplant-capable institutions that currently prioritize treatment, though prospective, randomized studies of such a management strategy are required.</span></span></p></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41224343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction to assorted topics II 2023","authors":"Carl J. Lavie","doi":"10.1016/j.pcad.2023.11.001","DOIUrl":"10.1016/j.pcad.2023.11.001","url":null,"abstract":"","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71490703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Different right ventricular dysfunction and pulmonary coupling in acute heart failure according to the left ventricular ejection fraction","authors":"Alberto Palazzuoli MD, PhD, FESC ,&nbsp;Alessandra Cartocci PhD ,&nbsp;Filippo Pirrotta MD ,&nbsp;Francesca Vannuccini MD ,&nbsp;Alessandro Campora MD ,&nbsp;Luca Martini MD ,&nbsp;Frank Loyd Dini MD ,&nbsp;Erberto Carluccio MD, FEACVI ,&nbsp;Gaetano Ruocco MD","doi":"10.1016/j.pcad.2023.07.008","DOIUrl":"10.1016/j.pcad.2023.07.008","url":null,"abstract":"<div><h3>Background</h3><p><span>Right ventricular (RV) dysfunction and pulmonary uncoupling are two acknowledged features associated with poor outcome, however few data defined RV adaptation across the different left ventricular ejection fraction (EF) cut-off. Additionally, less data are reported </span>in patients<span> with acute heart failure (AHF).</span></p></div><div><h3>Aims</h3><p>The aim of present study was to analyse RV function<span> in AHF patients presenting with either reduced or preserved EF.</span></p></div><div><h3>Methods</h3><p>This is a multi-center observational study including 380 patients affected by AHF: 235 had AHF with reduced EF (AHFrEF) and 145 had AHF with preserved EF<span> (AHFpEF). Pulmonary artery systolic pressure<span> (PASP), tricuspid annular plane systolic excursion (TAPSE), S′ wave velocity, and the RV end-diastolic diameter (RVEDD) were measured by echocardiography. TAPSE/PASP and S′/PASP ratios were calculated as non-invasive surrogates of RV-pulmonary arterial coupling.</span></span></p></div><div><h3>Results</h3><p>Factors associated with poor outcome were higher values of PASP (45 [40–55] mmHg vs 40 [35–46] mmHg; <em>p</em> &lt; 0.001), RVEDD (44 [38–47] mm vs 37 [35–42] mm; p &lt; 0.001), lower TAPSE values (17 [15–20] mm vs 20 [18–22] mm; <em>p</em> &lt; 0.001) and S′ wave (10 [8–12] cm/s vs 11 [10–13] cm/s; <em>p</em> &lt; 0.001), reduced TAPSE/PASP (0.37 [0.29–0.47] vs 0.50 [0.40–0.60]; p &lt; 0.001) and S′/PASP ratios (0.22 [0.18–0.28] vs 0.28 [0.22–0.34]; p &lt; 0.001). However, the prognostic parameters differed according to the LVEF value: in AHFpEF S′/PASP between 0.22 and 0.29 and &gt; 0.29 demonstrated a protective prognostic value (Respectively HR 0.29 (0.16–0.53), <em>p</em> &lt; 0.001 and HR 0.22 [0.12–0.42], p &lt; 0.001). Conversely, in AHFrEF, TAPSE &lt;16 mm (HR 2.59 [1.67–4.03], p &lt; 0.001), ICV &gt; 21 mm (HR 1.17 [1.17–1.28], <em>p</em> = 0.001) and TAPSE/PASP &lt;0.49 HR 1.92 [1.10–3.37], <em>p</em><span> = 0.023) were related to adverse outcome.</span></p></div><div><h3>Conclusions</h3><p>RV adaptation and RV pulmonary coupling differ in AHF according to the level of LVEF. S′ wave, and S′/PASP are associated with adverse outcome in patients with preserved EF; reduced TAPSE and TAPSE/PASP are better prognostic predictors in patients with reduced EF.</p></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10009140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-reported walking pace and 10-year cause-specific mortality: A UK biobank investigation","authors":"Jonathan Goldney ,&nbsp;Paddy C. Dempsey ,&nbsp;Joseph Henson ,&nbsp;Alex Rowlands ,&nbsp;Atanu Bhattacharjee ,&nbsp;Yogini V. Chudasama ,&nbsp;Cameron Razieh ,&nbsp;Jari A. Laukkanen ,&nbsp;Melanie J. Davies ,&nbsp;Kamlesh Khunti ,&nbsp;Thomas Yates ,&nbsp;Francesco Zaccardi","doi":"10.1016/j.pcad.2023.09.003","DOIUrl":"10.1016/j.pcad.2023.09.003","url":null,"abstract":"<div><h3>Objective</h3><p>To investigate associations of self-reported walking pace (SRWP) with relative and absolute risks of cause-specific mortality.</p></div><div><h3>Patients and methods</h3><p>In 391,652 UK Biobank participants recruited in 2006–2010, we estimated sex- and cause-specific (cardiovascular disease [CVD], cancer, other causes) mortality hazard ratios (HRs) and 10-year mortality risks across categories of SRWP (slow, average, brisk), accounting for confounders and competing risk. Censoring occurred in September 30, 2021 (England, Wales) and October 31, 2021 (Scotland).</p></div><div><h3>Results</h3><p>Over a median follow-up of 12.6 years, 22,413 deaths occurred. In women, the HRs comparing brisk to slow SRWP were 0.74 (95% CI: 0.67, 0.82), 0.40 (0.33, 0.49), and 0.29 (0.26, 0.32) for cancer, CVD, and other causes of death, respectively, and 0.71 (0.64, 0.78), 0.38 (0.33, 0.44), and 0.29 (0.26, 0.32) in men. Compared to CVD, HRs were greater for other causes (women: 39.6% [6.2, 72.9]; men: 31.6% [9.8, 53.5]) and smaller for cancer (−45.8% [−58.3, −33.2] and − 45.9% [−54.8, −36.9], respectively). For all causes in both sexes, the 10-year mortality risk was higher in slow walkers, but varied across sex, age, and cause, resulting in different risk reductions comparing brisk to slow: the largest were for other causes of death at age 75 years [women: −6.8% (−7.7, −5.8); men: −9.5% (−10.6, −8.4)].</p></div><div><h3>Conclusion</h3><p>Compared to slow walkers, brisk SRWP was associated with reduced cancer (smallest reduction), CVD, and other (largest) causes of death and may therefore be a useful clinical predictive marker. As absolute risk reductions varied across age, cause, and SRWP, certain groups may particularly benefit from interventions to increase SRWP.</p></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0033062023001032/pdfft?md5=a84b30ddf37067e3d50940f4ad96c493&pid=1-s2.0-S0033062023001032-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41157972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}