Mahmoud Assaad, Sinan Sarsam, Amir Naqvi, Marcel Zughaib
{"title":"CardioMems® device implantation reduces repeat hospitalizations in heart failure patients: A single center experience.","authors":"Mahmoud Assaad, Sinan Sarsam, Amir Naqvi, Marcel Zughaib","doi":"10.1177/2048004019833290","DOIUrl":"https://doi.org/10.1177/2048004019833290","url":null,"abstract":"<p><strong>Introduction: </strong>Hospital readmission for congestive heart failure remains one of the most important economic burdens on healthcare cost. The implantation of a wireless pressure monitoring device (CardioMEMS®) had led to nearly 40% reduction in readmission rates in the landmark CHAMPION trial. We aim to study the effectiveness of this wireless device in reducing heart failure admissions in a real-world setting.</p><p><strong>Methods: </strong>This is a retrospective chart review of patients with recurrent admissions for heart failure implanted with the wireless pressure monitoring system (CardioMEMS®) at our institution. We studied the total number of all-cause hospital admissions as well as heart failure-related admissions pre- and post-implantation.</p><p><strong>Results: </strong>A total of 27 patients were followed for 6-18 months. The total number of all-cause hospital admissions prior to device implantation was 61 admissions for all study patients, while the total number for the post-implantation period was 19, correlating with 2.26 + 1.06 admissions/person-year prior to device implantation versus 0.70 + 0.95 admissions/person-year post-implantation (p-value < 0.001). For heart failure-related admissions, the total number prior to device implantation was 46 compared to 9 admissions post device implantations, correlating with 1.70 + 1.07 admissions/person-years pre-implantation versus 0.33 + 0.62 admissions/person-years post-implantation (p-value < 0.001). This translates to 80.4% and 68.9% reduction in heart failure and all-cause admissions, respectively.</p><p><strong>Conclusion: </strong>In a real-world setting, the implantation of a wireless heart failure monitoring system in patients with heart failure and class III symptoms has resulted in 80.4% reduction in heart failure admissions and 69% reduction in all-cause admissions.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":"8 ","pages":"2048004019833290"},"PeriodicalIF":1.6,"publicationDate":"2019-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2048004019833290","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37018374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rafael de Athayde Soares, Marcelo Fernando Matielo, Francisco Cardoso Brochado Neto, Ana Paula Maia Pires, Rogério Duque de Almeida, Murilo de Jesus Martins, Roberto Sacilotto
{"title":"Impact of calcification and infrapopliteal outflow on the outcome of endovascular treatment of femoropopliteal occlusive disease.","authors":"Rafael de Athayde Soares, Marcelo Fernando Matielo, Francisco Cardoso Brochado Neto, Ana Paula Maia Pires, Rogério Duque de Almeida, Murilo de Jesus Martins, Roberto Sacilotto","doi":"10.1177/2048004019828941","DOIUrl":"10.1177/2048004019828941","url":null,"abstract":"<p><strong>Objectives: </strong>In this paper, we report the long-term outcomes of the endovascular treatment of femoropopliteal occlusive disease, focusing on the importance of calcification and runoff outflow on limb salvage and patency, and the factors associated with these outcomes at a single center.</p><p><strong>Methods: </strong>This retrospective cohort study included consecutive patients with femoropopliteal occlusive who underwent femoropopliteal angioplasty at the Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual, São Paulo, Brazil, between January 2015 and July 2017.</p><p><strong>Results: </strong>In total, 86 femoropopliteal occlusive angioplasties were performed in 86 patients, with an initial technical success rate of 95.34%. The mean ± standard deviation follow-up time was 880 ± 68.84 days. The analysis was performed at 720 days. Technical failure occurred in four patients, who were excluded from the analysis, leaving 82 patients and 82 femoropopliteal occlusive angioplasties. The estimated primary patency, secondary patency, limb salvage, and overall survival rates at 720 days were 60%, 96%, 90%, and 82.5%, respectively. In univariate and multivariate analyses, Cox regression showed worse primary patency rates in patients with one tibial vessel or isolated popliteal artery runoff (<i>p</i> = 0.005), calcification grade 4 (<i>p</i> = 0.019), calcification grade > 2 (<i>p</i> = 0.017), small vessel diameter < 4 mm (<i>p</i> = 0.03) or primary angioplasty without stenting (<i>p</i> = 0.021). A univariate analysis showed worse limb salvage in patients with one tibial vessel or isolated popliteal artery runoff (<i>p</i> = 0.039).</p><p><strong>Conclusions: </strong>In this study, the main factors associated with worse outcomes in the endovascular treatment of femoropopliteal occlusive in terms of loss of primary patency were one tibial vessel or isolated popliteal artery runoff, calcification grade 4, or calcification grade > 2, small vessel diameter < 4 mm, and no stents use. One tibial vessel or isolated popliteal artery runoff was also associated with limb loss in a univariate Cox regression analysis.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":"8 ","pages":"2048004019828941"},"PeriodicalIF":1.4,"publicationDate":"2019-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ba/10/10.1177_2048004019828941.PMC6376522.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36988495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mahmoud Assaad, Abeer Berry, Jaishree Palanisamy, Joseph Fenner, Marcel Zughaib
{"title":"Differential effect of regadenoson versus dipyridamole on heart rate in patients with left bundle branch block: How does it affect the results of pharmacological nuclear stress testing?","authors":"Mahmoud Assaad, Abeer Berry, Jaishree Palanisamy, Joseph Fenner, Marcel Zughaib","doi":"10.1177/2048004019828257","DOIUrl":"https://doi.org/10.1177/2048004019828257","url":null,"abstract":"<p><strong>Background: </strong>Myocardial perfusion imaging (MPI) stress test is performed either using exercise as a stress modality or through the use of pharmacological vasodilator agents in those who cannot exercise. Regadenoson and dipyridamole are some of the most common vasodilator agents used. We aim to study the effect of these agents on the heart rate and the imaging results.</p><p><strong>Methods: </strong>This was a retrospective study which included 187 patients with left bundle branch block. Patients received either dipyridamole or regadenoson during the myocardial perfusion imaging stress test. Charts were reviewed, and patient characteristics were recorded, as well as baseline heart rate, peak heart rate during stress, and angiographic data if available.</p><p><strong>Results: </strong>Regadenoson increased peak, absolute and relative heart rates significantly more compared to dipyridamole. The peak heart rate for Regadenoson was 94.1 ± 17.36 and for dipyridamole it was 85.38 ± 16.48 BPM (P < 0.001). The relative and absolute heart rate increase in the regadenoson group were 40.75 ± 23.01% and 26.06 ± 13.44 BPM, respectively. The relative and absolute heart rate increase in the dipyridamole group were 24.61 ± 18.25% and 16.23 ± 10.97 BPM. The frequency of reversible septal defects was similar in both groups (54% for Regadenoson vs. 63% for Dipyridamole; P = 0.24).</p><p><strong>Conclusions: </strong>There is a statistically significant increase in heart rate with the use of regadenoson for MPI compared to dipyridamole. However, the number of septal perfusion defects was similar between the two groups. The effect of this increase in heart rate, while statistically significant, is likely of no clinical significance.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":"8 ","pages":"2048004019828257"},"PeriodicalIF":1.6,"publicationDate":"2019-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2048004019828257","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36988493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mustafa Kozan, Zeynep Tugba Ozan, Vahit Demir, Hüseyin Ede
{"title":"The relation of novel cardiovascular risk parameters in patients with familial Mediterranean fever.","authors":"Mustafa Kozan, Zeynep Tugba Ozan, Vahit Demir, Hüseyin Ede","doi":"10.1177/2048004018823856","DOIUrl":"https://doi.org/10.1177/2048004018823856","url":null,"abstract":"<p><strong>Objective: </strong>In this study, we aimed at correlating the thickness of epicardial adipose tissue and levels of Vitamin D with cardiac risk in patients with familial Mediterranean fever.</p><p><strong>Methods: </strong>Sixty-five patients with familial Mediterranean fever and 38 healthy controls with matching age and sex were included in the study. The patients with a history of familial Mediterranean fever attacks within the previous two weeks or with any history of inflammatory or cardiovascular disease were excluded. Data regarding age, gender, weight, height, waist circumference, body mass index (calculated as weight/height<sup>2</sup>), pulse wave velocity, serum Vitamin D levels from fasting blood samples, and Homeostatic Model Assessment for insulin resistance were obtained for the patients and controls. The epicardial adipose tissue was visualized as an echo-free space between the outer surface of myocardium and visceral pericardium using two-dimensional echocardiography, and the thickness of epicardial adipose tissue was measured in parasternal long-axis view at the end of diastole.</p><p><strong>Results: </strong>The patients with familial Mediterranean fever had significantly higher levels of C-reactive protein, epicardial adipose tissue, and pulse wave velocity (p < 0.001, <0.05, <0.005, respectively) as compared with the control group. However, the serum Vitamin D levels in the two groups were observed to be similar (p = 0.486). Weak but significant positive correlations were observed between epicardial adipose tissue thickness and C-reactive protein (r = 0.302, p < 0.005), epicardial adipose tissue thickness and pulse wave velocity (r = 0.263, p < 0.01), and C-reactive protein and pulse wave velocity (r = 0.235, p < 0.05).</p><p><strong>Conclusion: </strong>Thickness of epicardial adipose tissue and pulse wave velocity were observed to increase in patients with familial Mediterranean fever.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":"8 ","pages":"2048004018823856"},"PeriodicalIF":1.6,"publicationDate":"2019-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2048004018823856","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36854085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Martin Sigl, Johannes Jung, Heinz Kölble, Klaus Amendt
{"title":"Multiple Stent Delivery System \"Multi-LOC\": Focal self-expanding nitinol stenting of complex femoropopliteal lesions-A monocenter feasibility pilot study.","authors":"Martin Sigl, Johannes Jung, Heinz Kölble, Klaus Amendt","doi":"10.1177/2048004018822618","DOIUrl":"https://doi.org/10.1177/2048004018822618","url":null,"abstract":"<p><strong>Aims: </strong>The Multiple Stent Delivery System (VascuFlex® Multi-LOC) is a novel stent delivery system with six short stents (13 mm long each) mounted on one wire-guided catheter, designed for the treatment of femoropopliteal arteries. The aim of the present study is to evaluate the safety and the feasibility of the VascuFlex® \"Multi-LOC\" stent delivery system, which enables spot stenting without changing the delivery system.</p><p><strong>Methods and results: </strong>After proof of concept in a porcine model and after <i><i>European Conformity</i></i> marking, first clinical experiences were gathered in 20 patients with severe intermittent claudication or critical limb ischemia. First-in-human data are presented. The study included 20 limbs that underwent femoropopliteal revascularization for claudication (n = 14) or critical limb ischemia (n = 6). \"Multi-LOC\" provisional spot stenting resulted in acute technical success in all lesions with resolution of flow-limiting dissection and elastic recoil after balloon dilatation of the femoropopliteal artery. There were no device-related complications. Follow-up examinations after 30 to 40 days revealed no major adverse events, and six months' results were encouraging.</p><p><strong>Conclusions: </strong>First clinical use of the novel Multiple Stent Delivery System (Multi-LOC) after balloon dilatation of the femoropopliteal artery was safe and feasible in this early study.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":"8 ","pages":"2048004018822618"},"PeriodicalIF":1.6,"publicationDate":"2019-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2048004018822618","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36854083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Estimation of stochastic behaviour in cardiac myocytes: I. Ca<sup>2+</sup> movements inside the cytosol and sarcoplasmic reticulum on curvilinear domains.","authors":"Serife Arif, Choi-Hong Lai, Nadarajah I Ramesh","doi":"10.1177/2048004018822428","DOIUrl":"10.1177/2048004018822428","url":null,"abstract":"<p><p>Since the discovery of Ca<sup>2+</sup> sparks and their stochastic behaviour in cardiac myocytes, models have focused on the inclusion of stochasticity in their studies. While most models pay much attention to the stochastic modelling of cytosolic Ca<sup>2+</sup> concentration the coupling of Ca<sup>2+</sup> sparks and blinks in a stochastic model has not been explored fully. The cell morphology in in silico studies in the past is assumed to be Cartesian, spherical or cylindrical. The application on curvilinear grids can easily address certain restrictions posed by such grid set up and provide more realistic cell morphology. In this paper, we present a stochastic reaction-diffusion model that couples Ca<sup>2+</sup> sparks and blinks in realistic shapes of cells in curvilinear domains. <b>Methodology:</b> Transformation of the model was performed to the curvilinear coordinate system. The set of equations is used to produce Ca<sup>2+</sup> waves initiated from sparks and blinks. A non-buffered and non-dyed version as well as a buffered and dyed version of these equations were studied in light of observing the dynamics on the two different systems. For comparison, results for both the Cartesian and curvilinear grids are provided. <b>Results and conclusions:</b> A successful demonstration of the application of curvilinear grids serving as basis for future developments.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":"8 ","pages":"2048004018822428"},"PeriodicalIF":1.6,"publicationDate":"2019-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2048004018822428","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36854081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Spaulding, C. Ballmann, J. Quindry, M. Hudson, J. Selsby
{"title":"Autophagy in the heart is enhanced and independent of disease progression in mus musculus dystrophinopathy models","authors":"H. Spaulding, C. Ballmann, J. Quindry, M. Hudson, J. Selsby","doi":"10.1177/2048004019879581","DOIUrl":"https://doi.org/10.1177/2048004019879581","url":null,"abstract":"Background Duchenne muscular dystrophy is a muscle wasting disease caused by dystrophin gene mutations resulting in dysfunctional dystrophin protein. Autophagy, a proteolytic process, is impaired in dystrophic skeletal muscle though little is known about the effect of dystrophin deficiency on autophagy in cardiac muscle. We hypothesized that with disease progression autophagy would become increasingly dysfunctional based upon indirect autophagic markers. Methods Markers of autophagy were measured by western blot in 7-week-old and 17-month-old control (C57) and dystrophic (mdx) hearts. Results Counter to our hypothesis, markers of autophagy were similar between groups. Given these surprising results, two independent experiments were conducted using 14-month-old mdx mice or 10-month-old mdx/Utrn± mice, a more severe model of Duchenne muscular dystrophy. Data from these animals suggest increased autophagosome degradation. Conclusion Together these data suggest that autophagy is not impaired in the dystrophic myocardium as it is in dystrophic skeletal muscle and that disease progression and related injury is independent of autophagic dysfunction.","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2048004019879581","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42351854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cardiovascular disease in transgendered people: A review of the literature and discussion of risk","authors":"L. Seal","doi":"10.1177/2048004019880745","DOIUrl":"https://doi.org/10.1177/2048004019880745","url":null,"abstract":"This review examines the impact of gender affirming hormone therapy used in the transgendered and non-binary populations on cardiovascular outcomes and surrogate markers of cardiovascular health. Current evidence suggests that hormonal therapy for transgendered women decreases or is neutral regarding myocardial infarction risk. There is an increased incidence of venous thromboembolism (VTE), but newer studies suggest that the risk is significantly lower than previously described. For transgendered men, there appears to be an adverse effect on lipid parameters but this does not translate into an increased risk of cardiovascular disease above that of general male population. In all transgendered people, risk factor interventions such as smoking cessation, weight management and treatment of co-morbid conditions are important in optimising cardiovascular health. The effect of gender affirming hormonal therapy in transgendered people is difficult to interpret due to the variety of hormone regimens used, the relative brevity of the periods of observation and the influence of confounding factors such as the historical use of less physiological, oestrogens such as conjugated equine oestrogen and ethinylestradiol which are more pro-thrombotic than the 17β oestradiol that is used in modern practice.","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2048004019880745","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48919827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Percutaneous treatments of acute myocardial infarction and major stroke: Two parallel roads","authors":"G. Vizzari, F. Versaci, A. Nicosia","doi":"10.1177/2048004019869162","DOIUrl":"https://doi.org/10.1177/2048004019869162","url":null,"abstract":"Neurological and cardiovascular ischemic diseases represent the main causes of morbidity and mortality in the world. Physiopathological mechanisms present several similarities, based on “thromboembolic” events, as well as the pharmacological and percutaneous treatment options. We report a case of contemporary presentation of acute coronary and cerebral syndromes, successfully managed with a combined percutaneous intervention driven by the emergency setting. Whereas invasive revascularization represents nowadays the “gold standard” therapy for acute coronary syndromes, catheter-based treatment of acute stroke is not yet widespread and still under debate.","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2048004019869162","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47244042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}