Kittelson KS, Junior AG, Fillmore N
… +1 more, da Silva Gomes R
Prog Cardiovasc Dis
· 2024 · PMID 39486671
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The American Heart Association recently defined the complex interactions among the cardiovascular, renal, and metabolic systems as CKM syndrome. To promote better patient outcomes, having a more profound understanding of...The American Heart Association recently defined the complex interactions among the cardiovascular, renal, and metabolic systems as CKM syndrome. To promote better patient outcomes, having a more profound understanding of CKM pathophysiology and pursuing holistic preventative and therapy strategies is critical. Despite many gaps in understanding CKM syndrome, this study attempts to elucidate two of these gaps: the new emerging biomarkers for screening and the role of inflammation in its pathophysiology. For this review, an extensive search for specific terms was conducted in the following databases: PubMed, Scopus, Web of Science, and Google Scholar. Studies were first assessed by title, abstract, keywords, and selected for portfolio according to eligibility criteria, which led to 38 studies. They provided background information about CKM syndrome; data suggested that serum uric acid, leptin, aldosterone, bilirubin, soluble neprilysin, lipocalin-type-prostaglandin-D-synthase, and endocan could be valuable biomarkers for CKM screening; and finally, the inflammation role in CKM.
Belmonte M, Foà A, Paolisso P
… +21 more, Bergamaschi L, Gallinoro E, Polimeni A, Scarsini R, Muscoli S, Amicone S, De Vita A, Villano A, Angeli F, Armillotta M, Sucato V, Tremamunno S, Morrone D, Indolfi C, Filardi PP, Ribichini F, Lanza GA, Chieffo A, Barbato E, Pizzi C, Coronary Physiopathology and Microcirculation Working Group of the Italian Society of Cardiology (SIC)
The prevalence of coronary microvascular dysfunction (CMD) beyond the spectrum of chronic coronary syndromes (CCS) is non-negligible, pertaining to pathophysiological and therapeutical implications. Thanks to the availab...The prevalence of coronary microvascular dysfunction (CMD) beyond the spectrum of chronic coronary syndromes (CCS) is non-negligible, pertaining to pathophysiological and therapeutical implications. Thanks to the availability of accurate and safe non-invasive technique, CMD can be identified as a key player in heart failure, cardiomyopathies, Takotsubo syndrome, aortic stenosis. While CMD is widely recognized as a cause of myocardial ischemia leading to a worse prognosis even in the absence of obstructive coronary artery disease, the characterization of CMD patterns beyond CCS might provide valuable insights on the underlying disease progression, being potentially a "red flag" of adverse cardiac remodeling and a major determinant of response to therapy and outcomes. In this review, we aimed to provide an overview of the latest evidence on the prevalence, mechanistic and prognostic implications of CMD beyond the spectrum of CCS (i.e. heart failure, cardiomyopathies, Takotsubo syndrome, aortic stenosis).
Cardiovascular disease (CVD) continues to be a leading cause of global mortality and morbidity. Various established risk factors are linked to CVD, and modifying these risk factors is fundamental in CVD management. Clini...Cardiovascular disease (CVD) continues to be a leading cause of global mortality and morbidity. Various established risk factors are linked to CVD, and modifying these risk factors is fundamental in CVD management. Clinical studies underscore the association between dyslipidemia and CVD, and therapeutic interventions that target low-density lipoprotein cholesterol elicit clear benefits. Despite the correlation between low high-density lipoprotein cholesterol (HDLC) and heightened CVD risk, HDL-raising therapies have yet to showcase significant clinical benefits. Furthermore, evidence from epidemiological and genetic studies reveals that not only low HDL-C levels, but also very high levels of HDL-C are linked to increased risk of CVD. In this review, we focus on HDL metabolism and delve into the relationship between HDL and CVD, exploring HDL functions and the observed alterations in its roles in disease. Altogether, the results discussed herein support the conventional wisdom that "too much of a good thing is not always a good thing". Thus, our recommendation is that a careful reconsideration of the impact of high HDL-C levels is warranted, and shall be revisited in future research.
Workman TE, Ahmed A, Sheriff HM
… +6 more, Raman VK, Zhang S, Shao Y, Faselis C, Fonarow GC, Zeng-Treitler Q
Prog Cardiovasc Dis
· 2024 · PMID 39442600
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BACKGROUND: Natural language processing (NLP) can facilitate research utilizing data from electronic health records (EHRs). Large language models can potentially improve NLP applications leveraging EHR notes. The objecti...BACKGROUND: Natural language processing (NLP) can facilitate research utilizing data from electronic health records (EHRs). Large language models can potentially improve NLP applications leveraging EHR notes. The objective of this study was to assess the performance of zero-shot learning using Chat Generative Pre-trained Transformer 4 (ChatGPT-4) for extraction of symptoms and signs, and compare its performance to baseline machine learning and rule-based methods developed using annotated data. METHODS AND RESULTS: From unstructured clinical notes of the national EHR data of the Veterans healthcare system, we extracted 1999 text snippets containing relevant keywords for heart failure symptoms and signs, which were then annotated by two clinicians. We also created 102 synthetic snippets that were semantically similar to snippets randomly selected from the original 1999 snippets. The authors applied zero-shot learning, using two different forms of prompt engineering in a symptom and sign extraction task with ChatGPT-4, utilizing the synthetic snippets. For comparison, baseline models using machine learning and rule-based methods were trained using the original 1999 annotated text snippets, and then used to classify the 102 synthetic snippets. The best zero-shot learning application achieved 90.6 % precision, 100 % recall, and 95 % F1 score, outperforming the best baseline method, which achieved 54.9 % precision, 82.4 % recall, and 65.5 % F1 score. Prompt style and temperature settings influenced zero-shot learning performance. CONCLUSIONS: Zero-shot learning utilizing ChatGPT-4 significantly outperformed traditional machine learning and rule-based NLP. Prompt type and temperature settings affected zero-shot learning performance. These findings suggest a more efficient means of symptoms and signs extraction than traditional machine learning and rule-based methods.
As the field of percutaneous coronary intervention grows in volume, expertise, and available tools, interventional cardiologists are increasingly performing more complex and higher-risk coronary artery procedures. Mechan...As the field of percutaneous coronary intervention grows in volume, expertise, and available tools, interventional cardiologists are increasingly performing more complex and higher-risk coronary artery procedures. Mechanical circulatory support devices, previously used only in urgent situations, are now being utilized as supplementary tools to enhance outcomes in elective complex cases. This shift has sparked significant discussions about patient and device selection, as well as the potential risks involved. In this article, we explore the various devices and their distinct features. Additionally, we also introduce algorithms for device selection, placement and weaning to help guide physicians during their care for their high-risk PCI patients.
BACKGROUND: Consumption of more plant-based foods is gaining popularity, but the role of healthy versus unhealthy plant-based diets in cardiovascular disease (CVD) risk remains inconclusive. OBJECTIVES: We investigated a...BACKGROUND: Consumption of more plant-based foods is gaining popularity, but the role of healthy versus unhealthy plant-based diets in cardiovascular disease (CVD) risk remains inconclusive. OBJECTIVES: We investigated associations of plant-based diet indices (PDIs) with incident CVDs in a prospective cohort study and conducted an updated meta-analysis. METHODS: We included 3507 men and 5345 women of the population-based Rotterdam Study. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for CVD, coronary heart disease (CHD) and stroke per SD increment of an overall PDI, healthy PDI (hPDI) and unhealthy PDI (uPDI), among men and women separately. We combined our findings with previously published effect estimates in an updated meta-analysis. RESULTS: We documented 2015 CVD cases (1231 CHD and 952 stroke) during 107,290 person-years follow-up. Among men, the PDI and hPDI were associated with a 7 % (HR 0.93, 95 % CI 0.87-0.99) and 8 % (HR 0.92, 95 % CI 0.86-0.98) lower CVD risk. Among women, there was evidence suggesting a U-shaped association of the PDI with stroke (p < 0.01). In meta-analyses including up to 43,067 incident CVD cases among 359,740 participants from nine studies, the PDI and hPDI, were associated with a lower CVD riskand the uPDI with a higher CVD risk (pooled HRs [95 % CI], per SD, PDI: 0.94 [0.91-0.97], I = 50.4 %; hPDI: 0.94 [0.91-0.98], I = 74.7 %; uPDI: 1.03 [1.01-1.06], I = 49.0 %). CONCLUSIONS: Our findings support recommendations to consume relatively more healthy plant-based foods for CVD prevention. Potential differences by sex and non-linear associations warrant further investigation.
Prog Cardiovasc Dis
· 2024 · PMID 39442597
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Endothelial dysfunction and microvascular remodeling underly the development and progression of a host of cardiovascular disease (CVD). However, current methods to assess coronary epicardial microvascular function are in...Endothelial dysfunction and microvascular remodeling underly the development and progression of a host of cardiovascular disease (CVD). However, current methods to assess coronary epicardial microvascular function are invasive, time-intensive, and costly. Optical coherence tomography angiography (OCTA) is an established technology within ophthalmology that provides a quick, noninvasive assessment of vascular structures within the retina. As a growing body of evidence reveals strong associations between the retinal changes on OCTA and the development and progression of CVD, OCTA may indeed be a surrogate test for end-organ dysfunction. OCTA has potential to enhance diagnostic performance, refine cardiovascular risk assessment, strengthen prognostication, and ultimately, improve patient care. We explore the current literature on OCTA in cardiovascular diseases to summarize the clinical utility of retinal OCTA imaging and discuss next-generation cardiovascular applications.
Seman S, Tesic M, Babic M
… +14 more, Mikic L, Velicki L, Okwose NC, Charman SJ, Tafelmeier M, Olivotto I, Filipovic N, Ristic A, Arena R, Guazzi M, Jakovljevic D, Allison TG, Popovic D, SILICOFCM study investigators
AIM: We sought the cardiopulmonary exercise testing (CPET) parameter that most accurately reflected therapeutic efficacy in patients with hypertrophic cardiomyopathy (HCM). METHODS: Well-being questionnaire, N-terminal b...AIM: We sought the cardiopulmonary exercise testing (CPET) parameter that most accurately reflected therapeutic efficacy in patients with hypertrophic cardiomyopathy (HCM). METHODS: Well-being questionnaire, N-terminal brain natriuretic peptide measurements, echocardiography, and CPET were performed in patients with symptomatic non-obstructive HCM during phase II, randomized, open-label multicentre study, before and after 16 weeks of traditional or sacubitril/valsartan treatment. Patients were followed 36 months after the initial CPET. Primary endpoints were changes in: 1) peak oxygen consumption (VO); 2) VO at anaerobic threshold (AT); 3) oxygen pulse; 4) minute ventilation (VE)/carbon-dioxide (CO) production slope; 5) VE/VCO at AT (VE/VCO_AT); 6) VE/VCO nadir; 7) VE/VCO intercept; and 8) partial end-tidal pressure of carbon-dioxide (PCO) change during CPET. RESULTS: Of 115 screened patients, 61 (52 ± 14 years, 43 % women) were included. Within subject therapy effects were detected only by the VE/VCO intercept and PCO change, whereas the differences between medical regimens were detected by differences in VE/VCO nadir and VE/VCO_AT changes after the treatment. The best predictors of the change in well-being were left ventricular outflow tract maximal gradient and VE/VCO intercept (B = 0.41,0.36; SE = 0.16,0.30; CI = 0.14-0.79, 0.15-1.14; p = 0.006,0.016, respectively). Adverse cardiac events were best predicted by the initial VE/VCO nadir. CONCLUSION: Ventilatory efficiency parameters outperform peak VO in gauging therapy effects in patients with HCM.
BACKGROUND: Takotsubo Cardiomyopathy (TCM) is a transient heart condition often precipitated by stress and characterized by atypical ventricular ballooning. The interplay between TCM and Adrenal Insufficiency (AI), parti...BACKGROUND: Takotsubo Cardiomyopathy (TCM) is a transient heart condition often precipitated by stress and characterized by atypical ventricular ballooning. The interplay between TCM and Adrenal Insufficiency (AI), particularly the influence of catecholamine excess and glucocorticoid deficiency on TCM's pathogenesis in individuals with AI, warrants comprehensive exploration for a better understanding of TCM pathophysiology and establishment of potential therapeutic strategies. METHODS: We conducted an extensive literature search via PubMed and Google Scholar, targeting reports on AI, heart failure, and cardiomyopathy, supplemented by forward and backward citation tracing. We analyzed 46 cases from 45 reports, assessing the clinical presentation and outcomes in the context of AI categorization. RESULTS: In patients with AI, a glucocorticoid deficit appears to exacerbate the myocardial vulnerability to catecholamine toxicity, precipitating TCM. Most conditions were reversible; however, three pre-1990 cases resulted in irreversible outcomes. CONCLUSIONS: The investigation into the AI and TCM intersection highlights the pathogenic significance of catecholamines in the absence of glucocorticoids. The data consolidates the hypothesis that glucocorticoid scarcity exacerbates the cardiac susceptibility to catecholaminergic toxicity, potentially triggering TCM. The study affirms glucocorticoids' cardioprotective roles and elucidates how catecholamine surges contribute to TCM pathogenesis, suggesting strategic clinical management adjustments for AI patients to reduce TCM incidence.
OBJECTIVE: To investigate the prospective dose-response association of accelerometer-measured moderate-to-vigorous physical activity (PA;MVPA) with all-cause mortality and cardiovascular disease (CVD) incidence. METHODS:...OBJECTIVE: To investigate the prospective dose-response association of accelerometer-measured moderate-to-vigorous physical activity (PA;MVPA) with all-cause mortality and cardiovascular disease (CVD) incidence. METHODS: This prospective cohort of 76,074 participants from the UK Biobank study contained one week of individual accelerometer-based PA data collected between June 1, 2013 and December 23, 2015. Using restricted cubic splines to allow for potential non-linearity, we examined dose-response associations of MVPA with all-cause mortality and incident CVD, respectively. RESULTS: The median follow-up time was 8.0 years (IQR 7.5-8.5). The dose-response association of MVPA with all-cause mortality and CVD showed a similar L-shaped association, with significant risk reductions already from 10 min of MVPA per week for all-cause mortality (hazard ratio [HR], 0.98 [95 % CI,0.98-0.99]) and 15 min per week for CVD incidence (HR, 0.99 [95 % CI,0.98-0.99]). Doing more MVPA was associated with further risk reduction, but beyond around 500 min per week the benefits levelled off at HR's around 0.6 to 0.7. The highest additional benefit of adding more minutes per week for all-cause mortality and CVD incidence were observed between 100 and 250 weekly minutes of MVPA. From this point forward, the mean risk reduction rates decreased and were close to 0 beyond 500 weekly minutes. CONCLUSIONS: Significant, but small, risk reductions in all-cause mortality and CVD incidence can be achieved with as little as 10 and 15 min of MVPA per week, respectively. However, public health organizations should promote the attainment of 250 min of MVPA per week (with 100 min as a possible first target for inactive individuals), as these thresholds are associated with the greatest efficiency. Beyond that, less pronounced risk reductions can be achieved by accumulating additional MVPA, with hardly any additional benefits beyond 500 weekly minutes.
The purpose of this perspective is to provide recommendations on the use of Artificial Intelligence (AI) in health promotion. To arrive at these recommendations, we followed a 6-step process. The first step was to recrui...The purpose of this perspective is to provide recommendations on the use of Artificial Intelligence (AI) in health promotion. To arrive at these recommendations, we followed a 6-step process. The first step was to recruit an international authorship team from the Healthy Living for Pandemic Event Protection (HL- PIVOT) network. This enabled us to achieve an international perspective with insights from Canada, Great Britain, Kenya, Italy, and the US. A philosophical inquiry was conducted addressing 5 questions. What should the relationship be between humans and AI in health promotion? How can the public and professionals trust AI? How can we ensure AI is aligned with our values? How can we ensure the ethical use of data by AI? How can we control AI? 4 hypothetical scenarios were also developed to provide perspectives on: i) Artificial 'Versus' Human Intelligence; ii) AI Empowerment in Self-Care; iii) Could AI Improve Patient Provider Relationship; and iii) The Kenyan Cancer Patient at the Height of a Pandemic. Based on the philosophical inquiry and the scenarios 11 recommendations are made by the HL-PIVOT on the use of AI in health promotion. The golden thread running through these recommendations is a human centric approach. The recommendations begin by suggesting that workforce planning should take account of AI. They conclude with the statement that any serious incidents involving an AI in Health Promotion should be reported to the relevant regulatory authority.
The growing burden of coronary artery disease (CAD) has led to a deeper exploration of the pathophysiologic mechanisms underlying the disease process with the hope of finding novel treatments to reduce CAD morbidity and...The growing burden of coronary artery disease (CAD) has led to a deeper exploration of the pathophysiologic mechanisms underlying the disease process with the hope of finding novel treatments to reduce CAD morbidity and mortality. Sleep is a normal physiologic phenomenon essential for maintaining homeostasis. Disruption in sleep physiology has been linked to the activation of pro-inflammatory cytokines that may predispose to a greater risk of CAD. Several studies have evaluated the etiologic relationship between sleep deficiency and CAD. In this review, we attempt to highlight the key mechanisms proposed to play a role in the association of sleep with the pathophysiology of CAD, the findings and limitations of the pertinent studies, and possible future direction for evaluating and leveraging the relationship between sleep and CAD to develop new therapeutics.
Stroke is a leading cause of death and disability worldwide, with diverse comorbidities that influence its clinical outcomes. However, a comprehensive understanding of the short- and long-term patterns of stroke-related...Stroke is a leading cause of death and disability worldwide, with diverse comorbidities that influence its clinical outcomes. However, a comprehensive understanding of the short- and long-term patterns of stroke-related comorbidities remains limited. To address this gap, we conducted a disease-wide association study (DWAS) to systematically explore the landscape of stroke comorbidities in a population-based cohort. Using data from the FinnGen cohort, which included 337,194 participants and 27,496 ischemic stroke cases, we analyzed 1,757 medical events as potential stroke comorbidities. We employed Cox proportional hazards regression, adjusting for sex and age, to identify significant associations between stroke and these medical events. Comorbidities were classified into pre- and post-stroke categories, and their temporal patterns were analyzed over a 1- to 15-year follow-up period. Our findings revealed that stroke comorbidities span multiple disease taxonomies, with significant enrichment in the circulatory, digestive, and musculoskeletal systems. Notably, the study identified distinct pre-stroke and post-stroke comorbidities that persist or evolve over time, supporting the concept of a disease continuum. These temporal patterns suggest that stroke risk and outcomes are shaped by sequential comorbidities rather than simultaneous occurrences. This study provides the most comprehensive profile of stroke comorbidities to date, highlighting the interconnected nature of diseases. By mapping the progression of comorbidities across time and disease categories, DWAS offers valuable insights for early intervention and long-term treatment. Our findings emphasize the importance of viewing stroke as part of a broader disease continuum, offering new opportunities for prevention, diagnosis, and treatment strategies tailored to individual risk profiles.
Clonal hematopoiesis of indeterminate potential (CHIP) is a well-studied phenomenon in hematologic malignancies. With advancements in gene sampling and analysis and the use of large cohort studies, CHIP has recently been...Clonal hematopoiesis of indeterminate potential (CHIP) is a well-studied phenomenon in hematologic malignancies. With advancements in gene sampling and analysis and the use of large cohort studies, CHIP has recently been linked to cardiovascular disease (CVD). The relationship between CHIP and CVD appears to be bidirectional, with traditional risk factors for cardiovascular disease increasing the mutation burden in CHIP, and CHIP itself effecting the incidence or prognosis of a variety of CVD. The purpose of this review is to understand the epidemiology, risk factors, and pathogenesis of CHIP in the context of various CVD conditions.
The COVID-19 pandemic, caused by SARS-CoV-2, has sparked recurring outbreaks and remains endemic, posing ongoing health risks. In addition to its immediate effects, COVID-19 has been linked to cardiovascular complication...The COVID-19 pandemic, caused by SARS-CoV-2, has sparked recurring outbreaks and remains endemic, posing ongoing health risks. In addition to its immediate effects, COVID-19 has been linked to cardiovascular complications, including stroke. However, it remains unclear whether COVID-19 causally increases future stroke risk. This study used Mendelian randomization (MR) analysis to explore the causal link between COVID-19 susceptibility and stroke risk. By analyzing genome-wide association study (GWAS) data, genetically determined susceptibility to COVID-19 was identified and linked to various stroke subtypes, including cardioembolic, small-vessel, and large-artery ischemic stroke. Results indicated a significant association between COVID-19 susceptibility and increased stroke risk, particularly for large-artery ischemic stroke. These findings suggest that SARS-CoV-2 infection could serve as a natural indicator of disease predisposition, revealing inherent cardiovascular vulnerabilities. This revolutionizes the way we view pathogen infections-not only as harmful threats, but also as opportunities to assess individual health risks. By analyzing how people respond to infections, we can gain valuable insights into their predisposition to other diseases later in life, offering an analytical framework for early diagnosis and prevention. This perspective-using pathogen infections as natural tests of disease predisposition-offers a transformative way to view human diseases as a continuum. Instead of merely treating infections as isolated diseases, we can exploit natural infections to assess broader population health, thus paving the way for precision medicine and personalized healthcare interventions.