Therapeutic Advances In Cardiovascular Disease[JOURNAL]
Sun
200 papers
Technical implications of a novel deep learning system in the segmentation and evaluation of computed tomography angiography before transcatheter aortic valve replacement.
Jin M, Mao Y, Yang J … +7 more , Liu J, Chen G, Noterdaeme T, Lange R, Ma C, Guo Y, Zhang H
Ther Adv Cardiovasc Dis · 2025 · PMID 40123453 · Full text
OBJECTIVE: The goal of this study was to compare the computed tomography angiography scans of the segmentation results from the Cvpilot, 3mensio, and Volume Viewer systems to explore the practicability of the Cvpilot sys...
OBJECTIVE: The goal of this study was to compare the computed tomography angiography scans of the segmentation results from the Cvpilot, 3mensio, and Volume Viewer systems to explore the practicability of the Cvpilot system in the automatic segmentation and technical evaluation of the aortic root before transcatheter aortic valve replacement (TAVR). DESIGN: A total of 154 patients who underwent TAVR at our center from January 2022 to May 2023 were enrolled, and their computed tomography angiography images were analyzed using the Cvpilot, 3mensio, and Volume Viewer systems, respectively. SETTING: Not applicable. PARTICIPANTS: Not applicable. MAIN OUTCOME MEASURES: The reconstructed computed tomography angiography images were evaluated by experts, and the measurements of the aortic roots were analyzed statistically. RESULTS: Compared with the 3mensio system, 92.2% of patients ( = 142) evaluated with the Cvpilot system reached grade A, 5.2% of patients ( = 8) reached grade B, and 2.6% of patients ( = 4) reached grade C. Compared with the Volume Viewer system, 90.9% of patients ( = 140) evaluated with the Cvpilot system achieved grade A, 7.1% of patients ( = 11) achieved grade B, and 2.0% of patients ( = 3) achieved grade C. Furthermore, there was no significant difference among the measurement results of the Cvpilot, 3mensio, and Volume Viewer systems (all > 0.05). CONCLUSION: Overall, the Cvpilot system is effective and reliable. It can accurately complete the segmentation and the measurement of aortic root structures, thereby effectively improving the measurement quality before TAVR. TRIAL REGISTRATION: Not applicable.
Response to the Letter to the Editor entitled "Carotid artery atherosclerosis, low and high volumes of high-intensity interval training in patients after myocardial infarction: the precision of measurement embarks on a precise measurement protocol".
Aispuru-Lanche R, Maldonado-Martín S
Ther Adv Cardiovasc Dis · 2025 · PMID 40119756 · Full text
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The effect of extent and localization of precordial ST-segment depression in acute inferior myocardial infarction as an indicator of infarct severity, coronary artery involvement, and cardiac outcomes.
Gholipour M, Noruzi S, Moayerifar M … +7 more , Khalili A, Eftekhari B, Mirbolouk F, Kheirkhah J, Salari A, Hassandokht T, Ghasemzadeh G
Ther Adv Cardiovasc Dis · 2025 · PMID 40084462 · Full text
BACKGROUND: It is crucial to timely recognize individuals presenting high-risk characteristics indicative of acute myocardial infarction. OBJECTIVES: Our study aimed to analyze the significance of evaluating ST-segment d...
BACKGROUND: It is crucial to timely recognize individuals presenting high-risk characteristics indicative of acute myocardial infarction. OBJECTIVES: Our study aimed to analyze the significance of evaluating ST-segment depression in patients with acute inferior myocardial infarction (MI). We assessed precordial ST-T changes as an indicator of ongoing ischemia, examined their correlation with the extent of coronary artery involvement, and potential association with both early and late cardiac outcomes. METHODS: We enrolled 200 hospitalized patients with acute inferior MI who displayed ST depression in their precordial leads and underwent angiography. Individuals were divided into three groups based on the location of ST depression (V1-V3, V4-V6, and V1-V6). Demographic and echocardiographic data were extracted, and cardiac outcomes were assessed during hospitalization and follow-ups. RESULTS: The findings revealed significant associations between ST depression in leads V1-V6 and V4-V6 with left ventricular systolic dysfunction, mitral regurgitation severity, and the extent of coronary artery stenosis in comparison with ST depression in V1-V3 ( < 0.05). Furthermore, a notable connection was found between the involved vessels and the degree of ST depression in precordial leads ( < 0.05). Moreover, individuals with prominent ST depression in V1-V6 and V1-V3 exhibited poorer outcomes ( < 0.05). CONCLUSION: Greater ST-segment depression in V1-V6 and V4-V6 in comparison with V1-V3 may signal multivessel disease, severe ischemia. Adverse outcomes like heart failure showed in V1-V6 especially V1-V3 versus V4-V6. This ST depression in acute inferior MI patients could indicate simultaneous ischemia or necrosis in other left ventricle regions, worsening cardiac function and prognosis. Thus, timely interventions are crucial.
Carotid artery atherosclerosis, low and high volumes of high-intensity interval training in patients after myocardial infarction: the precision of measurement embarks on a precise measurement protocol.
Saleh C
Ther Adv Cardiovasc Dis · 2025 · PMID 39921507 · Full text
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Ascending aortic replacement versus aortic root replacement in patients with type A aortic dissection involving the aortic root.
Biancari F, Gatti G, Mäkikallio T … +23 more , Juvonen T, Mariscalco G, El-Dean Z, Pettinari M, Rodriguez Lega J, Perrotti A, Onorati F, Wisniewki K, Demal T, Kacer P, Perna DD, Vendramin I, Rinaldi M, Ferrante L, Quintana E, Buech J, Radner C, Fiore A, Dell'Aquila AM, D'Errigo P, Rosato S, Polvani G, Peterss S
Ther Adv Cardiovasc Dis · 2025 · PMID 39840731 · Full text
BACKGROUND: Extensive surgical resection of the thoracic aorta in patients with type A aortic dissection (TAAD) is thought to reduce the risk of late aortic wall degeneration and the need for repeat aortic operations. OB...
BACKGROUND: Extensive surgical resection of the thoracic aorta in patients with type A aortic dissection (TAAD) is thought to reduce the risk of late aortic wall degeneration and the need for repeat aortic operations. OBJECTIVES: We evaluated the early and late outcomes after aortic root replacement and supracoronary ascending aortic replacement in patients with TAAD involving the aortic root. DESIGN: Retrospective, multicenter cohort study. METHODS: The outcomes after aortic root replacement and supracoronary ascending aortic replacement in patients with TAAD involving the aortic root, that is dissection flap located at least in one of the Valsava segments, were herein evaluated. In-hospital mortality, neurological complications, dialysis as well as 10-year repeat proximal aortic operation, and mortality were the outcomes of this study. RESULTS: Supracoronary ascending aortic replacement was performed in 198 patients and aortic root replacement in 215 patients. During a mean follow-up of 4.0 ± 4.0 years, 19 patients underwent 22 repeat procedures on the aortic root and/or aortic valve. No operative death occurred after these reinterventions. The risk of proximal aortic reoperation was significantly lower in patients who underwent aortic root replacement (5.5% vs 12.9%, adjusted subdistributional hazard ratio (SHR) 0.085, 95% CI 0.022-0.329). Aortic root replacement was associated with higher rates of in-hospital (14.4% vs 12.1%, adjusted odds ratio 2.192, 95% CI 1.000-4.807) and 10-year mortality (44.5% vs 30.4%, adjusted hazard ratio 2.216, 95% CI 1.338-3.671). Postoperative neurological complications and dialysis rates were comparable in the study groups. CONCLUSION: Among patients with TAAD involving the aortic root, its replacement was associated with a significantly lower rate of repeat proximal aortic operation of any type compared to supracoronary aortic replacement. Still, aortic root replacement seems to be associated with an increased risk of mortality in these patients. UNLABELLED: ClinicalTrials.gov: NCT04831073 (https://clinicaltrials.gov/study/NCT04831073).
Sex-related differences in heart failure patients: physiological mechanisms of cardiovascular ageing and evidence-based sex-specific medical therapies.
Ciutac AM, Pana T, Dawson D … +1 more , Myint PK
Ther Adv Cardiovasc Dis · 2025 · PMID 39749975 · Full text
This review aims to describe the sex differences in heart failure (HF) patients, with a particular emphasis on the effect of cardiovascular ageing. Additionally, it takes into consideration the sex-related variation in c...
This review aims to describe the sex differences in heart failure (HF) patients, with a particular emphasis on the effect of cardiovascular ageing. Additionally, it takes into consideration the sex-related variation in cardiovascular health and physiology and the role ageing plays in HF and its implications in drug therapy. The pharmacokinetics and pharmacodynamics of the common HF medications, classified according to the established sub-types, are summarised with respect to sex-specific documented findings. Despite numerous studies confirming significant differences in HF outcomes according to sex, there are no current guidelines that consider patients' sex in medical therapy of HF. Moreover, females are significantly under-represented in research trials, as well as under-treated in clinical practice, which hinders our understanding of HF in this demographic. Most of the current knowledge on sex-specific HF therapies is driven by secondary analyses of studies not primarily undertaking sex-specific analyses. Therefore, we propose a multi-faceted approach, including increased awareness among healthcare providers and more inclusive research to create a personalised care plan accounting for sex differences in HF management. Given the highlighted knowledge gaps, it is paramount for new research efforts to account for the different sex phenotypes in HF.
Outcomes among patients with coronary artery bypass grafts presenting with acute coronary syndrome: impact of revascularization.
Bews HJ, Hiebert B, Liu S … +7 more , Ducas J, Ravandi A, Minhas K, Kass M, Love MP, Wijeysundera HC, Shah AH
Ther Adv Cardiovasc Dis · 2025 · PMID 39745205 · Full text
BACKGROUND: Patients post-coronary artery bypass graft (CABG) can re-present with acute coronary syndrome (ACS); however, culprit lesion identification, as well as revascularization, is often challenging. Furthermore, th...
BACKGROUND: Patients post-coronary artery bypass graft (CABG) can re-present with acute coronary syndrome (ACS); however, culprit lesion identification, as well as revascularization, is often challenging. Furthermore, the impact of revascularization in this patient group is relatively unknown. OBJECTIVES: The purpose of our study was to evaluate the efficacy of percutaneous coronary intervention (PCI) in patients with previous CABG surgery presenting with ACS. METHODS: Using data from the Manitoba Center for Health Policy, we identified patients treated with CABG between April 1979 and March 2018, who subsequently presented with the primary diagnosis of ACS. Patients were divided into four groups: (1) managed medically and not investigated by cardiac catheterization and (2) investigated by cardiac catheterization and treated (2a) medically, (2b) with PCI, and (2c) with redo-CABG. Inverse probability treatment-weighted survival analyses were performed. Ethical approval was obtained from the local research board. RESULTS: Nearly 20% of patients treated with CABG presented with ACS at a median of 7.2 years (age at the time of CABG: 66 years (interquartile range: 58-73 years); 75.6% male). Patients treated with PCI ( = 929) demonstrated improved survival compared to the patients investigated by catheterization but treated medically ( = 952; hazard ratio 0.87, 95% confidence interval 0.77-0.97, = 0.02). Patients who underwent redo CABG ( = 171) experienced 13% mortality within the first year, but subsequently, demonstrated a trend toward improved survival. CONCLUSION: ACS is not uncommon following CABG. Revascularization is associated with prognostic improvement; however, such could be accounted for by inherent group differences, including comorbidities and coronary anatomy These findings should be validated in a prospective randomized study.
Lipoprotein(a) distribution in hospitalised Asian patients with ischaemic heart disease.
Loh WJ, Teo CB, Simon O … +1 more , Yeo C
Ther Adv Cardiovasc Dis · 2024 · PMID 39663671 · Full text
BACKGROUND: Elevated lipoprotein(a) [Lp(a)] is a common hyperlipidaemic condition with strong genetic predisposition and is independently associated with ischaemic heart disease (IHD). A Mendelian randomisation study has...
BACKGROUND: Elevated lipoprotein(a) [Lp(a)] is a common hyperlipidaemic condition with strong genetic predisposition and is independently associated with ischaemic heart disease (IHD). A Mendelian randomisation study has suggested that elevated Lp(a) is likely to confer similar causal risks as heterozygous familial hypercholesterolemia for premature IHD. We aimed to characterise the clinical profiles of admitted patients with IHD with at least one Lp(a) measurement. We also investigated whether elevated Lp(a) concentration was associated with premature onset of IHD. METHODS: This is a descriptive, non-interventional, retrospective study with data from a single tertiary hospital IHD Lp(a) cohort in Singapore, which consecutively recruited 521 patients with IHD admitted to the hospital. RESULTS: A total of 82.2% were men, 46.6% had newly diagnosed IHD and 10% had premature IHD. The median Lp(a) levels was 35.2 nmol/L. 70.8% of patients had normal Lp(a) concentrations (<70 nmol/L), 13.4% of people with Lp(a) ⩾ 70 to <120 nmol/L and 15.7% of patients with Lp(a) ⩾ 120 nmol/L. Lp(a) distribution was positively skewed to the right for all ethnicities. Patients of Indian ethnicity and of female gender had higher levels of Lp(a) compared with other ethnicities and gender, respectively. Multivariable regression analysis identified Lp(a) ⩾ 155 mmol/L to be associated with development of premature IHD (OR = 2.90, 95% CI: 1.26-6.67, = 0.012). CONCLUSION: There exist differences in Lp(a) distribution across ethnicities and gender. The subgroup analysis suggests that Lp(a) ⩾ 155 mmol/L was associated with premature onset of IHD.
Relevance of cardiac imaging in the evolving landscape of infective endocarditis management.
Haouzi A, Khayata M, Xu B
Ther Adv Cardiovasc Dis · 2024 · PMID 39655905 · Full text
Infective endocarditis (IE) is an increasingly recognized condition with high morbidity. Patients with atypical symptoms, culture-negative infections, and prosthetic cardiac devices and implants represent challenging pop...
Infective endocarditis (IE) is an increasingly recognized condition with high morbidity. Patients with atypical symptoms, culture-negative infections, and prosthetic cardiac devices and implants represent challenging populations to evaluate and manage. Recent major society guidelines have recommended the appropriate incorporation of multimodality imaging in the evaluation of these more complex IE cases. This article draws on the available literature regarding the different cardiac imaging modalities and discusses the role of multimodality imaging in IE.
Assessing the completeness of patient-reported outcomes reporting in congestive heart failure clinical trials.
Rorah D, Pollard J, Walters C … +4 more , Roberts W, Hartwell M, Hemmerich C, Vassar M
Ther Adv Cardiovasc Dis · 2024 · PMID 39641252 · Full text
OBJECTIVE: We aim to evaluate the quality of patient-reported outcomes included in randomized control trials for the treatment of congestive heart failure using the International Society for Quality of Life Research (ISO...
OBJECTIVE: We aim to evaluate the quality of patient-reported outcomes included in randomized control trials for the treatment of congestive heart failure using the International Society for Quality of Life Research (ISOQOL) checklist, a validated tool for critically appraising the quality of patient-reported outcomes. DESIGN: We performed a cross-sectional analysis of 65 randomized control trials with patient-reported outcomes for drug intervention trials for treating congestive heart failure. SETTING: N/A. PARTICIPANTS: N/A. MAIN OUTCOME MEASURES: The primary outcome of this study was to evaluate the reporting completeness of patient-reported outcomes in congestive heart failure clinical trials with drug interventions according to the ISOQOL checklist. RESULTS: Our search returned 1114 studies, of which, 65 are included in the analysis. The average completion of the ISOQOL reporting standards was 44.51%. Higher completion of the ISOQOL patient-reported outcome standards was observed in the clinical trials with patient-reported outcomes as primary endpoints compared to the clinical trials with patient-reported outcomes as a secondary endpoint. The multivariable regression model showed that clinical trials with patient-reported outcomes as a primary endpoint had a 21.46% better completion percentage ( = 4.45, ⩽ 0.001) when controlling for PRO recording duration and trial registration. Eight (8/65, 12.31%) of the clinical trials met the satisfaction criteria of completing two-thirds of the ISOQOL patient-reported outcomes reporting standards. All of these RCTs had a patient-reported outcome as a primary endpoint. CONCLUSION: Our analysis of the reporting of patient-reported outcomes in congestive heart failure clinical trials with drug interventions suggests that the quality of reporting is suboptimal. This evidence of substandard reporting of patient-reported outcomes is disconcerting as it reduces the transparency of randomized control trials, which are considered the foundation of evidenced-based medicine. Inadequate reporting may result in clinicians implementing misrepresented or incomplete evidence into clinical practice. Validated reporting tools, such as the ISOQOL, can be used by trialists and clinicians alike to improve and critically appraise the reporting of patient-reported outcomes in randomized control trials. TRIAL REGISTRATION: N/A.
Angiotensin receptor neprilysin inhibitor in chronic heart failure and comorbidity management: Indian consensus statement.
Mittal S, Harikrishnan S, Gupta A … +12 more , Bansal S, Koshy GA, Mohanan PP, Bhattacharya D, Kerkar P, Swamy A, Aggarwal V, Srivastava S, Mahajan A, Mehta A, Sharma K, Shetty S
Ther Adv Cardiovasc Dis · 2024 · PMID 39641242 · Full text
Heart failure (HF) is a significant public health concern characterized by notable rates of morbidity and mortality. Multimorbidity, ranging from 43% to 98% among HF patients, significantly impacts prognosis and treatmen...
Heart failure (HF) is a significant public health concern characterized by notable rates of morbidity and mortality. Multimorbidity, ranging from 43% to 98% among HF patients, significantly impacts prognosis and treatment response. HF management requires a holistic approach, including guideline-directed medical therapy. Sacubitril/valsartan (angiotensin receptor neprilysin inhibitor [ARNI]) is a cornerstone of HF treatment, supported by robust evidence from large-scale clinical trials across different levels of left ventricular ejection fraction. The recommendations presented in this paper have been developed by a group of cardiologists in India who convened in expert opinion meetings to discuss the utilization of ARNI in chronic HF patients with five different comorbid conditions like type 2 diabetes mellitus (T2DM), chronic kidney disease, myocardial infarction (MI), obesity, and hypertension. Key focus areas include initiation, dose titration, and management across different HF phenotypes and comorbidities. Emphasis is placed on the efficacy of ARNI irrespective of glycemic status in the T2DM population, its role in HF patients with obesity, and addressing challenges related to renal function decline and hyperkalemia. Additionally, the document highlights ARNI's potential benefits in hypertensive and post-MI HF patients, alongside observations on the obesity paradox in HF prognosis. Overall, these recommendations aim to optimize ARNI therapy in HF patient populations with different comorbidities, addressing specific challenges and considerations to improve outcomes and quality of life.
Enhancing coronary artery plaque analysis via artificial intelligence-driven cardiovascular computed tomography.
Xia J, Bachour K, Suleiman AM … +3 more , Roberts JS, Sayed S, Cho GW
Ther Adv Cardiovasc Dis · 2024 · PMID 39625215 · Full text
Coronary computed tomography angiography (CCTA) is a noninvasive imaging modality of cardiac structures and vasculature considered comparable to invasive coronary angiography for the evaluation of coronary artery disease...
Coronary computed tomography angiography (CCTA) is a noninvasive imaging modality of cardiac structures and vasculature considered comparable to invasive coronary angiography for the evaluation of coronary artery disease (CAD) in several major cardiovascular guidelines. Conventional image acquisition, processing, and analysis of CCTA imaging have progressed significantly in the past decade through advances in technology, computation, and engineering. However, the advent of artificial intelligence (AI)-driven analysis of CCTA further drives past the limitations of conventional CCTA, allowing for greater achievements in speed, consistency, accuracy, and safety. AI-driven CCTA (AI-CCTA) has achieved a significant reduction in radiation exposure for patients, allowing for high-quality scans with sub-millisievert radiation doses. AI-CCTA has demonstrated comparable accuracy and consistency in manual coronary artery calcium scoring against expert human readers. An advantage over invasive coronary angiography, which provides luminal information only, CCTA allows for plaque characterization, providing detailed information on the quality of plaque and offering further prognosticative value for the management of CAD. Combined with AI, many recent studies demonstrate the efficacy, accuracy, efficiency, and precision of AI-driven analysis of CCTA imaging for the evaluation of CAD, including assessing degree stenosis, adverse plaque characteristics, and CT fractional flow reserve. The limitations of AI-CCTA include its early phase in investigation, the need for further improvements in AI modeling, possible medicolegal implications, and the need for further large-scale validation studies. Despite these limitations, AI-CCTA represents an important opportunity for improving cardiovascular care in an increasingly advanced and data-driven world of modern medicine.
Effects of sacubitril/valsartan on renal function and outcome in patients with heart failure and reduced ejection fraction: an Italian cohort study.
Palazzuoli A, Pirrotta F, Cartocci A … +14 more , Delcuratolo E, Dini FL, Correale M, Dattilo G, Masarone D, Scelsi L, Ghio S, Tocchetti CG, Mercurio V, Brunetti ND, Nodari S, Barillà F, Ambrosio G, Carluccio E
Ther Adv Cardiovasc Dis · 2024 · PMID 39611607 · Full text
BACKGROUND: Sacubitril/valsartan (S/V) is a cornerstone treatment for heart failure (HF). Beneficial effects on hospitalization rates, mortality, and left ventricular remodeling have been observed in patients with heart...
BACKGROUND: Sacubitril/valsartan (S/V) is a cornerstone treatment for heart failure (HF). Beneficial effects on hospitalization rates, mortality, and left ventricular remodeling have been observed in patients with heart failure and reduced ejection fraction (HFrEF). Despite the positive results, the influence of S/V on renal function during long-term follow-up has received little attention. AIMS: We investigated the long-term effects of S/V therapy on renal function in a large cohort of patients with HFrEF. Additionally, we examined the effects of the drug in patients with chronic kidney disease (CKD) compared to those with preserved renal function and identified primary risk characteristics. METHODS: We studied 776 outpatients with HFrEF and left ventricular ejection fraction (LVEF) <40% from an observational registry of the Italian Society of Cardiology, all receiving optimized standard-of-care therapy with S/V. The patients were included in a multicentric open-label registry from 11 Italian academic hospitals. Kidney function was evaluated at baseline, after 6 months of S/V, and at 4 years. Patients were followed-up through periodic clinical visits. RESULTS: During a 48-month follow-up period, 591 patients remained stable and 185 patients (24%) experienced adverse events (85 deaths and 126 hospitalizations). S/V therapy marginally affects renal function during the follow-up period (estimated glomerular filtration rate (eGFR) at baseline 72.01 vs eGFR at follow-up 70.38 ml/min/m, = 0.01; and creatinine was 1.06 at baseline vs 1.10 at follow-up, < 0.04). Among patients who maintained preserved renal function, 35% were in Dose 3 and 10% dropped out of S/V therapy ( < 0.006). Univariate analysis showed that Drop-out of S/V (HR 2.73 [2.01, 3.71], < 0.001), history of previous HF hospitalization (HR 1.75 [1.30, 2.36], < 0.001), advanced NYHA class (HR 2.14 [1.60, 2.86], < 0.001), NT-proBNP values >1000 pg/ml (HR 1.95[1.38, 2.77], < 0.001), furosemide dose >50 mg (HR 2.04 [1.48, 2.82], < 0.001), and creatinine values >1.5 mg/dl occurred during follow-up (HR 1.74 [1.24, 2.43], < 0.001) were linked to increased risk. At multivariable analysis, increased doses of loop diuretics, advanced NYHA class, creatinine >1.5 mg/dl, and atrial fibrillation were independent predictors of adverse events. CONCLUSION: Long-term S/V therapy is associated with improved outcomes and renal protection in patients with HFrEF. This effect is more pronounced in patients who tolerate escalating doses. The positive effects of the drug are maintained in both CKD and preserved renal function. Future research may study the safety and underlying causes of current protection.
Diversity in the editorial boards of medical journals: a perspective from the Middle East.
Dakhil ZA, Marsool MDM, Qasim MS … +1 more , Al-Jorani MS
Ther Adv Cardiovasc Dis · 2024 · PMID 39569494 · Full text
Despite the significant increase in women in academic medicine over the last 50 years, women are still under-represented in leadership positions in academia. However, there is a lack of data on the diversity of editorial...
Despite the significant increase in women in academic medicine over the last 50 years, women are still under-represented in leadership positions in academia. However, there is a lack of data on the diversity of editorial boards in Middle Eastern medical journals. So, we aim to portray the diversity of editorial boards of Iraqi medical journals by conducting a cross-sectional analysis of the editorial boards' members of all Iraqi medical journals. Gender, affiliation and specialty were extracted from the journals' websites and/or from the professional profiles of the editorial board members. Twenty-five journals and 446 editorial board members were analysed. More than half of editorial board members specialized in basic science, while 39.76% specialized in clinical specialties. Approximately, 20.18% of editorial board members (regardless their role) were women. Four percent of editor-in-chief were women. There were significant differences in editorial role according to gender ( < 0.0001), yet residency ( = 0.688) and specialty ( = 0.190) did not differ according to their gender. Most editorial board members were affiliated with Baghdad. So, we can conclude that there is a significant under-representation of women across all roles on the editorial board of medical journals especially in the leading positions. All stakeholders, publishers, authors and academics should commit to ensure the diversity of editorial boards.
The impact of health maintenance organizations on improving cardiac surgery outcomes.
Skidmore KL, Flattmann FE, Cagle H … +2 more , Shekoohi S, Kaye AD
Ther Adv Cardiovasc Dis · 2024 · PMID 39535030 · Full text
BACKGROUND AND OBJECTIVES: California is one of a few states with mandatory reporting of mortality after coronary artery bypass graft (CABG) surgery. The Affordable Care Act restructured Medicaid, preferentially penalizi...
BACKGROUND AND OBJECTIVES: California is one of a few states with mandatory reporting of mortality after coronary artery bypass graft (CABG) surgery. The Affordable Care Act restructured Medicaid, preferentially penalizing patients experiencing poverty because payments to hospitals for isolated surgical events overshadow payments to primary care clinicians. We propose outcomes are superior when hospital networks organize surgical episodes within the context of primary care inside that same network. DESIGN AND METHODS: We listed factors impacting outcomes after CABG. CABG surgery outcome depends upon the integration of issues beginning years preoperatively and extending for decades. Therefore, we studied one health maintenance organization (HMO) from 2009 to 2020 compared to surrounding individual hospitals. We divided 58 hospitals in Northern California in 2009 according to income and population. To focus on changes introduced because of COVID-19, we compared a public database for the subset in 2009 for any relationship between poverty in a zip code and low volumes of CABG in that area to overall mortality in 2020. First, we defined low-income zip codes as those with a higher rate of poverty than the state average or with a lower per capita average income, per Census Bureau. Second, low volume was defined as a population under 165,000 because a hospital adjacent to a larger community can easily transfer care, sharing surgeons and processes. Third, we defined low volume as fewer than 180 CABG per year. RESULTS: Our qualitative evidence synthesis reveals that informal communication and hospital HMO policies improve CABG outcomes. In our small pilot data, Chi-square analysis showed higher crude mortality rates in 1507 CABG in 17 low-income low-volume hospitals versus 8163 CABG in the other 41 Northern California hospitals (2.72% vs 1.69%, = 0.0064). Low-income low-volume hospitals had a relative mortality risk of 1.61 (95% CI: 1.14-2.27). These hospitals had a mean mortality rate of 3.79%, readmission 11.12%, and stroke 1.84%. A patient undergoing CABG in a low-income low-volume hospital has a 61% higher chance of dying. The number needed to treat analysis shows that one life can potentially be saved for every 97 patients referred to another institution. CONCLUSION: We describe features of an HMO that contribute to up to fourfold lower mortality rates.
What's new in cardiac amyloidosis? Pharmacological treatment, physical activity, and care of patients with transthyretin cardiac amyloidosis.
Zaidel EJ, Song SC, Sterba JJ … +3 more , Piccinato A, Ramos MC, Cacia SL
Ther Adv Cardiovasc Dis · 2024 · PMID 39530293 · Full text
Awareness, proper diagnosis and treatment of cardiac amyloidosis have increased, but there are still several unmet needs that have to be addressed for the optimal care of the disease. In this comprehensive review, we des...
Awareness, proper diagnosis and treatment of cardiac amyloidosis have increased, but there are still several unmet needs that have to be addressed for the optimal care of the disease. In this comprehensive review, we describe current and future treatments for both hereditary and wild-type TTR cardiac amyloidosis and also review lifestyle, including current challenges and opportunities for specific dietary concerns and exercise sports for these patients.
Predicting the no-reflow phenomenon in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: a systematic review of clinical prediction models.
Ebrahimi R, Rahmani M, Fallahtafti P … +4 more , Ghaseminejad-Raeini A, Azarboo A, Jalali A, Mehrani M
Ther Adv Cardiovasc Dis · 2024 · PMID 39470690 · Full text
BACKGROUND: The no-reflow (NRF) phenomenon is the "Achilles heel" of interventionists after performing percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). No defi...
BACKGROUND: The no-reflow (NRF) phenomenon is the "Achilles heel" of interventionists after performing percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). No definitive treatment has been proposed for NRF, and preventive strategies are central to improving care for patients who develop NRF. OBJECTIVES: In this study, we aim to investigate the clinical prediction models developed to predict NRF in STEMI patients undergoing primary PCI. DESIGN: Systematic review. DATA SOURCES AND METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were observed. Studies that developed clinical prediction modeling for NRF after primary PCI in STEMI patients were included. Data extraction was performed using the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies (CHARMS) checklist. The Prediction Model Risk of Bias Assessment Tool (PROBAST) tool was used for critical appraisal of the included studies. RESULTS: The three most common predictors were age, total ischemic time, and preoperative thrombolysis in myocardial infarction flow grade. Most of the included studies internally validated their developed model via various methods: random split, bootstrapping, and cross-validation. Only three studies (18%) externally validated their model. Six studies (37%) reported a calibration plot with or without the Hosmer-Lemeshow test. The reported area under the curve ranged from 0.648 to 0.925. The most common biases were in the statistical domain. CONCLUSION: Clinical prediction models aid in individualizing care for STEMI patients with NRF after primary PCI. Of the 16 included studies, we report four to have a low risk of bias and low concern with regard to our research question, which should undergo external validation with or without updating in future studies.
Role of multilayer flow modulator stents in the treatment of arterial aneurysms.
Dinc R, Ekingen E
Ther Adv Cardiovasc Dis · 2024 · PMID 39418136 · Full text
Arterial aneurysms remain a significant public health problem because they often result in death when ruptured; therefore, they require immediate medical treatment. Endovascular aneurysm repair (EVAR) has recently become...
Arterial aneurysms remain a significant public health problem because they often result in death when ruptured; therefore, they require immediate medical treatment. Endovascular aneurysm repair (EVAR) has recently become the primary treatment option, owing to the fewer side effects compared to those with open surgery. However, stents used for conventional EVAR often cause side-branch occlusion, which alters the perfusion of vital organs. Recently, multilayer flow modulator (MFM) stents have been used as a new treatment for arterial aneurysms. These stents appear to be feasible owing to their unique design consisting of an uncoated three-dimensionally braided multilayered structure. MFM stents generally remodulate laminar flow and reduce the flow velocity in the aneurysmal sac, leading to thrombosis, which causes the aneurysm to shrink over time. Thus, they reduce the risk of mortality. Moreover, they reduce morbidity by preserving the side-branch blood flow. They can be easily applied to complex aneurysms and are ready to use without customization, which shortens the waiting time for interventions. This study aimed to evaluate the role of MFM stents in the treatment of arterial aneurysms based on available data.
Challenging anticoagulation decisions in atrial fibrillation: a narrative review.
Griffin M, Proietti R, Lip GYH … +1 more , Abdul-Rahim AH
Ther Adv Cardiovasc Dis · 2024 · PMID 39413210 · Full text
Atrial fibrillation (AF) is common and warrants consideration of oral anticoagulant (OAC) medication. Usually, the decision is straightforward, following the pathway outlined in the European Society of Cardiology's guide...
Atrial fibrillation (AF) is common and warrants consideration of oral anticoagulant (OAC) medication. Usually, the decision is straightforward, following the pathway outlined in the European Society of Cardiology's guideline; however, certain situations fall outside of this evidence base - such as a diagnosis of subclinical AF made via implanted devices or wearable electrocardiogram monitors, or alternatively diagnosis of 'secondary AF' following a major stressor. Subclinical AF is associated with stroke, though not to the extent of clinical AF, and the benefits of anticoagulation appear to be lower. Longer episodes are more clinically meaningful, and recent randomised controlled trials have demonstrated that some patients derive benefit from OAC. Similarly, when AF is triggered by sepsis or non-cardiac surgery, specific evidence supporting OAC initiation is lacking and clinician behaviour is variable. Observational data demonstrate poorer outcomes in these patients, implying that the perception of a transient, reversible phenomenon may not be correct. Contrastingly, cardiac surgery very frequently induces AF, and the benefits of anticoagulation rarely outweigh the risks of bleeding. Following ischaemic stroke, recent evidence suggests that early (re-)initiation of OAC should be considered as this does not increase the risk of haemorrhagic transformation as previously hypothesised. This narrative review summarises the available literature and outlines, where possible, practical advice for clinicians facing these common clinical dilemmas.
Empagliflozin and other SGLT2 inhibitors in patients with heart failure and preserved ejection fraction: a systematic review and meta-analysis.
Hamid AK, Tayem AA, Al-Aish ST … +3 more , Al Sakini AS, Hadi DD, Al-Aish RT
Ther Adv Cardiovasc Dis · 2024 · PMID 39400108 · Full text
BACKGROUND: Heart failure (HF) is a highly prevalent disease, among the primary factors contributing to morbidity and death. One of its types is heart failure with preserved ejection fraction (HFpEF) comprising 40%-50% o...
BACKGROUND: Heart failure (HF) is a highly prevalent disease, among the primary factors contributing to morbidity and death. One of its types is heart failure with preserved ejection fraction (HFpEF) comprising 40%-50% of newly diagnosed HF cases. Despite the high prevalence of HFpEF, there is still a lack of knowledge regarding the best drugs and treatment approaches to be used. However, the sodium-glucose co-transporter 2 (SGLT2) inhibitors could be a promising treatment. OBJECTIVES: To examine SGLT2 inhibitors' effect on hospitalization, cardiovascular death, and estimated glomerular filtration rate (eGFR) in HFpEF patients. SEARCH METHODS: We conducted searches for randomized controlled trials (RCTs) in PubMed, Embase, Scopus, and Web of Science up to July 2024. SELECTION CRITERIA: We chose RCTs that examined the effects of SGLT2 inhibitors and placebo in individuals with higher than 40% ejection fraction (HFpEF). DATA COLLECTION AND ANALYSIS: The methodology for the systematic review and meta-analysis was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. MAIN RESULTS: We included 8 studies with 16,509 participants. Drugs examined in our paper included empagliflozin, dapagliflozin, sotogliflozin, and ertugliflozin. Various outcomes were analyzed in different papers. However, different SGLT2 inhibitors lead to a decreased risk of cardiovascular hospitalization and kidney injury. Our meta-analysis showed a decreased risk of cardiovascular hospitalization but not death due to cardiovascular causes or other causes. These results were regardless of baseline status of eGFR, systolic blood pressure, atrial fibrillation or flutter, diabetes mellitus, sex, body mass index, and nt-proBNP. The included studies were of moderate to high quality. CONCLUSION: For individuals with HFpEF, SGLT2 inhibitors have been proven to be a safe and effective medication. However, more studies are needed for longer durations, reporting adverse events, effects on exercise tolerance, and other secondary outcomes.
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