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Showing 221–240 of 2058 publications.
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Savarese, Gianluigi; Gatti, Paolo; Benson, Lina; Adamo, Marianna; Chioncel, O. Dragomir; Crespo-Leiro, Mar Generosa; Anker, Stefan D.; Coats, Andrew J.S.; Filippatos, Gerasimos S.; Lain?ak, Mitja; McDonagh, Theresa A.; Mebazaa, Alexandre; Metra, Marco; PIEPOLI, MASSIMO Francesco; Rosano, Giuseppe Massimo Claudio; Ruschitzka, Frank T.; Seferovic, Petar M.; Volterrani, Maurizio; Maggioni, Aldo Pietro; Lund, Lars H.Aims: Aims were to evaluate (1) reclassification of patients from heart failure with mildly reduced (HFmrEF) to reduced (HFrEF) ejection fraction when an EF = 40% was considered as HFrEF, (2) role of EF digit bias, ie, EF reporting favouring 5% increments; (3) outcomes in relation to missing and biased EF reports, in a large multinational HF registry. Methods and results: Of 25,154 patients in the European Society of Cardiology (ESC) HF Long-Term registry, 17% had missing EF and of those with available EF, 24% had HFpEF (EF?50%), 21% HFmrEF (40%-49%) and 55% HFrEF (<40%) according to the 2016 ESC guidelines classification. EF was exactly 40% in 7%, leading to reclassifying 34% of the HFmrEF population defined as EF = 40% to 49% to HFrEF when applying the 2021 ESC Guidelines classification (14% had HFmrEF as EF = 41% to 49% and 62% had HFrEF as EF?40%). EF was reported as a value ending with 0 or 5 in ?37% of the population. Such potential digit bias was associated with more missing values for other characteristics and higher risk of all-cause death and HF hospitalization. Patients with missing EF had higher risk of all-cause and CV mortality, and HF hospitalization compared to those with recorded EF. Conclusions: Many patients had reported EF = 40%. This led to substantial reclassification of EF from old HFmrEF (40%-49%) to new HFrEF (?40%). There was considerable digit bias in EF reporting and missing EF reporting, which appeared to occur not at random and may reflect less rigorous overall care and worse outcomes. 2023 The Author(s)
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Clark, Amy Maree; Freedman, Ben; Thomas, Liza[No abstract available]
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Figtree, Gemma A.; Vernon, Stephen Thomas; Harmer, Jason A.; Gray, Michael P.; Arnott, Clare; Bachour, Eric; Barsha, Giannie; Brieger, David B.; Brown, Alex D.H.; Celermajer, David S.; Channon, Keith Michael; Chew, Nicholas W.S.; Chong, James J.H.; Chow, Clara Kayei; Cistulli, Peter A.; Ellinor, Patrick T.; Grieve, Stuart M.; Guzik, Tomasz Jan Guzik@glasgow Ac Uk; Hagstr, Emil G.; Jenkins, Alicia J.; Jennings, Garry L.R.; Keech, Anthony C.; Kott, Katharine A.; Kritharides, Leonard; Mamas, Mamas Andreas; Mehran, Roxana; Meikle, Peter J.; Natarajan, Pradeep; Negishi, Kazuaki; OSullivan, John F.; Patel, Sanjay; Psaltis, Peter James; Redfern, Julie; Steg, Philippe Gabriel; Sullivan, David R.; Sundstrom, Johan; Vogel, Birgit; Wilson, Andrew J.; Wong, Dennis T.L.; Bhatt, Deepak L.; Kovacic, Jason C.; Nicholls, Stephen J.; Ademi, Zanfina; Avis, Suzanne R.; Chan, Adam; Contreras, Osvaldo; Coorey, Craig Peter; Fathieh, Sina; Genetzakis, Elijah; Gholipour, Alireza; Giles, Corey; Hollings, Matthew A.; Hyun, Karice K.; Kazi, Samia N.; Larance, Mark; Marathe, Jessica A.; Marquina, Clara; Nelson, Adam James; Ng, Hooihooi; Patrick, Ellis; Peter, Karlheinz H.; Tran, Andy; Yang, Jean; Zhu, Dantong; Zwack, Clara C.Reducing the incidence and prevalence of standard modifiable cardiovascular risk factors (SMuRFs) is critical to tackling the global burden of coronary artery disease (CAD). However, a substantial number of individuals develop coronary atherosclerosis despite no SMuRFs. SMuRFless patients presenting with myocardial infarction have been observed to have an unexpected higher early mortality compared to their counterparts with at least 1 SMuRF. Evidence for optimal management of these patients is lacking. We assembled an international, multidisciplinary team to develop an evidence-based clinical pathway for SMuRFless CAD patients. A modified Delphi method was applied. The resulting pathway confirms underlying atherosclerosis and true SMuRFless status, ensures evidence-based secondary prevention, and considers additional tests and interventions for less typical contributors. This dedicated pathway for a previously overlooked CAD population, with an accompanying registry, aims to improve outcomes through enhanced adherence to evidence-based secondary prevention and additional diagnosis of modifiable risk factors observed. 2023 The Authors
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Zhang, Yingqi; Aye, San Seint; Cheng, Vivian; Nasser, Arian; Hong, Tianbo; Vatankhah, Parham; Jiang, Fengtao; Zhao, Yunduo Charles; Moldovan, Laura; Sun, Allan; Dupuy, Alexander; Wang, Yao; Li, Zhiyong; Ang, Timothy E.; Passam, Freda H.; Yong, Kentye; Ju, Lining ArnoldStenosis, characterized by partial vessel narrowing, alters blood hemodynamics and can lead to unpredictable thrombosis. Existing models struggle to accurately represent the complex vascular geometries and hemodynamics involved in such conditions. To address this challenge, a microvasculature-on-a-post chip is developed to mimic partially stenotic vascular geometries and thrombogenicity, featuring isolated 3D micropost structures with variable sizes that recreate disturbed flow profiles. To emulate the diseased vessel wall, the post microfluidics are vascularized with a confluent layer of endothelial cells. Subsequently, human blood is perfused through the endothelialized post microfluidics, observing the temporal and spatial thrombotic response governed by Virchow's triad, including vessel wall injury, hemodynamic disturbance, and hypercoagulability. The innovative model offers valuable insights into stenosis-induced thrombosis and endothelial behavior, paving the way for improved assessment of thrombotic risks associated with stenotic vessels. This advanced microfluidic platform also offers new approaches for evaluation of prothrombotic phenotypes and cardiovascular risk assessment in the future. 2023 The Authors. Advanced Materials Interfaces published by Wiley-VCH GmbH.
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Hutton, Michael; Frazer, Madeleine; Lin, Alexander; Patel, Sanjay; Misra, Ashish K.Purpose: Despite an increase in treatment options, and substantial reductions in cardiovascular mortality over the past half-century, atherosclerosis remains the most prevalent cause of premature mortality worldwide. The development of innovative new therapies is crucial to further minimize atherosclerosis-related deaths. The diverse array of cell phenotypes derived from vascular smooth muscle cells (SMCs) and macrophages within atherosclerotic plaques are increasingly becoming recognized for their beneficial and detrimental roles in plaque stability and disease burden. This review explores how contemporary transcriptomics and fate-mapping studies have revealed vascular cell plasticity as a relatively unexplored target for therapeutic intervention. Methods: Recent literature for this narrative review was obtained by searching electronic databases (ie, Google Scholar, PubMed). Additional studies were sourced from reference lists and the authors personal databases. Findings: The lipid-rich and inflammatory plaque milieu induces SMC phenotypic switching to both beneficial and detrimental phenotypes. Likewise, macrophage heterogeneity increases with disease burden to a variety of pro-inflammatory and anti-inflammatory activation states. These vascular cell phenotypes are determinants of plaque structure stability, and it is therefore highly likely that they influence clinical outcomes. Development of clinical treatments targeting deleterious phenotypes or promoting pro-healing phenotypes remains in its infancy. However, existing treatments (statins) have shown beneficial effects toward macrophage polarization, providing a rationale for more targeted approaches. In contrast, beneficial SMC phenotypic modulation with these pharmacologic agents has yet to be achieved. The range of modulated vascular cell phenotypes provides a multitude of novel targets and the potential to reduce future adverse events. Implications: Vascular cell phenotypic heterogeneity must continue to be explored to lower cardiovascular events in the future. The rapidly increasing weight of evidence surrounding the role of SMC plasticity and macrophage polarity in plaque vulnerability provides a strong foundation upon which development of new therapeutics must follow. This approach may prove to be crucial in reducing cardiovascular events and improving patient benefit in the future. 2023 Elsevier Inc.
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Doehner, Wolfram; ?elutkiene, Jelena; Yilmaz, Mehmet Birhan; Coats, Andrew J.S.In heart failure (HF) strong haemodynamic and neuronal signalling feedback interactions between the heart and the central nervous system (CNS) exist that are able to mutually provoke acute or chronic functional impairment. Cerebral injury secondary to HF may include acute stroke, cognitive decline and dementia and depressive disorders. Also brain stem functions are involved in the cardiac-cerebral interaction in HF as neurohormonal control and neuronal reflex circuits are known to be impaired or imbalanced in HF. In turn, impaired cerebral functions may account for direct and indirect myocardial injury and may contribute to symptomatic severity of HF, to disease progression and to increased mortality. Despite the clinical and pathophysiologic significance of the heartCNS interaction, this relevant field of HF comorbidity is clinically under-recognized with regard to both diagnostic workup and treatment efforts. Here, principal aspects of pathophysiologic heartCNS interactions related to HF are discussed such as stroke, effects on cognitive function, on depressive disorder and neurovegetative control and neuronal cardiovascular reflex regulation. Aspects of (limited) treatment options for cerebral functional interactions in HF are examined. The Author(s) 2023. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.
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Orchard, Jessica Joan; Giskes, Katrina; Orchard, John William; La Gerche, AndrCrossed D.Sign; Neubeck, Lis; Hespe, Charlotte Mary; Lowres, Nicole; Freedman, BenFrom 2012 to 2016, the oral anticoagulant (OAC) treatment determination for atrial fibrillation (AF) patients moved from the CHADS<inf>2</inf> score to the CHA<inf>2</inf>DS<inf>2</inf>-VASc score. A data set collated during previous studies (201119) with de-identified data extracted from clinical records at a single timepoint for active adult patients (n = 285 635; 8294 with AF) attending 164 general practices in Australia was analysed. The CHA<inf>2</inf>DS<inf>2</inf>-VASc threshold (score ?2 men/?3 women) captured a significantly higher proportion than CHADS<inf>2</inf>?2 (all ages: 85 vs. 68%, P < 0.0001; ?65 years: 96 vs. 76%, P < 0.0001). The change from CHADS<inf>2</inf> to CHA<inf>2</inf>DS<inf>2</inf>-VASc resulted in a significantly higher proportion of AF patients being recommended OAC, driven by the revised scoring for age. The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Playford, David A.; Stewart, S.; Harris, Sarah Ann; Chan, Yih Kai; Strange, G. A.BACKGROUND: Regional wall motion abnormalities (WMAs) after myocardial infarction are associated with adverse remodeling and increased mortality in the short to medium term. Their long-term prognostic impact is less well understood. METHODS AND RESULTS: Via the National Echo Database of Australia (20002019), we identified normal wall motion versus WMA for each left ventricular wall among 492 338 individuals aged 61.917.9 years. The wall motion score index was also calculated. We then examined actual 1-and 5-year mortality, plus adjusted risk of long-term mortality according to WMA status. Overall, 39 346/255 697 men (15.4%) and 17 834/236 641 women (7.5%) had a WMA. The likelihood of a WMA was associated with increasing age and greater systolic/diastolic dysfunction. A defect in the inferior versus anterior wall was the most and least common WMA in men (8.0% and 2.5%) and women (3.3% and 1.1%), respectively. Any WMA increased 5-year mortality from 17.5% to 29.7% in men and from 14.9% to 30.8% in women. Known myocardial infarction (hazard ratio [HR], 0.86 [95% CI, 0.800.93]) or revascularization (HR, 0.87 [95% CI, 0.820.92]) was independently associated with a better prognosis, whereas men (1.22-fold increase) and those with greater systolic/diastolic dysfunction had a worse prognosis. Among those with any WMA, apical (HR, 1.08 [95% CI, 1.021.13]) or inferior (HR, 1.09 [95% CI, 1.041.15]) akinesis, dyskinesis or aneurysm, or a wall motion score index >3.0 conveyed the worst prognosis. CONCLUSIONS: In a large real-world clinical cohort, twice as many men as women have a WMA, with inferior WMA the most common. Any WMA confers a poor prognosis, especially inferoapical akinesis/dyskinesis/aneurysm. 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
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Way, Kimberley L.; Thomas, Hannah J.; Parker, Lewan; Maiorana, Andrew John; Keske, Michelle A.; Scott, David S.; Reed, Jennifer L.; Tieng, Jessica; Hackett, Daniel A.; Hawkins, Tess C.; Latella, Christopher; Cordina, Rachael Louise; Tran, Derek L.The integration of resistance training for cardiac patients leads to important health outcomes that are not optimally obtained with aerobic exercise; these include an increase in muscle mass, maintenance of bone mineral density, and improvements in muscular fitness parameters. Despite the proliferation of evidence supporting resistance exercise in recent decades, the implementation of resistance training is underutilised, and prescription is often sub-optimal in cardiac patients. This is frequently associated with safety concerns and inadequate methods of practical exercise prescription. This review discusses the potential application of cluster sets to prescribe interval resistance training in cardiac populations. The addition of planned, regular passive intra-set rest periods (cluster sets) in resistance training (i.e., interval resistance training) may be a practical solution for reducing the magnitude of haemodynamic responses observed with traditional resistance training. This interval resistance training approach may be a more suitable option for cardiac patients. Additionally, many cardiac patients present with impaired exercise tolerance; this model of interval resistance training may be a more suitable option to reduce fatigue, increase patient tolerance and enhance performance to these workloads. Practical strategies to implement interval resistance training for cardiac patients are also discussed. Preliminary evidence suggests that interval resistance training may lead to safer acute haemodynamic responses in cardiac patients. Future research is needed to determine the efficacy and feasibility of interval resistance training for health outcomes in this population. 2023, Springer Nature Switzerland AG.
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Ting, Kaka; Coleman, Paul R.; Kim, Hani Jieun; Zhao, Yang; Mulangala, Jocelyne; Cheng, Nganching; Li, Wan; Gunatilake, Dilini; Johnstone, Daniel M.; Loo, Lipin; Neely, G. Gregory; Yang, Pengyi; Gz, Jgen; Vadas, Mathew Alexander; Gamble, Jennifer R.Alzheimers disease (AD) is an age-related disease, with loss of integrity of the bloodbrain barrier (BBB) being an early feature. Cellular senescence is one of the reported nine hallmarks of aging. Here, we show for the first time the presence of senescent cells in the vasculature in AD patients and mouse models of AD. Senescent endothelial cells and pericytes are present in APP/PS1 transgenic mice but not in wild-type littermates at the time of amyloid deposition. In vitro, senescent endothelial cells display altered VE-cadherin expression and loss of cell junction formation and increased permeability. Consistent with this, senescent endothelial cells in APP/PS1 mice are present at areas of vascular leak that have decreased claudin-5 and VE-cadherin expression confirming BBB breakdown. Furthermore, single cell sequencing of endothelial cells from APP/PS1 transgenic mice confirms that adhesion molecule pathways are among the most highly altered pathways in these cells. At the pre-plaque stage, the vasculature shows significant signs of breakdown, with a general loss of VE-cadherin, leakage within the microcirculation, and obvious pericyte perturbation. Although senescent vascular cells were not directly observed at sites of vascular leak, senescent cells were close to the leak area. Thus, we would suggest in AD that there is a progressive induction of senescence in constituents of the neurovascular unit contributing to an increasing loss of vascular integrity. Targeting the vasculature early in AD, either with senolytics or with drugs that improve the integrity of the BBB may be valid therapeutic strategies. 2023, The Author(s).
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Burger, Pascal M.; Dorresteijn, Johannes A.N.; Fiolet, Aernoud T.L.; Koudstaal, Stefan; Eikelboom, John W.; Nidorf, Stefan Mark; Thompson, Peter Lindsay; Cornel, Jan Hein; Budgeon, Charley A.; Westendorp, Iris C.D.; Beelen, Driek P.W.; Martens, Fabrice M.A.C.; Steg, Philippe Gabriel; Asselbergs, Folkert W.; Cramer, Maarten Jan Maria; Teraa, Martin; Bhatt, Deepak L.; Visseren, Frank L.J.; Mosterd, ArendAims Low-dose colchicine reduces cardiovascular risk in patients with coronary artery disease (CAD), but absolute benefits ma vary between individuals. This study aimed to assess the range of individual absolute benefits from low-dose colchicine ac cording to patient risk profile. Methods and results The European Society of Cardiology (ESC) guidelinerecommended SMART-REACH model was combined with the relative treatment effect of low-dose colchicine and applied to patients with CAD from the Low-Dose Colchicine 2 (LoDoCo2) trial and the Utrecht Cardiovascular Cohort-Second Manifestations of ARTerial disease (UCC-SMART) study (n = 10 830). Individual treatment benefits were expressed as 10-year absolute risk reductions (ARRs) for myocardial infarction, stroke, or cardiovascular death (MACE), and MACE-free life-years gained. Predictions were also performed for MACE plus coronary revascularization (MACE+), using a new lifetime model derived in the REduction of Atherothrombosis for Continued Health (REACH) registry. Colchicine was compared with other ESC guidelinerecommended intensified (Step 2) prevention strategies, i.e. LDL cholesterol (LDL-c) reduction to 1.4 mmol/L and systolic blood pressure (SBP) reduction to 130 mmHg. The generalizability to other populations was assessed in patients with CAD from REACH North America and Western Europe (n = 25 812). The median 10-year ARR from low-dose colchicine was 4.6% [interquartile range (IQR) 3.66.0%] for MACE and 8.6% (IQR 7.69.8%) for MACE+. Lifetime benefit was 2.0 (IQR 1.62.5) MACE-free years, and 3.4 (IQR 2.64.2) MACE+-free life-years gained. For LDL-c and SBP reduction, respectively, the median 10-year ARR for MACE was 3.0% (IQR 1.55.1%) and 1.7% (IQR 0.05.7%), and the lifetime benefit was 1.2 (IQR 0.62.1) and 0.7 (IQR 0.02.3) MACE-free life-years gained. Similar results were obtained for MACE+ and in American and European patients from REACH. Conclusion The absolute benefits of low-dose colchicine vary between individual patients with chronic CAD. They may be expected to be of at least similar magnitude to those of intensified LDL-c and SBP reduction in a majority of patients already on conventional lipid-lowering and blood pressurelowering therapy. The Author(s) 2023.
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Aprahamian, Ivan; Coats, Andrew J.S.; Morley, John Edward; Klompenhouwer, Tatiana; Anker, Stefan D.Background: Anorexia of aging is a common geriatric syndrome that includes loss of appetite and/or reduced food intake, with associated undernutrition, unintended weight loss, sarcopenia, functional decline, loss of independence and other adverse health outcomes. Anorexia of aging can have multiple and severe consequences and is often overlooked by healthcare professionals (HCPs). Even more concerningly, clinicians commonly accept anorexia of aging as an inevitable part of normal aging. The aim of this assessment was to identify current gaps in professional knowledge and practice in identifying and managing older persons with anorexia. Results may guide educational programmes to fill the gaps identified and therefore improve patient outcomes. Methods: This international assessment was conducted using a mixed-methods approach, including focus group interviews with subject matter experts and an electronic survey of practicing HCPs. The assessment was led by the Society on Sarcopenia, Cachexia and Wasting Disorders (SCWD) and was supported by in-country collaborating organizations. Results: A quantitative survey of 26 multiple-choice questions was completed by physicians, dietitians and other HCPs (n=1545). Most HCPs (56.8%) recognize a consistent definition of anorexia of aging as a loss of appetite and/or low food intake. Cognitive changes/dementia (91%) and dysphagia (87%) are seen as the biggest risk factors. Most respondents were confident to give nutritional (62%) and physical activity (59.4%) recommendations and engaged caregivers such as family members in supporting older adults with anorexia (80.6%). Most clinicians assessed appetite at each visit (66.7%), although weight is not measured at every visit (41.5%). Apart from the Mini-Nutritional Assessment Short Form (39%), other tools to screen for appetite loss are not frequently used or no tools are used at all (29.4%). A high number of respondents (38.7%) believe that anorexia is a normal part of aging. Results show that treatment is focused on swallowing disorders (78%), dentition issues (76%) and increasing oral intake (fortified foods [75%] and oral nutritional supplements [74%]). Nevertheless, the lack of high-quality evidence is perceived as a barrier to optimal treatment (49.2%). Conclusions: Findings from this international assessment highlight the challenges in the care of older adults with or at risk for anorexia of aging. Identifying professional practice gaps between individual HCPs and team-based gaps can provide a basis for healthcare education that is addressed at root causes, targeted to specific audiences and developed to improve individual and team practices that contribute to improving patient outcomes. 2023 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by Wiley Periodicals LLC.
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Molloy, Cal D.; Long, Linda; Mordi, Ify R.; Bridges, Charlene; Sagar, Viral; Davies, Edward J.; Coats, Andrew J.S.; Dalal, Hasnain M.; Rees, Karen M.; Singh, Sally J.; Taylor, Rod S.Aims: Despite strong evidence, access to exercise-based cardiac rehabilitation (ExCR) remains low across global healthcare systems. We provide a contemporary update of the Cochrane review randomized trial evidence for ExCR for adults with heart failure (HF) and compare different delivery modes: centre-based, home-based (including digital support), and both (hybrid). Methods and results: Databases, bibliographies of previous systematic reviews and included trials, and trials registers were searched with no language restrictions. Randomized controlled trials, recruiting adults with HF, assigned to either ExCR or a no-exercise control group, with follow-up of ?6 months were included. Two review authors independently screened titles for inclusion, extracted trial and patient characteristics, outcome data, and assessed risk of bias. Outcomes of mortality, hospitalization, and health-related quality of life (HRQoL) were pooled across trials using meta-analysis at short-term (?12 months) and long-term follow-up (>12 months) and stratified by delivery mode. Sixty trials (8728 participants) were included. In the short term, compared to control, ExCR did not impact all-cause mortality (relative risk [RR] 0.93; 95% confidence interval [CI] 0.711.21), reduced all-cause hospitalization (RR 0.69; 95% CI 0.560.86, number needed to treat: 13, 95% CI 922), and was associated with a clinically important improvement in HRQoL measured by the Minnesota Living with Heart Failure Questionnaire (MLWHF) overall score (mean difference: ?7.39; 95% CI ?10.30 to ?4.47). Improvements in outcomes with ExCR was seen across centre, home (including digitally supported), and hybrid settings. A similar pattern of results was seen in the long term (mortality: RR 0.87, 95% CI 0.721.04; all-cause hospitalization: RR 0.84, 95% CI 0.701.01, MLWHF: ?9.59, 95% CI ?17.48 to ?1.50). Conclusions: To improve global suboptimal levels of uptake for HF patients, global healthcare systems need to routinely recommend ExCR and offer a choice of mode of delivery, dependent on an individual patient's level of risk and complexity. 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Lund, Lars H.; Crespo-Leiro, Mar Generosa; Laroche, Cile; Garc-Pinilla, JosManuel; Bennis, Ahmed; Vataman, Eleonora Boris; Polovina, Marija M.; Radovanovi?, Slavica; Apostolovi?, Svetlana R.; Aanin, Milika Risto; Gackowski, Andrzej; Kap?on-Cies?licka, Agnieszka; Cabac-Pogorevici, Irina; Anker, Stefan D.; Chioncel, O. Dragomir; Coats, Andrew J.S.; Filippatos, Gerasimos S.; Lain?ak, Mitja; McDonagh, Theresa A.; Mebazaa, Alexandre; Metra, Marco; PIEPOLI, MASSIMO Francesco; Rosano, Giuseppe Massimo Claudio; Ruschitzka, Frank T.; Savarese, Gianluigi; Seferovic, Petar M.; Iung, Bernard; Popescu, Bogdan Alexandru; Maggioni, Aldo PietroAims: Heart failure outcomes remain poor despite advances in therapy. The European Society of Cardiology Heart Failure III Registry (ESC HF III Registry) aims to characterize HF clinical features and outcomes and to assess implementation of guideline-recommended therapy in Europe and other ESC affiliated countries. Methods: Between 1 November 2018 and 31 December 2020, 10 162 patients with chronic or acute/worsening HF with reduced, mildly reduced, or preserved ejection fraction were enrolled from 220 centres in 41 European or ESC affiliated countries. The ESC HF III Registry collected data on baseline characteristics (hospital or clinic presentation), hospital course, diagnostic and therapeutic decisions in hospital and at the clinic visit; and on outcomes at 12-month follow-up. These data include demographics, medical history, physical examination, biomarkers and imaging, quality of life, treatments, and interventionsincluding drug doses and reasons for non-use, and cause-specific outcomes. Conclusion: The ESC HF III Registry will provide comprehensive and unique insight into contemporary HF characteristics, treatment implementation, and outcomes, and may impact implementation strategies, clinical discovery, trial design, and public policy. 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Vestweber, Dietmar; Claesson-Welsh, Lena; McDonald, Donald M.; Williams, Timothy J.; Alexander Schwartz, Martin Alexander; Scallan, Joshua P.; Gavins, Felicity N.E.; van Buul, Jaap Diederik; Gamble, Jennifer R.; Vadas, Mathew Alexander; Annex, Brian Herb; Mess Steven R.; Perretti, Mauro A.; Andr Helder; Ferrara, Napoleone M.A.; Hla, Timothy T.; Nourshargh, Sussan; Simons, Michael P.[No abstract available]
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Zhao, Yunduo Charles; Zhang, Yingqi; Nasser, Arian; Hong, Tianbo; Wang, Zihao; Sun, Allan; Moldovan, Laura; Edwards, Leon Stephen; Passam, Freda H.; Butcher, Kenneth S.; Ang, Timothy E.; Ju, Lining ArnoldCerebral venous sinus thrombosis (CVST) is a type of stroke associated with COVID-19 vaccine-induced immune thrombotic thrombocytopenia. The precise etiology of CVST often remains elusive due to the highly heterogeneous nature of its governing mechanisms, specifically, Virchow's triad that involves altered blood flow, endothelial dysfunction, and hypercoagulability, which varies substantially amongst individuals. Existing diagnostic and monitoring approaches lack the capability to reflect the combination of these patient-specific thrombotic determinants. In response to this challenge, we introduce a Vein-Chip platform that recapitulates the CVST vascular anatomy from magnetic resonance venography and the associated hemodynamic flow profile using the Chinese Movable Type-like soft stereolithography technique. The resultant full-lumen personalized Vein-Chips, functionalized with endothelial cells, enable in-vitro thrombosis assays that can elucidate distinct thrombogenic scenarios between normal vascular conditions and those of endothelial dysfunction. The former displayed minimal platelet aggregation and negligible fibrin deposition, while the latter presented significant fibrin extrusion from platelet aggregations. The low-cost movable typing technique further enhances the potential for commercialization and broader utilization of personalized Vein-Chips in surgical labs and at-home monitoring. Future research and development in this direction will pave the way for improved management and prevention of CVST, ultimately benefiting both patients and healthcare systems. 2023 The Authors. Aggregate published by SCUT, AIEI, and John Wiley & Sons Australia, Ltd.
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Doehner, Wolfram; Bm, Michael; Boriani, Giuseppe; Christersson, Christina; Coats, Andrew J.S.; Haeusler, Karl Georg; Jones, Ian David; Lip, Gregory Y.H.; Metra, Marco; Ntaios, George C.; Savarese, Gianluigi; Shantsila, Eduard; Vilahur, Gemma; Rosano, Giuseppe Massimo ClaudioHeart failure (HF) is a major disease in our society that often presents with multiple comorbidities with mutual interaction and aggravation. The comorbidity of HF and stroke is a high risk condition that requires particular attention to ensure early detection of complications, efficient diagnostic workup, close monitoring, and consequent treatment of the patient. The bi-directional interaction between the heart and the brain is inherent in the pathophysiology of HF where HF may be causal for acute cerebral injury, andin turnacute cerebral injury may induce or aggravate HF via imbalanced neural and neurovegetative control of cardiovascular regulation. The present document represents the consensus view of the ESC Council on Stroke, the Heart Failure Association and the ESC Working Group on Thrombosis to summarize current insights on pathophysiological interactions of the heart and the brain in the comorbidity of HF and stroke. Principal aspects of diagnostic workup, pathophysiological mechanisms, complications, clinical management in acute conditions and in long-term care of patients with the comorbidity are presented and state-of-the-art clinical management and current evidence from clinical trials is discussed. Beside the physicians perspective, also the patients values and preferences are taken into account. Interdisciplinary cooperation of cardiologists, stroke specialists, other specialists and primary care physicians is pivotal to ensure optimal treatment in acute events and in continued long-term treatment of these patients. Key consensus statements are presented in a concise overview on mechanistic insights, diagnostic workup, prevention and treatment to inform clinical acute and continued care of patients with the comorbidity of HF and stroke. 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Cartland, Si; Stanley, Christopher P.; Bursill, C. A.; Passam, Freda H.; Figtree, Gemma A.; Patel, Sanjay; Loa, Jacky; Golledge, Jonathan; Robinson, David A.; Aitken, Sarah Joy; Kavurma, Mary M.Peripheral artery disease (PAD) is caused by blocked arteries due to atherosclerosis and/or thrombosis which reduce blood flow to the lower limbs. It results in major morbidity, including ischemic limb, claudication, and amputation, with patients also suffering a heightened risk of heart attack, stroke, and death. Recent studies suggest women have a higher prevalence of PAD than men, and with worse outcomes after intervention. In addition to a potential unconscious bias faced by women with PAD in the health system, with underdiagnosis, and lower rates of guideline-based therapy, fundamental biological differences between men and women may be important. In this review, we highlight sexual dimorphisms in endothelial cell functions and how they may impact PAD pathophysiology in women. Understanding sex-specific mechanisms in PAD is essential for the development of new therapies and personalized care for patients with PAD. 2023 by the authors.
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Nundlall, Nishant; Playford, David A.; Strange, G. A.; Davis, Timothy M.E.; Davis, Wendy AngelaAn elevated estimated right ventricular systolic pressure (eRVSP) identified on echocardiography is present in one-third of individuals with type 2 diabetes, but its prognostic significance is unknown. To assess the relationship between eRVSP and mortality, prospective data from 1732 participants in the Fremantle Diabetes Study Phase II were linked with the National Echocardiographic Database of Australia. Of this cohort, 416 (mean age 70.6 years, 47.4% males) had an eRVSP measured and 381 (91.4%) had previously confirmed type 2 diabetes. Receiver- operating characteristic analysis of the relationship between eRVSP and all-cause mortality was conducted. Survival analyses were performed for participants with type 2 diabetes diagnosed before first measured eRVSP (n = 349). Cox regression identified clinical and echocardiographic associates of all-cause mortality. There were 141 deaths (40.4%) during 2348 person-years (mean SD 6.7 4.0 years) of follow-up. In unadjusted KaplanMeier analysis, mortality rose with higher eRVSP (log-rank test, p < 0.001). In unadjusted pairwise comparisons, eRVSP >30 to 35, >35 to 40, and >40 mmHg had significantly increased mortality compared with eRVSP ? 30 mmHg (p = 0.025, p = 0.001, p < 0.001, respectively). There were 50 deaths in 173 individuals (29.1%) with eRVSP ? 30 mmHg, and 91 in 177 (51.4%) with eRVSP > 30 mmHg (log-rank test, p < 0.001). In adjusted models including age, Aboriginal descent, Charlson Comorbidity Index ? 3 and left heart disease, eRVSP > 30 mmHg predicted a two-fold higher all-cause mortality versus ? 30 mmHg. An eRVSP > 30 mmHg predicts increased all-cause mortality in type 2 diabetes. Where available, eRVSP could inform type 2 diabetes outcome models. 2023 by the authors.
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Hong, Jun Ki; Gresham, Isaac J.; Daniel, Dan; Waterhouse, Anna; Neto, ChiaraTethered-liquid perfluorocarbons (TLPs) are a class of liquid-infused surfaces with the ability to reduce blood clot formation (thrombosis) on blood-contacting medical devices. TLP comprises a tethered perfluorocarbon (TP) infused with a liquid perfluorocarbon (LP); this LP must be retained to maintain the antithrombotic properties of the layer. However, the stability of the LP layer remains in question, particularly for medical devices under blood flow. In this study, the lubricant thickness is spatially mapped and quantified in situ through confocal dual-wavelength reflection interference contrast microscopy. TLP coatings prepared on glass substrates are exposed to the flow of 37% glycerol/water mixtures (v/v) or whole blood at a shear strain rate of around 2900 s-1 to mimic physiological conditions (similar to flow conditions found in coronary arteries). Excess lubricant (>2 ?m film thickness) is removed upon commencement of flow. For untreated glass, the lubricant is completely depleted after 1 min of shear flow. However, on optimized TLP surfaces, nanoscale films of lubricants (thickness between 100 nm and 2 ?m) are retained over many tens of minutes of flow. The nanoscale films conform to the underlying structure of the TP layer and are sufficient to prevent the adhesion of red blood cells and platelets. 2023 American Chemical Society.
