Search
Showing 241–260 of 2058 publications.
-
Nadel, James; Giannotti, Nicola; Kong, Stephanie M.Y.; Ugander, Martin; Jabbour, Andrew; Stocker, Roland[No abstract available]
-
Jiang, Fengtao; Zhang, Yingqi; Ju, Lining ArnoldLi and colleagues have made a notable advancement in predicting cancer-associated thrombosis with a microfluidic device that monitors circulating platelet activity.1 This tool could improve the management of thrombotic events in patients with cancer, guiding timely treatment and potentially reducing mortality. 2023 The Author(s)
-
Strange, G. A.; Stewart, S.; Watts, Andrew; Playford, David A.Objective We developed an artificial intelligence decision support algorithm (AI-DSA) that uses routine echocardiographic measurements to identify severe aortic stenosis (AS) phenotypes associated with high mortality. Methods 631 824 individuals with 1.08 million echocardiograms were randomly spilt into two groups. Data from 442 276 individuals (70%) entered a Mixture Density Network (MDN) model to train an AI-DSA to predict an aortic valve area <1 cm 2, excluding all left ventricular outflow tract velocity or dimension measurements and then using the remainder of echocardiographic measurement data. The optimal probability threshold for severe AS detection was identified at the f1 score probability of 0.235. An automated feature also ensured detection of guideline-defined severe AS. The AI-DSA's performance was independently evaluated in 184 301 (30%) individuals. Results The area under receiver operating characteristic curve for the AI-DSA to detect severe AS was 0.986 (95% CI 0.985 to 0.987) with 4622/88 199 (5.2%) individuals (79.011.9 years, 52.4% women) categorised as 'high-probability' severe AS. Of these, 3566 (77.2%) met guideline-defined severe AS. Compared with the AI-derived low-probability AS group (19.2% mortality), the age-adjusted and sex-adjusted OR for actual 5-year mortality was 2.41 (95% CI 2.13 to 2.73) in the high probability AS group (67.9% mortality)-5-year mortality being slightly higher in those with guideline-defined severe AS (69.1% vs 64.4%; age-adjusted and sex-adjusted OR 1.26 (95% CI 1.04 to 1.53), p=0.021). Conclusions An AI-DSA can identify the echocardiographic measurement characteristics of AS associated with poor survival (with not all cases guideline defined). Deployment of this tool in routine clinical practice could improve expedited identification of severe AS cases and more timely referral for therapy. 2023 BMJ Publishing Group. All rights reserved.
-
Jankowska, Ewa Anita; Andersson, Tomas L.G.; Kaiser-Albers, Claudia; Bozkurt, Biykem; Chioncel, O. Dragomir; Coats, Andrew J.S.; Hill, Loreena Michelle; Koehler, Friedrich; Lund, Lars H.; McDonagh, Theresa A.; Metra, Marco; Mittmann, Clemens; Mullens, Wilfried; Siebert, Uwe; Solomon, Scott David; Volterrani, Maurizio; McMurray, John JVAlthough the development of therapies and tools for the improved management of heart failure (HF) continues apace, day-to-day management in clinical practice is often far from ideal. A Cardiovascular Round Table workshop was convened by the European Society of Cardiology (ESC) to identify barriers to the optimal implementation of therapies and guidelines and to consider mitigation strategies to improve patient outcomes in the future. Key challenges identified included the complexity of HF itself and its treatment, financial constraints and the perception of HF treatments as costly, failure to meet the needs of patients, suboptimal outpatient management, and the fragmented nature of healthcare systems. It was discussed that ongoing initiatives may help to address some of these barriers, such as changes incorporated into the 2021 ESC HF guideline, ESC Heart Failure Association quality indicators, quality improvement registries (e.g. EuroHeart), new ESC guidelines for patients, and the universal definition of HF. Additional priority action points discussed to promote further improvements included revised definitions of HF phenotypes based on trial data, the development of implementation strategies, improved affordability, greater regulator/payer involvement, increased patient education, further development of patient-reported outcomes, better incorporation of guidelines into primary care systems, and targeted education for primary care practitioners. Finally, it was concluded that overarching changes are needed to improve current HF care models, such as the development of a standardized pathway, with a common adaptable digital backbone, decision-making support, and data integration, to ensure that the model learns as the management of HF continues to evolve. 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
-
Litwin, Sheldon E.; Komtebedde, Jan; Hu, Mo; Burkhoff, Daniel; Hasenfuss, Gerd; Borlaug, Barry A.; Solomon, Scott David; Zile, Michael R.; Mohan, Rajeev C.; Khawash, Rami; L Sverdlov, Aaron Leonid; Fail, Peter S.; Chung, Eugene S.; Kaye, David M.; Blair, John Edward Abellera; Eicher, Jean Christophe; Hummel, Scott L.; Zirlik, Andreas; Westenfeld, Ralf; Hayward, Christopher S.; Gorter, Thomas M.; Demers, Catherine; Shetty, Ranjith; Lewis, Gregory Dyer; Starling, Randall C.; Patel, Sanjay; Gupta, Deepak K.; Morsli, Hakim; P?ni?ka, Martin; ?ike, Maja; Gustafsson, Finn; Silvestry, Frank E.; Rowin, Ethan J.; Cutlip, Donald E.; Leon, Martin B.; Kitzman, Dalane W.; Kleber, Franz Xaver; Shah, Sanjiv JayendraBackground: Many patients with heart failure and preserved ejection fraction have no overt volume overload and normal resting left atrial (LA) pressure. Objectives: This study sought to characterize patients with normal resting LA pressure (pulmonary capillary wedge pressure [PCWP] <15 mm Hg) but exercise-induced left atrial hypertension (EILAH). Methods: The REDUCE LAP-HF II (A Study to Evaluate the Corvia Medical, Inc. IASD System II to Reduce Elevated Left Atrial Pressure in Patients With Heart Failure) trial randomized 626 patients with ejection fraction ?40% and exercise PCWP ?25 mm Hg to atrial shunt or sham procedure. The primary trial outcome, a hierarchical composite of death, heart failure hospitalization, intensification of diuretics, and change in health status was compared between patients with EILAH and those with heart failure and resting left atrial hypertension (RELAH). Results: Patients with EILAH (29%) had similar symptom severity, but lower natriuretic peptide levels, higher 6-minute walk distance, less atrial fibrillation, lower left ventricular mass, smaller LA volumes, lower E/e?, and better LA strain. PCWP was lower at rest, but had a larger increase with exercise in EILAH. Neither group as a whole had a significant effect from shunt therapy vs sham. Patients with EILAH were more likely to have characteristics associated with atrial shunt responsiveness (peak exercise pulmonary vascular resistance <1.74 WU) and no pacemaker (63% vs 46%; P < 0.001). The win ratio for the primary outcome was 1.56 (P = 0.08) in patients with EILAH and 1.51 (P = 0.04) in those with RELAH when responder characteristics were present. Conclusions: Patients with EILAH had similar symptom severity but less advanced myocardial and pulmonary vascular disease. This important subgroup may be difficult to diagnose without invasive exercise hemodynamics, but it has characteristics associated with favorable response to atrial shunt therapy. (A Study to Evaluate the Corvia Medical, Inc. IASD System II to Reduce Elevated Left Atrial Pressure in Patients With Heart Failure [REDUCE LAP-HF TRIAL II]; NCT03088033) 2023 American College of Cardiology Foundation
-
Anker, Markus S.; Lena, Alessia; Roeland, Eric J.; Porthun, Jan; Schmitz, Sebastian; Hadzibegovic, Sara; Sikorski, Philipp; Wilkenshoff, Ursula M.; Frlich, Ann Kathrin; Ramer, Luisa Valentina; Rose, Matthias; Eucker, Jan; Rassaf, Tienush; Totzeck, Matthias; Lehmann, Lorenz H.; von Haehling, Stephan; Coats, Andrew J.S.; Friede, Tim; Butler, Javed J.; Anker, Stefan D.; Riess, Hanno B.; Landmesser, Ulf E.; Bullinger, Lars B.; Keller, Ulrich Bernd; Ahn, JohannBackground: Maintaining the ability to perform self-care is a critical goal in patients with cancer. We assessed whether the patient-reported ability to walk 4m and wash oneself predict survival in patients with pre-terminal cancer. Methods: We performed a prospective observational study on 169 consecutive hospitalized patients with cancer (52% female, 6412years) and an estimated 112months prognosis at an academic, inpatient palliative care unit. Patients answered functional questions for today, last week, and last month, performed patient-reported outcomes (PROs), and physical function assessments. Results: Ninety-two (54%) patients reported the ability to independently walk 4m and 100 (59%) to wash today. The median number of days patients reported the ability to walk 4m and wash were 6 (IQR 07) and 7 (07) days (last week); and 27 (530) and 26 (1030) days (last month). In the last week, 32% of patients were unable to walk 4m on every day and 10% could walk on 13days; 30% were unable to wash on every day and 10% could wash on 13days. In the last months, 14% of patients were unable to walk 4m on every day and 10% could only walk on 110days; 12% were unable to wash on every day and 11% could wash on 110days. In patients who could walk today average 4m gait speed was 0.780.28m/s. Patients who reported impaired walking and washing experienced more symptoms (dyspnoea, exertion, and oedema) and decreased physical function (higher Eastern Cooperative Oncology Group Performance Status, and lower Karnofsky Performance Status and hand-grip strength [unable vs. able to walk today: 20587 vs. 25278 Newton, P=0.001; unable vs. able to wash today: 20486 vs. 25080 Newton, P=0.001]). During the 27months of observation, 152 (90%) patients died (median survival 46days). In multivariable Cox proportional hazards regression analyses, all tested parameters were independent predictors of survival: walking 4m today (HR 0.63, P=0.015), last week (per 1day: HR 0.93, P=0.011), last month (per 1day: HR 0.98, P=0.012), 4m gait speed (per 1m/s: HR 0.45, P=0.002), and washing today (HR 0.67, P=0.024), last week (per 1 day HR 0.94, p=0.019), and last month (per 1day HR 0.99, P=0.040). Patients unable to walk and wash experienced the shortest survival and most reduced functional status. Conclusions: In patients with pre-terminal cancer, the self-reported ability to walk 4m and wash were independent predictors of survival and associated with decreased functional status. 2023 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.
-
Musella, Francesca; Rosano, Giuseppe Massimo Claudio; Hage, Camilla; Benson, Lina; Guidetti, Federica; Moura, Brenda; Sibilio, Gerolamo; Boccalatte, Marco; Dahlstrom?, Ulf; Coats, Andrew J.S.; Lund, Lars H.; Savarese, GianluigiAims: The Heart Failure Association of the European Society of Cardiology has recently proposed to optimize guideline-directed medical treatments according to patient's profiles. The aim of this analysis was to investigate prevalence/characteristics/treatments/outcomes for individual profiles. Methods and results: Patients with heart failure (HF) with reduced ejection fraction (HFrEF) enrolled in the Swedish Heart Failure Registry (SwedeHF) between 2013 and 2021 were considered. Among 108 profiles generated by combining different strata of renal function (by estimated glomerular filtration rate [eGFR]), systolic blood pressure (sBP), heart rate, atrial fibrillation (AF) status and presence of hyperkalaemia, 93 were identified in our cohort. Event rates for a composite of cardiovascular (CV) mortality or first HF hospitalization were calculated for each profile. The nine most frequent profiles accounting for 70.5% of the population had eGFR 3060 or ?60 ml/min/1.73 m2, sBP 90140 mmHg and no hyperkalaemia. Heart rate and AF were evenly distributed. The highest risk of CV mortality/first HF hospitalization was observed in those with concomitant eGFR 3060 ml/min/1.73 m2 and AF. We also identified nine profiles with the highest event rates, representing only 5% of the study population, characterized by no hyperkalaemia, even distribution among the sBP strata, predominance of eGFR <30 ml/min/1.73 m2 and AF. The three profiles with eGFR 3060 ml/min/1.73 m2 also showed sBP <90 mmHg. Conclusions: In a real-world cohort, most patients fit in a few easily identifiable profiles; the nine profiles at highest risk of mortality/morbidity accounted for only 5% of the population. Our data might contribute to identifying profile-tailored approaches to guide drug implementation and follow-up. 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
-
Hadzibegovic, Sara; Porthun, Jan; Lena, Alessia; Weinlder, Pia; Lk, Laura Carina; Potthoff, Sophia K.; Rnick, Lukas; Frlich, Ann Kathrin; Ramer, Luisa Valentina; Sonntag, Frederike; Wilkenshoff, Ursula M.; Ahn, Johann; Keller, Ulrich Bernd; Bullinger, Lars B.; Mahabadi, Amir Abbas; Totzeck, Matthias; Rassaf, Tienush; von Haehling, Stephan; Coats, Andrew J.S.; Anker, Stefan D.; Roeland, Eric J.; Landmesser, Ulf E.; Anker, Markus S.Background: Hand grip strength (HGS) is a widely used functional test for the assessment of strength and functional status in patients with cancer, in particular with cancer cachexia. The aim was to prospectively evaluate the prognostic value of HGS in patients with mostly advanced cancer with and without cachexia and to establish reference values for a European-based population. Methods: In this prospective study, 333 patients with cancer (85% stage III/IV) and 65 healthy controls of similar age and sex were enrolled. None of the study participants had significant cardiovascular disease or active infection at baseline. Repetitive HGS assessment was performed using a hand dynamometer to measure the maximal HGS (kilograms). Presence of cancer cachexia was defined when patients had ?5% weight loss within 6months or when body mass index was <20.0kg/m2 with ?2% weight loss (Fearon's criteria). Cox proportional hazard analyses were performed to assess the relationship of maximal HGS to all-cause mortality and to determine cut-offs for HGS with the best predictive power. We also assessed associations with additional relevant clinical and functional outcome measures at baseline, including anthropometric measures, physical function (Karnofsky Performance Status and Eastern Cooperative of Oncology Group), physical activity (4-m gait speed test and 6-min walk test), patient-reported outcomes (EQ-5D-5L and Visual Analogue Scale appetite/pain) and nutrition status (Mini Nutritional Assessment). Results: The mean age was 6014years; 163 (51%) were female, and 148 (44%) had cachexia at baseline. Patients with cancer showed 18% lower HGS than healthy controls (31.211.9 vs. 37.911.6kg, P<0.001). Patients with cancer cachexia had 16% lower HGS than those without cachexia (28.310.1 vs. 33.612.3kg, P<0.001). Patients with cancer were followed for a mean of 17months (range 650), and 182 (55%) patients died during follow-up (2-year mortality rate 53%) (95% confidence interval 4859%). Reduced maximal HGS was associated with increased mortality (per ?5kg; hazard ratio [HR] 1.19; 1.101.28; P<0.0001; independently of age, sex, cancer stage, cancer entity and presence of cachexia). HGS was also a predictor of mortality in patients with cachexia (per ?5kg; HR 1.20; 1.081.33; P=0.001) and without cachexia (per ?5kg; HR 1.18; 1.041.34; P=0.010). The cut-off for maximal HGS with the best predictive power for poor survival was <25.1kg for females (sensitivity 54%, specificity 63%) and <40.2kg for males (sensitivity 69%, specificity 68%). Conclusions: Reduced maximal HGS was associated with higher all-cause mortality, reduced overall functional status and decreased physical performance in patients with mostly advanced cancer. Similar results were found for patients with and without cancer cachexia. 2023 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.
-
Docherty, Kieran F.; Lam, Carolyn Su Ping; Rakisheva, Amina G.; Coats, Andrew J.S.; Greenhalgh, Trisha; Metra, Marco; Petrie, Mark Colquhoun; Rosano, Giuseppe Massimo ClaudioA significant proportion of patients experience delays in the diagnosis of heart failure due to the non-specific signs and symptoms of the syndrome. Diagnostic tools such as measurement of natriuretic peptide concentrations are fundamentally important when screening for heart failure, yet are frequently under-utilized. This clinical consensus statement provides a diagnostic framework for general practitioners and non-cardiology community-based physicians to recognize, investigate and risk-stratify patients presenting in the community with possible heart failure. 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
-
Moldovan, Laura; Song, Caroline Haoran; Chen, Yiyao Catherine; Wang, Haoqing Jerry; Ju, Lining ArnoldMechanical forces play a vital role in biological processes at molecular and cellular levels, significantly impacting various diseases such as cancer, cardiovascular disease, and COVID-19. Recent advancements in dynamic force spectroscopy (DFS) techniques have enabled the application and measurement of forces and displacements with high resolutions, providing crucial insights into the mechanical pathways underlying these diseases. Among DFS techniques, the biomembrane force probe (BFP) stands out for its ability to measure bond kinetics and cellular mechanosensing with pico-newton and nano-meter resolutions. Here, a comprehensive overview of the classical BFP-DFS setup is presented and key advancements are emphasized, including the development of dual biomembrane force probe (dBFP) and fluorescence biomembrane force probe (fBFP). BFP-DFS allows us to investigate dynamic bond behaviors on living cells and significantly enhances the understanding of specific ligand-receptor axes mediated cell mechanosensing. The contributions of BFP-DFS to the fields of cancer biology, thrombosis, and inflammation are delved into, exploring its potential to elucidate novel therapeutic discoveries. Furthermore, future BFP upgrades aimed at improving output and feasibility are anticipated, emphasizing its growing importance in the field of cell mechanobiology. Although BFP-DFS remains a niche research modality, its impact on the expanding field of cell mechanobiology is immense. 2023 The Authors. Exploration published by Henan University and John Wiley & Sons Australia, Ltd.
-
Adamopoulos, Stamatis N.; Miliopoulos, Dimitrios; Piotrowicz, Ewa; Snoek, Johan Aernout; Panagopoulou, Niki; Nanas, Serafim N.; Niederseer, David; Mazaheri, Reza; Ma, Jing; Chen, Yundai; Popovi?, Dejana R.; Seferovi?, Petar M.; Girola, Davide; Corr Ugo; Coats, Andrew J.S.; Metra, Marco; Rosano, Giuseppe Massimo Claudio; Volterrani, Maurizio; Apostolo, Anna; Campodonico, Jeness; Salvioni, Elisabetta; Agostoni, Piergiuseppe; PIEPOLI, MASSIMO FrancescoAims: Current European heart failure (HF) guidelines suggest the use of risk score: Among them, the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score has demonstrated to be one of the most accurate. However, the risk scores are still poorly implemented in clinical practice, also due to the lack of strong evidence regarding their external validation in different populations. Thus, the current study was designed as an external validation test of the MECKI score in an international multicentre setting. Methods and results: The study cohort consisted of patients diagnosed with HF with reduced ejection fraction (HFrEF) across international centres (not Italian), retrospectively recruited. Collected data included demographics, HF aetiology, laboratory testing, electrocardiogram (ECG), echocardiographic findings, and cardiopulmonary exercise testing (CPET) results as described in the original MECKI score publication. A total of 1042 patients across 8 international centres (7 European and 1 Asian) were included and followed up from 1998 till 2019. Patients were divided according to the calculated MECKI scores into three subgroups: (i) MECKI score <10%, (ii) 10-20%, and (iii) ? 20%. Survival analysis comparison among the three MECKI score subgroups showed a worse prognosis in patients with higher MECKI score value: median event-free survival times were 4396 days for MECKI score <10%, 3457 days for 10-20%, and 1022 days for ?20% (P < 0.0001). Receiver operating characteristic (ROC) curves and area under the ROC curves (AUC) were like those reported in the original internal validation studies. Conclusion: In patients diagnosed with HFrEF, the power of the MECKI score was confirmed in terms of prognosis and risk stratification, supporting its implementation as advised by the HF guidelines. 2023 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology.
-
Ratwatte, Seshika D.; Stewart, S.; Strange, G. A.; Playford, David A.; Celermajer, David S.Objective The significance of pulmonary hypertension (PHT) complicating aortic stenosis (AS) is poorly characterised. In a large cohort of adults with at least moderate AS, we aimed to describe the prevalence and prognostic importance of PHT in such patients. Methods In this retrospective study, we analysed the National Echocardiography Database of Australia (data from 2000 to 2019). Adults with an estimated right ventricular systolic pressure (eRVSP), left ventricular ejection fraction (LVEF) >50% and with moderate or greater AS were included (n=14 980). These subjects were then categorised according to their eRVSP. The relationship between PHT severity and mortality outcomes were evaluated (median follow-up of 2.6 years, IQR 1.0-4.6 years). Results Subjects were aged 7713 years and 57.4% were female. Overall, 2049 (13.7%), 5085 (33.9%), 4380 (29.3%), 1956 (13.1%) and 1510 (10.1%) patients had no (eRVSP<30.00 mm Hg), borderline (30.00-39.99 mm Hg), mild (40.00-49.99 mm Hg), moderate (50.00-59.99 mm Hg) and severe PHT (>60.00 mm Hg), respectively. An echocardiographic phenotype was evident with worsening PHT, showing rising E:e' ratio and right and left atrial sizes(p<0.0001, for all). Adjusted analyses showed that the risk of long-term mortality progressively rose as eRVSP level increased (HR 1.14-2.94, borderline to severe PHT, p<0.0001 for all). A mortality threshold was identified in the 4th decile of eRVSP categories (35.01-38.00 mm Hg; HR 1.19, 95% CI 1.04 to 1.35), with risk progressively increasing through to the 10th decile (HR 2.86, 95% CI 2.54 to 3.21). Conclusions In this large cohort study, we find that PHT is common in ?moderate AS and mortality increases as PHT becomes more severe. A threshold for higher mortality lies within the range of borderline-mild' PHT. Trial registration number ACTRN12617001387314. 2023 BMJ Publishing Group. All rights reserved.
-
Ratwatte, Seshika D.; Playford, David A.; Stewart, S.; Strange, G. A.; Celermajer, David S.Objective Aortic regurgitation (AR) can lead to pulmonary hypertension (PHT). There is a paucity of data on the prognostic importance of PHT in these patients. We therefore aimed to describe the prevalence and prognostic importance of PHT in such patients. Methods In this retrospective study, we analysed the National Echocardiography Database of Australia (data from 2000 to 2019). Adults with an estimated right ventricular systolic pressure (eRVSP), left ventricular ejection fraction (LVEF) >50% and with moderate or greater AR were included (n=8392). These subjects were then categorised according to their eRVSP. The relationship between PHT severity and mortality outcomes were evaluated (median follow-up of 3.1 years, IQR 1.5-5.7 years). Results Subjects were aged 7414 years and 58.4% (4901) were female. Overall, 1417 (16.9%) had no PHT, and 3253 (38.8%), 2249 (26.9%), 893 (10.6%) and 580 (6.9%) patients had borderline, mild, moderate and severe PHT, respectively. Mean eRVSP was slightly higher in females than males (4113 vs 3912 mm Hg, p<0.0001) and increased with age in both sexes. After adjustment for age and sex, the risk of long-term mortality increased as eRVSP increased (adjusted HR (aHR) 1.20, 95% CI 1.06 to 1.36 in borderline PHT, to aHR 3.32, 95% CI 2.85 to 3.86 in severe PHT, p<0.0001). There was a mortality threshold seen from mild PHT onwards (eRVSP 41.36-44.15 mm Hg; aHR 1.41, 95%CI 1.17 to 1.68). Conclusions In this large cohort study, we characterise the relationship between AR and PHT in adults. In patients with ?moderate AR, PHT is associated with a progressive risk of mortality, even at mildly elevated levels. 2023 BMJ Publishing Group. All rights reserved.
-
Riccardi, Mauro; Sammartino, Antonio Maria; Adamo, Marianna; Inciardi, Riccardo M.; Lombardi, Carlo Mario; Pugliese, Nicola Riccardo; Tomasoni, Daniela; Vizzardi, Enrico; Metra, Marco; Coats, Andrew J.S.; Pagnesi, MatteoHeart failure (HF) with preserved ejection fraction (HFpEF) causes a progressive limitation of functional capacity, poor quality of life (QoL) and increased mortality, yet unlike HF with reduced ejection fraction (HFrEF) there are no effective device-based therapies. Both HFrEF and HFpEF are associated with dysregulations in myocardial cellular calcium homeostasis and modifications in calcium-handling proteins, leading to abnormal myocardial contractility and pathological remodelling. Cardiac contractility modulation (CCM) therapy, based on a pacemaker-like implanted device, applies extracellular electrical stimulation to myocytes during the absolute refractory period of the action potential, which leads to an increase in cytosolic peak calcium concentrations and thereby the force of isometric contraction promoting positive inotropism. Subgroup analysis of CCM trials in HFrEF has demonstrated particular benefits in patients with LVEF between 35% and 45%, suggesting its potential effectiveness also in patients with higher LVEF values. Available evidence on CCM in HFpEF is still preliminary, but improvements in terms of symptoms and QoL have been observed. Future large, dedicated, prospective studies are needed to evaluate the safety and efficacy of this therapy in patients with HFpEF. 2023, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
-
Kap?on-Cies?licka, Agnieszka; Benson, Lina; Chioncel, O. Dragomir; Crespo-Leiro, Mar Generosa; Coats, Andrew J.S.; Anker, Stefan D.; Ruschitzka, Frank T.; Hage, Camilla; Dro?d?, Jaroslaw; Seferovi?, Petar M.; Rosano, Giuseppe Massimo Claudio; PIEPOLI, MASSIMO Francesco; Mebazaa, Alexandre; McDonagh, Theresa A.; Lain?ak, Mitja; Savarese, Gianluigi; Ferrari, Roberto; Mullens, Wilfried; Bay-Gen, Antoni; Maggioni, Aldo Pietro; Lund, Lars H.Aims: To comprehensively assess hyponatraemia in acute heart failure (AHF) regarding prevalence, associations, hospital course, and post-discharge outcomes. Methods and results: Of 8298 patients in the European Society of Cardiology Heart Failure Long-Term Registry hospitalized for AHF with any ejection fraction, 20% presented with hyponatraemia (serum sodium <135 mmol/L). Independent predictors included lower systolic blood pressure, estimated glomerular filtration rate (eGFR) and haemoglobin, along with diabetes, hepatic disease, use of thiazide diuretics, mineralocorticoid receptor antagonists, digoxin, higher doses of loop diuretics, and non-use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and beta-blockers. In-hospital death occurred in 3.3%. The prevalence of hyponatraemia and in-hospital mortality with different combinations were: 9% hyponatraemia both at admission and discharge (hyponatraemia Yes/Yes, in-hospital mortality 6.9%), 11% Yes/No (in-hospital mortality 4.9%), 8% No/Yes (in-hospital mortality 4.7%), and 72% No/No (in-hospital mortality 2.4%). Correction of hyponatraemia was associated with improvement in eGFR. In-hospital development of hyponatraemia was associated with greater diuretic use and worsening eGFR but also more effective decongestion. Among hospital survivors, 12-month mortality was 19% and adjusted hazard ratios (95% confidence intervals) were for hyponatraemia Yes/Yes 1.60 (1.351.89), Yes/No 1.35 (1.141.59), and No/Yes 1.18 (0.961.45). For death or heart failure hospitalization they were 1.38 (1.211.58), 1.17 (1.021.33), and 1.09 (0.931.27), respectively. Conclusion: Among patients with AHF, 20% had hyponatraemia at admission, which was associated with more advanced heart failure and normalized in half of patients during hospitalization. Admission hyponatraemia (possibly dilutional), especially if it did not resolve, was associated with worse in-hospital and post-discharge outcomes. Hyponatraemia developing during hospitalization (possibly depletional) was associated with lower risk. 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
-
Snir, Afik D.; Ng, Martin K.C.; Strange, G. A.; Playford, David A.; Stewart, S.; Celermajer, David S.Approximately 50% of patients with severe aortic stenosis (AS) in clinical practice present with low-gradient haemodynamics. Stroke Volume Index (SVI) is a measure of left ventricular output, with normal-flow considered as > 35ml/m2. The association between SVI and prognosis in severe low-gradient AS (LGAS) in currently not well-understood. We analysed the National Echo Database of Australia (NEDA) and identified 109,990 patients with sufficiently comprehensive echocardiographic data, linked to survival information. We identified 1,699 with severe LGAS and preserved ejection fraction (EF) (? 50%) and 774 with severe LGAS and reduced EF. One- and three-year survival in each subgroup were assessed (follow-up of 74 43months), according to SVI thresholds. In patients with preserved EF the mortality threshold was at SVI < 30ml/m2; 1- and 3-year survival was worse for those with SVI < 30ml/m2 relative to those with SVI > 35ml/m2 (HR 1.80, 95% CI 1.322.47 and HR 1.38, 95% CI 1.121.70), while survival was similar between those with SVI 3035ml/m2 and SVI > 35ml/m2. In patients with reduced EF the mortality threshold was 35ml/m2; 1- and 3-year survival was worse for both those with SVI < 30ml/m2 and 3035ml/m2 relative to those with SVI > 35ml/m2 (HR 1.98, 95% CI 1.273.09 and HR 1.41, 95% CI 1.051.93 for SVI < 30ml/m2 and HR 2.02, 95% CI 1.233.31 and HR 1.56, 95% CI 1.102.21 for SVI 3035ml/m2). The SVI prognostic threshold for medium-term mortality in severe LGAS patients is different for those with preserved LVEF (< 30ml/m2) compared to those with reduced LVEF (< 35ml/m2). 2023, The Author(s).
-
Zhang, Yingqi; Jiang, Fengtao; Zhao, Yunduo Charles; Cho, Ann-Na; Fang, Guocheng; Cox, Charles David; Zreiqat, Hala H.; Lu, Zufu; Lu, Hongxu; Ju, Lining ArnoldDuring the final stage of cancer metastasis, tumor cells embed themselves in distant capillary beds, from where they extravasate and establish secondary tumors. Recent findings underscore the pivotal roles of blood/lymphatic flow and shear stress in this intricate tumor extravasation process. Despite the increasing evidence, there is a dearth of systematic and biomechanical methodologies that accurately mimic intricate 3D microtissue interactions within a controlled hydrodynamic microenvironment. Addressing this gap, we introduce an easy-to-operate 3D spheroid-microvasculature-on-a-chip (SMAC) model. Operating under both static and regulated flow conditions, the SMAC model facilitates the replication of the biomechanical interplay between heterogeneous tumor spheroids and endothelium in a quantitative manner. Serving as an in vitro model for metastasis mechanobiology, our model unveils the phenomena of 3D spheroid-induced endothelial compression and cell-cell junction degradation during tumor migration and expansion. Furthermore, we investigated the influence of shear stress on endothelial orientation, polarization, and tumor spheroid expansion. Collectively, our SMAC model provides a compact, cost-efficient, and adaptable platform for probing the mechanobiology of metastasis. 2023 The Author(s). Published by IOP Publishing Ltd.
-
Chioncel, O. Dragomir; Benson, Lina; Crespo-Leiro, Mar Generosa; Anker, Stefan D.; Coats, Andrew J.S.; Filippatos, Gerasimos S.; McDonagh, Theresa A.; Margineanu, Cornelia; Mebazaa, Alexandre; Metra, Marco; PIEPOLI, MASSIMO Francesco; Adamo, Marianna; Rosano, Giuseppe Massimo Claudio; Ruschitzka, Frank T.; Savarese, Gianluigi; Seferovic, Petar M.; Volterrani, Maurizio; Ferrari, Roberto; Maggioni, Aldo Pietro; Lund, Lars H.Aims: To evaluate the prevalence and associations of non-cardiac comorbidities (NCCs) with in-hospital and post-discharge outcomes in acute heart failure (AHF) across the ejection fraction (EF) spectrum. Methods and results: The 9326 AHF patients from European Society of Cardiology (ESC)-Heart Failure Association (HFA)-EURObservational Research Programme Heart Failure Long-Term Registry had complete information for the following 12 NCCs: Anaemia, chronic obstructive pulmonary disease (COPD), diabetes, depression, hepatic dysfunction, renal dysfunction, malignancy, Parkinson's disease, peripheral vascular disease (PVD), rheumatoid arthritis, sleep apnoea, and stroke/transient ischaemic attack (TIA). Patients were classified by number of NCCs (0, 1, 2, 3, and ?4). Of the AHF patients, 20.5% had no NCC, 28.5% had 1 NCC, 23.1% had 2 NCC, 15.4% had 3 NCC, and 12.5% had ?4 NCC. In-hospital and post-discharge mortality increased with number of NCCs from 3.0% and 18.5% for 1 NCC to 12.5% and 36% for ?4 NCCs. Anaemia, COPD, PVD, sleep apnoea, rheumatoid arthritis, stroke/TIA, Parkinson, and depression were more prevalent in HF with preserved EF (HFpEF). The hazard ratio (95% confidence interval) for post-discharge death for each NCC was for anaemia 1.6 (1.4-1.8), diabetes 1.2 (1.1-1.4), kidney dysfunction 1.7 (1.5-1.9), COPD 1.4 (1.2-1.5), PVD 1.2 (1.1-1.4), stroke/TIA 1.3 (1.1-1.5), depression 1.2 (1.0-1.5), hepatic dysfunction 2.1 (1.8-2.5), malignancy 1.5 (1.2-1.8), sleep apnoea 1.2 (0.9-1.7), rheumatoid arthritis 1.5 (1.1-2.1), and Parkinson 1.4 (0.9-2.1). Anaemia, kidney dysfunction, COPD, and diabetes were associated with post-discharge mortality in all EF categories, PVD, stroke/TIA, and depression only in HF with reduced EF, and sleep apnoea and malignancy only in HFpEF. Conclusion: Multiple NCCs conferred poor in-hospital and post-discharge outcomes. Ejection fraction categories had different prevalence and risk profile associated with individual NCCs. 2023 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved.
-
Moura, Brenda; Aimo, Alberto; Al-Mohammad, Abdallah A.; Keramida, Kalliopi; Ben-Gal, Tuvia; Dorbala, Sharmila; Todiere, Giancarlo; Cameli, Matteo; Barison, Andrea; Bay-Gen, Antoni; von Bardeleben, Ralph Stephan; Bucciarelli-Ducci, Chiara; Delgado, Victoria; Mordi, Ify R.; Seferovi?, Petar M.; Savarese, Gianluigi; ?elutkiene, Jelena; Rapezzi, Claudio; Emdin, Michele; Coats, Andrew J.S.; Metra, Marco; Rosano, Giuseppe Massimo ClaudioLeft ventricular (LV) hypertrophy consists in an increased LV wall thickness. LV hypertrophy can be either secondary, in response to pressure or volume overload, or primary, i.e. not explained solely by abnormal loading conditions. Primary LV hypertrophy may be due to gene mutations or to the deposition or storage of abnormal substances in the extracellular spaces or within the cardiomyocytes (more appropriately defined as pseudohypertrophy). LV hypertrophy is often a precursor to subsequent development of heart failure. Cardiovascular imaging plays a key role in the assessment of LV hypertrophy. Echocardiography, the first-line imaging technique, allows a comprehensive assessment of LV systolic and diastolic function. Cardiovascular magnetic resonance provides added value as it measures accurately LV and right ventricular volumes and mass and characterizes myocardial tissue properties, which may provide important clues to the final diagnosis. Additionally, scintigraphy with bone tracers is included in the diagnostic algorithm of cardiac amyloidosis. Once the diagnosis is established, imaging findings may help predict future disease evolution and inform therapy and follow-up. This consensus document by the Heart Failure Association of the European Society of Cardiology provides an overview of the role of different cardiac imaging techniques for the differential diagnosis and management of patients with LV hypertrophy. 2023 European Society of Cardiology.
-
Stewart, S.; Chan, Yih Kai; Playford, David A.; Harris, Sarah Ann; Strange, G. A.Background We addressed the paucity of data describing the characteristics and natural history of incident pulmonary hypertension. Methods Adults (n=13 448) undergoing routine echocardiography without initial evidence of pulmonary hypertension (estimated right ventricular systolic pressure, eRVSP <30.0 mmHg) or left heart disease were studied. Incident pulmonary hypertension (eRVSP ?30.0 mmHg) was detected on repeat echocardiogram a median of 4.1 years apart. Mortality was examined according to increasing eRVSP levels (30.039.9, 40.049.9 and ?50.0 mmHg) indicative of mild-to-severe pulmonary hypertension. Results A total of 6169 men (45.9%, aged 61.416.7 years) and 7279 women (60.816.9 years) without evidence of pulmonary hypertension were identified (first echocardiogram). Subsequently, 5412 (40.2%) developed evidence of pulmonary hypertension, comprising 4125 (30.7%), 928 (6.9%) and 359 (2.7%) cases with an eRVSP of 30.039.9 mmHg, 40.049.9 mmHg and ?50.0 mmHg, respectively (incidence 94.0 and 90.9 cases per 1000 men and women, respectively, per year). Median (interquartile range) eRVSP increased by +0.0 (?2.27 to +2.67) mmHg and +30.68 (+26.03 to +37.31) mmHg among those with eRVSP <30.0 mmHg versus ?50.0 mmHg. During a median 8.1 years of follow-up, 2776 (20.6%) died from all causes. Compared to those with eRVSP <30.0 mmHg, the adjusted risk of all-cause mortality was 1.30-fold higher in 30.039.9 mmHg, 1.82-fold higher in 40.049.9 mmHg and 2.11-fold higher in ?50.0 mmHg groups (all p<0.001). Conclusions New-onset pulmonary hypertension, as indicated by elevated eRVSP, is a common finding among older patients without left heart disease followed-up with echocardiography. This phenomenon is associated with an increased morality risk even among those with mildly elevated eRVSP. The authors 2023.
