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Frontiers in Cardiovascular Medicine
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This is an Open Access Journal

Open Access journal
ISSN (Online) 2297-055X
Published by Frontiers Media

[86 journals]

The Longitudinal Association Between Cardiovascular Risk and Cognitive
Function in Middle-Aged and Older Adults in China: A Nationally
Representative Cohort Study
- Authors: Wei Hua, Jianhua Hou, Taiyi Jiang, Bin Su, Jiangning Fu, Runsong Sun, Biru Chang, Wei Xia, Hao Wu, Tong Zhang, Caiping Guo, Wen Wang
  Abstract: Objective: China has the largest population living with dementia, causing a tremendous burden on the aging society. Cardiovascular disease (CVD) may trigger a cascade of pathologies associated with cognitive aging. We aim to investigate the association between cardiovascular risk (CVR) factors and cognitive function in the nationally representative cohort in China.Methods: Participants were recruited from 150 counties in 28 provinces via a four-stage sampling method. The outcomes included several cognitive tasks. The independent variable was a composite score of cardiovascular risk calculated from sex-specific equations. We fitted the time-lagged regression to model the association between CVR and cognition. Besides, we performed cross-group analyses to test for model invariance across sex and age. We thus constrained path coefficients to be equal across each grouping variable (e.g., sex) and compared the fit of this constrained model with an unconstrained model in which the path coefficients were allowed to vary by group.Results: A total of 3,799 participants were included in the final analyses. We found that the CVR had a negative linear association with global cognition (β = −0.1, p < 0.01). Additionally, CVR had inverse linear associations with domain-specific measurements of memory and learning, calculation, orientation, and visual–spatial ability (all values of p < 0.01). Regarding sex and age moderation, males had a more pronounced association between higher CVR and worse general cognition, immediate recall, orientation, calculation, and visual–spatial ability (all values of p < 0.0001). In contrast, females exhibited a slightly larger negative association in delayed recall. Older participants (>65 years old) had a more pronounced association between higher CVR and worse calculation ability (p = 0.003).Conclusion: CVD are risk factors for lower global cognition and cognitive subdomains in middle-aged and older adults in China.
  PubDate: 2020-10-19T00:00:00Z
Commentary: Studies in Zebrafish Demonstrate That CNNM2 and NT5C2 Are Most
Likely the Causal Genes at the Blood Pressure-Associated Locus on Human
Chromosome 10q24.32
- Authors: Daniela Sorriento, Guido Iaccarino
  PubDate: 2020-10-19T00:00:00Z
The Role of microRNAs in Heart Failure: A Systematic Review
- Authors: Ana Peterlin, Karolina Počivavšek, Danijel Petrovič, Borut Peterlin
  Abstract: MicroRNAs are highly investigated for their role in the pathogenesis of cardiovascular diseases. Nevertheless, evidence for clinical implementation is still lacking. In our systematic review, we evaluated the potential of microRNAs as pathophysiological and diagnostic biomarkers of heart failure. We identified 72 differentially expressed microRNA molecules among groups of heart failure patients and control groups by searching the PubMed database. We did not identify a substantial overlap of differentially expressed microRNAs among different studies; only five microRNAs (miR-1228, miR-122, miR-423-5p, miR-142-3p, and exosomal miR-92b-5p) were differentially expressed in more than one included study. Gene set enrichment analysis, based on the gene targets of microRNAs presented in the included studies, showed that gene targets of differentially expressed microRNAs were enriched in the MAPK, TGFβ, PI3K-Akt, and IL-2 signaling pathways, as well as apoptosis pathway, p53 activity regulation, and angiogenesis pathway. Results of our systematic review show that there is currently insufficient support for the use of any of the presented microRNAs as pathophysiological or prognostic biomarkers in the clinical setting.
  PubDate: 2020-10-15T00:00:00Z
Engineering Myocardium for Heart Regeneration—Advancements,
Considerations, and Future Directions
- Authors: Dillon K. Jarrell, Ethan J. Vanderslice, Mitchell C. VeDepo, Jeffrey G. Jacot
  Abstract: Heart disease is the leading cause of death in the United States among both adults and infants. In adults, 5-year survival after a heart attack is
  PubDate: 2020-10-15T00:00:00Z
Editorial: Hypertension During Pregnancy and Future Risk of Cardiovascular
and Other Long-Term Health Outcomes
- Authors: Amanda Henry, Dexter Canoy
  PubDate: 2020-10-15T00:00:00Z
Cellular Protein Quality Control in Diabetic Cardiomyopathy: From Bench to
Bedside
- Authors: Namrita Kaur, Rida Raja, Andrea Ruiz-Velasco, Wei Liu
  Abstract: Heart failure is a serious comorbidity and the most common cause of mortality in diabetes patients. Diabetic cardiomyopathy (DCM) features impaired cellular structure and function, culminating in heart failure; however, there is a dearth of specific clinical therapy for treating DCM. Protein homeostasis is pivotal for the maintenance of cellular viability under physiological and pathological conditions, particularly in the irreplaceable cardiomyocytes; therefore, it is tightly regulated by a protein quality control (PQC) system. Three evolutionarily conserved molecular processes, the unfolded protein response (UPR), the ubiquitin-proteasome system (UPS), and autophagy, enhance protein turnover and preserve protein homeostasis by suppressing protein translation, degrading misfolded or unfolded proteins in cytosol or organelles, disposing of damaged and toxic proteins, recycling essential amino acids, and eliminating insoluble protein aggregates. In response to increased cellular protein demand under pathological insults, including the diabetic condition, a coordinated PQC system retains cardiac protein homeostasis and heart performance, on the contrary, inappropriate PQC function exaggerates cardiac proteotoxicity with subsequent heart dysfunction. Further investigation of the PQC mechanisms in diabetes propels a more comprehensive understanding of the molecular pathogenesis of DCM and opens new prospective treatment strategies for heart disease and heart failure in diabetes patients. In this review, the function and regulation of cardiac PQC machinery in diabetes mellitus, and the therapeutic potential for the diabetic heart are discussed.
  PubDate: 2020-10-15T00:00:00Z
Optically Generated Ultrasound for Intracoronary Imaging
- Authors: Callum D. Little, Richard J. Colchester, Sacha Noimark, Gavin Manmathan, Malcolm C. Finlay, Adrien E. Desjardins, Roby D. Rakhit
  Abstract: Conventional intravascular ultrasound (IVUS) devices use piezoelectric transducers to electrically generate and receive US. With this paradigm, there are numerous challenges that restrict improvements in image quality. First, with miniaturization of the transducers to reduce device size, it can be challenging to achieve the sensitivities and bandwidths required for large tissue penetration depths and high spatial resolution. Second, complexities associated with manufacturing miniaturized electronic transducers can have significant cost implications. Third, with increasing interest in molecular characterization of tissue in-vivo, it has been challenging to incorporate optical elements for multimodality imaging with photoacoustics (PA) or near-infrared spectroscopy (NIRS) whilst maintaining the lateral dimensions suitable for intracoronary imaging. Optical Ultrasound (OpUS) is a new paradigm for intracoronary imaging. US is generated at the surface of a fiber optic transducer via the photoacoustic effect. Pulsed or modulated light is absorbed in an engineered coating on the fiber surface and converted to thermal energy. The subsequent temperature rise leads to a pressure rise within the coating, which results in a propagating ultrasound wave. US reflections from imaged structures are received with optical interferometry. With OpUS, high bandwidths (31.5 MHz) and pressures (21.5 MPa) have enabled imaging with axial resolutions better than 50 μm and at depths>20 mm. These values challenge those of conventional 40 MHz IVUS technology and show great potential for future clinical application. Recently developed nanocomposite coating materials, that are highly transmissive at light wavelengths used for PA and NIRS light, can facilitate multimodality imaging, thereby enabling molecular characterization.
  PubDate: 2020-10-14T00:00:00Z
Clinical Relevance of Plasma Endogenous Tissue-Plasminogen Activator and
Aortic Valve Sclerosis: Performance as a Diagnostic Biomarker
- Authors: Zhongli Chen, Ying Shen, Qiqi Xue, Bo Wen Lin, Xiao Yan He, Yi Bo Zhang, Ying Yang, Wei Feng Shen, Ye Hong Liu, Ke Yang
  Abstract: Background: Aortic valve sclerosis (AVSc), a common precursor to calcific aortic valve disease, may progress into advanced aortic stenosis with hemodynamic instability. However, plasma biomarkers of such a subclinical condition remain lacking. Since impaired fibrinolysis featuring dysregulated tissue plasminogen activator (t-PA) is involved in several cardiovascular diseases, we investigated whether endogenous t-PA was also associated with AVSc.Methods: Plasma t-PA levels were measured in 295 consecutive patients undergoing standard echocardiography and Doppler flow imaging. Multiple logistic regression analyses were used to assess the association between t-PA and AVSc. Receiver operating characteristic curve analysis was performed for determining the diagnostic value of t-PA for AVSc. The performance of adding t-PA to clinical signatures of AVSc was evaluated. Concentration of t-PA was assessed in human sclerotic and non-sclerotic aortic valves by histology and immunohistochemistry analysis.Results: Plasma t-PA was higher in patients with AVSc than in non-AVSc counterparts (median, 2063.10 vs. 1403.17 pg/mL, p < 0.01). C-statistics of plasma t-PA for discriminating AVSc was 0.698 (95%CI: 0.639–0.758). The performance of t-PA for identifying AVSc was better among male and non-hypertensive patients [C-statistics (95%CI): 0.712 (0.634–0.790) and 0.805 (0.693–0.916), respectively]. Combination of t-PA and clinical factors improved classification of the patients (category-free NRI: 0.452, p < 0.001; IDI: 0.020, p = 0.012). The concentration of t-PA was three times higher in sclerotic compared to non-sclerotic aortic valves.Conclusion: Elevated circulating t-PA level confers an increased risk for AVSc. Further prospective studies with larger sample size are needed to examine if t-PA could serve as a diagnostic clinical marker for AVSc.
  PubDate: 2020-10-14T00:00:00Z
Future Perspectives in Percutaneous Treatment of Tricuspid Regurgitation
- Authors: Antonio Mangieri, Matteo Pagnesi, Damiano Regazzoli, Alessandra Laricchia, Edwin Ho, Ythan Goldberg, Mei Chau, Francesco Gallo, Andrea Fisicaro, Arif Khokhar, Antonio Colombo, Francesco Giannini, Azeem Latib
  Abstract: Tricuspid regurgitation (TR) has a not negligible prevalence and its severity is correlated with poorer outcomes. However, surgical options are rarely offered to these patients because of their high surgical risk. Given that medical therapy plays a limited role in the management of these patients, there is an increasing clinical need for transcatheter treatment options. Although, transcatheter tricuspid valve interventions (TTVIs) are still at an early stage, emerging data suggests their clinical effectiveness and safety, with preliminary results highlighting the potential benefits of transcatheter treatments over medical therapy. In this review, we highlight the challenges and future directions of current and emerging technologies dedicated to the treatment of TR along with an analysis of the next steps required in future clinical trials and studies dedicated to the treatment of the forgotten valve.
  PubDate: 2020-10-14T00:00:00Z
Comorbidities, Cardiovascular Therapies, and COVID-19 Mortality: A
Nationwide, Italian Observational Study (ItaliCO)
- Authors: Francesca Polverino, Debra A. Stern, Gaetano Ruocco, Elisabetta Balestro, Matteo Bassetti, Marcello Candelli, Bruno Cirillo, Marco Contoli, Angelo Corsico, Filippo D'Amico, Emilia D'Elia, Giuseppe Falco, Stefano Gasparini, Stefano Guerra, Sergio Harari, Monica Kraft, Luigi Mennella, Alberto Papi, Roberto Parrella, Paolo Pelosi, Venerino Poletti, Mario Polverino, Claudio Tana, Roberta Terribile, Jason C. Woods, Fabiano Di Marco, Fernando D. Martinez
  Abstract: Background: Italy has one of the world's oldest populations, and suffered one the highest death tolls from Coronavirus disease 2019 (COVID-19) worldwide. Older people with cardiovascular diseases (CVDs), and in particular hypertension, are at higher risk of hospitalization and death for COVID-19. Whether hypertension medications may increase the risk for death in older COVID 19 inpatients at the highest risk for the disease is currently unknown.Methods: Data from 5,625 COVID-19 inpatients were manually extracted from medical charts from 61 hospitals across Italy. From the initial 5,625 patients, 3,179 were included in the study as they were either discharged or deceased at the time of the data analysis. Primary outcome was inpatient death or recovery. Mixed effects logistic regression models were adjusted for sex, age, and number of comorbidities, with a random effect for site.Results: A large proportion of participating inpatients were ≥65 years old (58%), male (68%), non-smokers (93%) with comorbidities (66%). Each additional comorbidity increased the risk of death by 35% [adjOR = 1.35 (1.2, 1.5) p < 0.001]. Use of ACE inhibitors, ARBs, beta-blockers or Ca-antagonists was not associated with significantly increased risk of death. There was a marginal negative association between ARB use and death, and a marginal positive association between diuretic use and death.Conclusions: This Italian nationwide observational study of COVID-19 inpatients, the majority of which ≥65 years old, indicates that there is a linear direct relationship between the number of comorbidities and the risk of death. Among CVDs, hypertension and pre-existing cardiomyopathy were significantly associated with risk of death. The use of hypertension medications reported to be safe in younger cohorts, do not contribute significantly to increased COVID-19 related deaths in an older population that suffered one of the highest death tolls worldwide.
  PubDate: 2020-10-09T00:00:00Z
A Novel Dried Blood Spot Detection Strategy for Characterizing
Cardiovascular Diseases
- Authors: Linsheng Liu, Xurui Jin, Yangfeng Wu, Mei Yang, Tao Xu, Xianglian Li, Jianhong Ren, Lijing L. Yan
  Abstract: Cardiovascular diseases (CVDs) are the leading cause of death in China. Conventional diagnostic methods are dependent on advanced instruments, which are expensive, inaccessible, and inconvenient in underdeveloped areas. To build a novel dried blood spot (DBS) detection strategy for imaging CVDs, in this study, a total of 12 compounds, including seven amino acids [homocysteine (Hcy), isoleucine (Ile), leucine (Leu), valine (Val), phenylalanine (Phe), tyrosine (Tyr), and tryptophan (Trp)], three amino acid derivatives [choline, betaine, and trimethylamine N-oxide (TMAO)], L-carnitine, and creatinine, were screened for their ability to identify CVD. A rapid and reliable method was established for the quantitative analysis of the 12 compounds in DBS. A total of 526 CVD patients and 200 healthy volunteers in five provinces of China were recruited and divided into the following groups: stroke, coronary heart disease, diabetes, and high blood pressure. The orthogonal projection to latent structures-discriminant analysis (OPLSDA) model was used to characterize the difference between each CVD group. Marked differences between the groups based on the OPLSDA model were observed. Based on the model, the patients in the three training sets were mostly accurately categorized into the appropriate group. In addition, the receiver operating characteristic (ROC) curves and logistic regression of each metabolite chosen by the OPLSDA model had an excellent predictive value in both the test and validation groups. DBS detection of 12 biomarkers was sensitive and powerful for characterizing different types of CVD. Such differentiation may reduce unnecessary invasive coronary angiography, enhance predictive value, and complement current diagnostic methods.
  PubDate: 2020-10-09T00:00:00Z
Feasibility of CardioSecur®, a Mobile 4-Electrode/22-Lead ECG Device, in
the Prehospital Emergency Setting
- Authors: Sebastian Spaich, Hanna Kern, Thomas A. Zelniker, Jan Stiepak, Michael Gabel, Erik Popp, Hugo A. Katus, Michael R. Preusch
  Abstract: Background: This study explores the application of CardioSecur® (CS-ECG), a hand-held 4-electrode/22-lead ECG-device, in comparison with conventional 12-lead electrocardiogram (c12L-ECG) in patients with acute chest pain in the prehospital emergency setting.Methods: CS-ECG systems were provided for two physician-staffed emergency ambulances and parallel recordings of c12L-ECG and CS-ECG were obtained from all patients with acute chest pain. Treating emergency physicians were asked to evaluate the CS-ECG system with a standardized questionnaire. Following study completion, acquired ECGs were analyzed separately by two independent cardiologists blinded to all other medical records.Results: Over a period of 20 months a total of 203 patients were included in our study. According to a standardized questionnaire, 79% of emergency medical professionals preferred application of CS-ECG, with 87% of teams judging CS-ECG to be beneficial for patients. Morover, 79% of physicians reported a reduction in time to definitive diagnosis with implementation of CS-ECG. The majority of professional users attested user-friendliness and feasibility of CS-ECG in terms of easy general handling (94%), application (93%), and placement of electrodes (98%). During prehospital triage, both c12L-ECG and CS-ECG correctly identified 31 (91%) patients with ST-elevation myocardial infarction (STEMI).Conclusion: In this first pilot study, implementation of the CardioSecur®-ECG system in the prehospital emergency setting demonstrated feasibility and user-friendliness so that emergency teams generally preferred CS-ECG to c12L-ECG. Diagnostic yield of CS-ECG was similar to c12L-ECG recordings.
  PubDate: 2020-10-09T00:00:00Z
Editorial: Innovative Approaches to Tackle Atrial Fibrillation: From Bench
to Bedside
- Authors: Xun Ai, Bianca J. J. M. Brundel
  PubDate: 2020-10-09T00:00:00Z
In-hospital Routes of Acute Heart Failure Admissions During COVID-19
- Authors: Gaetano Ruocco, Mauro Feola, Alberto Palazzuoli
  PubDate: 2020-10-08T00:00:00Z
Noncanonical WNT Activation in Human Right Ventricular Heart Failure
- Authors: Jonathan J. Edwards, Jeffrey Brandimarto, Dong-Qing Hu, Sunhye Jeong, Nora Yucel, Li Li, Kenneth C. Bedi, Shogo Wada, Danielle Murashige, Hyun Tae V. Hwang, Mingming Zhao, Kenneth B. Margulies, Daniel Bernstein, Sushma Reddy, Zoltan Arany
  Abstract: Background: No medical therapies exist to treat right ventricular (RV) remodeling and RV failure (RVF), in large part because molecular pathways that are specifically activated in pathologic human RV remodeling remain poorly defined. Murine models have suggested involvement of Wnt signaling, but this has not been well-defined in human RVF.Methods: Using a candidate gene approach, we sought to identify genes specifically expressed in human pathologic RV remodeling by assessing the expression of 28 WNT-related genes in the RVs of three groups: explanted nonfailing donors (NF, n = 29), explanted dilated and ischemic cardiomyopathy, obtained at the time of cardiac transplantation, either with preserved RV function (pRV, n = 78) or with RVF (n = 35).Results: We identified the noncanonical WNT receptor ROR2 as transcriptionally strongly upregulated in RVF compared to pRV and NF (Benjamini-Hochberg adjusted P < 0.05). ROR2 protein expression correlated linearly to mRNA expression (R2 = 0.41, P = 8.1 × 10−18) among all RVs, and to higher right atrial to pulmonary capillary wedge ratio in RVF (R2 = 0.40, P = 3.0 × 10−5). Utilizing Masson's trichrome and ROR2 immunohistochemistry, we identified preferential ROR2 protein expression in fibrotic regions by both cardiomyocytes and noncardiomyocytes. We compared RVF with high and low ROR2 expression, and found that high ROR2 expression was associated with increased expression of the WNT5A/ROR2/Ca2+ responsive protease calpain-μ, cleavage of its target FLNA, and FLNA phosphorylation, another marker of activation downstream of ROR2. ROR2 protein expression as a continuous variable, correlated strongly to expression of calpain-μ (R2 = 0.25), total FLNA (R2 = 0.67), calpain cleaved FLNA (R2 = 0.32) and FLNA phosphorylation (R2 = 0.62, P < 0.05 for all).Conclusion: We demonstrate robust reactivation of a fetal WNT gene program, specifically its noncanonical arm, in human RVF characterized by activation of ROR2/calpain mediated cytoskeleton protein cleavage.
  PubDate: 2020-10-07T00:00:00Z
Sex-Specific Associations of Risks and Cardiac Structure and Function With
Microalbumin/Creatinine Ratio in Diastolic Heart Failure
- Authors: Fang-Fei Wei, Ruicong Xue, Yuzhong Wu, Weihao Liang, Xin He, Yuanyuan Zhou, Marvin Owusu-Agyeman, Zexuan Wu, Wengen Zhu, Jiangui He, Jan A. Staessen, Yugang Dong, Chen Liu
  Abstract: Background: Heart failure with preserved ejection fraction (HFpEF) affects women more frequently than men. However, data on sex-specific associations of adverse health outcomes and left ventricular structure and function and with microalbuminuria in patients with HFpEF are scarce.Methods: In 1,334 participants enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) Trial, we estimated the sex-specific multivariable-adjusted risk and LV traits with urine microalbumin/creatine ratio (ACR), using Cox or linear regression.Results: In total, 604 (45.3%) were women. In multivariable-adjusted analyses, a doubling of ACR in both men and women was associated with higher posterior (+0.014 cm, p = 0.012/+0.012 cm, p = 0.033) wall thickness and left ventricular mass index (+2.55 mg/m2, p = 0.004/+2.45 mg/m2, p = 0.009), whereas was also associated with higher septal (+0.018 cm, p = 0.002) and left atrial volume index (+1.44 mL/m2, p = 0.001) in men. ACR was a key predictor of all-cause (HR, 1.11; p = 0.006) and cardiovascular (HR, 1.17; p = 0.002) death in women, whereas in men ACR was associated with HF hospitalization (HR, 1.23; p < 0.001), any hospitalization (HR, 1.06; p = 0.006), and myocardial infarction (HR, 1.19; p = 0.017). The interactions of sex with ACR were significant for hospitalization for heart failure and any hospitalization (p ≤ 0.034).Conclusions: Outcomes and cardiac structure and function in patients with HFpEF appear to be influenced by ACR that vary according to sex. In men, ACR was significant associated with LV diastolic function, hospitalization, and myocardial infarction, whereas in women was associated with mortality.
  PubDate: 2020-10-07T00:00:00Z
Clinical Approach to Assessment and Amelioration of Atherosclerotic
Vascular Disease in Diabetes
- Authors: Ronald B. Goldberg
  Abstract: Atherosclerotic cardiovascular disease is increased on average 2–3-fold in people with diabetes as compared to their non-diabetic counterparts and is the major cause of the increased morbidity and mortality in this disease. There is however heterogeneity in cardiovascular risk between individuals based on demographic, cardiometabolic and clinical risk factors in the setting of hyperglycemia, insulin resistance and obesity that needs to be taken into consideration in planning preventive interventions. Randomized clinical trials of agents or procedures used for amelioration of augmented CVD risk in diabetes have been pivotal in providing evidenced-based treatments. Improvement in hyperglycemia in both type 1 and type 2 diabetes is considered to be central in the prevention of microvascular and macrovascular complications although selected antihyperglycemic agents have demonstrated beneficial as well as possible deleterious off-target effects. Lowering low density lipoprotein cholesterol, treating hypertension and stopping smoking each play important roles in preventing cardiovascular disease in diabetes as they do in the general population and low dose aspirin is overall beneficial in high risk individuals. Hypertriglyceridemia may represent another important marker for augmented cardiovascular risk in diabetes and newer agents targeting dyslipidemia appear promising. The fall in cardiovascular events over the past two decades offers hope that modern intervention strategies as well as novel approaches such as those targeting inflammation may contribute to a continued reduction of cardiovascular disease in people with diabetes.
  PubDate: 2020-10-06T00:00:00Z
Importance of Sensitive Vascular Measurements for Evaluating Effects of
Lifestyle in Premenopausal Women
- Authors: Abbi D. Lane-Cordova, Samantha Bouknight
  Abstract: Premenopausal women generally have a favorable cardiovascular risk profile, owing to young age and the protective effects of estrogen. Rates of hypertension and more advanced cardiovascular disease (CVD) are low in premenopausal women. A large body of epidemiological evidence has shown that lifestyle behaviors in midlife, i.e., cardiorespiratory fitness, physical activity, and healthy diet, are associated with lower risk of overt CVD and adverse cardiovascular outcomes in the future for men and women. Despite differences in future cardiovascular risk, brachial blood pressures might be similar between premenopausal women with favorable vs. unfavorable levels of lifestyle behaviors in early-to-mid-life. Here we make the case for deeper phenotyping by means of vascular function measurements, such as arterial stiffness, augmentation index, and endothelial function, to identify potential mechanistic pathways linking lifestyle behaviors in early-to-mid-adulthood with lifelong CVD risk in women. We describe considerations for vascular function measurement in premenopausal women and opportunities for investigators to fill in knowledge gaps to further our understanding of CVD risk assessment and CVD progression in premenopausal women.
  PubDate: 2020-09-29T00:00:00Z
Case Report First-in-Man Method Description: Left Ventricular Unloading
With iVAC2L During Veno-Arterial Extracorporeal Membrane Oxygenation: From
- Authors: Carsten Tschöpe, Alessio Alogna, Alessandro Faragli, Karin Klingel, Gunther Schmidt, Torsten Wolfgang Heilmann, Marcelo B. Bastos, Frank Spillmann
  Abstract: Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is increasingly used in bi-ventricular failure with cardiogenic shock to maintain systemic perfusion. Nonetheless, it tends to increase left ventricular (LV) afterload and myocardial oxygen demand. In order to mitigate these negative effects on the myocardium, an Impella CP® (3.5 L/min Cardiac Output) can be used in conjunction with V-A ECMO (ECMELLA approach). We implemented this strategy in a patient with severe acute myocarditis complicated by cardiogenic shock. Due to a hemolysis crisis, Impella CP® had to be substituted with PulseCath iVAC2L®, which applies pulsatile flow to unload the LV. A subsequent improvement in LV systolic function was noted, with increased LV ejection fraction (LVEF), LV end-diastolic diameter (LVEDD) reduction, and a reduction in plasma free hemoglobin. This case documents the efficacy of iVAC2L in replacing Impella CP as a LV vent during V-A ECMO, with less hemolysis.
  PubDate: 2020-09-25T00:00:00Z
Prevalence of Myocardial Fibrosis in Intensive Endurance Training
Athletes: A Systematic Review and Meta-Analysis
- Authors: Cheng-Duo Zhang, Shun-Lin Xu, Xin-Yu Wang, Li-Yuan Tao, Wei Zhao, Wei Gao
  Abstract: Objective: To review the published literature reporting on the incidence of myocardial fibrosis (MF) in high-intensity endurance athletes measured by late gadolinium enhancement (LGE) with cardiac magnetic resonance imaging (CMR).Methods: Five databases (PubMed, Cochrane Controlled Trials Register, EMBASE, Web of Science, and SPORTDiscus) were searched to obtain case cohort studies published before November 10, 2019. From 96 abstracts or reports extracted, 18 full-text articles were reviewed. The incidence of LGE was reported as outcome measures. Subgroup analysis was performed by age (under or above 50 years). Pooled estimates were obtained using a fixed-effects model.Results: After a full-text assessment, 12 studies involving 1,359 participants were included for analysis. Among them, 163/772 participants in the endurance athletes group showed LGE positive, compared with 19/587 participants in the comparison group. The results of the meta-analysis suggested that the prevalence of LGE was higher in the athletes group with long-term endurance exercise (OR 7.20;95%CI: 4.51–11.49). In addition, the same conclusion was drawn after the stratification of age.Conclusions: The available evidence demonstrates that high-intensity endurance athletes is associated with an increased incidence of LGE positive.
  PubDate: 2020-09-25T00:00:00Z