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1.
Radiol Cardiothorac Imaging ; 6(3): e230271, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38842455

RESUMO

Purpose To provide a comprehensive head-to-head comparison and temporal analysis of cardiac MRI indications between the European Society of Cardiology (ESC) and American College of Cardiology/American Heart Association (ACC/AHA) guidelines to identify areas of consensus and divergence. Materials and Methods A systematic review and meta-analysis was conducted. ESC and ACC/AHA guidelines published until May 2023 were systematically screened for recommendations related to cardiac MRI. The class of recommendation (COR) and level of evidence (LOE) for cardiac MRI recommendations were compared between the two guidelines and between newer versus older versions of each guideline using χ2 or Fisher exact tests. Results ESC guidelines included 109 recommendations regarding cardiac MRI, and ACC/AHA guidelines included 90 recommendations. The proportion of COR I and LOE B was higher in ACC/AHA versus ESC guidelines (60% [54 of 90] vs 46.8% [51 of 109]; P = .06 and 53% [48 of 90] vs 35.8% [39 of 109], respectively; P = .01). The increase in the number of cardiac MRI recommendations over time was significantly higher in ESC guidelines (from 63 to 109 for ESC vs from 65 to 90 for ACC/AHA; P = .03). The main areas of consensus were found in heart failure and hypertrophic cardiomyopathy, while the main divergences were in valvular heart disease, arrhythmias, and aortic disease. Conclusion ESC guidelines included more recommendations related to cardiac MRI use, whereas the ACC/AHA recommendations had higher COR and LOE. The number of cardiac MRI recommendations increased significantly over time in both guidelines, indicating the increasing role of cardiac MRI evaluation and management of cardiovascular disease. Keywords: Cardiovascular Magnetic Resonance, Guideline, European Society of Cardiology, ESC, American College of Cardiology/American Heart Association, ACC/AHA Supplemental material is available for this article. © RSNA, 2024.


Assuntos
American Heart Association , Imageamento por Ressonância Magnética , Guias de Prática Clínica como Assunto , Humanos , Guias de Prática Clínica como Assunto/normas , Imageamento por Ressonância Magnética/normas , Imageamento por Ressonância Magnética/métodos , Estados Unidos , Europa (Continente) , Cardiologia/normas , Cardiologia/tendências , Cardiopatias/diagnóstico por imagem , Sociedades Médicas
2.
Circ Res ; 134(12): 1663-1680, 2024 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-38843286

RESUMO

Over the past 30 years, the field of cardioimmunology has moved from being dismissed as a field that was chasing an epiphenomenon of little biological consequence to a scientific discipline that is providing important new insights into the immunologic basis for hypertension, atherosclerosis, myocarditis, pericarditis, autoimmune heart disease, and heart failure. In this article, we will review the conceptual insights and technical breakthroughs that have allowed the field to move forward, as well as the clinical trials in the cardioimmunology space, to provide a historical context for the articles that will appear in the compendium that is focused on the interface between cardioimmunology, myocardial function, and disease.


Assuntos
Cardiopatias , Humanos , Animais , Cardiopatias/imunologia , Cardiopatias/terapia , Alergia e Imunologia/tendências , Alergia e Imunologia/história , Doenças Cardiovasculares/imunologia , História do Século XXI , História do Século XX
5.
Cell Mol Biol (Noisy-le-grand) ; 70(6): 171-177, 2024 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-38836663

RESUMO

Chronic heart disease (CHD) is still a major global cause of morbidity and mortality, necessitating effective therapeutic interventions to mitigate its progression. Omega-3 fatty acids (FAs) have garnered attention for their potential anti-inflammatory and endothelial-protective properties in CHD management. The present study aims to assess the efficacy of Omega-3 FA supplementation on markers of inflammation and endothelial function in patients with CHD. To achieve this, we used the relevant keywords to search international databases (Web of Science, PubMed, Embase, and Scopus) and extract publications evaluating the effectiveness of omega-3 FA supplementation on inflammation markers and endothelial function in patients with CHD. STATA (version 15) and the random and fixed-effects models were used to evaluate the collected data. Thirteen clinical trial studies met inclusion criteria, with a total sample size of 853 individuals (406 cases and 447 controls). The cases had a mean age of 58 ± 10.3 years. The pooled results indicated that omega-3 Omega-3 FA supplementation significantly reduced the level of circulating IL-6 (SMD = -0.47, 95% CI -1.29 to 0.35, %, p < 0.001), hs-CRP (SMD = -0.21, 95% CI -0.70 to 0.28, p = 0.01), and TNF-α (SMD = -0.56, 95% CI -1.14 to 0.01, p < 0.001) in patients with CHD. Also, findings revealed that a daily supplement of omega-3 significantly increased FMD by 0.34% (95% CI: 0.14-0.54%, p < 0.001) as compared with placebo by a fixed-effect model in patients with CHD. These findings underscore the potential therapeutic utility of omega-3 fatty acid supplementation in modulating inflammation and endothelial dysfunction in patients with CHD.


Assuntos
Biomarcadores , Suplementos Nutricionais , Ácidos Graxos Ômega-3 , Inflamação , Humanos , Pessoa de Meia-Idade , Biomarcadores/sangue , Doença Crônica , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/fisiopatologia , Ácidos Graxos Ômega-3/uso terapêutico , Ácidos Graxos Ômega-3/farmacologia , Cardiopatias/tratamento farmacológico , Cardiopatias/sangue , Inflamação/tratamento farmacológico , Inflamação/sangue , Idoso
6.
A A Pract ; 18(6): e01796, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38842207

RESUMO

Most of the cases demonstrating describing acute findings using point-of-care ultrasound (POCUS) have been described in emergency medicine and critical care medicine. While the use of POCUS has become more prevalent in anesthesia practice, documentation of acute findings resulting in alteration in management based on real-time ultrasound findings during pediatric anesthesia remains limited. This case highlights the use of POCUS during cardiopulmonary collapse occurring during correction of neuromuscular scoliosis. POCUS excluded the presumed diagnosis of venous air embolism and identified an intracardiac thrombus leading to the diagnosis and treatment of pulmonary embolism.


Assuntos
Sistemas Automatizados de Assistência Junto ao Leito , Embolia Pulmonar , Ultrassonografia , Humanos , Cardiopatias/diagnóstico por imagem , Cardiopatias/cirurgia , Embolia Pulmonar/diagnóstico por imagem , Escoliose/cirurgia , Escoliose/diagnóstico por imagem , Trombose/diagnóstico por imagem , Trombose/cirurgia , Masculino , Criança
7.
Hipertens. riesgo vasc ; 41(2): 95-103, abr.-jun2024. tab, graf
Artigo em Inglês | IBECS | ID: ibc-232395

RESUMO

Introduction: Evidence about nefroprotective effect with RAAS blockers in elderly patients with chronic kidney disease (CKD) without proteinuria is lacking. The primary outcome of our study is to evaluate the impact of RAAS blockers in CKD progression in elderly patients without proteinuria. Materials and methods: Multicenter open-label, randomized controlled clinical trial including patients over 65 year-old with hypertension and CKD stages 3–4 without proteinuria. Patients were randomized in a 1:1 ratio to either receive RAAS blockers or other antihypertensive drugs and were followed up for three years. Primary outcome is estimated glomerular filtration rate (eGFR) decline at 3 years. Secondary outcome measures include BP control, renal and cardiovascular events and mortality. Results: 88 patients were included with a mean age of 77.9±6.1 years and a follow up period of 3 years: 40 were randomized to RAAS group and 48 to standard treatment. Ethiology of CKD was: 53 vascular, 16 interstitial and 19 of unknown ethiology. In the RAAS group eGFR slope during follow up was −4.3±1.1ml/min, whereas in the standard treatment group an increase on eGFR was observed after 3 years (+4.6±0.4ml/min), p=0.024. We found no differences in blood pressure control, number of antihypertensive drugs, albuminuria, potassium serum levels, incidence of cardiovascular events nor mortality during the follow up period. Conclusions: In elderly patients without diabetes nor cardiopathy and with non proteinuric CKD the use of RAAS blockers does not show a reduction in CKD progression. The PROERCAN (PROgresión de Enfermedad Renal Crónica en ANcianos) trial (trial registration: NCT03195023). (AU)


Introducción: Actualmente no existe suficiente evidencia sobre el efecto nefroprotector de los bloqueantes del sistema renina-angiotensina-aldosterona (BSRAA) en pacientes añosos con enfermedad renal crónica (ERC) sin proteinuria y sin cardiopatía. El objetivo es evaluar el efecto de los BSRAA en la progresión de la ERC en este grupo poblacional. Métodos: Se trata de un estudio prospectivo, aleatorizado, que compara la eficacia de los BSRAA vs. otros tratamientos antihipertensivos en la progresión renal en personas mayores de 65 años con ERC estadios 3 y 4 e índice albúmina/creatinina<30mg/g. Aleatorización 1:1 BSRAA o tratamiento antihipertensivo estándar. Se recogieron cifras tensionales y parámetros analíticos de un año previo a la aleatorización y durante el seguimiento. Resultados: Se incluyeron 88 pacientes seguidos durante tres años con edad media de 77,9±6,1 años. De estos, se aleatorizaron 40 al grupo BSRAA y 48 al estándar. La etiología de ERC fue: 53 vascular, 16 intersticial y 19 no filiada. En el primer grupo se observó una progresión de la ERC con una caída del filtrado glomerular estimado (FGe) de -4,3±1,1mL/min, mientras que en el grupo estándar un aumento del FGe durante el seguimiento de 4,6±0,4mL/min, p=0,024. No se apreciaron diferencias entre ambos en el control tensional, el número de antihipertensivos, la albuminuria, los niveles de potasio, la incidencia de eventos cardiovasculares ni la mortalidad durante el seguimiento. Conclusiones: En pacientes añosos no diabéticos con ERC no proteinúrica y sin cardiopatía el uso de BSRAA no añade beneficio en la progresión de la ERC. Ensayo clínico Progresión de Enfermedad Renal Crónica en Ancianos (PROERCAN) (NCT03195023). (AU)


Assuntos
Humanos , Pessoa de Meia-Idade , Albuminúria , Insuficiência Renal Crônica , Hipertensão , Sistema Renina-Angiotensina , Proteinúria , Cardiopatias , Estudos Prospectivos
8.
G Ital Nefrol ; 41(2)2024 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-38695229

RESUMO

Background. Neonatal high blood pressure has been diagnosed more frequently in recent years, and its impact extends to adulthood. However, the knowledge gaps on associated factors, diagnosis, and treatment are challenging for medical personnel. The incidence of this condition varies depending on neonatal conditions. Patients in the Newborn Unit are at increased risk of developing high blood pressure. The persistence of this condition beyond the neonatal stage increases the risk of cardiovascular disease and chronic kidney disease in childhood and adulthood. Methodology. A case-control study was carried out. It included hospitalized patients with neonatal hypertension as cases. Three controls were randomly selected for each case and matched by gestational age. The variables were analyzed based on their nature. Multivariate analysis was performed using a multivariate conditional regression model to identify variables associated with the outcome. Finally, the model was adjusted for possible confounders. Results. 37 cases were obtained and matched with 111 controls. In the univariate analysis, heart disease (OR 2.86; 95% CI 1.22-6.71), kidney disease (OR 7.24; 95% CI 1.92-28.28), bronchopulmonary dysplasia (OR 6.62; 95% CI 1.42-50.82) and major surgical procedures (OR 3.71; 95% CI 1.64-8.39) had an association with neonatal arterial hypertension. Only the latter maintained this finding in the multivariate analysis (adjusted OR 2.88; 95% CI 1.14-7.30). A significant association of two or more comorbidities with neonatal arterial hypertension was also found (OR 3.81; 95% CI 1.53-9.49). Conclusions. The study analyzed the factors related to high blood pressure in hospitalized neonates, finding relevant associations in the said population. The importance of meticulous neonatal care and monitoring of risk factors such as birth weight and major surgeries is highlighted.


Assuntos
Hipertensão , Humanos , Estudos de Casos e Controles , Recém-Nascido , Hipertensão/epidemiologia , Hipertensão/complicações , Feminino , Masculino , Fatores de Risco , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/complicações , Cardiopatias/epidemiologia , Cardiopatias/complicações , Cardiopatias/etiologia
9.
BMC Cardiovasc Disord ; 24(1): 242, 2024 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-38724937

RESUMO

BACKGROUND: Cardiac autonomic neuropathy (CAN) is a complication of diabetes mellitus (DM) that increases the risk of morbidity and mortality by disrupting cardiac innervation. Recent evidence suggests that CAN may manifest even before the onset of DM, with prediabetes and metabolic syndrome potentially serving as precursors. This study aims to identify genetic markers associated with CAN development in the Kazakh population by investigating the SNPs of specific genes. MATERIALS AND METHODS: A case-control study involved 82 patients with CAN (cases) and 100 patients without CAN (controls). A total of 182 individuals of Kazakh nationality were enrolled from a hospital affiliated with the RSE "Medical Center Hospital of the President's Affairs Administration of the Republic of Kazakhstan". 7 SNPs of genes FTO, PPARG, SNCA, XRCC1, FLACC1/CASP8 were studied. Statistical analysis was performed using Chi-square methods, calculation of odds ratios (OR) with 95% confidence intervals (CI), and logistic regression in SPSS 26.0. RESULTS: Among the SNCA gene polymorphisms, rs2737029 was significantly associated with CAN, almost doubling the risk of CAN (OR 2.03(1.09-3.77), p = 0.03). However, no statistically significant association with CAN was detected with the rs2736990 of the SNCA gene (OR 1.00 CI (0.63-1.59), p = 0.99). rs12149832 of the FTO gene increased the risk of CAN threefold (OR 3.22(1.04-9.95), p = 0.04), while rs1801282 of the PPARG gene and rs13016963 of the FLACC1 gene increased the risk twofold (OR 2.56(1.19-5.49), p = 0.02) and (OR 2.34(1.00-5.46), p = 0.05) respectively. rs1108775 and rs1799782 of the XRCC1 gene were associated with reduced chances of developing CAN both before and after adjustment (OR 0.24, CI (0.09-0.68), p = 0.007, and OR 0.43, CI (0.22-0.84), p = 0.02, respectively). CONCLUSION: The study suggests that rs2737029 (SNCA gene), rs12149832 (FTO gene), rs1801282 (PPARG gene), and rs13016963 (FLACC1 gene) may be predisposing factors for CAN development. Additionally, SNPs rs1108775 and rs1799782 (XRCC1 gene) may confer resistance to CAN. Only one polymorphism rs2736990 of the SNCA gene was not associated with CAN.


Assuntos
Predisposição Genética para Doença , PPAR gama , Polimorfismo de Nucleotídeo Único , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Estudos de Casos e Controles , Cazaquistão/epidemiologia , Fatores de Risco , PPAR gama/genética , Idoso , Fenótipo , Dioxigenase FTO Dependente de alfa-Cetoglutarato/genética , Medição de Risco , Estudos de Associação Genética , Proteína 1 Complementadora Cruzada de Reparo de Raio-X/genética , Cardiopatias/genética , Cardiopatias/etnologia , Cardiopatias/diagnóstico , Doenças do Sistema Nervoso Autônomo/genética , Doenças do Sistema Nervoso Autônomo/diagnóstico , Adulto , Neuropatias Diabéticas/genética , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/etnologia , Neuropatias Diabéticas/epidemiologia , Sistema Nervoso Autônomo/fisiopatologia , Marcadores Genéticos , alfa-Sinucleína
10.
Clin Exp Med ; 24(1): 103, 2024 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-38758248

RESUMO

COVID-19 vaccination has been shown to prevent and reduce the severity of COVID-19 disease. The aim of this study was to explore the cardioprotective effect of COVID-19 vaccination in hospitalized COVID-19 patients. In this retrospective, single-center cohort study, we included hospitalized COVID-19 patients with confirmed vaccination status from July 2021 to February 2022. We assessed outcomes such as acute cardiac events and cardiac biomarker levels through clinical and laboratory data. Our analysis covered 167 patients (69% male, mean age 58 years, 42% being fully vaccinated). After adjustment for confounders, vaccinated hospitalized COVID-19 patients displayed a reduced relative risk for acute cardiac events (RR: 0.33, 95% CI [0.07; 0.75]) and showed diminished troponin T levels (Cohen's d: - 0.52, 95% CI [- 1.01; - 0.14]), compared to their non-vaccinated peers. Type 2 diabetes (OR: 2.99, 95% CI [1.22; 7.35]) and existing cardiac diseases (OR: 4.31, 95% CI [1.83; 10.74]) were identified as significant risk factors for the emergence of acute cardiac events. Our findings suggest that COVID-19 vaccination may confer both direct and indirect cardioprotective effects in hospitalized COVID-19 patients.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Hospitalização , SARS-CoV-2 , Humanos , COVID-19/prevenção & controle , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/imunologia , Idoso , Hospitalização/estatística & dados numéricos , SARS-CoV-2/imunologia , Vacinação , Cardiopatias/prevenção & controle , Fatores de Risco , Adulto , Troponina T/sangue
11.
J Bodyw Mov Ther ; 38: 417-424, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38763587

RESUMO

BACKGROUND: Heart disease is the leading cause of death in many countries around the world and is linked to numerous complications. In addition to conventional pharmacological treatments, complementary and alternative medicines like massage and dry cupping are employed to help manage the disease and its symptoms. This study aimed to compare the effects of massage and dry cupping on dysrhythmia in patients with heart diseases. METHODS: This randomized parallel controlled clinical trial study was conducted in two critical care units of Shafa hospital in Kerman, southeastern Iran, in 2019-2020. A total of 90 eligible patients were allocated into three groups: massage (n = 30), dry cupping (n = 30), and control (n = 30) using a stratified block randomization method. In the massage group, the head and face were massaged for three consecutive nights, while the dry cupping group received dry cupping between the fifth cervical vertebra and the second thoracic vertebra for the same duration. Each intervention session lasted 15 min. Data collection tools included a socio-demographic and clinical characteristics questionnaire, a form for hemodynamic parameters (systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation), and a form for assessing dysrhythmia using electrocardiogram readings. Dysrhythmia in the participants was evaluated after each session. RESULTS: The results within each group indicated a statistically significant difference in the prevalence of dysrhythmia in the dry cupping group after the intervention (P < 0.05), but this difference was not statistically significant in the massage and control groups. However, when comparing between the groups, no significant difference was found among the three groups. Additionally, there was no significant difference in the type of dysrhythmia between the groups (P > 0.05). CONCLUSION: While there was no difference in the type of dysrhythmia between the three groups, the additional reduction of dysrhythmia in the dry cupping group could hold clinical significance. Further studies are recommended to validate or refute the findings of the present study.


Assuntos
Arritmias Cardíacas , Massagem , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Massagem/métodos , Adulto , Arritmias Cardíacas/terapia , Frequência Cardíaca/fisiologia , Ventosaterapia/métodos , Idoso , Cardiopatias , Irã (Geográfico) , Pressão Sanguínea/fisiologia
12.
Port J Card Thorac Vasc Surg ; 31(1): 17-22, 2024 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-38743515

RESUMO

INTRODUCTION: Cardiac disease is associated with a risk of death, both by the cardiac condition and by comorbidities. The waiting time for surgery begins with the onset of symptoms and includes referral, completion of the diagnosis and surgical waiting list (SWL). This study was conducted during the COVID-19 pandemic, which affected surgical capacity and patients' morbidities. METHODS: The cohort includes 1914 consecutive adult patients (36.6% women, mean age 67 ±11 years), prospectively registered in the official SWL from January 2019 to December 2021. We analyzed waiting times ranging from 4 days to one year to exclude urgencies and outliers. Priority was classified by the national criteria for non-oncologic or oncology surgery. RESULTS: During the study period, 74% of patients underwent surgery, 19.2% were still waiting, and 4.3% dropped out. Most cases were valvular (41.2%) or isolated bypass procedures (34.2%). Patients were classified as non-priority in 29.7%, priority in 61.8%, and high priority in 8.6%, with significantly different SWL mean times between groups (p<0.001). The overall mean waiting time was 167 ± 135 days. Mortality on SWL was 2.5%, or 1.1 deaths per patient/weeks. There were two mortality independent predictors: age (HR 1.05) and the year 2021 versus 2019 (HR 2.07) and a trend toward higher mortality in priority patients versus non-priority (p=0.065). The overall risk increased with time with different slopes for each year. Using the time limits for SWL in oncology, there would have been a significant risk reduction (p=0.011). CONCLUSION: The increased risk observed in 2021 may be related to the pandemic, either by increasing waiting time or by direct mortality. Since risk stratification is not entirely accurate, waiting time emerges as the most crucial factor influencing mortality, and implementing stricter time limits could have led to lower mortality rates.


Assuntos
COVID-19 , Procedimentos Cirúrgicos Cardíacos , Cardiopatias , Listas de Espera , Humanos , Feminino , Listas de Espera/mortalidade , Masculino , COVID-19/epidemiologia , Idoso , Procedimentos Cirúrgicos Cardíacos/mortalidade , Pessoa de Meia-Idade , Cardiopatias/cirurgia , Cardiopatias/mortalidade , Cardiopatias/epidemiologia , SARS-CoV-2 , Fatores de Tempo , Medição de Risco , Pandemias , Tempo para o Tratamento/estatística & dados numéricos
14.
Pak J Pharm Sci ; 37(1): 17-23, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38741396

RESUMO

As a major concern in the healthcare sector, polypharmacy is correlated with an increased risk of potential drug-drug interactions (pDDIs), treatment costs and adverse drug reactions (ADR). To assess the prevalence of polypharmacy and its associated factors among postoperative cardiac patients admitted to the National Institute of Cardiovascular Diseases (NICVD), a hospital-based cross-sectional study was conducted between November 2021 and April 2022. Medication charts of postoperative patients were reviewed for medication utilization and polypharmacy. Data was collected using a form approved by the Ethical Review Committee (ERC) regarding patient's clinical and demographic characteristics and medications administered. Statistical analysis was performed using the SPSS software version 25.0. Patients were taking an average of 10.3±1.7 medications. The minimum number of drugs taken per patient was 5, while the maximum was 15 drugs. Only 114 (29.7%) received polypharmacy (5-9 drugs) and hyper-polypharmacy (≥10 drugs) was 270 (70.3%). The mean±SD cardiovascular drugs used were 5.45±1.18 and the mean±SD non-cardiovascular drugs were 4.83±1.18. The prevalence of hyper-polypharmacy suggests a critical need for optimized medication management strategies in this population. Incorporating clinical pharmacists within public healthcare institutions can address polypharmacy-related challenges and enhance medication safety, adherence and patient outcomes.


Assuntos
Farmacêuticos , Polimedicação , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Transversais , Paquistão , Idoso , Adulto , Interações Medicamentosas , Serviço de Farmácia Hospitalar , Cardiopatias/cirurgia , Prevalência
15.
PLoS One ; 19(5): e0303276, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38768166

RESUMO

Binary classification methods encompass various algorithms to categorize data points into two distinct classes. Binary prediction, in contrast, estimates the likelihood of a binary event occurring. We introduce a novel graphical and quantitative approach, the U-smile method, for assessing prediction improvement stratified by binary outcome class. The U-smile method utilizes a smile-like plot and novel coefficients to measure the relative and absolute change in prediction compared with the reference method. The likelihood-ratio test was used to assess the significance of the change in prediction. Logistic regression models using the Heart Disease dataset and generated random variables were employed to validate the U-smile method. The receiver operating characteristic (ROC) curve was used to compare the results of the U-smile method. The likelihood-ratio test demonstrated that the proposed coefficients consistently generated smile-shaped U-smile plots for the most informative predictors. The U-smile plot proved more effective than the ROC curve in comparing the effects of adding new predictors to the reference method. It effectively highlighted differences in model performance for both non-events and events. Visual analysis of the U-smile plots provided an immediate impression of the usefulness of different predictors at a glance. The U-smile method can guide the selection of the most valuable predictors. It can also be helpful in applications beyond prediction.


Assuntos
Curva ROC , Humanos , Modelos Logísticos , Algoritmos , Funções Verossimilhança , Cardiopatias
16.
Front Immunol ; 15: 1365174, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38774873

RESUMO

Introduction: Sepsis remains a major source of morbidity and mortality in neonates, and characterization of immune regulation in the neonatal septic response remains limited. HVEM is a checkpoint regulator which can both stimulate or inhibit immune responses and demonstrates altered expression after sepsis. We hypothesized that signaling via HVEM would be essential for the neonatal response to sepsis, and that therefore blockade of this pathway would improve survival to septic challenge. Methods: To explore this, neonatal mice were treated with cecal slurry (CS), CS with Anti-HVEM antibody (CS-Ab) or CS with isotype (CS-IT) and followed for 7-day survival. Mice from all treatment groups had thymus, lung, kidney and peritoneal fluid harvested, weighed, and stained for histologic evaluation, and changes in cardiac function were assessed with echocardiography. Results: Mortality was significantly higher for CS-Ab mice (72.2%) than for CS-IT mice (22.2%). CS resulted in dysregulated alveolar remodeling, but CS-Ab lungs demonstrated significantly less dysfunctional alveolar remodeling than CS alone (MCL 121.0 CS vs. 87.6 CS-Ab), as well as increased renal tubular vacuolization. No morphologic differences in alveolar septation or thymic karyorrhexis were found between CS-Ab and CS-IT. CS-Ab pups exhibited a marked decrease in heart rate (390.3 Sh vs. 342.1 CS-Ab), stroke volume (13.08 CS-IT vs. 8.83 CS-Ab) and ultimately cardiac output (4.90 Sh vs. 3.02 CS-Ab) as well as a significant increase in ejection fraction (73.74 Sh vs. 83.75 CS-Ab) and cardiac strain (40.74 Sh vs. 51.16 CS-Ab) as compared to CS-IT or Sham animals. Discussion: While receptor ligation of aspects of HVEM signaling, via antibody blockade, appears to mitigate aspects of lung injury and thymic involution, stimulatory signaling via HVEM still seems to be necessary for vascular and hemodynamic resilience and overall neonatal mouse survival in response to this experimental polymicrobial septic insult. This dissonance in the activity of anti-HVEM neutralizing antibody in neonatal animals speaks to the differences in how septic cardiac dysfunction should be considered and approached in the neonatal population.


Assuntos
Animais Recém-Nascidos , Sepse Neonatal , Transdução de Sinais , Animais , Camundongos , Sepse Neonatal/imunologia , Sepse Neonatal/mortalidade , Membro 14 de Receptores do Fator de Necrose Tumoral/metabolismo , Membro 14 de Receptores do Fator de Necrose Tumoral/imunologia , Modelos Animais de Doenças , Feminino , Cardiopatias/etiologia , Cardiopatias/imunologia , Pulmão/imunologia , Pulmão/patologia , Sepse/imunologia , Sepse/metabolismo
17.
Sci Rep ; 14(1): 11514, 2024 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-38769364

RESUMO

Comorbidity is widespread in the ageing population, implying multiple and complex medical needs for individuals and a public health burden. Determining risk factors and predicting comorbidity development can help identify at-risk subjects and design prevention strategies. Using socio-demographic and clinical data from approximately 11,000 subjects monitored over 11 years in the English Longitudinal Study of Ageing, we develop a dynamic Bayesian network (DBN) to model the onset and interaction of three cardio-metabolic comorbidities, namely type 2 diabetes (T2D), hypertension, and heart problems. The DBN allows us to identify risk factors for developing each morbidity, simulate ageing progression over time, and stratify the population based on the risk of outcome occurrence. By applying hierarchical agglomerative clustering to the simulated, dynamic risk of experiencing morbidities, we identified patients with similar risk patterns and the variables contributing to their discrimination. The network reveals a direct joint effect of biomarkers and lifestyle on outcomes over time, such as the impact of fasting glucose, HbA1c, and BMI on T2D development. Mediated cross-relationships between comorbidities also emerge, showcasing the interconnected nature of these health issues. The model presents good calibration and discrimination ability, particularly in predicting the onset of T2D (iAUC-ROC = 0.828, iAUC-PR = 0.294) and survival (iAUC-ROC = 0.827, iAUC-PR = 0.311). Stratification analysis unveils two distinct clusters for all comorbidities, effectively discriminated by variables like HbA1c for T2D and age at baseline for heart problems. The developed DBN constitutes an effective, highly-explainable predictive risk tool for simulating and stratifying the dynamic risk of developing cardio-metabolic comorbidities. Its use could help identify the effects of risk factors and develop health policies that prevent the occurrence of comorbidities.


Assuntos
Envelhecimento , Teorema de Bayes , Comorbidade , Diabetes Mellitus Tipo 2 , Modelos Estatísticos , Humanos , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Masculino , Idoso , Pessoa de Meia-Idade , Estudos Longitudinais , Fatores de Risco , Hipertensão/epidemiologia , Adulto , Idoso de 80 Anos ou mais , Cardiopatias/epidemiologia
18.
BMC Cardiovasc Disord ; 24(1): 260, 2024 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-38769516

RESUMO

INTRODUCTION: Use of doxorubicin, an anthracycline chemotherapeutic agent has been associated with late-occurring cardiac toxicities. Detection of early-occurring cardiac effects of cancer chemotherapy is essential to prevent occurrence of adverse events including toxicity, myocardial dysfunction, and death. OBJECTIVE: To investigate the prevalence of elevated cardiac troponin T (cTnT) and associated factors of myocardial injury in children on doxorubicin cancer chemotherapy. METHODS: Design: A cross-sectional study. SETTING AND SUBJECTS: A hospital-based study conducted on children aged 1-month to 12.4-years who had a diagnosis of cancer and were admitted at Kenyatta National Hospital (KNH). INTERVENTIONS AND OUTCOMES: The patients underwent Echocardiography (ECHO) before their scheduled chemotherapy infusion. Twenty-four (24) hours after the chemotherapy infusion the patients had an evaluation of the serum cardiac troponin T (cTnT) and a repeat ECHO. Myocardial injury was defined as cTnT level > 0.014 ng/ml or a Fractional Shortening (FS) of < 29% on ECHO. RESULTS: One hundred (100) children were included in the final analysis. Thirty-two percent (32%) of the study population had an elevated cTnT. A cumulative doxorubicin dose of > 175 mg/m2 was significantly associated with and elevated cTnT (OR, 10.76; 95% CI, 1.18-97.92; p = 0.035). Diagnosis of nephroblastoma was also associated with an elevated cTnT (OR, 3.0; 95% CI, 1.23-7.26) but not statistically significant (p = 0.105). Nine percent (9%) of the participants had echocardiographic evidence of myocardial injury. CONCLUSION: When compared to echocardiography, elevated levels of cTnT showed a higher association with early-occurring chemotherapy-induced myocardial injury among children on cancer treatment at a tertiary teaching and referral hospital in Kenya.


Assuntos
Antibióticos Antineoplásicos , Biomarcadores , Cardiotoxicidade , Doxorrubicina , Neoplasias , Centros de Atenção Terciária , Troponina T , Humanos , Estudos Transversais , Masculino , Feminino , Doxorrubicina/efeitos adversos , Criança , Quênia/epidemiologia , Troponina T/sangue , Pré-Escolar , Antibióticos Antineoplásicos/efeitos adversos , Lactente , Neoplasias/tratamento farmacológico , Neoplasias/sangue , Fatores de Risco , Biomarcadores/sangue , Prevalência , Fatores de Tempo , Regulação para Cima , Cardiopatias/induzido quimicamente , Cardiopatias/epidemiologia , Cardiopatias/diagnóstico por imagem , Cardiopatias/diagnóstico , Cardiopatias/sangue , Fatores Etários , Medição de Risco , Ecocardiografia
19.
Europace ; 26(5)2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38691672

RESUMO

AIMS: Blood stasis is crucial in developing left atrial (LA) thrombi. LA appendage peak flow velocity (LAAFV) is a quantitative parameter for estimating thromboembolic risk. However, its impact on LA thrombus resolution and clinical outcomes remains unclear. METHODS AND RESULTS: The LAT study was a multicentre observational study investigating patients with atrial fibrillation (AF) and silent LA thrombi detected by transoesophageal echocardiography (TEE). Among 17 436 TEE procedures for patients with AF, 297 patients (1.7%) had silent LA thrombi. Excluding patients without follow-up examinations, we enrolled 169 whose baseline LAAFV was available. Oral anticoagulation use increased from 85.7% at baseline to 97.0% at the final follow-up (P < 0.001). During 1 year, LA thrombus resolution was confirmed in 130 (76.9%) patients within 76 (34-138) days. Conversely, 26 had residual LA thrombi, 8 had thromboembolisms, and 5 required surgical removal. These patients with failed thrombus resolution had lower baseline LAAFV than those with successful resolution (18.0 [15.8-22.0] vs. 22.2 [17.0-35.0], P = 0.003). Despite limited predictive power (area under the curve, 0.659; P = 0.001), LAAFV ≤ 20.0 cm/s (best cut-off) significantly predicted failed LA thrombus resolution, even after adjusting for potential confounders (odds ratio, 2.72; 95% confidence interval, 1.22-6.09; P = 0.015). The incidence of adverse outcomes including ischaemic stroke/systemic embolism, major bleeding, or all-cause death was significantly higher in patients with reduced LAAFV than in those with preserved LAAFV (28.4% vs. 11.6%, log-rank P = 0.005). CONCLUSION: Failed LA thrombus resolution was not rare in patients with AF and silent LA thrombi. Reduced LAAFV was associated with failed LA thrombus resolution and adverse clinical outcomes.


Assuntos
Anticoagulantes , Apêndice Atrial , Fibrilação Atrial , Ecocardiografia Transesofagiana , Trombose , Humanos , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/complicações , Masculino , Feminino , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/fisiopatologia , Idoso , Trombose/fisiopatologia , Trombose/diagnóstico por imagem , Trombose/complicações , Pessoa de Meia-Idade , Velocidade do Fluxo Sanguíneo , Anticoagulantes/uso terapêutico , Fatores de Risco , Resultado do Tratamento , Doenças Assintomáticas , Fatores de Tempo , Cardiopatias/fisiopatologia , Cardiopatias/complicações , Cardiopatias/diagnóstico por imagem , Tromboembolia/etiologia , Tromboembolia/fisiopatologia , Idoso de 80 Anos ou mais , Função do Átrio Esquerdo
20.
Cardiovasc Toxicol ; 24(6): 563-575, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38700665

RESUMO

Anthracycline antibiotic is one of the most effective anti-tumor drugs used to manage certain types of breast cancers, lymphomas, and leukemias. However, anthracyclines induce a dose-dependent cardiotoxicity that may progress to heart failure. Thus, using a sensitive predictor of early cardiac dysfunction in patients treated with anthracyclines can help detect subclinical cardiac dysfunction early and help initiate interventions to protect these patients. Among parameters of myocardial measure, cardiac magnetic resonance (CMR)-measured native myocardial T1 mapping is considered a sensitive and accurate quantitative measure of early subclinical cardiac changes, particularly cardiac inflammation and fibrosis. However, to understand the quality and the validity of the current evidence supporting the use of these measures in patients treated with anthracyclines, we aimed to conduct a systematic review of clinical studies of this measure to detect early myocardial changes in cancer patients treated with anthracyclines. The primary outcome was the level of native T1 mapping. We performed fixed-effects meta-analyses and assessed certainty in effect estimates. Of the 1780 publications reviewed (till 2022), 23 were retrieved, and 9 articles met the inclusion criteria. Our study showed that exposure to anthracycline was associated with a significant elevation of native myocardial T1 mapping from baseline (95% CI 0.1121 to 0.5802; p = 0.0037) as well as compared to healthy control patients (95% CI 0.2925 to 0.7448; p < 0.0001). No significant publication bias was noted on the assessment of the funnel plot and Egger's test. According to the Q test, there was no significant heterogeneity in the included studies (I2 = 0.0000% versus healthy controls and I2 = 14.0666% versus baseline). Overall, our study suggests that native myocardial T1 mapping is useful for detecting anthracycline-induced cardiotoxicity in patients with cancer.


Assuntos
Antraciclinas , Antibióticos Antineoplásicos , Cardiotoxicidade , Cardiopatias , Neoplasias , Valor Preditivo dos Testes , Humanos , Antraciclinas/efeitos adversos , Neoplasias/tratamento farmacológico , Antibióticos Antineoplásicos/efeitos adversos , Feminino , Cardiopatias/induzido quimicamente , Cardiopatias/diagnóstico por imagem , Cardiopatias/fisiopatologia , Cardiopatias/diagnóstico , Masculino , Pessoa de Meia-Idade , Diagnóstico Precoce , Fatores de Risco , Adulto , Idoso , Medição de Risco , Imageamento por Ressonância Magnética , Função Ventricular Esquerda/efeitos dos fármacos , Adulto Jovem
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