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1.
Cardio-oncology: the new frontier of clinical and preventive cardiology.
Paris, S, Tarantini, L, Navazio, A, Faggiano, P
Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace. 2020;(2)
Abstract
Even if cancer and cardiovascular diseases are considered two distinct diseases, an intricate interconnection between these conditions has been established. Increased risk of malignancy has been identified in patients with cardiovascular disease, as well as a greater propensity to the development of cardiovascular diseases has been observed in patients with cancer. The development of cardiotoxicity following exposure to certain anticancer drugs only partially explains this relationship. Shared risk factors and common pathogenic mechanisms suggest the existence of a common biology and a complex interplay between these two conditions. Due to improving longevity and therapeutic advances, the number of patients affected or potentially at risk of developing these two diseases is constantly increasing and currently, several drugs against cancer from anthracyclines to checkpoint inhibitors, can also cause a wide range of unexpected cardiovascular side effects. Management of these issues in clinical practice is an emerging challenge for cardiologists and oncologists, and led to the development of a new dedicated discipline called cardio-oncology. Surveillance and prevention strategies as well as interventions to reduce cardiovascular risk and prevent cardiotoxicities are the primary objectives of cardio-oncology. In this review, we explore the etiopathogenesis common to cardiovascular disease and cancer and the complex interplay between them. We also report the main characteristics of the drugs responsible for cardiotoxicity, highlighting the available strategies for optimal patient management based on a multidisciplinary approach in the cardio-oncology setting.
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2.
[123I]Metaiodobenzylguanidine (MIBG) Cardiac Scintigraphy and Automated Classification Techniques in Parkinsonian Disorders.
Nuvoli, S, Spanu, A, Fravolini, ML, Bianconi, F, Cascianelli, S, Madeddu, G, Palumbo, B
Molecular imaging and biology. 2020;(3):703-710
Abstract
PURPOSE To provide reliable and reproducible heart/mediastinum (H/M) ratio cut-off values for parkinsonian disorders using two machine learning techniques, Support Vector Machines (SVM) and Random Forest (RF) classifier, applied to [123I]MIBG cardiac scintigraphy. PROCEDURES We studied 85 subjects, 50 with idiopathic Parkinson's disease, 26 with atypical Parkinsonian syndromes (P), and 9 with essential tremor (ET). All patients underwent planar early and delayed cardiac scintigraphy after [123I]MIBG (111 MBq) intravenous injection. Images were evaluated both qualitatively and quantitatively; the latter by the early and delayed H/M ratio obtained from regions of interest (ROIt1 and ROIt2) drawn on planar images. SVM and RF classifiers were finally used to obtain the correct cut-off value. RESULTS SVM and RF produced excellent classification performances: SVM classifier achieved perfect classification and RF also attained very good accuracy. The better cut-off for H/M value was 1.55 since it remains the same for both ROIt1 and ROIt2. This value allowed to correctly classify PD from P and ET: patients with H/M ratio less than 1.55 were classified as PD while those with values higher than 1.55 were considered as affected by parkinsonism and/or ET. No difference was found when early or late H/M ratio were considered separately thus suggesting that a single early evaluation could be sufficient to obtain the final diagnosis. CONCLUSIONS Our results evidenced that the use of SVM and CT permitted to define the better cut-off value for H/M ratios both in early and in delayed phase thus underlining the role of [123I]MIBG cardiac scintigraphy and the effectiveness of H/M ratio in differentiating PD from other parkinsonism or ET. Moreover, early scans alone could be used for a reliable diagnosis since no difference was found between early and late. Definitely, a larger series of cases is needed to confirm this data.
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Associations of 24-Hour Urinary Sodium and Potassium Excretion with Cardiac Biomarkers: The Maastricht Study.
Martens, RJH, Henry, RMA, Bekers, O, Dagnelie, PC, van Dongen, MCJM, Eussen, SJPM, van Greevenbroek, M, Kroon, AA, Stehouwer, CDA, Wesselius, A, et al
The Journal of nutrition. 2020;(6):1413-1424
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Abstract
BACKGROUND It is a matter of debate whether sodium and potassium intake are associated with heart disease. Further, the mechanisms underlying associations of sodium and potassium intake with cardiac events, if any, are not fully understood. OBJECTIVES We examined cross-sectional associations of 24-h urinary sodium excretion (UNaE) and potassium excretion (UKE), as estimates of their intakes, with high-sensitivity cardiac troponins T (hs-cTnT) and I (hs-cTnI), and N-terminal pro-B-type natriuretic peptide (NT-proBNP), which are markers of cardiomyocyte injury and cardiac dysfunction. METHODS We included 2961 participants from the population-based Maastricht Study (mean ± SD age 59.8 ± 8.2 y, 51.9% men), who completed the baseline survey between November 2010 and September 2013. Associations were examined with restricted cubic spline linear regression analyses and ordinary linear regression analyses, adjusted for demographics, lifestyle, and cardiovascular disease (CVD) risk factors. RESULTS Median [IQR] 24-h UNaE and UKE were 3.7 [2.8-4.7] g/24 h and 3.0 [2.4-3.6] g/24 h, respectively. After adjustment for potential confounders, 24-h UNaE was not associated with hs-cTnT, hs-cTnI, and NT-proBNP concentrations. In contrast, after adjustment for potential confounders, lower 24-h UKE was nonlinearly associated with higher hs-cTnT and NT-proBNP. For example, as compared with the third/median quintile of 24-h UKE (range: 2.8-3.2 g/24 h), participants in the first quintile (range: 0.5-2.3 g/24 h) had 1.05 (95% CI: 0.99, 1.11) times higher hs-cTnT and 1.14 (95% CI: 1.03, 1.26) times higher NT-proBNP. Associations were similar after further adjustment for estimated glomerular filtration rate, albuminuria, blood pressure, and serum potassium. CONCLUSIONS Twenty-four-hour UNaE was not associated with the studied cardiac biomarkers. In contrast, lower 24-h UKE was nonlinearly associated with higher hs-cTnT and NT-proBNP. This finding supports recommendations to increase potassium intake in the general population. In addition, it suggests that cardiac dysfunction and/or cardiomyocyte injury may underlie previously reported associations of lower potassium intake with CVD mortality.
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Cardiac Imaging With 123I-meta-iodobenzylguanidine and Analogous PET Tracers: Current Status and Future Perspectives.
Wan, N, Travin, MI
Seminars in nuclear medicine. 2020;(4):331-348
Abstract
Autonomic innervation plays an important role in proper functioning of the cardiovascular system. Altered cardiac sympathetic function is present in a variety of diseases, and can be assessed with radionuclide imaging using sympathetic neurotransmitter analogues. The most studied adrenergic radiotracer is cardiac 123I-meta-iodobenzylguanidine (123I-mIBG). Cardiac 123I-mIBG uptake can be evaluated using both planar and tomographic imaging, thereby providing insight into global and regional sympathetic innervation. Standardly assessed imaging parameters are the heart-to-mediastinum ratio and washout rate, customarily derived from planar images. Focal tracer deficits on tomographic imaging also show prognostic utility, with some data suggesting that the best approach to tomographic image interpretation may differ from conventional methods. Cardiac 123I-mIBG image findings strongly correlate with the severity and prognosis of many cardiovascular diseases, especially heart failure and ventricular arrhythmias. Cardiac 123I-mIBG imaging in heart failure is FDA approved for prognostic purposes. With the robustly demonstrated ability to predict occurrence of potentially fatal arrhythmias, cardiac 123I-mIBG imaging shows promise for better selecting patients who will benefit from an implantable cardioverter defibrillator, but clinical use has been hampered by lack of the randomized trial needed for incorporation into societal guidelines. In patients with ischemic heart disease, cardiac 123I-mIBG imaging aids in assessing the extent of damage and in identifying arrhythmogenic regions. There have also been studies using cardiac 123I-mIBG for other conditions, including patients following heart transplantation, diabetic related cardiac abnormalities and chemotherapy induced cardiotoxicity. Positron emission tomographic adrenergic radiotracers, that improve image quality, have been investigated, especially 11C-meta-hydroxyephedrine, and most recently 18F-fluorbenguan. Cadmium-zinc-telluride cameras also improve image quality. With better spatial resolution and quantification, PET tracers and advanced camera technologies promise to expand the clinical utility of cardiac sympathetic imaging.
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A quick glance at selected topics in this issue.
Bhambhvani, P, Hage, FG, Iskandrian, AE
Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology. 2020;(2):351-354
Abstract
"A quick glance at selected topics in this issue" aims to highlight contents of the Journal and provide a quick review to the readers.
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Effect of alternate-day fasting on obesity and cardiometabolic risk: A systematic review and meta-analysis.
Park, J, Seo, YG, Paek, YJ, Song, HJ, Park, KH, Noh, HM
Metabolism: clinical and experimental. 2020;:154336
Abstract
BACKGROUND & AIMS Alternate-day fasting (ADF) is related to weight reduction, lowered risks of weight regain, and relative lean body mass preservation compared to continuous energy restriction. This meta-analysis aimed to assess the effects of ADF on obesity-related factors and cardiometabolic risk factors in adults. METHODS Using PubMed, EMBASE, and Cochrane online databases, an electronic search was performed. Randomized controlled trials were investigated to evaluate ADF effects on body mass index (BMI), body weight (BW), waist circumference, body fat mass (FM), lean body mass, and cardiometabolic risk factors in adults aged ≥18 years. By utilizing a random-effects model, meta-analyses to assess weighted mean difference (WMD) with 95% confidence intervals (CIs) were performed for eight randomized controlled trials (total participants = 728). RESULTS We observed significant effects of ADF for BMI (WMD -0.73 kg/m2, 95% CI -1.13 to -0.34), FM (WMD -1.27 kg, 95% CI -2.09 to -0.46), and total cholesterol (WMD -8.14 mg/dL, 95% CI -14.59 to -1.69). Subgroup analyses indicated that significant intervention effects were observed for BMI, BW, FM, and total cholesterol when compared to the control, the participants were overweight, and the study duration was <6 months. ADF is effective in reducing waist circumference in adults aged ≥40 years with obesity. However, there was no difference between ADF and continuous energy restriction, time-restricted feeding, or control with regard to lean body mass. CONCLUSIONS Current evidence suggests that ADF effectively lowers BMI, BW, FM, and total cholesterol in adults with overweight within 6 months compared to the control.
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Brain-heart interaction after acute ischemic stroke.
Battaglini, D, Robba, C, Lopes da Silva, A, Dos Santos Samary, C, Leme Silva, P, Dal Pizzol, F, Pelosi, P, Rocco, PRM
Critical care (London, England). 2020;(1):163
Abstract
Early detection of cardiovascular dysfunctions directly caused by acute ischemic stroke (AIS) has become paramount. Researchers now generally agree on the existence of a bidirectional interaction between the brain and the heart. In support of this theory, AIS patients are extremely vulnerable to severe cardiac complications. Sympathetic hyperactivity, hypothalamic-pituitary-adrenal axis, the immune and inflammatory responses, and gut dysbiosis have been identified as the main pathological mechanisms involved in brain-heart axis dysregulation after AIS. Moreover, evidence has confirmed that the main causes of mortality after AIS include heart attack, congestive heart failure, hemodynamic instability, left ventricular systolic dysfunction, diastolic dysfunction, arrhythmias, electrocardiographic anomalies, and cardiac arrest, all of which are more or less associated with poor outcomes and death. Therefore, intensive care unit admission with continuous hemodynamic monitoring has been proposed as the standard of care for AIS patients at high risk for developing cardiovascular complications. Recent trials have also investigated possible therapies to prevent secondary cardiovascular accidents after AIS. Labetalol, nicardipine, and nitroprusside have been recommended for the control of hypertension during AIS, while beta blockers have been suggested both for preventing chronic remodeling and for treating arrhythmias. Additionally, electrolytic imbalances should be considered, and abnormal rhythms must be treated. Nevertheless, therapeutic targets remain challenging, and further investigations might be essential to complete this complex multi-disciplinary puzzle. This review aims to highlight the pathophysiological mechanisms implicated in the interaction between the brain and the heart and their clinical consequences in AIS patients, as well as to provide specific recommendations for cardiovascular management after AIS.
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Prognostic value of cardiac CT.
Seitun, S, Clemente, A, Maffei, E, Toia, P, La Grutta, L, Cademartiri, F
La Radiologia medica. 2020;(11):1135-1147
Abstract
In the past decades, coronary computed tomography angiography (CCTA) has become a powerful tool in the management of coronary artery disease. The diagnostic and prognostic value of CCTA has been extensively demonstrated in both large observational studies and clinical trials among stable chest pain patients. The quantification of coronary artery calcium score (CACS) is a well-established predictor of cardiovascular morbidity and mortality in asymptomatic subjects. Besides CACS, the main strength of CCTA is the accurate assessment of the individual total atherosclerotic plaque burden, which holds important prognostic information. In addition, CCTA, by providing detailed information on coronary plaque morphology and composition with identification of specific high-risk plaque features, may further improve the risk stratification beyond the assessment of coronary stenosis. The development of new CCTA applications, such as stress myocardial CT perfusion and computational fluids dynamic applied to standard CCTA to derive CT-based fractional flow reserve (FFR) values have shown promising results to guide revascularization, potentially improving clinical outcomes in stable chest pain patients. In this review, starting from the role of CACS and moving beyond coronary stenosis, we evaluate the existing evidence of the prognostic effectiveness of the CCTA strategy in real-world clinical practice.
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Hierarchical modeling of force generation in cardiac muscle.
Kimmig, F, Caruel, M
Biomechanics and modeling in mechanobiology. 2020;(6):2567-2601
Abstract
Performing physiologically relevant simulations of the beating heart in clinical context requires to develop detailed models of the microscale force generation process. These models, however, may reveal difficult to implement in practice due to their high computational costs and complex calibration. We propose a hierarchy of three interconnected muscle contraction models-from the more refined to the more simplified-that are rigorously and systematically related to each other, offering a way to select, for a specific application, the model that yields a good trade-off between physiological fidelity, computational cost and calibration complexity. The three model families are compared to the same set of experimental data to systematically assess what physiological indicators can be reproduced or not and how these indicators constrain the model parameters. Finally, we discuss the applicability of these models for heart simulation.
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The evolution of the heart-healthy diet for vascular health: A walk through time.
Fischer, NM, Pallazola, VA, Xun, H, Cainzos-Achirica, M, Michos, ED
Vascular medicine (London, England). 2020;(2):184-193
Abstract
The rate of cardiovascular disease (CVD) mortality reduction in the United States has plateaued recently, despite the development of novel preventive pharmacotherapies, increased access to care, and healthcare spending. This is largely due to American's poor dietary patterns and practices causing increasing trends in the prevalence of obesity and type 2 diabetes mellitus. For decades, dietary guidelines on 'healthy diets' to reduce CVD risk, grounded in epidemiological research, have been nationally distributed to Americans. In this review, we highlight landmark events in modern nutrition science and how these have framed past and current understandings of diet and health. We also follow the evolution of dietary recommendations for Americans throughout the years, with an emphasis on recommendations aimed to reduce risk for CVD and mortality. Secondly, we examine how the low-fat ideology came to dominate America in the last decades of the 20th century and subsequently contributed to an excess intake of refined carbohydrates which, in the context of an increasingly sedentary lifestyle, may have fueled the obesity epidemic. We then examine the current major evidence-based dietary patterns and specific dietary approaches to reduce CVD risk, reviewing the literature surrounding nutritional components of the heart-healthy diet and discussing the dietary patterns proven most effective for CVD prevention: the Dietary Approaches to Stop Hypertension (DASH) diet, the Mediterranean diet, and the healthy vegetarian diet. Finally, we discuss emerging dietary trends, considerations for nutrition counseling, and future directions within the important field of nutrition, with the ultimate goal of improving vascular health.