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Comparison of the Effect of Sacubitril/Valsartan on Left Ventricular Systolic Function in Patients with Non-ischaemic and Ischaemic Cardiomyopathy.
Ioannou, A, Metaxa, S, Simon, S, Mandal, AKJ, Missouris, CG
Cardiovascular drugs and therapy. 2020;(6):755-762
Abstract
PURPOSE Sacubitril/valsartan has been demonstrated to improve prognosis and outcomes in heart failure with reduced ejection fraction (HFrEF) patients. We sought to compare the improvement in cardiac function between non-ischaemic and ischaemic cardiomyopathy for patients receiving sacubitril/valsartan. METHODS We conducted a single centre prospective cohort survey of patients reviewed in the Heart Function Clinic between February 2017 and January 2018. Functional evaluation and measurement of biochemical and echocardiographic parameters occurred before the initiation of sacubitril/valsartan, and after 3 months of treatment. RESULTS We identified 52 patients (26 non-ischaemic and 26 ischaemic cardiomyopathy) suitable for treatment with sacubitril/valsartan. Treatment was followed by a significant decrease in a New York Heart Association (NYHA) class in both patients with non-ischaemic (2.3 ± 0.6 vs. 1.6 ± 0.7, P < 0.001) and ischaemic cardiomyopathy (2.3 ± 0.5 vs. 1.5 ± 0.6, P < 0.001), along with an increase in ejection fraction in both patients with non-ischaemic (26.2% ± 6.5% vs. 37.2% ± 13.8%, P < 0.001) and ischaemic cardiomyopathy (28.1% ± 5.7% vs. 31.5% ± 8.4%, P = 0.007). The improvement in ejection fraction was significantly greater in the patients with non-ischaemic cardiomyopathy compared to those with ischaemic cardiomyopathy (10.7% ± 13.0% vs. 3.9% ± 6.0%, P = 0.023). CONCLUSION Our study suggests that treatment with sacubitril/valsartan in patients with non-ischaemic cardiomyopathy is followed by a greater improvement in ejection fraction than in patients with ischaemic cardiomyopathy.
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Comparison of the effect of 12- and 24-session cardiac rehabilitation on physical, psychosocial and biomedical factors in ischemic heart disease patients.
Sadeghi, M, Izadi, A, Mahdi Hadavi, M, Rafati Fard, M, Roohafza, H
Hormone molecular biology and clinical investigation. 2020;(1)
Abstract
Background Cardiac rehabilitation (CR) is a key component of effective care for patients with a wide spectrum of cardiac problems. It seems that the short-term provision of these services can facilitate their use and meeting of related needs for patients participating in the CR programs. Materials and methods In this interventional study on patients with ischemic heart disease (IHD) referred to the Cardiac Rehabilitation Center of Chamran Hospital, Isfahan, Iran. One-hundred and twelve patients were randomly divided into two groups of 12 and 24 sessions of CR [mean age: 59.2 ± (9.02) and 60.7 ± (9.3) years, respectively] and underwent a CR program. All information was collected in two stages, before the beginning of the program and after completion of 12- and 24-session rehabilitation programs. The data collection tools were demographics questionnaire, the International Physical Activity Questionnaires (IPAQ), McNew Quality of Life Questionnaire, Beck Depression Inventory (BDI), and Zung Self-Rating Anxiety Scale (SAS). Results The results of this study showed that in both groups, total physical activity (PA) and functional capacity increased, and the quality of life (QOL) was statistically improved. Comparison of changes in mean differences at the end of the rehabilitation periods between the two groups, showed that only the weight, body mass index (BMI), waist circumference (WC) and high-density lipoprotein (HDL) in the 24-session group significantly decreased compared to the 12-session group and, but no significant difference in other variables was observed. Conclusion Overall, the findings of this study support the overall benefits of the CR program in both the short and the long term. Therefore it can be suggested that a short-term program can still be a valuable option for reducing the risk in cardiac patients and meeting their service needs.
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Change of plasmalogen content of red blood cells in myocardial hypoxia and acidosis.
Osipenko, AN
Acta cardiologica. 2018;(1):61-68
Abstract
BACKGROUND The contribution of hypoxic conditions to the chemical composition of membranes is not completely established. Plasmalogens, containing an alkenyl group with aldehydogenic ether linkage, are significant components of membrane lipids and their level can change in oxygen deficiency. METHODS Analysis of plasmalogens in red blood cells was performed in patients (n = 17) with coronary heart disease, stable angina (functional class II-III) and coronary atherosclerosis. The control group consisted of 17 healthy volunteers. In addition, isolated blood samples of seven healthy volunteers were analysed before and after 180 min incubation at 37 °C. Fatty acid ethyl esters and diethyl acetals of fatty aldehydes, obtained during sample preparation from red blood cells, were analysed by capillary gas-liquid chromatography. Quantitative assessment of the change of the plasmalogen levels was evaluated as change of the share of fatty aldehyde diethyl acetals in the total sum of fatty aldehyde diethyl acetals and fatty acid ethyl esters. RESULTS In comparison with the healthy volunteers, an increase in plasmalogen content of red blood cells and a reduction of the pH of the blood plasma in the group of patients with coronary heart disease were detected. In experimental hypoxia, there was an increase in the plasmalogen content of the red blood cells and a plasma pH decrease in all samples subjected to the incubation. CONCLUSIONS The results indicate changes in the physicochemical properties of the cell membrane in hypoxia. One of the most likely reasons of the increase of plasmalogen content in the membranes may be a more significant increase in activity of calcium-dependent phospholipases in comparison with the activity of calcium-independent plasmalogen phospholipases.
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Temporal trends in ischemic heart disease mortality in 21 world regions, 1980 to 2010: the Global Burden of Disease 2010 study.
Moran, AE, Forouzanfar, MH, Roth, GA, Mensah, GA, Ezzati, M, Murray, CJ, Naghavi, M
Circulation. 2014;(14):1483-92
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Abstract
BACKGROUND Ischemic heart disease (IHD) is the leading cause of death worldwide. The Global Burden of Diseases, Risk Factors and Injuries 2010 Study estimated global and regional IHD mortality from 1980 to 2010. METHODS AND RESULTS Sources for IHD mortality estimates were country-level surveillance, verbal autopsy, and vital registration data. Regional income, metabolic and nutritional risk factors, and other covariates were estimated from surveys and a systematic review. An estimation and validation process led to an ensemble model of IHD mortality for 21 world regions. Globally, age-standardized IHD mortality has declined since the 1980s, and high-income regions (especially Australasia, Western Europe, and North America) experienced the most remarkable declines. Age-standardized IHD mortality increased in former Soviet Union countries and South Asia in the 1990s and attenuated after 2000. In 2010, Eastern Europe and Central Asia had the highest age-standardized IHD mortality rates. More IHD deaths occurred in South Asia in 2010 than in any other region. On average, IHD deaths in South Asia, North Africa and the Middle East, and sub-Saharan Africa occurred at younger ages in comparison with most other regions. CONCLUSIONS In most world regions, particularly in high-income regions, age-standardized IHD mortality rates have declined significantly since 1980. High age-standardized IHD mortality in Eastern Europe, Central Asia, and South Asia point to the need to prevent and control established risk factors in those regions and to research the unique behavioral and environmental determinants of higher IHD mortality.
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Characteristics and drug utilization patterns of new users of rosuvastatin and other statins in four countries.
McAfee, AT, Rodríguez, LA, Goettsch, WG, González-Pérez, A, Johansson, S, Ming, EE, Wallander, MA, Herings, RM
Minerva cardioangiologica. 2010;(6):611-22
Abstract
AIM: This study was undertaken to increase understanding of the utilization of a newly introduced statin through evaluation of characteristics of 'real-life' patients in a pharmacoepidemiology program in the USA, the Netherlands, the UK and Canada. METHODS This was an observational analysis of prospectively collected data from primary care patients classified as new users of rosuvastatin or any other statin. New users (naïve or switched initiators) of rosuvastatin were compared with initiators of other statins, as identified from automated healthcare databases in the first 1 to 2 years of rosuvastatin availability. Demographics, statin doses, previous statin use and other lipid-lowering therapies, and relevant comorbidities were recorded. The main outcome measure was proportion of naïve and non-naïve statin users in patients prescribed rosuvastatin or 'other statins'. RESULTS Among 346.547 new statin users identified in the cohorts, 46.838 (13.5%) were new users of rosuvastatin and most (84.1%) were statin-naïve. Patients receiving rosuvastatin were more likely to have been previously treated with another statin or non-statin lipid-lowering therapy and tended to be younger, compared with first users of other statins. CONCLUSION These findings suggest that rosuvastatin is preferentially prescribed to patients who have not responded satisfactorily to established treatment.
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[Cardiac rehabilitation. Recent advances].
Lellamo, F, Volterrani, M
Recenti progressi in medicina. 2010;(3):118-26
Abstract
Evidence derived from studies which support the relevance of exercise as a core component of cardiac rehabilitation programs are presented, along with the beneficial effects of exercise training in counteracting the mechanisms sustaining the atherosclerotic process and cardiovascular risk factors in the context of secundary, as well as primary, cardiovascular prevention. Practical guides to plan exercise training programs are also provided with suggestions for specific pathological conditions and advanced age. Recent advances on the benefits of exercise training in patients with heart failure are reported along with the potential of telemedicine for home rehabilitation aiming to a widespread diffusion of exercise as a cardiovascular therapy. Finally, the possible risks of exercise and practical open questions in cardiac rehabilitation are discussed.
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A randomized multifactorial intervention study for prevention of ischaemic heart disease (Inter99): the long-term effect on physical activity.
von Huth Smith, L, Ladelund, S, Borch-Johnsen, K, Jørgensen, T
Scandinavian journal of public health. 2008;(4):380-8
Abstract
AIM: To examine the effect of a randomized multiple risk factor intervention study for prevention of ischaemic heart disease (IHD) on the development in physical activity over a 36-month period. METHODS Two random samples (high intensity intervention, group A, n=11,708; low intensity intervention, group B, n=1,308) were invited for a health examination, an assessment of absolute risk of developing IHD, and an individualized lifestyle intervention. The participation rate was 52.5%. High-risk persons in group A were also offered diet/physical activity and/or smoking cessation group counselling. High-risk persons in group B were referred to their GP. High-risk persons were re-counselled after 12 and 36 months. The control group (group C, n=5,264, response rate=61.3%) answered a mailed questionnaire. Data were analysed using longitudinal linear regression models with random effects. MAIN OUTCOME Change in physical activity from baseline to 12-and 36-month follow-up. RESULTS In men, the high-intensity (group A) intervention had a beneficial effect at 12-month follow-up, whereas after 36 months both the high-intensity and the low-intensity (group B) intervention had a beneficial effect on the development in physical activity when compared with group C. This was regardless of baseline physical activity level. At 36-month follow-up there was no significant difference between groups A and B. There was no intervention effect among women. CONCLUSIONS Only men seemed to benefit from the intervention.
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Meta-analysis of published reports on the effect of statin treatment before percutaneous coronary intervention on periprocedural myonecrosis.
Merla, R, Reddy, NK, Wang, FW, Uretsky, BF, Barbagelata, A, Birnbaum, Y
The American journal of cardiology. 2007;(5):770-6
Abstract
Myonecrosis, manifested by an increase in cardiac markers, may occur in up to 50% of patients undergoing elective percutaneous coronary intervention (PCI). The degree of periprocedural myonecrosis, measured by the peak creatine kinase-MB fraction, has been associated with incidence of adverse clinical outcomes. Therefore, strategies to decrease myonecrosis may translate into a decrease in mortality. We evaluated the efficacy of statin pretreatment in decreasing the incidence of myonecrosis after PCI on the basis of results of published studies. A systematic search of the PubMed database from its inception to October 2006 and from the references of identified studies was performed. Only studies with concurrent control groups were included. Information on baseline characteristics of included patients and clinical outcomes was independently extracted by 2 investigators. A random effects model was used to pool odds ratios of the incidence of periprocedural myonecrosis in statin-treated patients versus controls. A total of 9 trials was included in the analysis, 2 randomized trials (n = 604) and 7 retrospective cohort studies (n = 4,751), which assessed the impact of statin pretreatment on periprocedural myonecrosis. During this period, 196 of 2,149 patients (9%) in the statin-treated group compared with 455 of 2,602 (17.5%) in the control group (odds ratio 0.45, 95% confidence interval 0.33 to 0.62, p <0.01) developed myonecrosis. In conclusion, based on existing evidence, routine pretreatment with statins may decrease the risk of postprocedure myonecrosis. Large randomized controlled trials addressing the dose, duration, and type of statin on periprocedural myonecrosis are necessary before recommending routine use of statins to prevent myonecrosis in the elective PCI setting.
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Effects of intensive versus moderate lipid-lowering therapy on myocardial ischemia in older patients with coronary heart disease: results of the Study Assessing Goals in the Elderly (SAGE).
Deedwania, P, Stone, PH, Bairey Merz, CN, Cosin-Aguilar, J, Koylan, N, Luo, D, Ouyang, P, Piotrowicz, R, Schenck-Gustafsson, K, Sellier, P, et al
Circulation. 2007;(6):700-7
Abstract
BACKGROUND Clinical trials have demonstrated that, compared with placebo, intensive statin therapy reduces ischemia in patients with acute coronary syndromes and in patients with stable coronary artery disease. However, no studies to date have assessed intensive versus moderate statin therapy in older patients with stable coronary syndromes. METHODS AND RESULTS A total of 893 ambulatory coronary artery disease patients (30% women) 65 to 85 years of age with > or = 1 episode of myocardial ischemia that lasted > or = 3 minutes during 48-hour ambulatory ECG at screening were randomized to atorvastatin 80 mg/d or pravastatin 40 mg/d and followed up for 12 months. The primary efficacy parameter (absolute change from baseline in total duration of ischemia at month 12) was significantly reduced in both groups at month 3 and month 12 (both P<0.001 for each treatment group) with no significant difference between the treatment groups. Atorvastatin-treated patients experienced greater low-density lipoprotein cholesterol reductions than did pravastatin-treated patients, a trend toward fewer major acute cardiovascular events (hazard ratio, 0.71; 95% confidence interval, 0.46, 1.09; P=0.114), and a significantly greater reduction in all-cause death (hazard ratio, 0.33; 95% confidence interval, 0.13, 0.83; P=0.014). CONCLUSIONS Compared with moderate pravastatin therapy, intensive atorvastatin therapy was associated with reductions in cholesterol, major acute cardiovascular events, and death in addition to the reductions in ischemia observed with both therapies. The contrast between the therapies' differing efficacy for major acute cardiovascular events and death and their nonsignificant difference in efficacy for reduction of ischemia suggests that low-density lipoprotein cholesterol-lowering thresholds for ischemia and major acute cardiovascular events may differ. The Study Assessing Goals in the Elderly (SAGE) demonstrates that older men and women with coronary artery disease benefit from intensive statin therapy.
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Metabolic imaging with beta-methyl-p-[(123)I]-iodophenyl-pentadecanoic acid identifies ischemic memory after demand ischemia.
Dilsizian, V, Bateman, TM, Bergmann, SR, Des Prez, R, Magram, MY, Goodbody, AE, Babich, JW, Udelson, JE
Circulation. 2005;(14):2169-74
Abstract
BACKGROUND After myocardial ischemia, prolonged suppression of fatty acid metabolism may persist despite restoration of blood flow, which is called metabolic stunning. We hypothesized that a branched-chain fatty acid, beta-methyl-p-[(123)I]-iodophenyl-pentadecanoic acid (BMIPP), might identify the presence of myocardial ischemia late after demand ischemia at rest up to 30 hours later. METHODS AND RESULTS In 32 patients with exercise-induced ischemia on thallium SPECT, BMIPP was injected at rest within 30 hours of ischemia. SPECT images were acquired beginning 10 minutes after injection (early) and again 30 minutes after injection (delayed). Thallium and BMIPP SPECT data were read separately by 3 observers blinded to other imaging and clinical data. Agreement between BMIPP and thallium data for the presence of an abnormality on the patient level was 91% (95% CI, 75 to 98) for the early BMIPP data and 94% (95% CI, 79 to 99) for the delayed BMIPP data. Agreement between delayed BMIPP and thallium was 95% among 21 patients studied on the same day, a mean of 6.2+/-1.4 hours after exercise-induced ischemia, and 91% among the 11 patients studied on the next calendar day, a mean of 24.9+/-2.6 hours after ischemia (P=NS). The magnitude of resting BMIPP metabolic defect by semiquantitative visual analysis was correlated to the magnitude of exercise-induced thallium perfusion defect (r=0.6, P<0.001 for early BMIPP; r=0.5, P=0.005 for delayed BMIPP). CONCLUSIONS Metabolic imaging with BMIPP identifies patients with recent exercise-induced myocardial ischemia. These findings support the concept that BMIPP imaging can successfully demonstrate the metabolic imprint of a stress-induced ischemic episode, also known as ischemic memory.