ISSN 1671-5411 CN 11-5329/R

2021 Vol. 18, No. 6

Acute heart failure in the elderly: setting related differences in clinical features and management
Francesco Orso, Alessandra Pratesi, Andrea Herbst, Anna Chiara Baroncini, Francesca Bacci, Gabriele Ciuti, Andrea Berni, Camilla Tozzetti, Carlo Nozzoli, Alberto Moggi Pignone, Loredana Poggesi, Luciano Gabbani, Mauro Di Bari, Francesco Fattirolli, Massimo Milli, Andrea Ungar, Niccolò Marchionni, Samuele Baldasseroni
2021, 18(6): 407-415. doi: 10.11909/j.issn.1671-5411.2021.06.003
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 BACKGROUND Administrative data show that acute heart failure (HF) patients are older than those enrolled in clinical registries and frequently admitted to non-cardiological settings of care. The purpose of this study was to describe clinical characteristics of old patients hospitalised for acute HF in Cardiology, Internal Medicine or Geriatrics wards. METHODS Data came from ATHENA (AcuTe Heart failurE in advaNced Age) registry which included elderly patients (≥ 65 years) admitted to the above mentioned settings of care from December 1, 2014 to December 1, 2015. RESULTS We enrolled 396 patients, 15.4% assigned to Cardiology, 69.7% to Internal Medicine, and 14.9% to a Geriatrics ward. Mean age was 83.5 ± 7.6 years (51.8% of patients ≥ 85 years) and was higher in patients admitted to Geriatrics (P < 0.001); more than half were females. Medical treatments did not differ significantly among settings of care (in a context of a low prescription rate of renin-angiotensin-aldosterone system inhibitors) whereas significant differences were observed in comorbidity patterns and management guidelines recommendation adherence for decongestion evaluation with comparison of weight and N-terminal pro-B-type natriuretic peptide levels on admission and at discharge (both P = 0.035 and P < 0.001), echocardiographic evaluation (P < 0.001) and follow-up visits planning (P < 0.001), all higher in Cardiology. Mean in-hospital length of stay was 9 ± 5.9 days, significantly higher in Geriatrics (13.7 ± 6.5 days) and Cardiology (9.9 ± 6.7 days) compared to Internal Medicine (8 ± 5.2 days), P < 0.001. In-hospital mortality was 9.3%, resulting higher in Geriatrics (18.6%) and Cardiology (16.4%) than Internal Medicine (5.8%), P = 0.001. CONCLUSIONS In elderly patients hospitalised for acute HF, clinical characteristics and management differ significantly according to the setting of admission.
Epidemiology, etiology, and outcomes of in-hospital cardiac arrest in Lebanon
Ahmed Eltarras, Youssef Jalloul, Ola Assaad, Michael Bejjani, Yara Yammine, Nina Khatib, Abdallah Rebeiz, Mazen El Sayed, Marwan Refaat
2021, 18(6): 416-425. doi: 10.11909/j.issn.1671-5411.2021.06.005
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 BACKGROUND In-hospital cardiac arrest (IHCA) constitutes a significant cause of morbidity and mortality. As data is scarce in the Middle East and Lebanon, we devised this study to shed some light on it to better inform both hospitals and policymakers about the magnitude and quality of IHCA care in Lebanon. METHODS We analyzed retrospective data from 680 IHCA events at the American University of Beirut Medical Center between July 1, 2016 and May 2, 2019. Sociodemographic variables included age and sex, in addition to the comorbidities listed in the Charlson comorbidity index. IHCA event variables were day, event location, time from activation to arrival, initial cardiac rhythm, and the total number of IHCA events. We also looked at the months and years. We considered the return of spontaneous circulation (ROSC) and survival to discharge (StD) to be our outcomes of interest. RESULTS The incidence of IHCA was 6.58 per 1,000 hospital admissions (95% CI: 6.09−7.08). Non-shockable rhythms were 90.7% of IHCAs. Most IHCA cases occurred in the closed units (87.9%) (intensive care unit, respiratory care unit, neurology care unit, and cardiology care unit) and on weekdays (76.5%). ROSC followed more than half the IHCA events (56%). However, only 5.4% of IHCA events achieved StD. Both ROSC and StD were higher in cases with a shockable rhythm. Survival outcomes were not significantly different between day, evening, and nightshifts. ROSC was not significantly different between weekdays and weekends; however, StD was higher in events that happened during weekdays than weekends (6.7% vs. 1.9%, P = 0.002). CONCLUSIONS The incidence of IHCA was high, and its outcomes were lower compared to other developed countries. Survival outcomes were better for patients who had a shockable rhythm and were similar between the time of day and days of the week. These findings may help inform hospitals and policymakers about the magnitude and quality of IHCA care in Lebanon.
Downregulation of miR-181a-5p alleviates oxidative stress and inflammation in coronary microembolization-induced myocardial damage by directly targeting XIAP
You ZHOU, Man-Yun LONG, Zhi-Qing CHEN, Jun-Wen HUANG, Zhen-Bai QIN, Lang LI
2021, 18(6): 426-439. doi: 10.11909/j.issn.1671-5411.2021.06.007
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 BACKGROUND Coronary microembolization (CME) is a complicated problem that commonly arises in the context of coronary angioplasty. MicroRNAs play crucial roles in cardiovascular diseases. However, the role and mechanism of miR-181a-5p in CME-induced myocardial injury remains unclear. METHODS We established CME rat models. Cardiac function was detected by echocardiography. Haematoxylin-basic fuchsin-picric acid staining was used to measure micro-infarction size. Serum samples and cell culture supernatants were evaluated via enzyme-linked immunosorbent assay. Cellular reactive oxygen species were determined by dichloro-dihydro-fluorescein diacetate assay, and the other oxidative stress related parameters were assayed by spectrophotometry. The dual-luciferase reporter (DLR) assay and RNA pulldown were conducted to validate the association between miR-181a-5p and X-linked inhibitor of apoptosis protein (XIAP). The expression of miR-181a-5p and XIAP mRNA were determined by quantitative reverse transcription polymerase chain reaction. Proteins were evaluated via immunoblotting. The viability of the cell was evaluated via cell counting kit-8 assay. RESULTS The miR-181a-5p level was significantly increased in CME myocardial tissues. Downregulation of miR-181a-5p improved CME-induced cardiac dysfunction and alleviated myocardial oxidative stress and inflammatory injury, whereas miR-181a-5p exhibited the opposite effects. Then, the DLR assay and RNA pulldown results revealed that miR-181a-5p directly targeting on XIAP. The XIAP level was found to be remarkably decreased after CME. XIAP overexpression attenuated CME-induced myocardial oxidative stress and inflammatory injury. Finally, in vitro rescue experiments revealed that knockdown of XIAP could abolish the protective effects of miR-181a-5p knockdown on hypoxia-induced cardiomyocyte oxidative stress and inflammatory injury. CONCLUSIONS Downregulation of miR-181a-5p alleviates CME-induced myocardial damage by suppressing myocardial oxidative stress and inflammation through directly targeting XIAP.
Effects of sodium-glucose cotransporter 2 inhibitors on cardiovascular outcomes in elderly patients with comorbid coronary heart disease and diabetes mellitus
Hu XU, Wen-Zhe CAO, Yong-Yi BAI, Rui-Hua CAO, Lei TIAN, Feng CAO, Li FAN
2021, 18(6): 440-448. doi: 10.11909/j.issn.1671-5411.2021.06.001
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 OBJECTIVE  To investigate the effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on cardiovascular outcomes in elderly Chinese patients with comorbid coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM).  METHODS  A retrospective cohort study was conducted on 501 elderly inpatients (≥ 60 years) with comorbid CHD/T2DM in Department of Cardiovascular Medicine and Endocrinology, Chinese PLA General Hospital from January 2018 to December 2019. These patients were divided into two groups according to the administration of SGLT2i. All the demographic characteristics and clinical data were collected. Cardiovascular outcomes, including all-cause mortality, major adverse cardiovascular events (MACE), and hospitalization for heart failure (HHF), were followed up.  RESULTS  In the cohort, there were 167 patients in the SGLT2i group and 334 patients in the control group. In the efficacy analyses, the incidence of MACE was lower in the SGLT2i group than in the control group: 3.6% vs. 9.3% (P = 0.022). A lower risk of MACE was observed in the SGLT2i group [hazard ratio (HR) = 0.40, 95% CI: 0.17–0.95]. There was no significant difference in the incidence of all-cause mortality or HHF between the two groups. No significant difference of HR was observed for all-cause mortality (HR = 0.41, 95% CI: 0.12–1.41) or HHF (HR = 0.58, 95% CI: 0.12–2.81).  CONCLUSIONS  SGLT2i treatment exhibited benefits for elderly patients with comorbid CHD/T2DM with a lower risk for MACE.
Severe bleeding following off-pump coronary artery bypass grafting: predictive factors and risk model
Yu LIU, Xing WANG, Zi-Ying CHEN, Wen-Li ZHANG, Lin GUO, Yong-Quan SUN, Hong-Zhan CUI, Ji-Qiang BU, Jian-Hui CAI
2021, 18(6): 449-461. doi: 10.11909/j.issn.1671-5411.2021.06.006
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 BACKGROUND Severe bleeding following cardiac surgery remains a troublesome complication, but to date, there is a lack of comprehensive predictive models for the risk of severe bleeding following off-pump coronary artery bypass grafting (OPCABG). This study aims to analyze relevant indicators of severe bleeding after isolated OPCABG and establish a corresponding risk assessment model. METHODS The clinical data of 584 patients who underwent OPCABG from January 2018 to April 2020 were retrospectively analyzed. We gathered the preoperative baseline data and postoperative data immediately after intensive care unit admission and used multifactor logistic regression to screen the potential predictors of severe bleeding, upon which we established a predictive model. Using the consistency index and calibration curve, decision curve, and clinical impact curve analysis, we evaluated the performance of the model. RESULTS This study is the first to establish a risk assessment and prediction model for severe bleeding following isolated OPCABG. Eight independent risk factors were identified: male sex, aspirin/clopidogrel withdrawal time, platelet count, fibrinogen level, C-reactive protein, serum creatinine, and total bilirubin. Among the 483 patients in the training group, 138 patients (28.6%) had severe bleeding; among the 101 patients in the verification group, 25 patients (24.8%) had severe bleeding. Receiver operating characteristic (ROC) curve analysis for the internal training group revealed a convincing performance with a concordance index (C-index) of 0.859, while the area under the ROC curve for the external validation data was 0.807. Decision curve analysis showed that the model was useful for both groups. CONCLUSIONS Although there are some limitations, the model can effectively predict the probability of severe bleeding following isolated OPCABG and is therefore worthy of further exploration and verification.
Cardiovascular risk and aging: the need for a more comprehensive understanding
Ljiljana Trtica Majnarić, Zvonimir Bosnić, Tomislav Kurevija, Thomas Wittlinger
2021, 18(6): 462-478. doi: 10.11909/j.issn.1671-5411.2021.06.004
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Frailty in patients undergoing transcatheter aortic valve replacement: from risk scores to frailty-based management
Andreas Tzoumas, Damianos G. Kokkinidis, Stefanos Giannopoulos, George Giannakoulas, Leonidas Palaiodimos, Dimitrios V Avgerinos, Polydoros N Kampaktsis, Robert T. Faillace
2021, 18(6): 479-486. doi: 10.11909/j.issn.1671-5411.2021.06.002
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A new sequential two-stent strategy for treating true distal left main trifurcation lesion
Yu-Xiang DAI, Chen-Guang LI, Jia HUANG, Ren-De XU, Shu-Fu CHANG, Hao LU, Dao-Yuan REN, Lei GE, Ju-Ying QIAN, Feng ZHANG, Jun-Bo GE
2021, 18(6): 487-491. doi: 10.11909/j.issn.1671-5411.2021.06.008
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A case of applying left bundle branch pacing combined with atrioventricular node ablation to treat atrial fibrillation-induced heart failure
Lahati HA, Li-Yun HE, Lei LI, Jiang-Li HAN, Shu-Wang LIU, Yuan ZHANG, Wei XU, Wei GAO
2021, 18(6): 492-497. doi: 10.11909/j.issn.1671-5411.2021.06.010
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Partial closure with a self-made fenestrated device of secundum atrial septal defect with severe pulmonary artery hypertension in adults
Tullio Tesorio, Luigi Salemme, Sebastiano Verdoliva, Marco Ferrone, Paola Tesorio, Eustaquio Maria Onorato
2021, 18(6): 498-504. doi: 10.11909/j.issn.1671-5411.2021.06.009
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