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JACC. Advances Feb 2024
PubMed: 38939380
DOI: 10.1016/j.jacadv.2023.100788 -
JACC. Advances Feb 2024The initiation of coronary artery calcium (CAC) is an important physiologic milestone associated with increased cardiovascular disease risk. However, traditional risk...
BACKGROUND
The initiation of coronary artery calcium (CAC) is an important physiologic milestone associated with increased cardiovascular disease risk. However, traditional risk factors (RF) do not perform well for predicting incident CAC among the 54 million older U.S. adults.
OBJECTIVES
The authors sought to assess the association between nontraditional cardiovascular disease RF and incident CAC in older persons.
METHODS
There were 815 MESA (Multi-Ethnic Study of Atherosclerosis) participants ≥65 years of age who had CAC = 0 at Visit 1 and a follow-up CAC scan. Multivariable adjusted Cox hazards ratios (aHR) and C-statistics were calculated to examine the association of nontraditional RF with incident CAC.
RESULTS
The mean age was 70.2 years and 67% were women. The median follow-up time to repeat CAC scan was 3.6 years (IQR: 2.6-9.2 years) and 45% of participants developed incident CAC. Albuminuria (aHR: 1.50, 95% CI: 1.07-2.09), carotid plaque (aHR: 1.32, 95% CI: 1.04-1.66), and thoracic aortic calcification (TAC) (aHR: 1.38, 95% CI: 1.10-1.75) were significantly associated with incident CAC, while higher levels of nontraditional RF including apolipoprotein-B, lipoprotein(a), high-sensitivity troponin T, and N-terminal pro-brain natriuretic peptide were not. When added to demographics, albuminuria, carotid plaque, and TAC provided a greater C-statistic improvement (+0.047, = 0.004) vs all traditional RF combined (+0.033, = 0.05).
CONCLUSIONS
Among nontraditional RF and measures of subclinical atherosclerosis, only albuminuria, carotid plaque, and TAC were significantly associated with incident CAC in persons ≥65 years of age. Identification of albuminuria or extracoronary atherosclerosis may help guide the timing of repeat CAC scoring in older persons with baseline CAC = 0.
PubMed: 38939371
DOI: 10.1016/j.jacadv.2023.100755 -
Pulmonary Circulation Apr 2024
PubMed: 38939305
DOI: 10.1002/pul2.12408 -
Cureus May 2024Pulmonary embolism (PE) is a life-threatening condition resulting from the obstruction of pulmonary arteries by blood clots, usually originating from deep veins....
Pulmonary embolism (PE) is a life-threatening condition resulting from the obstruction of pulmonary arteries by blood clots, usually originating from deep veins. Symptoms of PE might vary from nothing to sudden death. Clinically, individuals may present very differently. When a diagnosis of PE is suspected, any possible life-saving intervention must be implemented because survival from cardiac arrest following PE is often quite low. Although there are not many randomized controlled trials that provide guidelines for treating suspected PE in cardiac arrest victims, the few published case reports and other minor studies suggest that thrombolysis and other therapies are associated with good outcomes. We report a patient with PE who presented in cardiac arrest with its clinical, electrographic, and radiologic findings, along with the appropriate therapy chosen based on hemodynamic stability. It is important to intervene early to prevent severe complications and improve the patient's outcomes.
PubMed: 38939235
DOI: 10.7759/cureus.61213 -
Pathogens & Immunity 2024Neuropathic adverse events occur frequently in linezolid-containing regimens, some of which remain irreversible after drug discontinuation.
BACKGROUND
Neuropathic adverse events occur frequently in linezolid-containing regimens, some of which remain irreversible after drug discontinuation.
OBJECTIVE
We aimed to identify and validate a host RNA-based biomarker that can predict linezolid-associated neuropathy before multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) treatment initiation and to identify genes and pathways that are associated with linezolid-associated neuropathy.
METHODS
Adult patients initiating MDR/RR-TB treatment including linezolid were prospectively enrolled in 3 independent cohorts in Germany. Clinical data and whole blood RNA for transcriptomic analysis were collected. The primary outcome was linezolid-associated optic and/or peripheral neuropathy. A random forest algorithm was used for biomarker identification. The biomarker was validated in an additional fourth cohort of patients with MDR/RR-TB from Romania.
RESULTS
A total of 52 patients from the 3 identification cohorts received linezolid treatment. Of those, 24 (46.2%) developed peripheral and/or optic neuropathies during linezolid treatment. The majority (59.3%) of the episodes were of moderate (grade 2) severity. In total, the expression of 1,479 genes differed significantly at baseline of treatment. Suprabasin () was identified as a potential biomarker to predict linezolid-associated neuropathy. In the validation cohort, 10 of 42 (23.8%) patients developed grade ≥3 neuropathies. The area under the curve for the biomarker algorithm prediction of grade ≥3 neuropathies was 0.63 (poor; 95% confidence interval: 0.42 - 0.84).
CONCLUSIONS
We identified and preliminarily validated a potential clinical biomarker to predict linezolid-associated neuropathies before the initiation of MDR/RR-TB therapy. Larger studies of the biomarker in more diverse populations are warranted.
PubMed: 38939039
DOI: 10.20411/pai.v9i2.705 -
JACC. Advances Jul 2023
PubMed: 38938991
DOI: 10.1016/j.jacadv.2023.100412 -
JACC. Advances Jun 2024People with HIV (PWH) have a high burden of coronary plaques; however, the comparison to people without known HIV (PwoH) needs clarification.
BACKGROUND
People with HIV (PWH) have a high burden of coronary plaques; however, the comparison to people without known HIV (PwoH) needs clarification.
OBJECTIVES
The purpose of this study was to determine coronary plaque burden/phenotype in PWH vs PwoH.
METHODS
Nonstatin using participants from 3 contemporary populations without known coronary plaques with coronary CT were compared: the REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) studying PWH without cardiovascular symptoms at low-to-moderate risk (n = 755); the SCAPIS (Swedish Cardiopulmonary Bioimage Study) of asymptomatic community PwoH at low-to-intermediate cardiovascular risk (n = 23,558); and the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) of stable chest pain PwoH (n = 2,291). The coronary plaque prevalence on coronary CT was compared, and comparisons were stratified by 10-year atherosclerotic cardiovascular disease (ASCVD) risk, age, and coronary artery calcium (CAC) presence.
RESULTS
Compared to SCAPIS and PROMISE PwoH, REPRIEVE PWH were younger (50.8 ± 5.8 vs 57.3 ± 4.3 and 60.0 ± 8.0 years; < 0.001) and had lower ASCVD risk (5.0% ± 3.2% vs 6.0% ± 5.3% and 13.5% ± 11.0%; < 0.001). More PWH had plaque compared to the asymptomatic cohort (48.5% vs 40.3%; < 0.001). When stratified by ASCVD risk, PWH had more plaque compared to SCAPIS and a similar prevalence of plaque compared to PROMISE. CAC = 0 was more prevalent in PWH (REPRIEVE 65.2%; SCAPIS 61.6%; PROMISE 49.6%); among CAC = 0, plaque was more prevalent in PWH compared to the PwoH cohorts (REPRIEVE 20.8%; SCAPIS 5.4%; PROMISE 12.3%, < 0.001).
CONCLUSIONS
Asymptomatic PWH in REPRIEVE had more plaque than asymptomatic PwoH in SCAPIS but had similar prevalence to a higher-risk stable chest pain cohort in PROMISE. In PWH, CAC = 0 does not reliably exclude plaque.
PubMed: 38938873
DOI: 10.1016/j.jacadv.2024.100968 -
JACC. Advances Jun 2024In 2022, the Life's Simple 7 (LS7) score was replaced with the Life's Essential 8 (LE8) score as a tool to measure cardiovascular health. The risk prediction values of...
BACKGROUND
In 2022, the Life's Simple 7 (LS7) score was replaced with the Life's Essential 8 (LE8) score as a tool to measure cardiovascular health. The risk prediction values of LE8 and LS7 scores for mortality have not been compared. Additionally, the risk prediction value of these scores has not been compared with the pooled cohort equations (PCE) in individuals aged 40 to 79 years.
OBJECTIVES
This study compared the risk prediction value of the: 1) LE8 and LS7 scores in the overall population; and 2) LE8 score, LS7 score, and PCE in the 40- to 79-year-old age group for all-cause and cardiovascular mortality in a nationally representative US population.
METHODS
The LS7 and LE8 scores and the PCE were calculated in the National Health and Nutrition Examination Survey cycles 2007 to 2018. All-cause and cardiovascular mortality were identified by linking the participants to the National Death Index. The C-statistics of the respective weighted Cox models were used to compare the risk prediction value of the standardized scores.
RESULTS
Among 21,721 individuals included, the C-statistics for all-cause mortality were 0.823 (95% CI: 0.803-0.843) and 0.819 (95% CI: 0.799-0.838) in the LE8 and LS7 score-based models, respectively. The C-statistics for cardiovascular mortality were 0.887 (95% CI: 0.857-0.905) for the LE8 score-based model and 0.883 (95% CI: 0.861-0.905) for the LS7 score-based model. Among 12,943 individuals aged 40 to 79 years, the C-statistics for the outcome of all-cause mortality were 0.756 (95% CI: 0.732-0.779), 0.674 (95% CI: 0.646-0.701), and 0.681 (95% CI: 0.656-0.706) for the PCE, LS7 score, and LE8 score-based models, respectively.
CONCLUSIONS
The LS7 and LE8 scores had similar risk prediction values for all-cause and cardiovascular mortality. Among 40- to 79-year-old individuals, the PCE had better risk discrimination in the LE8 and LS7 scores in predicting all-cause mortality.
PubMed: 38938862
DOI: 10.1016/j.jacadv.2024.100945 -
JACC. Advances Jun 2024Decompensated heart failure (HF) can be categorized as de novo or worsening of chronic HF. In PARAGLIDE-HF (Prospective comparison of ARNI with ARB Given following...
BACKGROUND
Decompensated heart failure (HF) can be categorized as de novo or worsening of chronic HF. In PARAGLIDE-HF (Prospective comparison of ARNI with ARB Given following stabiLization In DEcompensated HFpEF), among patients with an ejection fraction >40% that stabilized after worsening HF, sacubitril/valsartan led to a significantly greater reduction in N-terminal pro-B-type natriuretic peptide (NT-proBNP) and was associated with clinical benefit compared to valsartan.
OBJECTIVES
This prespecified analysis characterized patients with de novo vs worsening chronic HF in PARAGLIDE-HF and assessed the interaction between HF chronicity and the effect of sacubitril/valsartan.
METHODS
Patients were classified as de novo (first diagnosis of HF) or chronic (known HF prior to the index event). Time-averaged proportional change in NT-proBNP from baseline to weeks 4 and 8 was analyzed using an analysis of covariance model. A win ratio consisting of time to cardiovascular death, number and times of HF hospitalizations during follow-up, number and times of urgent HF visits during follow-up, and time-averaged proportional change in NT-proBNP was assessed for each group.
RESULTS
Of the 466 participants, 153 (33%) had de novo HF and 313 (67%) had chronic HF. De novo patients had lower rates of atrial fibrillation/flutter and lower creatinine. There was a nonsignificant reduction in NT-proBNP with sacubitril/valsartan vs valsartan for de novo (0.82; 95% CI: 0.62-1.07) and chronic HF (0.88; 95% CI: 0.73-1.07), interaction = 0.66. The win ratio was nominally in favor of sacubitril/valsartan for both de novo (1.12; 95% CI: 0.70-1.58) and chronic HF (1.24; 95% CI: 0.89-1.71).
CONCLUSIONS
There is no interaction between HF chronicity and the effect of sacubitril-valsartan.
PubMed: 38938861
DOI: 10.1016/j.jacadv.2024.100984 -
JACC. Advances Jun 2024Cardiogenic shock (CS) in the setting of acute myocardial infarction (AMI) is associated with high morbidity and mortality. Frailty is a common comorbidity in patients...
BACKGROUND
Cardiogenic shock (CS) in the setting of acute myocardial infarction (AMI) is associated with high morbidity and mortality. Frailty is a common comorbidity in patients with cardiovascular disease and is also associated with adverse outcomes. The impact of preexisting frailty at the time of CS diagnosis following AMI has not been studied.
OBJECTIVES
The purpose of this study was to examine the prevalence of frailty in patients admitted with AMI complicated by CS (AMI-CS) hospitalizations and its associations with in-hospital outcomes.
METHODS
We retrospectively analyzed the National Inpatient Sample from 2016 to 2020 and identified all hospitalizations for AMI-CS. We classified them into frail and nonfrail groups according to the hospital frailty risk score cut-off of 5 and compared in-hospital outcomes.
RESULTS
A total of 283,700 hospitalizations for AMI-CS were identified. Most (70.8%) occurred in the frail. Those with frailty had higher odds of in-hospital mortality (adjusted OR [aOR]: 2.17, 95% CI: 2.07 to 2.26, < 0.001), do-not-resuscitate status, and discharge to a skilled nursing facility compared with those without frailty. They also had higher odds of in-hospital adverse events, including intracranial hemorrhage, gastrointestinal hemorrhage, acute kidney injury, and delirium. Importantly, AMI-CS hospitalizations in the frail had lower odds of coronary revascularization (aOR: 0.55, 95% CI: 0.53-0.58, < 0.001) or mechanical circulatory support (aOR: 0.89, 95% CI: 0.85-0.93, < 0.001). Lastly, hospitalizations for AMI-CS showed an overall increase from 53,210 in 2016 to 57,065 in 2020 ( trend <0.001), with this trend driven by a rise in the frail.
CONCLUSIONS
A high proportion of hospitalizations for AMI-CS had concomitant frailty. Hospitalizations with AMI-CS and frailty had higher rates of in-hospital morbidity and mortality compared to those without frailty.
PubMed: 38938859
DOI: 10.1016/j.jacadv.2024.100949