Cardiovascular Physician Research Articles

The first description of mucous membrane pemphigoid induced by enalapril maleate: a case report

BackgroundMucous membrane pemphigoid (MMP) is an autoimmune blistering disease (AIBD). Some reports suggest that it has a drug-related pathogenesis especially anti-hypertensive drug.Case presentationA 67-year-old man with a 7-year history of essential hypertension was prescribed enalapril maleate for 5 months. He presented at our department with pain, ulcers, and blisters on the oral mucosa. We performed clinical, histopathology, and direct immunofluorescence examinations, and findings were consistent with the diagnostic criteria for MMP. Consequently, we consulted with the cardiovascular physician and agreed to discontinue the enalapril maleate replacing it with irbesartan/hydrochlorothiazide tablets and topical corticosteroid therapies instead. The lesions healed without recurrence.ConclusionsABID induced by antihypertensive drugs have been reported, and enalapril maleate has been implicated as an antihypertensive agent that may trigger AIBDs, such as MMP. This case highlights the potential relationship between antihypertensive drugs and MMP, of which clinicians should be aware to accurately diagnose and promptly relieve patients’ pain.

Chinese expert consensus on transfemoral transcatheter aortic valve replacement for pure aortic regurgitation (2023)

Transcatheter aortic valve replacement (TAVR) was initially used to treat aortic stenosis (AS), and gradually expanded into aortic regurgitation (AR) treatment. Scholars worldwide have explored the use of marketed transfemoral TAVR (TF-TAVR) valves for AR patients, offering another option for high-risk surgical patients. However, AR presents distinct challenges compared to AS, including anatomical differences, valve selection, procedural nuances, and complication profiles. Overall, TF-TAVR for AR is more complex with lower success rate than for AS. In order to promote the safe and standardized TF-TAVR for AR in China, the Structural Heart Disease Group of Chinese College of Cardiovascular Physician drafted this consensus. The writing expert team focused on key clinical challenges in TF-TAVR for AR patients, combining evidence from literature up to September 1, 2023, to formulate nine core viewpoints. These encompass indications, valve selection, preoperative evaluation, intraoperative techniques, complication prevention and management, postoperative care, and other aspects.

Five-Year Experience From a Cardiovascular Physician and Advanced Practice Providers Leadership-Development Program

Five-Year Experience From a Cardiovascular Physician and Advanced Practice Providers Leadership-Development Program

Design and application of distal radial artery hemostat

Transradial approach is the classical access for coronary angiography and percutaneous coronary intervention (PCI). With the increase in the number of interventional procedures, some disadvantages of the transradial approach have also been found, it is easy to lead to various complications, such as radial artery occlusion, radial nerve injury, and puncture difficulties after radial artery spasm. Therefore, some experts put forward the approach of distal radial artery approach for interventional therapy, which has the advantages of convenient positioning, easy postoperative hemostasis, less damage to the proximal radial artery and improving patients' comfort. However, there is no special distal radial artery hemostat in clinic, which limits the development of this approach to a certain extent. Therefore, based on the principles of anatomy and physics, cardiovascular physician at Jiading District District Central Hospital in Shanghai designed and invented a distal radial artery hemostatic device, which is convenient for clinical hemostasis of distal radial artery puncture, and obtained the National Utility Model Patent (patent number: ZL 2021 2 2097829.6). The hemostatic device consists of a glove body with a silicone gasket protruding towards the skin on the inner surface and a binding component. The patient's hand is inserted into the glove body, and after being fixed by the restraint component, the silicone gasket can effectively compress the location of the radial artery puncture point, and play a good hemostatic effect with less pressure, avoid the common complications of proximal radial artery hemostatic, and reduce the discomfort of the patient. Has good application value.

We do not need more Guidelines, nor more Drugs, nor more Combinations! The priority is a Medical Ecosystem that favors Evidence-Based Medicine, Personalization, Empowerment, Access, and Reflection

A growing number of publications evidencing the poor achievement of the therapeutic goals of the so-called atherosclerotic cardiovascular risk factors (especially hypercholesterolemia, hypertension, and diabetes). Many authors propose therapeutic inertia as the most compelling cause of this situation. This article aims to provide a vision from a dedicated cardiovascular prevention physician's perspective, based on four pillars (in order of importance): "face-to-face" assistance with social responsibility, clinical research, teaching, and consulting. Beyond the bureaucratic vision, it proposes the necessary conditions to achieve an efficient medical ecosystem (evidence-based medicine, personalization, empowerment, access, and reflection). Likewise, the therapeutic failure palliatives, as called by the author (more guidelines, more high-tech drugs, and more combinations of drugs), are exposed. These palliatives feed into a vicious circle and are insufficient to mitigate a medical-social problem, as is the cardio-metabolic risk and diseases

Spiral Computed Tomography in the Quantitative Measurement of the Adjacent Structure of the Left Atrial Appendage in Patients with Atrial Fibrillation.

Cardiac arrhythmias are common clinical cardiovascular diseases. Arrhythmias are abnormalities in the frequency, rhythm, site of origin, conduction velocity, or sequence of excitation of the cardiac impulses. Arrhythmia mechanisms include foldback, altered autonomic rhythm, and triggering mechanisms. It can cause palpitations, dizziness, black dawn, syncope, and angina pectoris and can worsen a preexisting cardiac disease, reduce the quality of life, and increase mortality. Also, by making it one of the constant challenges for the clinical cardiovascular physician, we can get more information. The study included 94 patients with atrial fibers, including 56 men and 38 women aged 57, 46, 11, and 68 years. There are 80 patients with nonatrial fibers, including 44 men and 36 women aged 56, 10, and 83 years. Those who can perform a normal coronary angiography and exclude congenital heart disease, heart valve disease, and other cardiovascular diseases. In both groups, a 256-layer spiral CT examination was performed. A pulmonary vein scanning protocol was applied to the patients with atrial fibrillation, and this can perform normal coronary angiography and exclude those with cardiovascular diseases such as congenital heart disease and valvular heart disease. The purpose of this study is to investigate the anatomical changes of the left atrium and its adjacent structures by applying the 256 nm spiral CT imaging to visualize the left atrium and its adjacent structures and by applying the MPR technology, VR technology, and simulation endoscope techniques.

Respiratory and cardiovascular condition-related physician visits associated with wildfire smoke exposure in Calgary, Canada, in 2015: a population-based study.

We studied the impact of fine particulate matter (PM2.5) exposure due to a remote wildfire event in the Pacific Northwest on daily outpatient respiratory and cardiovascular physician visits during wildfire (24-31 August, 2015) and post-wildfire period (1-30 September, 2015) relative to the pre-wildfire period (1-23 August, 2015) in the city of Calgary, Canada. A quasi-Poisson regression model was used for modelling daily counts of physician visits due to PM2.5 while adjusting for day of the week (weekday versus weekend or public holiday), wildfire exposure period (before, during, after), methane, relative humidity, and wind direction. A subgroup analysis of those with pre-existing diabetes or hypertension was performed. An elevated risk of respiratory disease morbidity of 33% (relative risk: RR) [95% confidence interval (CI): 10%-59%] and 55% (95% CI: 42%-69%) was observed per 10µg/m3 increase in PM2.5 level during and after wildfire, respectively, relative to the pre-wildfire time period. Increased risk was observed for children aged 0-9 years during (RR = 1.57, 95% CI: 1.21-2.02) and after the wildfire (RR = 2.11, 95% CI: 1.86-2.40) especially for asthma, acute bronchitis and acute respiratory infection. The risk of physician visits among seniors increased by 11% (95% CI: 3%-21%), and 19% (95% CI: 7%-33%) post-wildfire for congestive heart failure and ischaemic heart disease, respectively. Individuals with pre-existing diabetes had an increased risk of both respiratory and cardiovascular morbidity in the post-wildfire period (RR = 1.35, 95% CI: 1.09-1.67; RR = 1.22, 95% CI: 1.01-1.46, respectively). Wildfire-related PM2.5 exposure led to increased respiratory condition-related outpatient physician visits during and after wildfires, particularly for children. An increased risk of physician visits for congestive heart failure and ischaemic heart disease among seniors in the post-wildfire period was also observed.

Longitudinal association between adiposity measures and regression of prediabetes/diabetes

Background and aimsThe recent COVID-19 pandemic has further increased the importance of reducing obesity and prediabetes/diabetes. We aimed to evaluate the association between adiposity and regression of prediabetes/diabetes. Methods and resultsThe San Juan Overweight Adults Longitudinal Study (SOALS) included 1351 individuals with overweight/obesity, aged 40–65, free of major cardiovascular diseases and physician diagnosed diabetes. From the 1012 participants with baseline prediabetes/diabetes, 598 who completed the follow-up were included. Over the follow-up, 25% regressed from prediabetes to normoglycemia or from diabetes to prediabetes or normoglycemia. Poisson regression with robust standard error was used to estimate the relative risk (RR) adjusting for major confounders. Higher neck circumference (NC) was associated with regression of prediabetes/diabetes (RR = 0.45 comparing extreme tertiles; 95% CI:0.30–0.66); RR was 0.49 (95% CI:0.34–0.73) for waist circumference (WC) and 0.64 (95% CI:0.44–0.92) for BMI. Significant associations were found using median cut-offs or continuous measures for weight and BMI. Greater reduction in BMI (comparing extreme tertiles) was significantly associated with regression of prediabetes/diabetes (RR = 1.44; 95% CI:1.02–2.02). Continuous measures of change in adiposity (except for NC) were also associated with regression of prediabetes/diabetes for BMI and weight. Participants who reduced BMI (>5%) increased prediabetes/diabetes regression (RR = 1.61; 95% CI:1.15–2.25) compared to those who did not; similarly for weight (RR = 1.55; 95% CI: 1.10–2.19). Additional analysis for body fat percentage showing slightly weaker results than BMI/weight further supported our findings. ConclusionLower baseline adiposity and higher reduction in adiposity were associated with regression of prediabetes/diabetes among individuals with overweight/obesity.

Atrial flutter with 1:1 rapid wide QRS atrioventricular conduction in a patient following traditional surgical repair on atrial septal defect: a case study

: One-to-one atrioventricular conduction (AVC) during atrial flutter (AFL) is one of the most life-threatening arrhythmias and hemodynamically perilous. We present the diagnostic and analytical strategy for a patient who developed a paroxysm of AFL with 1:1 AVC. We did Brugada’s stepwise approach and the ventricular tachycardia (VT) score for the diagnosis. Meanwhile, we did RS/QRS ratio in lead V6. Through observations of the dynamic changes during and after amiodarone treatment, we made the diagnosis. Firstly, we calculated the VT score, and the result showed score 1. Secondly, we made Brugada’s stepwise approach to exclude VT. Meanwhile, we did RS/QRS ratio in lead V6, and the result showed the rate of 0.369 (<0.41, cut off 0.41). The result also suggested that the wide QRS AV tachycardia was not VT. Finally, amiodarone was administered under the guidance of a cardiovascular physician. Through observations of the dynamic changes during and after amiodarone treatment, the electrocardiogram (ECG) showed AFL with 2:1 AVC. The AFL rate was the same as the rate of rapid arrhythmia attack. Retrospectively, the rapid arrhythmia ECG was diagnosed as AFL with 1:1 rapid wide QRS AVC. AFL with 1:1 AVC is an uncommon but challenging arrhythmia. Brugada’s stepwise approach and the VT score can assist clinical physicians in making the diagnosis. In our study, we also verify that the RS/QRS ratio in lead V6 is beneficial to differentiate supraventricular tachycardia (SVT) with a right bundle branch block (RBBB) pattern from VT. Through observation of the changes of ECG before and after amiodarone, we can make the diagnosis. One should be conscious of the different presentations of AFL with 1:1 wide QRS AVC to avoid misdiagnosis and mismanagement.

A multicenter study of radiation doses to the eye lenses of clinical physicians performing radiology procedures in Japan.

PurposeWe investigated occupational dose to the lens of the eye for physicians engaged in radiology procedures. We evaluated the potential for compliance with the new‐equivalent dose limits to the lens of the eye. Further, a “multiple radiation protection” protocol was proposed according to the basic principles of occupational health, and its effectiveness was estimated.MethodsPhysicians engaged in radiology procedure at medical facilities in Japan were included in this study. The eye lens dose (3‐mm dose equivalent: Hp(3)) for each participant was measured using a small radio‐photoluminescence glass dosimeter mounted on lead glasses. Physicians were directed to procedure multiple radiation protection measures to evaluate their usefulness.ResultsThe Hp(3) was reduced by multiple radiation protection in all physicians. In particular, the Hp(3) reduced from 207.7 to 43.2 μSv/procedure and from 21.6 to 10.2 μSv/procedure in cardiovascular internal physician and cerebrovascular physician, respectively, after the implementation of the proposed multiple radiation protection measures. The dose reduction rate of these measures was 53% (range: 37%–79%).ConclusionsThe radiation doses received by the eye lenses of physicians engaged in radiology procedure may exceed the dose limits to the lens of the eye if radio‐protective equipment and imaging conditions are not properly controlled. However, based on the lens equivalent dose data, the implementation of “multiple radiation protection” according to the basic principles of occupational health can ensure compliance with the new‐equivalent dose limits to the lens of the eye without placing an undue burden on individual physicians or medical facilities.

Meet the First Author.

Meet the First Author.

Organiser les parcours de soins de la femme hypertendue à la ménopause

Menopause requires the implementation of organized screening and dedicated care pathways in collaboration with the attending physician, the gynaecologist-obstetrician and the cardiovascular physician. It will be necessary to take into account the hormonal specificities of the cardiovascular risk, in order to know-how to properly prescribe hormonal treatments.

Physician network position and patient outcomes following implantable cardioverter defibrillator therapy.

To evaluate two novel measures of physician network centrality and their associations with implantable cardioverter defibrillator (ICD) procedure volume and health outcomes. Medicare claims and the National Cardiovascular Data Registry data from 2007 to 2011. We constructed a national cardiovascular disease patient-sharing physician network and used network analysis to characterize physician network centrality with two measures: within-hospital degree centrality (number of connections within a hospital) and across-hospital degree centrality (number of connections across hospitals). The primary outcome was risk-adjusted 2-year case fatality. Hierarchical logistic regression estimated the effects of physician's within-hospital and across-hospital degree centrality on case fatality. We included 105109 ICD therapy patients and 3474 ICD implanting physicians in our analyses. After controlling for other physician and hospital characteristics, we observed greater risk-adjusted case fatality among patients treated by physicians in the highest across-hospital degree tertile compared to lowest tertile (OR [95% CI]=1.10 [1.04-1.16], P=0.001) and lowest tertile volume physicians compared with highest volume (OR [95% CI]=0.90 [0.84-0.95], P<0.001). Physician's within-hospital degree tertile was inversely associated with case fatality but not statistically significant. Degree centrality measures capture information independent of procedure volume and raise questions about the quality of physicians with networks that predict worse health outcomes.

Linking air pollution and administrative health databases to examine health effects of wildfire smoke exposure in Calgary, Canada in 2015

IntroductionWildfires are increasing in frequency and severity due to climate change. Fine particulate matter (PM2.5) in wildfire smoke is an important indicator of health effects of most combustion sources. The evidence based on adverse health impacts of PM2.5 from wildfire smoke are increasingly being studied but some gaps still remain.&#x0D; Objectives and ApproachWe examined the association of PM2.5 from Pacific Northwest wildfires with multiple respiratory and cardiovascular morbidity events related physician and emergency department visits, hospital admissions, health-link calls and medications dispensed among Calgary city population from August 1 – September 30, 2015. Physician billing claims, discharge abstract, Pharmaceutical Information Network, Health-link calls databases were linked with the air quality monitoring information database. Quasi-Poisson regression model for time lags of zero to five days and a three-day moving average, and conditional logistic regression model was used with adjustment for air pollutants and meteorological variables. Age and disease-specific stratified analyses were performed.&#x0D; ResultsCompared to the pre-wildfire period (Aug 1 – Aug 23), a 10 µg/m3 increase in PM2.5 increased the risk for respiratory physician visits by 54.8% (95% CI: 41.6% - 69.3%) and 32.6% (95% CI: 10.4% - 58.9%) in the respective post (Sep 1- Sep 30) and during (Aug 24 – Aug 31) wildfire periods. The strongest association of PM2.5 with respiratory physician visits was observed for children aged 0-9 years in the post-wildfire period (Relative Risk [RR] = 2.11, 95% CI: 1.86 - 2.39) compared to during wildfire period (RR = 1.56, 95% CI: 1.21 - 2.02) and was consistent for asthma, acute bronchitis and acute respiratory infection. Statistically significant effects of PM2.5 on cardiovascular hospitalizations, ED and physician visits were not observed during the wildfire period.&#x0D; Conclusion/ImplicationsWildfire-related PM2.5 led to increased physician visits due to respiratory morbidity during and after the wildfires, particularly for asthma, acute bronchitis and acute respiratory infections in children. The absence of cardiovascular health impact in general population during wildfires provides useful information for targeted public health messaging during adverse air quality events.

Sepsis in a Panorama: What the Cardiovascular Physician Should Know.

Sepsis accounts for an estimated 30 million cases and 6 million deaths globally each year. According to a multidisciplinary task force convened by the Society of Critical Care Medicine and European Society of Intensive Care Medicine, sepsis is defined as life-threatening organ dysfunction due to a dysregulated host response to infection. Sepsis is a medical emergency, so much so that the World Health Organization made it a global health priority. Since patients with cardiovascular diseases have unique risk factors for sepsis, prompt and accurate diagnosis is critical. In this regard, the sepsis-specific Sequential Organ Failure Assessment (SOFA) helps clinicians identify the organ dysfunction and predict outcomes. Sepsis management is grouped into specific interventions called bundles, and completion of each bundle element is time sensitive. The U.S. Centers for Medicaid and Medicare Services and some state-specific regulations have made compliance with these bundles reportable as a quality measure. The updated Surviving Sepsis Campaign Hour-1 bundle recommends that lactate measurement, blood cultures procurement, broad spectrum antibiotics administration, resuscitation with 30 mL/kg crystalloid, and vasopressor initiation for hypotension all be initiated within 1 hour of time zero, which is from the time of triage in the emergency department or from sepsis diagnosis. Septic shock is defined as hypotension with a mean arterial pressure less than 65 mm Hg, requiring vasopressors despite adequate fluid resuscitation and/or lactic acid levels above 2 mmol/L. Both fluid resuscitation and clinical re-evaluation with lactate measurement guide the fluid and vasopressor therapy. Specific guidelines exist for organ support that address mechanical ventilation, blood transfusions, vasopressor choices, and nutrition.

Recent Evolution of the Treatment of Coronary Artery Disease in China: A Conversation With Ya-Ling Han, MD, PhD.

Ya-Ling Han, MD, PhD, was born in Wuhan, Hubei province, in 1953. She graduated from Haebin Medical University in 1978. She received her doctorate in 1994 from Shanghai Second Military Medical University. She was a visiting scholar at the National Heart Center, Singapore. She is currently a professor and the director of the Department of Cardiology, General Hospital of Shenyang Military Region; the director of the Cardiovascular Research Institute; and the director of the Key Laboratory of Acute Severe Cardiovascular Treatment Research of the Chinese People’s Liberation Army. She is the president of the Chinese College of Cardiovascular Physicians and Chairperson-elect of the Chinese Society of Cardiology. Dr Rutherford asks: Could you describe the scope of clinical cardiac care provided in the Department of Cardiology at the General Hospital of Shenyang Military Region? Dr Ya-L ing Han replies : The Department of Cardiology at the General Hospital of Shenyang Military Region, together with the departments of congenital heart disease and cardiovascular surgery, constitute the cardiovascular institute of the People’s Liberation Army, which is among the top 5 centers in China providing comprehensive care for CVD. Our center is located in Northeast China, an area with the highest prevalence of CAD, so the treatment and prevention of CAD is our major focus. We are a busy center: we perform ≈7000 PCIs, 1400 radiofrequency ablations, 550 pacemaker implantations, 900 congenital heart disease interventions, and ≈2500 cardiovascular surgeries annually, with an overall in-hospital mortality rate of <1%. We have pioneered many facets of CVD treatment in China, including PCI for complicated coronary lesions, CTO of coronary arteries, left main coronary disease, treatment of high-risk patients with AMI, novel antithrombotic strategies for coronary patients, and surgical and percutaneous treatment of complicated congenital heart disease. Over the past 2 decades, you and your team have …

Victor Dzau: cardiovascular physician scientist takes helm at IOM.

After a 4-decade career combining medicine, basic and translational science, administration, drug development, and health policy, cardiologist Victor Dzau, MD, has begun a 6-year term as the eighth president of the Institute of Medicine (IOM) and will become the first president of the National Academy of Medicine when the IOM changes status in July. Dzau, chancellor emeritus of Duke University and previously president and CEO of the Duke University Health System, took a leave of absence from Duke to serve the IOM in its mission to address the larger problems of medicine and health care,1 but he has no intention of giving up his laboratory. “Many people think I’m insane to continue to do science and deal with the time demands, the competition and the headaches of grant funding. But I will continue because I love it. It’s what I live for. And I want to be a good role model, to understand the challenges scientists have, so I can be a better person to serve the nation in my capacity at the IOM,” says Dzau. Multitasking has been a constant in Dzau’s busy career. While serving as chief medical resident at Peter Bent Brigham Hospital in Boston under Eugene Braunwald, Dzau simultaneously conducted research as a postdoctoral fellow in physiology at Harvard University and cardiac biochemistry at Massachusetts General Hospital. There he purified and cloned renin2 and later used an experimental angiotensin-converting enzyme (ACE) inhibitor in treating human heart failure.3 He pioneered the concept of the tissue angiotensin system—the now widely accepted idea that angiotensin’s influence was not simply because of the circulating hormone, but instead to angiotensin produced and functioning within cardiac, vascular, and renal tissues.4 He also pioneered gene therapy for vascular disease, and his recent work on stem cell paracrine mechanisms5 …

Atlas of Vascular Anatomy An Angiographic Approach

This&nbsp;his is a comprehensive book on vascular anatomy and the lymphatic system with high quality illustrations. This is an essential text for the daily practice of the cardiovascular physician, the interventional radiologist or vascular surgeon. It is intended to be used as a quick and practical reference for the diagnosis and treatment of vascular anatomy. This 2nd Edition has been fully revised, expanded and updated to include all vascular areas to correlate with the functional and critical anatomical structures related to clinical applications.

GW24-e3734 A brief intervention for cardiovascular inpatients’ long-term effects after discharging on smoking cessation and influence factors

ObjectivesSocial, Family, and Personal suffers a lot from smoking. For cardiovascular inpatients, smoking cessation is not only a effective method of secondary prevention, but also can significantly improve the prognosis,...

Impact of an integrated intervention program on atorvastatin adherence: a randomized controlled trial

BackgroundThis trial evaluated the effectiveness of an integrated intervention program that included a 3-to-5-minute nurse counseling session, copay relief cards, and a monthly newsletter on adherence to atorvastatin treatment.Methods and resultsA prospective, integrated (composed of nurse counseling, adherence tip sheet, copay relief card, opportunity to enroll in 12-week cholesterol management program) randomized interventional study was designed involving patients >21 years of age who were prescribed atorvastatin at a large single-specialty cardiovascular physician practice in Illinois from March 2010 to May 2011. Data from the practice’s electronic medical record were matched/merged to IMS Health’s longitudinal data. A total of 500 patients were enrolled (125 in the control arm; 375 in the intervention arm). After data linkage, 53 control patients and 155 intervention patients were included in the analysis.ResultsMean age was 67.8 years (control) and 69.5 years (intervention); 67.9% and 58.7%, respectively, were male. The mean 6-month adherence rate was 0.82 in both arms. The mean proportion of days covered for both the new-user control and intervention groups was the same, averaging 0.70 day (standard deviation [SD], 0.27 day); for continuing users, the proportion of days covered for the control group was 0.83 (SD, 0.24) and for the intervention group was 0.84 (SD, 0.22). For continuing users, the control group had mean persistent days of 151.6 (SD, 50.2) compared with 150.9 days (SD, 50.9) for the intervention group. New users had fewer persistent days (control 111.4 days, SD, 69.6 days; intervention 112.0 days, SD, 58.8 days) compared with continuing users. The Cox proportional hazards model of the risk of discontinuation with index therapy was not significantly different between the intervention and control groups (hazard ratio 0.83, P = 0.55).ConclusionThe integrated intervention program did not significantly improve atorvastatin adherence relative to usual care in the studied patient population.