Cardiovascular Science Research Articles

Clinical and etiological profile of acute heart failure: an observational study

Background: Acute heart failure (AHF) is a common and growing medical problem associated with major morbidity and mortality. It is the leading reason for hospital admission among patients over age 65 years. Not much of data is available from India, there are a lot of differences between the western data and available Indian data. Prompt diagnosis, identification of reversible causes and supportive management in ICU is of paramount importance.Methods: This study was conducted at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka after the institutional ethics committee approval. Those patients who were diagnosed to have AHF, were evaluated and treated as per the institution protocols in ICU and standard medical care which includes diuretics, inotropes and vasopressors. All the patients were prospectively studied; investigated for the etiology of AHF.Results: Majority of patients presenting as Acute Heart Failure are of 60 years mean age, with 63% males. Ischemic heart disease is the leading cause of Acute Heart Failure. Shortness of breath was the commonest presentation followed by crackles. Abdominal pain was the most common (28%) non cardiac symptom. There is no significant correlation between the presence of anemia and mortality. Hyponatremia had relation with mortality. 22% had HFpEF, rest had HFrEF. The mean hospital stay was 8.3 days. The study mortality was 9 % and the 30-day mortality was 13 % in our study.Conclusions: Current available data from Indian studies and registries has a lot of difference from the western data with regards to causes, response to treatment, and more such data is needed to frame regional guidelines for better understanding of presentation of heart failure ,treatment and risk factors for mortality.

Building a Career in Cardiovascular Research: A Conversation With Barbara Casadei, MD, DPhil.

Building a Career in Cardiovascular Research: A Conversation With Barbara Casadei, MD, DPhil.

Understanding the use of observational and randomized data in cardiovascular medicine.

The availability of large datasets from multiple sources [e.g. registries, biobanks, electronic health records (EHRs), claims or billing databases, implantable devices, wearable sensors, and mobile apps], coupled with advances in computing and analytic technologies, have provided new opportunities for conducting innovative health research. Equally, improved digital access to health information has facilitated the conduct of efficient randomized controlled trials (RCTs) upon which clinical management decisions can be based, for instance, by permitting the identification of eligible patients for recruitment and/or linkage for follow-up via their EHRs. Given these advances in cardiovascular data science and the complexities they behold, it is important that health professionals have clarity on the appropriate use and interpretation of observational, so-called 'real-world', and randomized data in cardiovascular medicine. The Cardiovascular Roundtable of the European Society of Cardiology (ESC) held a workshop to explore the future of RCTs and the current and emerging opportunities for gathering and exploiting complex observational datasets in cardiovascular research. The aim of this article is to provide a perspective on the appropriate use of randomized and observational data and to outline the ESC plans for supporting the collection and availability of clinical data to monitor and improve the quality of care of patients with cardiovascular disease in Europe and provide an infrastructure for undertaking pragmatic RCTs. Moreover, the ESC continues to campaign for greater engagement amongst regulators, industry, patients, and health professionals in the development and application of a more efficient regulatory framework that is able to take maximal advantage of new opportunities for improving the design and efficiency of observational studies and RCT in patients with cardiovascular disease.

Relation between central aortic pulse pressure and coronary artery disease: a coronary angiographic study in a tertiary care center

Background: Aortic pulse pressure is a significant marker of cardiovascular morbidity independently of mean blood pressure and pulse pressure of 60 mm Hg should be considered as the threshold at risk both in normotensives and hypertensives. Coronary perfusion is dependent on diastolic blood pressure and patients with CAD may be susceptible to the adverse effects of low diastolic blood pressure. This study conducted to examine the relation between central aortic pulse pressure and the prevalence and extent of CAD.Methods: A cross sectional, hospital-based study conducted in Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, among patients undergoing diagnostic coronary angiography.Results: Risk factors like Diabetes, Hypertension, Dyslipidemia and smoking rates were significantly higher in patients with PP of >60 mmHg (p<0.01). In the first group, the ratio of having normal coronaries is higher 61.9% vs 38% and diseased coronaries was lower when compared to the other group 38% vs 98%. In patients with aortic pulse pressure >60 mmHg, 4 patients had left main coronary artery (LMCA) disease, 20 patients had single vessel disease, 11 patients had two vessel disease and 20 patients had triple vessel disease.Conclusions: In this study it was demonstrated aortic pulse pressure of more than 60 mm Hg is associated with significant CAD.

In Memoriam: James T. Willerson, MD (1939-2020).

In Memoriam: James T. Willerson, MD (1939-2020).

Cardiovascular Research Using the Korean National Health Information Database.

The Korean National Health Information Database (NHID) contains nationwide claims data, including sociodemographic data, health care utilization, health screening data, and healthcare provider information. To compensate for the limitations of randomized clinical trials, real-world observational studies using claims data have emerged as a novel research tool. We summarized the structure of the Korean NHID and the recent researches conducted in the field of cardiovascular science. Epidemiological studies, prescription patterns, temporal trends, comparison of effectiveness and safety of treatments, variability index using laboratory data, and rare intractable disease constitute interesting topics of research in cardiovascular science using the NHID. The operational definition of covariates and clinical outcomes is important for researchers interested in using the NHID data as new tools to prove their hypothesis. A step-by-step approach adopted by a team of data scientists, epidemiologists, statisticians, and clinical researchers may be most effective while designing research studies. The ultimate direction of research using the NHID should aim to improve the welfare of the public by promoting public health, reducing medical costs, and guiding healthcare policies.

Echocardiographic Assessment of Cardiac Anatomy and Function in Adult Rats.

The use of experimental animal models has become crucial in cardiovascular science. Most studies using rodent models are focused on two-dimensional imaging to study the cardiac anatomy of the left ventricle and M-mode echo to assess its dimensions. However, this could limit a comprehensive study. Herein, we describe a protocol that allows an assessment of the heart chamber size, left ventricular function (systolic and diastolic) and valvular function. A conventional medical ultrasound machine was used in this protocol and different echo views were obtained through left parasternal, apical and suprasternal windows. In the left parasternal window, the long and short axis were acquired to analyze left chamber dimensions, right ventricle and pulmonary artery dimensions, and mitral, pulmonary and aortic valve function. The apical window allows the measurement of heart chamber dimensions and evaluation of systolic and diastolic parameters. It also allows Doppler assessment with detection and quantification of heart valve disturbances (regurgitation or stenosis). Different segments and walls of the left ventricle are visualized throughout all views. Finally, the ascending aorta, aortic arch, and descending aorta can be imaged through the suprasternal window. A combination of ultrasound imaging, Doppler flow and tissue Doppler assessment have been obtained to study cardiac morphology and function. This represents an important contribution to improve the assessment of cardiac function in adult rats with impact for research using these animal models.

Single-Cell RNA Sequencing of the Cardiovascular System: New Looks for Old Diseases.

Cardiovascular disease encompasses a wide range of conditions, resulting in the highest number of deaths worldwide. The underlying pathologies surrounding cardiovascular disease include a vast and complicated network of both cellular and molecular mechanisms. Unique phenotypic alterations in specific cell types, visualized as varying RNA expression-levels (both coding and non-coding), have been identified as crucial factors in the pathology underlying conditions such as heart failure and atherosclerosis. Recent advances in single-cell RNA sequencing (scRNA-seq) have elucidated a new realm of cell subpopulations and transcriptional variations that are associated with normal and pathological physiology in a wide variety of diseases. This breakthrough in the phenotypical understanding of our cells has brought novel insight into cardiovascular basic science. scRNA-seq allows for separation of widely distinct cell subpopulations which were, until recently, simply averaged together with bulk-tissue RNA-seq. scRNA-seq has been used to identify novel cell types in the heart and vasculature that could be implicated in a variety of disease pathologies. Furthermore, scRNA-seq has been able to identify significant heterogeneity of phenotypes within individual cell subtype populations. The ability to characterize single cells based on transcriptional phenotypes allows researchers the ability to map development of cells and identify changes in specific subpopulations due to diseases at a very high throughput. This review looks at recent scRNA-seq studies of various aspects of the cardiovascular system and discusses their potential value to our understanding of the cardiovascular system and pathology.

Stent Dislodgement During Coronary Angioplasty Complicated by Left Main Thrombosis: Application of VA-ECMO in The Catheterization Laboratory

Nusca A*, Segreti A, Mastroianni C and Di Sciascio G Author Affiliations Unit of Cardiovascular Science, Italy Received: November 01, 2019 | Published: November 08, 2019 Corresponding author: Annunziata Nusca, Unit of Cardiovascular SciencesCampus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy DOI: 10.26717/BJSTR.2019.22.003783

Basic Cardiovascular Sciences Scientific Sessions 2019: Integrative Approaches to Complex Cardiovascular Diseases.

The annual Basic Cardiovascular Sciences (BCVS) Scientific Sessions remains a premier conference destination for those in the basic and translational cardiovascular research community. This year’s BCVS meeting was held at the downtown waterfront in Boston, MA from July 29 to August 1, 2019. To say that BCVS 2019 was well-attended is truly an understatement, as this year’s meeting broke all BCVS conference records with over 1000 registered attendees, over 600 posters, and a plethora of new offerings, such as expanded early career sessions and the first Asian Cardiovascular Symposium. Here, we highlight some of the emerging science and exciting programming that was featured at the 2019 BCVS Scientific Sessions.

Oral Anticoagulation in 2017

In this paper we describe the properties and clinical use of new anticoagulants:dabigatran (a direct thrombin inhibitor) and direct anti-Xa agents (rivaroxaban, apixaban,edoxaban ). Major studies that have been performed with these agents in comparisonwith warfarin are reported. Recommendations for use in clinical practice are provided.Information on the disappearance of the anticoagulant effect after stopping drug intakeand on the administration of agents that neutralize the effect of the new anticoagulantis provided. Keywords : warfarin, dabigatran, anti-Xa agents, idarucizumab Address Correspondence to author: Frans Van, MD, PhD, FESC, FACC, FAHA Department of Cardiovascular Sciences University Hospital Leuven Herestraat-49, B-3000 Leuven, Belgium email: frans.vandewerf@uzleuven.be Received: November 10, 2018 Revision received: December 28, 2018 Accepted after revision: January 10, 2018 BKK Med J 2018;14(2): 81-94. DOI: 10.31524/bkkmedj.2018.09.015

Chemokines: A Potential Therapeutic Target for the Stabilisation of Vulnerable Plaque

The introduction of lipid lowering medications was initially thought to provide a solution to the growing burden of coronary heart disease. However, 30 years later, the rates of acute coronary syndrome remain unacceptably high. This realisation forced cardiovascular scientists to look beyond lipids and led to the now widely accepted understanding of atherosclerosis pathobiology: immune-facilitated lipid retention with focal and generalised chronic inflammation. A fundamental component of this inflammatory process is chemokines: a class of cytokines characterised by their ability to facilitate cell recruitment, although it is now known that their function extends beyond chemotaxis. Mounting evidence suggests that chemokines are essential for the destabilisation and subsequent rupture of atherosclerotic plaque. Therefore, chemokine pathways provide a novel therapeutic target for plaque stabilisation. This review addresses the role of chemokines in regulating plaque vulnerability and discusses therapeutic approaches targeted at manipulating chemokine pathways.

Welcome to motherhood

My doctors said it was impossible... After all the radiation and chemotherapy, I was told that I would not be able to have children. We searched for a surrogate, we looked into adoption… it seemed so hopeless and then, it happened. I was a bit nervous to tell my program because I am the first University of Alberta cardiac surgery resident to become pregnant. I did not expect their response, “Michiko, our job is to create excellent surgeons. Being an excellent surgeon does not just include being technically skilled. It involves being well rounded and excelling at all areas of life. If part of your life involves being a mother and having a family, then we are here to support and encourage you all the way.” I am proud to share that I am the mother of a beautiful baby boy.
 "Welcome to Motherhood” is an illustrative photograph that represents my experience as a surgical resident and, at the time, a soon to be mother. I am the first cardiac surgery resident at the University of Alberta to become pregnant. I am so thankful to my program for all their support and encouragement throughout my pregnancy and after, when I entered motherhood. The relevance to cardiovascular science is that I feel it is important to acknowledge my cardiac surgery programs response to my pregnancy announcement. In a male dominated field with no experience of pregnant trainees, they did an incredible job to support and encourage me along the way.

The Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.

The Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.

Special issue of selected papers from the 5th European Section Meeting of the International Academy of Cardiovascular Sciences held in Smolenice, Slovakia, on 23-26 May 2018.

Special issue of selected papers from the 5th European Section Meeting of the International Academy of Cardiovascular Sciences held in Smolenice, Slovakia, on 23-26 May 2018.

Cardioprotective mechanism of FTY720 in ischemia reperfusion injury.

Cardioprotection is a very challenging area in the field of cardiovascular sciences. Myocardial damage accounts for nearly 50% of injury due to reperfusion, yet there is no effective strategy to prevent this to reduce the burden of heart failure. During last couple of decades, by combining genetic and bimolecular studies, many new drugs have been developed to treat hypertension, heart failure, and cancer. The use of percutaneous coronary intervention has reduced the mortality and morbidity of acute coronary syndrome dramatically. However, there is no standard therapy available that can mitigate cardiac reperfusion injury, which contributes to up to half of myocardial infarcts. Literature shows that the activation of sphingosine receptors, which are G protein-coupled receptors, induces cardioprotection both in vitro and in vivo. The exact mechanism of this protection is not clear yet. In this review, we discuss the mechanism of ischemia reperfusion injury and the role of the FDA-approved sphingosine 1 phosphate drug fingolimod in cardioprotection.

Meet the First Authors.

Meet the First Authors.

PET imaging of vulnerable coronary artery plaques

In the last years, the identification of vulnerable atherosclerotic plaques to prevent acute coronary events has been one of the main objectives of the cardiovascular science community. In this review, we provide an overview of vulnerable coronary artery plaque imaging by positron emission tomography (PET). Relevant methodological and technical aspects of PET on coronary artery plaque imaging are first analysed. Second, the main radiotracers used in this area as well as the main results of the clinical studies published so far are described. From published data, specialized approaches are recommended for imaging protocol and quantitative analysis of plaque activity. 18F-fluorodeoxyglucose (18F-FDG), the first radiotracer used for its wide availability, has several limitations for the detection and quantification of coronary artery plaque inflammation. 18F-sodium fluoride (18F-NaF), a marker of vascular microcalcification, seems to be the most promising radiotracer for vulnerable coronary artery plaque imaging. 68Ga-DOTATATE and 68Ga-pentixafor have also shown interesting results on coronary plaque inflammation in humans. Data on coronary imaging in humans are lacking for other radiotracers that target inflammation, hypoxia and neoangiogenesis. Molecular imaging by PET is a powerful tool for imaging different components of vulnerable coronary artery plaques and, potentially, for selecting patients at high-risk of myocardial infarction for personalized treatments. However, the results of large clinical trials on asymptomatic patients to link coronary plaque activity to patient outcome are strongly required.

Morbidity After cardiac surgery under cardiopulmonary bypass and associated factors: A retrospective observational study

BackgroundThe present study aimed to assess the morbidity after cardiac surgery and identify the preoperative and intraoperative factors associated with postoperative morbidity. MethodsA retrospective observational study was conducted including 362 adult patients aged 18–75 years who underwent open-heart surgery under cardiopulmonary bypass at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India, during the period from June 2016 to May 2017. Using a structured schedule, preoperative and intraoperative data were collected from the hospital's cardiac surgery database, whereas the postoperative data were collected from the intensive care unit (ICU) database and the hospital's clinical information system database. ResultsOf 362 patients, 254 (70.2%) had at least one major complication, and the most frequently occurring complication was low cardiac output state (29.8%). The ICU length of stay (LOS) was for > 2 days in 23.2% of patients, and the hospital LOS was for > 7 days in almost 60% of the patients. Multivariate logistic regression analyses revealed that gender, type of surgery, body weight, blood lactate level at ICU admission, and 12-h blood lactate level were significant predictors of complications; gender and 24-h blood lactate level were significantly associated with the prolonged ICU LOS, whereas type of surgery and 24-h blood lactate level were significantly associated with prolonged hospital LOS. ConclusionThe appropriate patient management strategy can be tailored based on the personal attributes, surgery type, and blood lactate level for individual patients undergoing cardiac surgery to reduce the likelihood of postoperative complications, ICU LOS, and hospital LOS.

Favorable early outcomes of composite grafts with the Edwards resilia valve in young patients

Journal of Cardiac SurgeryVolume 34, Issue 7 p. 649-650 LETTER TO THE EDITOR Favorable early outcomes of composite grafts with the Edwards resilia valve in young patients Marco Gennari MD, Corresponding Author Marco Gennari MD marcogennari.md@gmail.com orcid.org/0000-0001-9079-3275 Centro Cardiologico Monzino, IRCCS, Milan, Italy Correspondence Marco Gennari MD, IRCCS Centro Cardiologico Monzino, Via Parea 4 – 20138 Milan, Italy. Email: marcogennari.md@gmail.comSearch for more papers by this authorMarco Agrifoglio MD, PhD, Marco Agrifoglio MD, PhD Centro Cardiologico Monzino, IRCCS, Milan, Italy Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, ItalySearch for more papers by this authorGianluca Polvani MD, Gianluca Polvani MD Centro Cardiologico Monzino, IRCCS, Milan, Italy Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, ItalySearch for more papers by this author Marco Gennari MD, Corresponding Author Marco Gennari MD marcogennari.md@gmail.com orcid.org/0000-0001-9079-3275 Centro Cardiologico Monzino, IRCCS, Milan, Italy Correspondence Marco Gennari MD, IRCCS Centro Cardiologico Monzino, Via Parea 4 – 20138 Milan, Italy. Email: marcogennari.md@gmail.comSearch for more papers by this authorMarco Agrifoglio MD, PhD, Marco Agrifoglio MD, PhD Centro Cardiologico Monzino, IRCCS, Milan, Italy Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, ItalySearch for more papers by this authorGianluca Polvani MD, Gianluca Polvani MD Centro Cardiologico Monzino, IRCCS, Milan, Italy Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, ItalySearch for more papers by this author First published: 17 May 2019 https://doi.org/10.1111/jocs.14076Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume34, Issue7July 2019Pages 649-650 RelatedInformation