Incidence Of Adverse Cardiovascular Events Research Articles

#1578 Left ventricular ejection fraction: association with risk of mortality and the incidence of AVF dysfunction

Abstract Background and Aims Ejection fraction (EF) and chronic heart failure (HF) are often considered as criteria for the possibility of arteriovenous fistula (AVF) creation in relation to an increased risk of death, without sufficient evidence for this. There is, however, rare but compelling evidence that low EF increases the risk of AVF dysfunction. Aims: to evaluate the association between EF at the time of AVF creation and the incidence of adverse cardiovascular events, all-cause mortality, as well as AVF dysfunction Method This retrospective cohort study included 962 adult patients who had a first-time created functioning AVF. Only patients with a more than three months period after AVF creation and within a five-year period were included. The mean follow-up period was 34 ± 13 months. Four groups were identified based on EF and the presence of HF at the time of AVF creation (transthoracic echocardiogram): HF with reduced EF (rEF) <40%, with mid-range (mrEF) of 40-49%, or with preserved EF (pEF) ≥50% + HF, and a “no HF” group with EF ≥50% and no HF. Results In the univariate analysis, a reduced EF was associated with an increased risk of mortality, with the hazard ratios (HRs) of 2.706 [95% CI 1.330; 5.507], p = 0.006 for mrEF and 8.250 [95% CI 2.621; 25.97], p < 0.001 for rEF, compared to the “no HF” group (here and thereafter)—Fig. 1. However, after adjusting for age, sex, and Charlson Comorbidity Index (CCI), the EF was not significantly associated with the risk of death. Only the CCI score remained a significant factor (HR = 1.748 [95% CI 1.482; 2.063], p < 0.001). A decreased EF was associated with the incidence of AVF dysfunction both in the univariate analysis and after adjustments. In the univariate analysis, the incidence rate ratios (IRRs) of 6.88 [95% CI 3.88; 12.1], p < 0.001 for mrEF, and 19.9 [95% CI 8. 64; 41.6], p < 0.001 for rEF, were shown. After adjusting for age, sex, and CCI, the IRR for mrEF was 8.96 [95% CI 5.81; 13.7], p < 0.001, and for rEF it was 23.4 [95% CI 13.8; 38.6], p < 0.001. Even in the presence of polycystic kidney disease and diabetes mellitus in the fully adjusted model, the association between EF and the incidence of AVF dysfunction remained statistically significant: the IRR was 8.61 [95% CI 5.61; 13.1], p < 0.001 for mrEF, and 33.4 [95% CI 19.5; 56.2], p < 0.001 for rEF. The findings were confirmed in a sensitivity analysis that included adjustments for unplanned onset of dialysis and competing risks survival analysis (death—outcome of interest, conversion of HD to PD or kidney transplantation and conversion of AVF to CVC—competing events). According to our results patients with EF<40% will inevitably lose AVF function for various reasons within 3.5 years—Fig. 2. Meanwhile, this approach will give the patient additional time of HD via AVF, but not CVC, without increasing the risk of death, subject to Qa monitoring. Conclusion In patients with CKD 5 who are initiating treatment with maintenance hemodialysis, a decreased EF is associated to a greater extent with a higher risk of AVF dysfunction than with an increased risk of mortality. The burden of comorbidities, rather than a standalone assessment of EF, is one of the major risk factors determining patient survival.

Cardiovascular adverse events associated with immune checkpoint inhibitors: A retrospective multicenter cohort study.

Over the past decade, immune checkpoint inhibitors (ICIs) have significantly transformed cancer treatment. However, ICIs inevitably may cause a spectrum of immune-related adverse events, among which cardiovascular toxicity, particularly myocarditis, while infrequent, has garnered increasing attention due to its high fatality rate. We conducted a multicenter retrospective study to characterize ICI-associated cardiovascular adverse events. Logistic regression was performed to explore the risk factors for the development of myocarditis and severe myocarditis. Receiver operating characteristic curves were conducted to assess the diagnostic abilities of cardiac biomarkers to distinguish different cardiovascular toxicities, and the performance and calibration were evaluated using Hosmer-Lemeshow test. Forty-four patients were identified, including thirty-five myocarditis, five heart failure, three arrhythmias, and one myocardial infarction. Compared with other patients, myocarditis patients had higher cardiac troponin-I (cTnI) levels (p < 0.001), higher creatine kinase levels (p = 0.003), higher creatine kinase isoenzyme-MB (CK-MB) levels (p = 0.013), and shorter time to the incidence of adverse cardiovascular events (p = 0.022) after ICI treatment. Twenty-one patients (60%) were classified as severe myocarditis, and they presented higher cardiac troponin I (cTnI) levels (p = 0.013), higher N-terminal pro-B-type natriuretic peptide levels (p = 0.031), higher creatine kinase levels (p = 0.018), higher CK-MB levels (p = 0.026), and higher neutrophil to lymphocyte ratio (NLR) levels (p = 0.016) compared to non-severe myocarditis patients after ICI treatment. Multivariate logistic regression showed that CK-MB (adjusted odds ratio [OR]: 1.775, 95% confidence interval [CI]: 1.055-2.984, p = 0.031) was the independent risk factor of the development of ICI-associated myocarditis, and cTnI (adjusted OR: 1.021, 95% CI: 1.002-1.039, p = 0.03) and NLR (adjusted OR: 1.890, 95% CI: 1.026-3.483, p = 0.041) were the independent risk factors of ICI-associated severe myocarditis. The receiver operating characteristic curve showed an area under curve of 0.785 (95% CI: 0.642 to 0.928, p = 0.013) for CK-MB, 0.765 (95% CI: 0.601 to 0.929, p = 0.013) for cTnI, and 0.773 for NLR (95% CI: 0.597 to 0.948, p = 0.016). Elevated CK-MB after ICI treatment is the independent risk factor for the incidence of ICI-associated myocarditis, and elevated cTnI and NLR after ICI treatment are the independent risk factors for the development of ICI-associated severe myocarditis. CK-MB, cTnI, and NLR demonstrated a promising predictive utility for the identification of ICI-associated myocarditis and severe myocarditis.

Improving therapeutic outcomes in heart failure with reduced nonvalvular ejection fraction: A clinical study of heart failure education intervention.

The current study delves into the impact of heart failure education intervention on improving therapeutic outcomes for heart failure (HF) patients with reduced nonvalvular ejection fraction. There involved a total of 60 HF patients with non-valvular ejection fraction reduction who met the inclusion requirements. Patients enrolled were randomly distributed into an observation group and a control group. The observation group received heart failure education intervention, while the control group received conventional intervention. The therapeutic effect, changes in physical indicators, cardiac function indicators, coagulation function, self-management scale scores, and the incidence of adverse cardiovascular events were meticulously evaluated. The total effective proportion in the observation group was 96.67%, which was significantly higher than the control group's proportion of 76.67% (p < .05). After treatment, several parameters in the observation group showed significant improvements compared to the control group: hs-CRP, IL-6, LVEDV value, LVESV value, PT value, APTT value, and TT value were all evidently lower in the observation group. Additionally, the cardiac index, LVEF value, and heart failure self-management scale fraction were significantly higher in the observation group compared to the control group (p < .05). Furthermore, the incidence of adverse cardiovascular events in the observation group was only 6.67%, which was significantly lower than the control group's incidence of 20.00% (p < .05). Heart failure education intervention demonstrates effectiveness in improving the therapeutic outcomes for HF patients and reduced nonvalvular ejection fraction. Additionally, it enhances patients' self-management abilities. Given these positive results, it is highly recommended to promote and implement HF education intervention in clinical practice.

Cardiovascular toxicity with CTLA‐4 inhibitors in cancer patients: A meta‐analysis

AbstractBackgroundWith the emergence of cytotoxic T lymphocyte‐associated protein‐4 (CTLA‐4) inhibitors, the outcomes of patients with malignant tumors have improved significantly. However, the incidence of cardiovascular adverse events has also increased, which can affect tumor treatment. In this study, we evaluated the incidence and severity of adverse cardiovascular events caused by CTLA‐4 inhibitors by analyzing reported trials that involved CTLA‐4 inhibitor therapy.MethodsRandomized clinical trials published in English from January 1, 2013, to November 30, 2022, were searched using the Cochrane Library and PubMed databases. All included trials examined all grade and grades 3–5 cardiac and vascular adverse events. These involved comparisons of CTLA‐4 inhibitors to placebo, CTLA‐4 inhibitors plus chemotherapy to chemotherapy alone, CTLA‐4 inhibitors combined with PD‐1/PD‐L1 inhibitors to PD‐1/PD‐L1 inhibitors alone, and CTLA‐4 inhibitors plus target agent to PD‐1/PD‐L1 inhibitors plus target agent. The odds ratio (OR) and corresponding 95% confidence intervals (CIs) were calculated using the Mantel‐Haenszel method.ResultsOverall, 20 trials were included. CTLA‐4 inhibitors significantly increased the incidence of all‐grade cardiovascular toxicity (OR = 1.33, 95% CI: 1.00–1.75, p = 0.05). The incidence of all‐grade cardiovascular toxicity increased in malignant tumor patients who received single‐agent CTLA‐4 inhibitors (OR = 1.73, 95% CI: 1.13–2.65, p = 0.01), as well as the incidence rate of grades 3–5 cardiovascular adverse events (OR = 2.00, 95% CI: 1.08–3.70, p = 0.03). Compared with the non‐CTLA‐4 inhibitor group, CTLA‐4 inhibitors plus chemotherapy, PD‐1/PD‐L1 inhibitors, or target agent did not significantly affect the incidence of cardiac and vascular toxicity. The incidence of grades 3–5 cardiac failure, hypertension, pericardial effusion, myocarditis, and atrial fibrillation were much higher among patients exposed to CTLA‐4 inhibitor, but the data were not statistically significant.ConclusionOur findings suggest that the incidence rate of all cardiovascular toxicity and severe cardiovascular toxicity increased in patients who were administered CTLA‐4 inhibitors. In addition, the risk of serious cardiovascular toxic events was independent of the type of adverse event. From these results, physicians should assess the benefits and risks of CTLA‐4 inhibitors when treating malignancies.

Application and Effect of Patient Portal System in the Remote Management of Chronic Diseases for Older Adults With Coronary Heart Disease

To investigate the application of personal health record (PHR) and chronic disease management platform established on the basis of patient portal system (PPS) in managing older adults with coronary heart disease and to examine the effect on patients' self-care ability, coping mode, and quality of life. A total of 532 elderly patients with coronary heart disease were included in the study. All the participants enrolled were admitted to a tertiary-care hospital between January 2019 and June 2021. They were randomly assigned to the study group (269 cases) and the control group (263 cases). Patients in the control group were discharged with the routine discharge procedures and received the routine follow-up care. On the other hand, patients in the study group were discharged and followed up through the PHR and chronic disease management platform established on the basis of PPS. After 6 months, 12 months, and 18 months of patient management, the Exercise of Self-Care Agency (ESCA) Scale, Medical Coping Modes Questionnaire (MCMQ) and Seattle Angina Questionnaire (SAQ) were used to evaluate the patients' self-care ability, coping mode, and quality of life, respectively. The patient management effects of the two groups were analyzed. Before the management programs started, there was no statistically significant difference in the scores for the scales between the two groups of patients. After 6 months, 12 months, and 18 months of patient management, the ESCA scores of both groups were higher than those before patient management started (P<0.05). Facing scores in the MCMQ of both groups were higher than those before patient management started (P<0.05), while the scores for avoidance and yielding were lower than those before patient management started (P<0.05). The SAQ scores of both groups were higher than those before patient management started (P<0.05). After 6 months, 12 months and 18 months of patient management, the ESCA scores of the study group were always higher compared with those of the control group (P<0.05). The facing score of the study group was higher, while the scores for avoidance and yielding were lower compared with those of the control group (P<0.05). The SAQ scores of the study group were higher compared with those of the control group (P<0.05). The medication compliance rate in the study group (83.27%) was higher than that in the control group (69.96%) (P<0.05). The incidence of adverse cardiovascular events in the study group (4.09%) was lower than that in the control group (10.27%) (P<0.05). The average times of emergency treatment and readmission in the study group were lower compared with those of the control group (P<0.05). The patient satisfaction score of the study group was higher compared with that of the control group (P<0.05). The PHR and chronic disease management platform established on the basis of PPS can increase the convenient access to medical care among elderly patients with coronary heart disease, which is conducive to improving their self-care ability, coping mode, and quality of life. In addition, the patient management effect is good.

Moscatilin inhibits vascular calcification by activating IL13RA2-dependent inhibition of STAT3 and attenuating the WNT3/β-catenin signalling pathway

IntroductionVascular calcification, a devastating vascular complication accompanying atherosclerotic cardiovascular disease and chronic kidney disease, increases the incidence of adverse cardiovascular events and compromises the efficacy of vascular interventions. However, effective therapeutic drugs and treatments to delay or prevent vascular calcification are lacking. ObjectivesThis study was designed to test the therapeutic effects and mechanism of Moscatilin (also known as dendrophenol) from Dendrobium huoshanense (an eminent traditional Chinese medicine) in suppressing vascular calcification in vitro, ex vivo and in vivo. MethodsMale C57BL/6J mice (25-week-old) were subjected to nicotine and vitamin D3 (VD3) treatment to induce vascular calcification. In vitro, we established the cellular model of osteogenesis of human aortic smooth muscle cells (HASMCs) under phosphate conditions. ResultsBy utilizing an in-house drug screening strategy, we identified Moscatilin as a new naturally-occurring chemical entity to reduce HASMC calcium accumulation. The protective effects of Moscatilin against vascular calcification were verified in cultured HASMCs. Unbiased transcriptional profiling analysis and cellular thermal shift assay suggested that Moscatilin suppresses vascular calcification via binding to interleukin 13 receptor subunit A2 (IL13RA2) and augmenting its expression. Furthermore, IL13RA2 was reduced during HASMC osteogenesis, thus promoting the secretion of inflammatory factors via STAT3. We further validated the participation of Moscatilin-inhibited vascular calcification by the classical WNT/β-catenin pathway, among which WNT3 played a key role in this process. Moscatilin mitigated the crosstalk between WNT3/β-catenin and IL13RA2/STAT3 to reduce osteogenic differentiation of HASMCs. ConclusionThis study supports the potential of Moscatilin as a new naturally-occurring candidate drug for treating vascular calcification via regulating the IL13RA2/STAT3 and WNT3/β-catenin signalling pathways.

Toward a Better Understanding of Cardiovascular Risk in the Transgender and Gender-Diverse Community: A Global Call to Action.

On World Heart Day 2022, the Mexican Society of Cardiology, the Inter-American Society of Cardiology, and the World Heart Federation collaborated on a public call to action regarding the increased risk of adverse cardiovascular health outcomes in transgender and gender diverse (TGD) individuals. The aim of this article is to unpack the numerous factors that contribute to this, such as the social stigma faced by members of the TGD community, their reduced access to clinical care, and the scarcity of research regarding the unique needs of their community, which makes it difficult for clinicians to provide individualized medical care. Decreasing the incidence of adverse cardiovascular events among TGD individuals requires interventions such as educational reform in the medical community, an increase in inclusive research studies, and broader social initiatives intended to reduce the stigma faced by TGD individuals.

Cardiovascular Outcomes in Fontan Patients With Right vs Left Univentricular Morphology: A Multicenter Study

BackgroundThere is a paucity of data on long-term outcomes after Fontan palliation in patients with a dominant morphological univentricular right (uRV) vs left (uLV) ventricle. ObjectivesThe purpose of this study was to compare the incidence of atrial arrhythmias, thromboembolic events, cardiac transplantation, and death following Fontan palliation in patients with uRV vs uLV. MethodsThe Alliance for Adult Research in Congenital Cardiology conducted a multicenter retrospective cohort study on patients with total cavopulmonary connection Fontan palliation across 12 centers in North America. All components of the composite outcome, that is, atrial arrhythmias, thromboembolic events, cardiac transplantation, and death, were reviewed and classified by a blinded adjudicating committee. Time-to-event analyses were performed that accounted for competing risks. ResultsA total of 384 patients were followed for 10.5 ± 5.9 years. The composite outcome occurred in 3.7 vs 1.7 cases per 100 person-years for uRV (N = 171) vs uLV (N = 213), respectively (P < 0.001). In multivariable analyses, uRV conferred a >2-fold higher risk of the composite outcome (HR: 2.17, 95% CI: 1.45-3.45, P < 0.001). In secondary analyses of components of the primary outcome, uRV was significantly associated with a greater risk of cardiac transplantation or death (HR: 9.09, 95% CI: 2.17-38.46, P < 0.001) and atrial arrhythmias (HR: 2.17, 95% CI: 1.20-4.00, P = 0.010) but not thromboembolic events (HR: 1.64, 95% CI: 0.86-3.16, P = 0.131). ConclusionsFontan patients with uRV vs uLV morphology have a higher incidence of adverse cardiovascular events, including atrial arrhythmia, cardiac transplantation, and all-cause mortality.

Clinical outcomes of patients with acute myeloid leukemia and cardiovascular disease

Incidence of both acute myeloid leukemia (AML) and cardiovascular disease (CVD) increases with age. We evaluated whether pre-existing CVD impacts clinical outcomes in AML. We retrospectively evaluated 291 consecutive adult AML patients treated at our institution, 2014–2020. Pretreatment comorbidities were identified by chart review. Outcomes included complete remission (CR) and CR with incomplete count recovery (CRi) rates, disease-free survival (DFS), overall survival (OS) and incidence of cardiovascular adverse events. CVD was present in 34% of patients at AML diagnosis. CVD patients had worse performance status (p=0.03) and more commonly had secondary AML (p=0.03) and received hypomethylating (HMA) agent-based therapy (72% vs 38%, p< 0.001). CVD (0.45 vs 0.71, p<0.001) and diabetes mellitus (HR= 0.24, 95% CI: 0.08 – 0.8, p= 0.01) were associated with lower probability of achieving CR/CRi. Accounting for age, performance status (PS), complex karyotype, secondary disease and treatment, CVD patients had shorter OS (HR=1.5, 95% CI: 1.1–2.2, p=0.002), with 1- and 3-year OS 44% vs 67% and 25% vs 40%, respectively, but there was no difference in cumulative incidence of relapse between patients with vs without CVD. Thus, CVD is an independent risk factor for lower response rate and shorter survival in AML patients.

Impact of Chronic Kidney Disease on Major Adverse Cardiac Events in Patients with Acute Myocardial Infarction: A Retrospective Cohort Study

Background: Acute Myocardial Infarction (AMI) results in a reduction in patients’ life expectancy. Different risk factors affect the risk of Major Adverse Cardiac Events (MACE). Although the role of kidney dysfunction in patients with Chronic Kidney Disease (CKD) in cardiac events has been identified, many patients with AMI are unaware of their underlying kidney disease. This study aimed to compare the incidence of adverse cardiovascular events and identify predictors of major adverse cardiovascular events in the medium term among patients with and without renal dysfunction following AMI. Methods: This retrospective cohort study was conducted on 1039 patients who were hospitalized for Acute Myocardial Infarction (AMI) between 2018 and 2019. The patient cohort comprised 314 women (mean age: 69.8 ± 13.2 years) and 725 men (mean age: 60.5 ± 13.8 years). Patient data were obtained from the registry of patients with acute myocardial infarction and the participants were followed up for a minimum of one year following hospital discharge to assess the incidence of MACE. Results: The study found that patients with a Glomerular Filtration Rate (GFR) level below 60 had a significantly higher mortality rate than those with a GFR level of 60 or above (15.7% vs. 3.5%, p &lt; 0.0001). The multivariate analysis showed that Diabetes Mellitus (DM), GFR, and Non-ST Elevation Myocardial Infarction (NSTEMI) are significant risk factors for cardiovascular events. (p = 0.016, p = 0.015, p = 0.006 respectively), while variables such as sex, age, and Hypertension (HTN) were not significant risk factors. There was a negative correlation between GFR and death (0.241 - = r, p &lt; 0.0001) Conclusion: This study highlights the importance of detecting kidney disease during an AMI and managing risk factors for cardiovascular disease to improve health outcomes and reduce the risk of mortality.

Positive Airway Pressure therapy predicts lower mortality and Major Adverse Cardiovascular Events incidence in medicare beneficiaries with Obstructive Sleep Apnea

Positive Airway Pressure therapy predicts lower mortality and Major Adverse Cardiovascular Events incidence in medicare beneficiaries with Obstructive Sleep Apnea

Pitavastatin calcium significantly improves glucose and lipid metabolism of patients with coronary atherosclerosis and reduces the occurrence of adverse cardiovascular events

Purpose: To determine the efficacy of pitavastatin calcium and atorvastatin calcium on coronary atherosclerosis (CA) and compare the influence of the two schemes on adverse cardiovascular events.&#x0D; Methods: The medical records of 198 patients with CA admitted at Affiliated Hospital of Jiangsu University, China from August 2019 to May 2011 were analyzed retrospectively. The patients were grouped into pitavastatin calcium group (n = 102) and atorvastatin calcium group (n = 96). The efficacy, incidence of adverse cardiovascular events, as well as changes in blood lipid metabolism and blood glucose metabolism indices before and after therapy were recorded and compared.&#x0D; Results: Compared with atorvastatin calcium group, pitavastatin calcium group yielded a significantly higher overall response rate (ORR, p &lt; 0.05) and presented a significantly lower total incidence of cardiovascular adverse events (p &lt; 0.05). After therapy, pitavastatin calcium group displayed significantly lower triglyceride, total cholesterol and low-density lipoprotein-cholesterol levels (p &lt; 0.05), and also presented significantly higher high-density lipoprotein-cholesterol levels (p &lt; 0.05) in contrast to atorvastatin calcium group. Furthermore, pitavastatin calcium group presented significantly lower fasting blood glucose and glycosylated hemoglobin levels than atorvastatin calcium group (p &lt; 0.05).&#x0D; Conclusion: Compared with atorvastatin calcium, pitavastatin calcium displays a better therapeutic effect in patients with CA, lowers the incidence of adverse cardiovascular events and improves glucose and lipid metabolism of patients. Future studies will focus on longer follow-up sessions to better understand the impact of the drugs on patient’s prognosis.

Clinical and functional status and postoperative complications in patients with chronic thromboembolic pulmonary hypertension in the age aspect

Aim. To study the clinical and functional status and the early postoperative follow-up in elderly patients with chronic thromboembolic pulmonary hypertension (CTEPH).Material and methods. Patients with CTEPH were divided into two groups: group 1 (35 people) – patients ≥65 years old, group 2 (98 people) – &lt;65 years old. The baseline clinical and functional data of both groups and the in-hospital period after pulmonary endarterectomy, were analysed.Results. Patients with CTEPH ≥65 years old compared with patients &lt;65 years old were characterized by a higher comorbidity, a higher incidence of adverse cardiovascular events and the presence of chronic heart failure IV class (p&lt;0.05). Echo-CG data in patients with CTEPH ≥65 years old were characterized by a large size of the left atrium, more pronounced hypertrophy of the right ventricle free wall, interventricular septum and the left ventricular posterior wall compared with younger patients (p&lt;0.05). Also, in patients ≥65 years old, lower values of the left ventricular ejection fraction were found with preservation of global myocardial contractility (p&lt;0.05). The early postoperative period in patients with CTEPH ≥65 years is characterized by a more severe course compared to the group of patients &lt;65 years due to a larger proportion of patients with the development of newly diagnosed atrial fibrillation, multiple organ failure and postoperative bleeding (p&lt;0.05). Despite this, there were no intergroup differences in the length of the hospital period and in-hospital mortality (p&gt;0.05).Conclusion. The early postoperative results of pulmonary endarterectomy in elderly patients with CTEPH showed no differences in the length of hospital stay and in-hospital mortality compared with younger patients, which indicates the feasibility of surgical treatment of this category of patients in the specialized cardiac surgical centers.

A Randomized Controlled Study of Enhanced External Counterpulsation with Cardiac Rehabilitation in Patients with Nonobstructive Coronary Artery Disease and Coronary Microvascular Dysfunction.

Treatment with enhanced external counterpulsation (EECP) or cardiac rehabilitation (CR) benefits patients with coronary heart disease; this paper intends to explore the feasibility of EECP combined with CR in patients with nonobstructive coronary heart disease (NOCAD) and coronary microcirculation disorders (CMD).In January 2021-2022 month June our income NOCAD patients as the research object, the line of cardiac magnetic resonance (CMR), myocardial perfusion reserve (MPR) < 2.0 coronary microcirculation disorders (CMD, 80 cases). Random indicator method 80 CMD patients divided into two groups, 40 cases in each. Usual treatment group: conventional drugs and CR therapy. EECP treatment group: on the basis of standard treatment group, employ EECP therapy. Comparing the two groups before and after the treatment curative effect cardiac function index, endothelial unction index, adverse cardiovascular events, etc.After EECP treatment, the treatment group showed a higher effective rate compared to the usual treatment group (P < 0.05). EECP group curative effect, left ventricular ejection fraction,plasma NO and vascular endothelial growth factor levels higher than the usual group, the incidence of adverse cardiovascular events is lower than the usual group. The difference was statistically significant (P < 0.05).EECP combined with cardiac rehabilitation in patients with CMD symptoms has better effect and safety and provides reference for treatment of CMD patients.

Whole-Blood Transcriptome Unveils Altered Immune Response in Acute Myocardial Infarction Patients With Aortic Valve Sclerosis.

Aortic valve sclerosis (AVSc) presents similar pathogenetic mechanisms to coronary artery disease and is associated with short- and long-term mortality in patients with coronary artery disease. Evidence of AVSc-specific pathophysiological traits in acute myocardial infarction (AMI) is currently lacking. Thus, we aimed to identify a blood-based transcriptional signature that could differentiate AVSc from no-AVSc patients during AMI. Whole-blood transcriptome of AVSc (n=44) and no-AVSc (n=66) patients with AMI was assessed by RNA sequencing on hospital admission. Feature selection, differential expression, and enrichment analyses were performed to identify gene expression patterns discriminating AVSc from no-AVSc and infer functional associations. Multivariable Cox regression analysis was used to estimate the hazard ratios of cardiovascular events in AVSc versus no-AVSc patients. This cross-sectional study identified a panel of 100 informative genes capable of distinguishing AVSc from no-AVSc patients with 94% accuracy. Further analysis revealed significant mean differences in 143 genes, of which 30 genes withstood correction for age and previous AMI or coronary interventions. Functional inference unveiled a significant association between AVSc and key biological processes, including acute inflammatory responses, type I IFN (interferon) response, platelet activation, and hemostasis. Notably, patients with AMI with AVSc exhibited a significantly higher incidence of adverse cardiovascular events during a 10-year follow-up period, with a full adjusted hazard ratio of 2.4 (95% CI, 1.3-4.5). Our findings shed light on the molecular mechanisms underlying AVSc and provide potential prognostic insights for patients with AMI with AVSc. During AMI, patients with AVSc showed increased type I IFN (interferon) response and earlier adverse cardiovascular outcomes. Novel pharmacological therapies aiming at limiting type I IFN response during or immediately after AMI might improve poor cardiovascular outcomes of patients with AMI with AVSc.

Effectiveness and safety of different doses of febuxostat compared with allopurinol in the treatment of hyperuricemia: a meta-analysis of randomized controlled trials

BackgroundThe prevalence of hyperuricemia has increased steadily with the continuous improvement of living standards. Some studies have reported the clinical effectiveness and safety of different doses of febuxostat in comparison with allopurinol in hyperuricemia treatment, but the sample sizes of the studies have been small, and the results have been inconsistent. We designed this meta-analysis to evaluate the effectiveness and safety of different doses of febuxostat compared with allopurinol in the treatment of hyperuricemia.MethodsThe Cochrane Library, Embase, PubMed, Web of Science and ClinicalTrials.gov databases were searched to identify randomized controlled trials (RCTs) comparing the use of febuxostat and allopurinol for the treatment of hyperuricemia. The effectiveness and safety of different doses of febuxostat and allopurinol in treating hyperuricemia were assessed using meta-analysis.ResultsA total of 11 randomized controlled trials were included in the meta-analysis. The results of the meta-analysis showed that the percentage of patients achieving serum uric acid levels of 6.0 mg/dL or less was higher among patients taking febuxostat (80 mg/d) than among patients taking allopurinol (200–300 mg/d) [RR = 1.79, 95% CI (1.55, 2.08), P < 0.00001]. However, there was no statistically significant difference in the percentage of patients achieving serum uric acid levels of 6.0 mg/dL or less between febuxostat (40 mg/d) and allopurinol (200–300 mg/d) [RR = 1.10, 95% CI (0.93, 1.31), P = 0.25]. There was also no statistically significant difference in the incidence of gout between the febuxostat (40 mg/d) and allopurinol (200–300 mg/d) [RR = 0.97, 95% CI (0.64, 1.49), P = 0.91] or between the febuxostat (80 mg/d) and allopurinol (200–300 mg/d) [RR = 1.13, 95% CI (0.81, 1.58), P = 0.48].No significant difference in the incidence of major adverse reactions as observed between the febuxostat (40 mg/d) and allopurinol (200–300 mg/d) [RR = 1.16; 95% CI (0.43, 3.16), P = 0.77] or between the febuxostat (80 mg/d) and allopurinol (200–300 mg/d) [RR = 1.06; 95% CI (0.79, 1.42), P = 0.70]. The incidence of adverse cardiovascular events did not differ significantly between the febuxostat (40 mg/d) and allopurinol (200–300 mg/d) [RR = 1.30; 95% CI (0.57, 2.95), P = 0.53] or between the febuxostat (80 mg/d) and allopurinol (200–300 mg/d) [RR = 1.79; 95% CI (0.74, 4.32), P = 0.20].ConclusionsFebuxostat (80 mg/d) was associated with a higher percentage of patients achieving serum uric acid levels of 6.0 mg/dL or less than allopurinol (200–300 mg/d), however, febuxostat (80 mg/d) did not exhibit better efficacy in reducing the incidence of gout. More attention should be devoted to the adverse reactions caused by an increase in febuxostat doses.

Advancements in understanding inflammatory responses and the development of cardiovascular diseases under cold stimulation

Abstract Cold stimulation has been linked to acute myocardial infarction and other cardiovascular diseases. Residents in the frigid zones, such Heilongjiang Province, experience a higher incidence of adverse cardiovascular events during winter, posing a significant health threat and increasing the overall medical burden. Cold stimulation serves as an detrimental stressor, inducing inflammation in the body. Therefore, understanding the role of inflammatory responses induced by cold stimulation in the occurrence and development of cardiovascular diseases is of paramount importance. Given the impact of cold on inflammation in cardiovascular diseases and the expanding array of anti-inflammatory methods for the treatment of cardiovascular diseases, delving into the inflammatory responses mediated by can significantly complement cardiovascular disease management. This review explorest the synergistic relationship between cold stimulation and inflammation induction, elucidating how this interplay influences the occurrence and progression of cardiovascular diseases.

Pre-Existing Cardiovascular Disease Increases the Risk of Cardiovascular Adverse Events during Bruton Tyrosine Kinase Inhibitor Therapy

Background Bruton tyrosine kinase inhibitors (BTKis) have revolutionized the treatment of B-cell neoplasms. BTKi treatment has been associated with a higher incidence of cardiovascular adverse events (CVAE), which contribute significantly to morbidity and mortality in this population. Ibrutinib has been more strongly associated with CVAE compared to more selective 2 nd-generation BTKis. Although predisposing factors are not clear, pre-existing cardiovascular disease (CVD) appears to increase the risk of atrial arrhythmias and mortality during BTKi treatment. Our primary objective was to evaluate and compare the rate of CVAE during BTKi therapy, in individuals with and without pre-existing CVD. In addition, we aimed to compare the outcomes of patients treated with 1 st vs. 2 nd generation BTKis and characterize management decisions. Methods A retrospective review was conducted on patients treated with BTKis for hematologic malignancies from 2013 to 2022 at Beth Israel Deaconess Medical Center. Exclusion criteria included prior treatment with anthracyclines and BTKis, prescription of BTKi therapy without administration, prior BTKi treatment for graft-vs-host disease, and loss to follow-up. CVAE were defined as new-onset or worsening atrial fibrillation (AF), new-onset or worsening hypertension (HTN), supraventricular or ventricular arrhythmias, and sudden cardiac death. Pre-existing CVD included coronary artery disease, congestive heart failure, cerebrovascular disease, and pulmonary HTN. Student's t-test and Fisher's exact test were performed to compare the differences in continuous and categorical variables between patients with and without pre-existing CVD, respectively. Logistic regression analyses were performed to evaluate the association between pre-existing CVD and CVAE. All statistics were performed using R version 4.3. Results We identified 274 patients and 180 met inclusion criteria. Primary indications were Chronic Lymphocytic Leukemia (CLL) in 106 patients (60%), Mantle Cell Lymphoma (MCL) in 31 (17.2%), Diffuse Large B-Cell Lymphoma (DLBCL) in 17 (9.4%), and Waldenström Macroglobulinemia (WM) in 16 (8.9%). In terms of BTKi selection, 141 patients (78.3%) received ibrutinib, 35 (19.4%) acalabrutinib, and 4 (2.2%) zanubrutinib. Prevalent comorbidities were HTN in 103 patients (57%), dyslipidemia in 80 (44%), and diabetes in 26 (14%). Overall, 49 patients (27.2%) had preexisting CVD, and 21 (11.6%) experienced CVAE during BTKi therapy. In our cohort, (11/49) patients with pre-existing CVD developed CVAE, compared to (10/131) patients without pre-existing CVD, (22% vs 8% respectively), OR 3.38 (95%CI = [1.3, 8.5], p-value= 0.01). The OR remained robust ranging from 3.4 to 4.1 (p &amp;lt; 0.05) in multiple adjusted logistic regression models, accounting for imbalances in gender, comorbidities, type of BTKi, and baseline medications. Patients with pre-existing CVD had significantly higher odds of developing new or worsening AF, (16% vs. 5% respectively), OR = 3.94, (95%CI = [1.3, 12.0], p-value= 0.02) (Table 1). In subgroup analysis, patients treated with 1 st generation BTKis had a numerically higher rate of CVAE than those treated with 2 nd generation BTKis, OR = 6.28 (95%CI = [0.8, 48.3], p-value= 0.08) (Table 2). Regarding management, BTKi treatment was discontinued in 13 patients (62%) and continued in 8 (38%). Medical interventions were required in 17 patients (80%). In contrast, the event resolved in 4 patients (19%) with only BTKi discontinuation. Following CVAE, 3 patients (14%) were transitioned to a 2 nd generation BTKi with complete resolution. Conclusions CVAE remain significant contributors to treatment discontinuation. Patients treated with 1st-generation BTKis and pre-existing CVD had significantly higher odds of developing CVAE. Our study is the first to evaluate the impact of pre-existing CVD on CVAE during treatment with 2nd-generation BTKis. Patients on Ibrutinib developed more CVAE compared to patients on 2nd-generation BTKis, though differences were not statistically significant. This study was limited due to its retrospective and single-centered nature. Results highlight the need for structured approaches to prevent and promptly detect CVAE, particularly in patients with pre-existing CVD.

Cardiovascular Toxicity after Carfilzomib, Lenalidomide, and Dexamethasone Combination Chemotherapy in the Real-World 364 Asian Multiple Myeloma Patients on Behalf of the Korean Multiple Myeloma Working Party (KMM2201 study)

Background: Carfilzomib, a selective and irreversible epoxyketone proteasome inhibitor (PI), in combination with lenalidomide and dexamethasone (KRd) significantly improved the survival of relapsed and/or refractory multiple myeloma (RRMM) patients as well as newly diagnosed MM patients. The major dose-limiting toxicity of carfilzomib, cardiovascular adverse events (CVAE), have been reported in a variety of studies, which necessitates cautious risk management for patients who are treated with carfilzomib-based combination regimen. By far, the incidence and risk factors, as well as the outcome of CVAE in a large cohort of Asian patients after KRd regimen is lacking. Patient and method: Retrospective data of 364 RRMM patients who have received KRd regimen for RRMM in 21 centers participating in the Korean multiple myeloma working party (KMMWP) between February, 2018 and October, 2020, was analyzed. 41% of the patient was trial-ineligible, which was defined by patient-, disease-, and treatment-related features that were insufficient to meet the eligibility criteria for ASPIRE trial. CVAE was defined by dyspnea, hypertension (HTN), congestive heart failure (CHF), ischemic heart disease (IHD), arrhythmias, and venous thromboembolism (VTE). Time to onset of CVAE was defined by the first date of KRd therapy to the onset date of first CVAE. Results: The median age was 63 years (range, 28-85). CVAEs were observed in 16% of total analyzed patients after a median 9 months (range, 0-36 months) of KRd treatment, among which 3 patients (1%) showed fatal CVAEs. More specifically, dyspnea, HTN, CHF, IHD, arrhythmias, and VTE occurred in 11%, 3%, 3%, 1%, 2%, and 3% of the patients after a median of 9, 21, 16, 31, 8, and 16 months after KRd therapy. CVAE resulted in dose reduction and discontinuation of carfilzomib in 13 (4%) and 14 patients (4%), respectively. 5 patients (1%) discontinued KRd treatment due to any CVAE. By univariate analysis, among the factors affecting the cardiovascular events, such as age ≥75 years, ECOG performance status ≥ 3, creatinine clearance &amp;lt; 30 ml/min, Hb &amp;lt; 8g/dL, diabetes mellitus, HTN, underlying heart disease, cerebrovascular disease, prior bortezomib, thalidomide, doxorubicin, and cyclophosphamide therapy, and autologous stem cell transplantation, HTN was the only factor that significantly affected the occurrence of CVAEs after KRd therapy (odds ratio 1.877, 95% confidence interval, 1.025-3.440, P=0.041). CVAEs after KRd regimen did not affect progression-free or overall survival in the study cohort (Figure1A, and 1B). Conclusion: The incidence of CVAE after KRd therapy in this large cohort of real-world Asian RRMM patients was comparable with previous prospective and retrospective studies. Cardiovascular event after carfilzomib-based regimen did not affect progression-free or overall survival in RRMM patients. The recognition and management of underlying HTN has the utmost importance amongst the CV risk factors to mitigate CVAE in the Asian RRMM patients treated with KRd regimen. Acknowledgement This study would not have been possible without the collaboration of the Korean multiple myeloma working party. We especially thank the patients, families, caregivers who participated in this study. This work was supported by Amgen.

Abstract 12849: Assessing Cardiovascular Toxicity in Cancer Treatment: Validation of the Heart Failure Association and International Cardio-Oncology Society Tool Using Prospective Registry Data

Introduction: Cancer treatment-related cardiovascular toxicity (CTR-CVT) is a growing concern in patients undergoing anticancer therapy. The Heart Failure Association (HFA) and International Cardio-Oncology Society (ICOS) risk assessment tools have been proposed for the baseline cardiovascular (CV) risk stratification of patients with cancer. This study examined the incidence of adverse CV events associated with cancer treatment in clinical practice, also using the HFA-ICOS risk assessment tool. Methods: This single-center, prospective, observational study was conducted at Kurume University Hospital between October 2016 and August 2021 in patients aged ≥20 years with hematologic malignancies or breast cancer who were receiving anticancer agents. CV assessments were performed at enrollment and every 6 months until February 2022, with additional assessments for suspected CV adverse events. The primary endpoint was adverse CV event as defined by Common Terminology Criteria for Adverse Events (CTCAE) v4.0 grade ≥2, and the secondary endpoints were all-cause and CV death. Results: Of the enrolled 486 patients, adverse CV events occurred in 24.5% of patients with leukemia, 15.8% of patients with malignant lymphoma, 38.1% of patients with multiple myeloma, and 18.0% of patients with breast cancer, respectively. Kaplan-Meier curves of the primary endpoint and heart failure (HF)/ left ventricular (LV) dysfunction stratified by HFA-ICOS risk assessment group have shown the significant worse events in high/very high-risk group, in which the hazard ratios in the high/very high-risk group compared to the low-risk group were 2.34 (95% CI 1.48-3.71, p&lt;0.001) in the primary endpoint and 3.57 (95% CI 1.70-7.51, p&lt;0.001) in HF/LV dysfunction. There was no significant difference in the event risk between the low- and moderate-risk groups. CV death occurred in 4 patients (0.8 %) during follow-up. Conclusions: This study showed that 16-38% of patients with hematologic malignancies and breast cancer developed CTR-CVT during follow-up, in which high/very high-risk patients were well predicted by the HFA-ICOS risk assessment tool. The monitoring and managing CV risk factors are essential for safe cancer therapy.