Understanding Of Ischemic Heart Disease Research Articles

Sex-based differences in remote monitoring of biometric, psychometric and biomarker indices in stable ischemic heart disease

BackgroundSex-based differences are crucial to consider in the formulation of a personalized treatment plan. We evaluated sex-based differences in adherence and remotely monitored biometric, psychometric, and biomarker data among patients with stable ischemic heart disease (IHD).MethodsThe Prediction, Risk, and Evaluation of Major Adverse Cardiac Events (PRE–MACE) study evaluated patients with stable IHD over a 12-week period. We collected biometric and sleep data using remote patient monitoring via FitBit and psychometric data from Patient-Reported Outcomes Measurement Information System (PROMIS), Kansas City Cardiomyopathy (KCC) and Seattle Angina Questionnaire-7 (SAQ-7) questionnaires. Serum biomarker levels were collected at the baseline visit. We explored sex-based differences in demographics, adherence to study protocols, biometric data, sleep, psychometric data, and biomarker levels.ResultsThere were 198 patients enrolled, with mean age 65.5 ± 11 years (± Standard deviation, SD), and 60% were females. Females were less adherent to weekly collection of PROMIS, KCC and SAQ-7 physical limitations questionnaires (all p < 0.05), compared to males. There was no difference in biometric physical activity. There was a statistically significant (p < 0.05) difference in sleep duration between sexes, with females sleeping 6 min longer. However, females reported higher PROMIS sleep disturbance scores (p < 0.001) and poorer psychometric scores overall (p < 0.05). A higher proportion of males had clinically significant elevations of median N-terminal pro-brain natriuretic peptide (p = 0.005) and high-sensitivity cardiac troponin levels (p < 0.001) compared to females.ConclusionsAmong females and males with stable IHD, there are sex-based differences in remote monitoring behavior and data. Females are less adherent to psychometric data collection and report poorer psychometric and sleep quality scores than males. Elevated levels of biomarkers for MACE are more common in males. These findings may improve sex-specific understanding of IHD using remote patient monitoring.

Pharmacological Agents Targeting Myocardial Metabolism for the Management of Chronic Stable Angina : an Update.

Despite continuous advances in myocardial revascularization procedures and intracoronary devices, patients with ischemic heart disease (IHD) still experience worse prognosis and poor quality of life (QoL). Indeed, chronic stable angina (CSA) is a common disease with a large burden on healthcare costs. Traditionally, CSA is interpreted as episodes of reversible myocardial ischemia related to the presence of stable coronary artery plaque causing myocardial demand/supply mismatch when myocardial oxygen consumption increases. Accordingly, revascularization procedures are performed with the aim to remove the flow limiting stenosis, whereas traditional medical therapy (hemodynamic agents) aims at reducing myocardial oxygen demands. However, although effective, none of these treatment strategies or their combination is either able to confer symptomatic relief in all patients, nor to reduce mortality. Failure to significantly improve QoL and prognosis may be attributed at least in part to this "restrictive" understanding of IHD. Despite for many years myocardial metabolic derangement has been overlooked, recently it has gained increased attention with the development of new pharmacological agents (metabolic modulators) able to influence myocardial substrate selection and utilization thus improving cardiac efficiency. Shifting cardiac metabolism from free fatty acids (FA) towards glucose is a promising approach for the treatment of patients with stable angina, independently of the underling disease (macrovascular and/or microvascular disease). In this sense cardiac metabolic modulators open the way to a "revolutionary" understanding of ischemic heart disease and its common clinical manifestations, where myocardial ischemia is no longer considered as the mere oxygen and metabolites demand/supply unbalance, but as an energetic disorder. Keeping in mind such an alternative approach to the disease, development of new pharmacological agents directed toward multiple metabolic targets is mandatory.

Sex differences in the pathophysiology, treatment, and outcomes in IHD.

Heart disease is the number one killer of women. Although there are many similarities between men and women, the evolving understanding of ischemic heart disease in women allow us to emphasize the important differences that need to be recognized. These differences, including symptoms at presentation, importance of particular risk factors, pathophysiology of disease, and treatments/outcomes, will be discussed in this review.

Can Changes in Troponin Results Be Useful in Diagnosing Myocardial Infarction?

In 1979, the WHO defined 3 specific criteria for use in the diagnosis of myocardial infarction (MI)1 : (a) clinical symptoms typical for ischemic heart disease, (b) specific electrocardiogram changes, and (c) a typical change in serial measurements of cardiac enzymes (1). Later definitions have continued in the mold of listing specific criteria, and in the current definition of MI, a characteristic increase and/or decrease in a cardiac biomarker with at least 1 result >99 percentile of a healthy population and evidence of myocardial ischemia (either specific symptoms or electrocardiographic or ultrasound findings) are mandatory (2). During the last decade, troponin T or I molecules, which are found only in myocardial cells and released after cell necrosis, have been the preferred cardiac biomarkers because of their high sensitivity and specificity (3), although myocardial cell necrosis can be seen in conditions other than myocardial ischemia (renal failure, sepsis, treatment with cardiotoxic drugs, myocarditis, and so on). A common problem in clinical practice is how to diagnose an acute MI in a patient who already has increased troponin concentrations. The National Academy of Clinical Biochemistry has suggested that a 20% increase in troponin results can be used to diagnose an ischemic event. This recommendation is based on analytical variation for troponin analysis alone, without taking biological variation into account (4). Recently, troponin assays with better analytical sensitivity have become commercially available. These assays not only have opened up new diagnostic opportunities but also have challenged our understanding of ischemic heart disease, because the assays can detect low troponin concentrations, even in the healthy population (5)(6). The natural fluctuations of troponin concentrations around a homeostatic set point (i.e., within-person biological variation) as well as the between-person biological variation can be established, as is reported by Vasile et al. in …

Aspects of our present understanding of ischemic heart disease: more answers than questions.

Aspects of our present understanding of ischemic heart disease: more answers than questions.

Severe Coronary Artery Disease in a Marathon Runner

A 55-year-old male runner was found to have severe three-vessel coronary disease on angiography soon after completing a 25-mile marathon with no symptoms. This patient raises important questions concerning our understanding of ischemic heart disease.

Learned Control of Coronary Blood Flow

Mongrel dogs with chronically implanted electromagnetic flow probes on the left coronary artery were curarized and trained to decrease coronary blood flow in order to avoid and escape from stress. Each of four animals learned to consistently decrease coronary flow with increasing independence from changes in other cardiovascular dynamics. One animal achieved dramatic decreases suggestive of profound coronary vasoconstriction. The results may have important implications for the understanding of ischemic heart disease.