Cardiovascular Science Open Access

Cardiovascular Science: A New Open-Access Journal to Share Your Research on Cardiovascular Diseases

Early Experience Using Implanted Hemodynamic Monitor (CardioMEMs) for Hemodynamic Assessment during Exercise in Pediatric Patients with Fontan Circulation

Assessment of Fontan pressures during exercise has been previously challenging. We report our experience with 4 children, in whom implanted hemodynamic monitor was utilized to assess Fontan pressures during exercise. Data was used to modify treatment in one case. The device provided useful insight into exercise-related changes in Fontan patients.

Interstage Growth Failure May Adversely Affect Clinical Outcomes in Hypoplastic Left Heart Syndrome: Results from a Single Center Ten-Year Review

Purpose: Infants with Hypoplastic left heart syndrome (HLHS) are particularly vulnerable during their interstage period which is the time between Stage 1 palliation (S1P) and Stage 2 palliation (S2P). Interstage Monitoring Program (IMP) was established to reduce mortality after discharge following S1P and consists of close monitoring of certain key parameters including hypoxia, growth failure and occurrence of major events. As somatic growth is a potentially modifiable determinant of interstage mortality, we aimed to study the incidence and risk factors of growth failure among infants followed by our IMP over the last 10 years. Methods: We included HLHS infants who were enrolled in institutional IMP following discharge after S1P from May 2009 to April 2019. Growth failure was defined as per the NPC-QIC criterion as failure to achieve target interstage weight of 20–30 g per day and risk factors for growth failure were explored. Results: A total of 87 patients were enrolled during the study period, of whom 72 (n = 83%) underwent S2P. About one third (23 patients) failed to achieve the target growth rate despite close monitoring through a robust IMP. Growth failure significantly delayed the time to more stable S2P circulation (median IS duration: 131 days vs 86 days, p = 0.002). Patients with growth failure had a significantly higher incidence of death/transplant prior to Stage 3 (Fontan) completion (39% vs 16%, p = 0.03). Interstage growth failure was significantly associated with a “Hybrid-type” of repair during S1P (p = 0.03); and with the need for opioids at discharge (p = 0.04). Conclusion: This study highlights that growth failure is common in HLHS patients, despite active intervention through an IMP program. These patients appear to have significantly worse transplant-free survival rates compared to their counterparts. Pre-interstage risk factors including use of opioids may need to be addressed to assist adequate somatic growth during interstage.

The Response of Vascular Endothelial Cells Post-Stroke and Its Role in Accelerating Atherosclerosis Progression

A Novel Comprehensive Program Combining Optimal Medical Treatment with Lifestyle Modification for Type 2 Diabetes

There are more and more individuals with type 2 diabetes (T2D) in the globe. It’s a huge burden of public health and a great challenge in clinical due to a high linkage with atherosclerosis, cardiovascular disease (CVD), stroke, and cancer. However, little is known about a comprehensive program of management and self-management of T2D. This article introduces briefly the current status in T2D and an updated classical standardized comprehensive program which combines optimal medical treatment (OMT) (the glucagon-like peptide-1 receptor agonists, the sodium-glucose cotransporter 2 inhibitors, and the ultralong-acting, once-daily basal insulin) with lifestyle modification, that is, intervention of RT-ABCDEFG (iRT-ABCDEFG) for control and prevention of T2D, and discusses its advantages and prospects. As an effective comprehensive program and strategy for interventions of diabetes, this program can be used as a reversible, right, and routine treatment. Several pivotal goals including less major adverse cardiocerebrovascular events (MACCE) and diabetic complications, less medical costs, longer life expectancy, lower morbidity and mortality, and higher quality of life, will be realized by consistently practicing this program due to early diagnosis, OMT, and lifestyle modification for overall prevention. All in all, since T2D highly links to CVD and cancer, as well as other MACCE, this novel iRT-ABCDEFG program is very helpful in comprehensive management and self-management of T2D and worth recommending for further application and health care of T2D due to better clinical efficacy and cost-effective relationship.

Risk Factors for Adverse Outcomes Following Surgical Repair of Simple Coarctation in Early Infancy: A Ten-Year Single Center Review

Coarctation of the aorta is a frequently diagnosed congenital heart defect and often requires surgical repair in early infancy. Infants born with this condition remain at risk for post-operative morbidity and reintervention within the first year of life. A single-center, retrospective chart review was performed. The protocol was approved by the Institutional Review Board (IRB-21-156, 14 August 2021). A 10-year review from January 2010 to December 2020 identified all children diagnosed with coarctation of the aorta or arch hypoplasia; without any associated major congenital cardiac pathology (i.e., simple coarctation). Reintervention-free-survival at one year for all infants who underwent surgical repair was assessed. Patient characteristics for those who did and did not experience significant adverse event (SAE) in the postoperative period were obtained and compared. A total of 105 patients diagnosed with isolated coarctation of the aorta or arch hypoplasia and who underwent surgical repair were identified. Of these, 11 patients (10%) experienced a SAE (i.e., vocal cord palsy, diaphragm palsy, chylothorax, stroke/neurological complication, need for reintubation or tracheostomy, necrotizing enterocolitis, major bleeding or thrombotic vascular complication, or reintervention) in the post-operative period. Patients who experienced a SAE were more likely to have a prenatal diagnosis of coarctation of the aorta (p = 0.03), a known genetic anomaly (p = 0.0001), or had undergone a median sternotomy approach/complex arch repair (i.e., requiring patching of the aorta) (p = 0.0001). Genetic anomaly (mainly Turner syndrome) was the only independent predictor of SAE in multivariate analysis (OR = 6.7) Follow up data at one year was available for 79 patients, with only 6 patients requiring reintervention before 1 year of age. Overall, infants who undergo surgical repair of simple coarctation of aorta have an excellent chance of reintervention-free-survival at one year post intervention. Those with a known genetic anomaly or requiring median sternotomy approach appear to have a higher risk for a SAE in the postoperative period.

Tumour Necrosis Factor Receptor-Associated Protein 1 (TRAP1): A Pivotal Regulator of Smooth Muscle Cell Senescence and Atherosclerosis through Metabolic Reprogramming

Utilization of High Intensity Statins in Patients Hospitalized for Myocardial Infarction

High intensity statin (HIS) therapy decreases LDL cholesterol and risk of recurrent cardiovascular events after acute myocardial infarction (MI). Recognizing the therapeutic significance of HIS, the ACC/AHA cholesterol treatment guidelines have recommended HIS for all patients following acute MI since 2013.The authors sought to define factors that result in continued underutilization and limited adherence to HIS among individuals post MI. This is a retrospective observational analysis of patients who had a diagnosis of MI between 2013 and 2018 at a single, large academic medical center. There was a significant increase in HIS prescriptions upon discharge after MI following, versus prior to 2013. Within the first year of guideline change (2013–2014), only 35.3% of patients with MI were discharged on a HIS compared to 80.1% in 2018. There was no significant difference between race or gender regarding HIS utilization. However, older age predicted a lower likelihood of being appropriately discharged on HIS. The use of statin therapy prior to hospitalization decreased the probability of being appropriately up titrated to HIS on discharge. Strikingly, HIS use was associated with a reduction in the 30-day readmission rate (4.7% versus 6.8%). Increased age was associated with lower rates of HIS use, which could stem from prior statin exposure uncovering titrational statin intolerance prior to the index event, a process that would be much less likely in younger patients, who tend to be statin naive. Although HIS have historically been underutilized in Blacks, this was not observed in the current study. Individuals discharged on HIS had lower readmission rates; while confounding factors separate from a pure treatment effect of HIS attenuating readmission rate may be represented, this remains a key finding underscoring the benefits of statin therapy in lowering societal burden of cardiovascular disease and associated costs.

Cardiovascular Science: A New Open-Access Journal to Share Your Research on Cardiovascular Diseases

Early Experience Using Implanted Hemodynamic Monitor (CardioMEMs) for Hemodynamic Assessment during Exercise in Pediatric Patients with Fontan Circulation

Assessment of Fontan pressures during exercise has been previously challenging. We report our experience with 4 children, in whom implanted hemodynamic monitor was utilized to assess Fontan pressures during exercise. Data was used to modify treatment in one case. The device provided useful insight into exercise-related changes in Fontan patients.utf-8

A Novel Comprehensive Program Combining Optimal Medical Treatment with Lifestyle Modification for Type 2 Diabetes

There are more and more individuals with type 2 diabetes (T2D) in the globe. It’s a huge burden of public health and a great challenge in clinical due to a high linkage with atherosclerosis, cardiovascular disease (CVD), stroke, and cancer. However, little is known about a comprehensive program of management and self-management of T2D. This article introduces briefly the current status in T2D and an updated classical standardized comprehensive program which combines optimal medical treatment (OMT) (the glucagon-like peptide-1 receptor agonists, the sodium-glucose cotransporter 2 inhibitors, and the ultralong-acting, once-daily basal insulin) with lifestyle modification, that is, intervention of RT-ABCDEFG (iRT-ABCDEFG) for control and prevention of T2D, and discusses its advantages and prospects. As an effective comprehensive program and strategy for interventions of diabetes, this program can be used as a reversible, right, and routine treatment. Several pivotal goals including less major adverse cardiocerebrovascular events (MACCE) and diabetic complications, less medical costs, longer life expectancy, lower morbidity and mortality, and higher quality of life, will be realized by consistently practicing this program due to early diagnosis, OMT, and lifestyle modification for overall prevention. All in all, since T2D highly links to CVD and cancer, as well as other MACCE, this novel iRT-ABCDEFG program is very helpful in comprehensive management and self-management of T2D and worth recommending for further application and health care of T2D due to better clinical efficacy and cost-effective relationship.utf-8

Interstage Growth Failure May Adversely Affect Clinical Outcomes in Hypoplastic Left Heart Syndrome: Results from a Single Center Ten-Year Review

Purpose: Infants with Hypoplastic left heart syndrome (HLHS) are particularly vulnerable during their interstage period which is the time between Stage 1 palliation (S1P) and Stage 2 palliation (S2P). Interstage Monitoring Program (IMP) was established to reduce mortality after discharge following S1P and consists of close monitoring of certain key parameters including hypoxia, growth failure and occurrence of major events. As somatic growth is a potentially modifiable determinant of interstage mortality, we aimed to study the incidence and risk factors of growth failure among infants followed by our IMP over the last 10 years. Methods: We included HLHS infants who were enrolled in institutional IMP following discharge after S1P from May 2009 to April 2019. Growth failure was defined as per the NPC-QIC criterion as failure to achieve target interstage weight of 20–30 g per day and risk factors for growth failure were explored. Results: A total of 87 patients were enrolled during the study period, of whom 72 (n = 83%) underwent S2P. About one third (23 patients) failed to achieve the target growth rate despite close monitoring through a robust IMP. Growth failure significantly delayed the time to more stable S2P circulation (median IS duration: 131 days vs 86 days, p = 0.002). Patients with growth failure had a significantly higher incidence of death/transplant prior to Stage 3 (Fontan) completion (39% vs 16%, p = 0.03). Interstage growth failure was significantly associated with a “Hybrid-type” of repair during S1P (p = 0.03); and with the need for opioids at discharge (p = 0.04). Conclusion: This study highlights that growth failure is common in HLHS patients, despite active intervention through an IMP program. These patients appear to have significantly worse transplant-free survival rates compared to their counterparts. Pre-interstage risk factors including use of opioids may need to be addressed to assist adequate somatic growth during interstage.utf-8

Risk Factors for Adverse Outcomes Following Surgical Repair of Simple Coarctation in Early Infancy: A Ten-Year Single Center Review

Coarctation of the aorta is a frequently diagnosed congenital heart defect and often requires surgical repair in early infancy. Infants born with this condition remain at risk for post-operative morbidity and reintervention within the first year of life. A single-center, retrospective chart review was performed. The protocol was approved by the Institutional Review Board (IRB-21-156, 14 August 2021). A 10-year review from January 2010 to December 2020 identified all children diagnosed with coarctation of the aorta or arch hypoplasia; without any associated major congenital cardiac pathology (i.e., simple coarctation). Reintervention-free-survival at one year for all infants who underwent surgical repair was assessed. Patient characteristics for those who did and did not experience significant adverse event (SAE) in the postoperative period were obtained and compared. A total of 105 patients diagnosed with isolated coarctation of the aorta or arch hypoplasia and who underwent surgical repair were identified. Of these, 11 patients (10%) experienced a SAE (i.e., vocal cord palsy, diaphragm palsy, chylothorax, stroke/neurological complication, need for reintubation or tracheostomy, necrotizing enterocolitis, major bleeding or thrombotic vascular complication, or reintervention) in the post-operative period. Patients who experienced a SAE were more likely to have a prenatal diagnosis of coarctation of the aorta (p = 0.03), a known genetic anomaly (p = 0.0001), or had undergone a median sternotomy approach/complex arch repair (i.e., requiring patching of the aorta) (p = 0.0001). Genetic anomaly (mainly Turner syndrome) was the only independent predictor of SAE in multivariate analysis (OR = 6.7) Follow up data at one year was available for 79 patients, with only 6 patients requiring reintervention before 1 year of age. Overall, infants who undergo surgical repair of simple coarctation of aorta have an excellent chance of reintervention-free-survival at one year post intervention. Those with a known genetic anomaly or requiring median sternotomy approach appear to have a higher risk for a SAE in the postoperative period.utf-8

Tumour Necrosis Factor Receptor-Associated Protein 1 (TRAP1): A Pivotal Regulator of Smooth Muscle Cell Senescence and Atherosclerosis through Metabolic Reprogramming

The Response of Vascular Endothelial Cells Post-Stroke and Its Role in Accelerating Atherosclerosis Progression

Utilization of High Intensity Statins in Patients Hospitalized for Myocardial Infarction

High intensity statin (HIS) therapy decreases LDL cholesterol and risk of recurrent cardiovascular events after acute myocardial infarction (MI). Recognizing the therapeutic significance of HIS, the ACC/AHA cholesterol treatment guidelines have recommended HIS for all patients following acute MI since 2013.The authors sought to define factors that result in continued underutilization and limited adherence to HIS among individuals post MI. This is a retrospective observational analysis of patients who had a diagnosis of MI between 2013 and 2018 at a single, large academic medical center. There was a significant increase in HIS prescriptions upon discharge after MI following, versus prior to 2013. Within the first year of guideline change (2013–2014), only 35.3% of patients with MI were discharged on a HIS compared to 80.1% in 2018. There was no significant difference between race or gender regarding HIS utilization. However, older age predicted a lower likelihood of being appropriately discharged on HIS. The use of statin therapy prior to hospitalization decreased the probability of being appropriately up titrated to HIS on discharge. Strikingly, HIS use was associated with a reduction in the 30-day readmission rate (4.7% versus 6.8%). Increased age was associated with lower rates of HIS use, which could stem from prior statin exposure uncovering titrational statin intolerance prior to the index event, a process that would be much less likely in younger patients, who tend to be statin naive. Although HIS have historically been underutilized in Blacks, this was not observed in the current study. Individuals discharged on HIS had lower readmission rates; while confounding factors separate from a pure treatment effect of HIS attenuating readmission rate may be represented, this remains a key finding underscoring the benefits of statin therapy in lowering societal burden of cardiovascular disease and associated costs.utf-8