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- Outcomes After Acute Myocardial Infarction in HIV-Infected Patients: Analysis of Data From a French Nationwide Hospital Medical Information Database
- Pregnancy Loss and Later Risk of Atherosclerotic Disease
- Physiological Right Ventricular Adaptation in Elite Athletes of African and Afro-Caribbean Origin
- Comparison of Clinical Interpretation With Visual Assessment and Quantitative Coronary Angiography in Patients Undergoing Percutaneous Coronary Intervention in Contemporary Practice: The Assessing Angiography (A2) Project
- Identifying Locations for Public Access Defibrillators Using Mathematical Optimization
- Enterococcus faecalis Infective Endocarditis: A Pilot Study of the Relationship Between Duration of Gentamicin Treatment and Outcome
- MicroRNA-93 Controls Perfusion Recovery After Hindlimb Ischemia by Modulating Expression of Multiple Genes in the Cell Cycle Pathway
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Outcomes After Acute Myocardial Infarction in HIV-Infected Patients: Analysis of Data From a French Nationwide Hospital Medical Information Database
After more than 2 decades of the AIDS epidemic, the spectrum of HIV-associated vascular diseases has evolved considerably. Now that patients have better life expectancy, it has been found that they are more likely than the population at large to experience premature cardiovascular diseases such as acute myocardial infarction. This excess risk may be the consequence of HIV infection, antiretroviral therapies, or other factors. The pathophysiology of this accelerated process is complex and multifactorial and may potentiate the impact of traditional cardiovascular risk factors. The analysis of this large nationwide hospital database, using a matching method, confirmed in a population of acute myocardial infarction patients receiving antiretroviral therapies in a developed country that HIV-infected patients share the same short-term and 1-year mortality as uninfected patients. However, in the year after acute myocardial infarction, HIV-infected patients experience an increased risk of hospitalization for heart failure (odds ratio, 2.82; 95% confidence interval, 1.32–6.01). Despite several study limitations, our study showed that the occurrence of acute myocardial infarction in a population infected with HIV was often associated with asymptomatic cardiac dysfunction and increased incidence of symptomatic heart failure after acute myocardial infarction. Prospective studies are needed to better understand the potential impact of treatment adherence, as well as management of risk factors in secondary cardiovascular prevention. See p 1767.
Pregnancy Loss and Later Risk of Atherosclerotic Disease
Pregnancy losses and atherosclerotic disease may be etiologically linked through underlying vascular pathology. In a population-based cohort of >1 million women, we found increased rates of myocardial infarction, cerebral infarction, and renovascular hypertension in women with previous stillbirths or miscarriages. Given a history of only 1 miscarriage, the risk was increased 10%, and we observed increasing risks with more miscarriages; risks for all outcomes increased 10% to 20% with each additional miscarriage. Given a previous stillbirth or ≥4 miscarriages, relative risks were increased ≥2-fold for all 3 outcomes. Associations were even stronger in the youngest women. Our findings support either a shared etiology (likely with a genetic component) for pregnancy loss and later atherosclerotic conditions or the initiation of pathological processes by a miscarriage or stillbirth that then lead to these conditions. In either case, inflammatory processes might be the common denominator. Risks conferred by 1 or 2 miscarriages were statistically significant but too small to be of clinical relevance. Women with 2 or 3 miscarriages had markedly increased risk in the range of 1.1- to 1.8-fold. Given ≥4 miscarriages or a previous stillbirth, risks were 2- to 4-fold for all outcomes, suggesting that these kinds of events should be considered when one evaluates a woman’s future risk of atherosclerotic events. See p 1775.
Physiological Right Ventricular Adaptation in Elite Athletes of African and Afro-Caribbean Origin
The ethnic differences in left ventricular adaptation to exercise are well established. Athletes of African/Afro-Caribbean (black) origin exhibit a greater magnitude of left ventricular hypertrophy than their Caucasian counterparts, which occasionally results in diagnostic overlap with morphologically mild hypertrophic cardiomyopathy. The present study provides novel data on right ventricular adaptation in black athletes. The issue is particularly pertinent because black athletes frequently reveal T-wave inversion in the anterior precordial leads (V1 through V4), a common feature of arrhythmogenic right ventricular cardiomyopathy. Six hundred seventy-five elite male and female athletes, of whom 300 were black, were investigated by use of ECG and echocardiography. Right ventricular enlargement was frequently observed in athletes of both ethnicities, exceeding diagnostic thresholds for arrhythmogenic right ventricular cardiomyopathy in approximately half of all cases. More strikingly, anterior precordial T-wave inversion was present in 1 in 7 black athletes, some 4-fold more prevalent than in the Caucasian cohort. The combination of right ventricular enlargement with concomitant T-wave inversion compatible with 2 major diagnostic criteria for arrhythmogenic right ventricular cardiomyopathy was almost exclusively observed in black athletes (3%), although further investigation did not diagnose a quiescent heart muscle disorder in any case. The result is a diagnostic “gray zone” between the healthy athlete’s heart and arrhythmogenic right ventricular cardiomyopathy that is 10-fold greater in black than white athletes. Recognition of this phenomenon has the potential to reduce the burden of investigations after preparticipation screening and to prevent erroneous exclusion of black athletes from sports participation. See p 1783.
Comparison of Clinical Interpretation With Visual Assessment and Quantitative Coronary Angiography in Patients Undergoing Percutaneous Coronary Intervention in Contemporary Practice: The Assessing Angiography (A2) Project
Studies conducted decades ago described substantial disagreement and errors in physicians’ clinical interpretation of coronary stenosis severity during coronary angiography. Despite the potential implications of such findings, no large-scale efforts to measure or improve clinical interpretation have been undertaken, and contemporary data on this topic are limited. We conducted a quality improvement initiative to compare the clinical interpretation of coronary stenosis severity with an independent assessment by quantitative coronary angiography. We examined lesions in 175 randomly selected patients undergoing elective percutaneous coronary intervention at 7 US hospitals in 2011. Overall, we found that physicians tended to assess coronary lesions treated with percutaneous coronary intervention as more severe with regard to stenosis severity than measurements by quantitative coronary angiography. Almost all treated lesions were ≥70% by clinical interpretation, whereas approximately one quarter were <70% by quantitative coronary angiography. Although future work will need to link such findings more directly to clinical decisions and outcomes, these results suggest potential opportunities to improve clinical interpretation of coronary angiography and to further optimize the use of percutaneous coronary intervention. See p 1793.
Identifying Locations for Public Access Defibrillators Using Mathematical Optimization
Hundreds of thousands of people suffer out-of-hospital cardiac arrest in North America every year. Early recognition and bystander resuscitative efforts are associated with improved chances of survival. For those with ventricular fibrillation or pulseless tachycardia, prompt defibrillation with an automated external defibrillator (AED) can allow return of spontaneous circulation and markedly reduce morbidity and mortality. Delaying defibrillation until the arrival of professional rescuers is associated with reduced probability of survival. Unfortunately, public access defibrillators are rarely used. Despite best efforts by governments, emergency medical services, charities, and citizens to place AEDs in optimal locations, this process is usually not driven by cardiac arrest location data. This article describes the use of historical cardiac arrest data in the city of Toronto and the application of a well-known and validated mathematical optimization model to guide AED placement. This strategy for planning AED distribution is compared with a “common sense” method based on daytime population estimates. The investigators in this study describe how the mathematical optimization strategy appears superior to the current population-guided strategy when evaluated with cross-validation and the metric of historical cardiac arrest coverage. The results of this article provide guidance for other communities seeking to optimize AED placement with a data-driven approach. See p 1801.
Enterococcus faecalis Infective Endocarditis: A Pilot Study of the Relationship Between Duration of Gentamicin Treatment and Outcome
Our study indicates that 2 weeks of gentamicin treatment might be adequate and preferable for treating patients with Enterococcus faecalis infective endocarditis. The data apply to patients with symptom duration of <3 months. Our results show equal cure rates and survival between patients treated with gentamicin for a median of 14 days and those treated for a median of 28 days. However, a progressive decline in renal function was revealed only during the prolonged gentamicin treatment. Reduced renal function is in general an indicator of an ominous outcome. Therefore, reducing the duration of gentamicin treatment should be considered in these patients. See p 1810.
MicroRNA-93 Controls Perfusion Recovery After Hindlimb Ischemia by Modulating Expression of Multiple Genes in the Cell Cycle Pathway
Although rates of death from ischemic heart disease in the United States are declining, peripheral arterial disease (PAD) of the lower extremity has not declined. PAD can be expected to become an even greater health care problem in the years ahead. The primary problem in PAD is reduced blood flow to the leg, and because total occlusions in 1 or more of the major inflow arteries to the leg(s) is common in patients with PAD, blood flow to the leg becomes dependent on the number and extent of collateral blood vessels and their ability to connect to the distal microvasculature in ischemic muscle. Current medical therapies used to treat patients with PAD are for systemic atherosclerosis, but these agents do not treat the primary problem in PAD, which is impaired blood flow. MicroRNAs are small 15- to 22-base pair noncoding RNAs that are now being recognized as key regulators of gene regulation, in general, and especially in the response to injury. In a simple model, a single microRNA can bind to the 3′ untranslated region of a single messenger RNA and target that messenger RNA for degradation. However, a single microRNA can bind to several functionally related mRNAs and thereby regulate entire biological pathways. In this report, we used in vivo models, a computational approach, in vitro and gene expression studies that demonstrated that miR-93 regulated several genes simultaneously to orchestrate multiple processes in skeletal muscle adaptation to ischemia. This provides the framework for the development of a potentially novel approach for the treatment of PAD. See p 1818.
- © 2013 American Heart Association, Inc.
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Jump to
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- Outcomes After Acute Myocardial Infarction in HIV-Infected Patients: Analysis of Data From a French Nationwide Hospital Medical Information Database
- Pregnancy Loss and Later Risk of Atherosclerotic Disease
- Physiological Right Ventricular Adaptation in Elite Athletes of African and Afro-Caribbean Origin
- Comparison of Clinical Interpretation With Visual Assessment and Quantitative Coronary Angiography in Patients Undergoing Percutaneous Coronary Intervention in Contemporary Practice: The Assessing Angiography (A2) Project
- Identifying Locations for Public Access Defibrillators Using Mathematical Optimization
- Enterococcus faecalis Infective Endocarditis: A Pilot Study of the Relationship Between Duration of Gentamicin Treatment and Outcome
- MicroRNA-93 Controls Perfusion Recovery After Hindlimb Ischemia by Modulating Expression of Multiple Genes in the Cell Cycle Pathway
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