This systematic review and meta-analysis investigated the association of diabetes and glycemic control with myocardial fibrosis (MF).
MF is associated with an increased risk of heart failure, ...coronary artery disease, arrhythmias, and death. Diabetes may influence the development of MF, but evidence is inconsistent.
The authors searched EMBASE, Medline Ovid, Cochrane CENTRAL, Web of Science, and Google Scholar for observational and interventional studies investigating the association of diabetes, glycemic control, and antidiabetic medication with MF assessed by histology and cardiac magnetic resonance (ie, extracellular volume fraction ECV% and T
time).
A total of 32 studies (88% exclusively on type 2 diabetes) involving 5,053 participants were included in the systematic review. Meta-analyses showed that diabetes was associated with a higher degree of MF assessed by histological collagen volume fraction (n = 6 studies; mean difference: 5.80; 95% CI: 2.00-9.59) and ECV% (13 studies; mean difference: 2.09; 95% CI: 0.92-3.27), but not by native or postcontrast T
time. Higher glycosylated hemoglobin levels were associated with higher degrees of MF.
Diabetes is associated with higher degree of MF assessed by histology and ECV% but not by T
time. In patients with diabetes, worse glycemic control was associated with higher MF degrees. These findings mostly apply to type 2 diabetes and warrant further investigation into whether these associations are causal and which medications could attenuate MF in patients with diabetes.
This systematic review and meta-analysis investigated the association of diabetes and glycemic control with myocardial fibrosis (MF).
MF is associated with an increased risk of heart failure, ...coronary artery disease, arrhythmias, and death. Diabetes may influence the development of MF, but evidence is inconsistent.
The authors searched EMBASE, Medline Ovid, Cochrane CENTRAL, Web of Science, and Google Scholar for observational and interventional studies investigating the association of diabetes, glycemic control, and antidiabetic medication with MF assessed by histology and cardiac magnetic resonance (ie, extracellular volume fraction ECV% and T1 time).
A total of 32 studies (88% exclusively on type 2 diabetes) involving 5,053 participants were included in the systematic review. Meta-analyses showed that diabetes was associated with a higher degree of MF assessed by histological collagen volume fraction (n = 6 studies; mean difference: 5.80; 95% CI: 2.00-9.59) and ECV% (13 studies; mean difference: 2.09; 95% CI: 0.92-3.27), but not by native or postcontrast T1 time. Higher glycosylated hemoglobin levels were associated with higher degrees of MF.
Diabetes is associated with higher degree of MF assessed by histology and ECV% but not by T1 time. In patients with diabetes, worse glycemic control was associated with higher MF degrees. These findings mostly apply to type 2 diabetes and warrant further investigation into whether these associations are causal and which medications could attenuate MF in patients with diabetes.
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Underrepresentation of migrants, women, and older adults in cardiovascular disease (CVD) trials may contribute to disparate care and survival. Among patients who underwent percutaneous coronary ...intervention (PCI), we aimed to investigate the associations of (i) underrepresented groups with major adverse cardiac events (MACE), CVD mortality, and non-CVD mortality, (ii) underrepresented groups with cardiac rehabilitation (CR) uptake, and (iii) CR uptake with outcomes.
We included 15 211 consecutive patients from the CARDIOBASE Bern PCI registry (2009-18). In multi-state models comparing transition probabilities of events, sex was not associated with increased risk of any event. For each year increase in age, the increased risk of non-CVD and CVD mortality was 8% 95% confidence interval (CI) 6-9%. Being migrant was associated with a lower risk of non-CVD mortality hazard ratio (HR) (95% CI) 0.49 (0.27-0.90) but not with CVD mortality. In logistic regression analysis, CR uptake was lower among women odds ratio (95% CI) = 0.72 (0.57-0.86) and older adults 0.32 (0.27-0.38), but not among migrants. In cox regression, CR was independently associated with lower all-cause HR (95% CI) = 0.12 (0.03-0.37) and CVD mortality 0.1 (0.02-0.7), but not with MACE 1.08 (0.8-1.4).
Among underrepresented groups undergoing PCI, age, but not migration status nor sex, contributed to disparities in mortality. Migrant status did not result in lower attendance of CR. Considering the protective associations of CR on CVD mortality independent of age, sex, and migration status, the lower uptake in women and older adults is noteworthy.
The Surprise Question (SQ) is a prognostic screening tool used to identify patients with limited life expectancy. We assessed the SQ's performance predicting 1-year mortality among patients in ...ambulatory heart failure (HF) clinics. We determined that the SQ's performance changes according to sex and other demographic (age) and clinical characteristics, mainly left ventricular ejection fraction (LVEF) and the New York Heart Association (NYHA) functional classifications.
We conducted a prospective cohort study in two HF clinics. To assess the performance of the SQ in predicting 1-year mortality, we calculated the sensitivity, specificity, positive and negative likelihood ratios, and the positive and negative predictive values. To illustrate if the results of the SQ changes the probability that a patient dies within 1 year, we created Fagan's nomograms. We report the results from the overall sample and for subgroups according to sex, age, LVEF and NYHA functional class.
We observed that the SQ showed a sensitivity of 85% identifying ambulatory patients with HF who are in the last year of life. We determined that the SQ's performance predicting 1-year mortality was similar among women and men. The SQ performed better for patients aged under 70 years, for patients with reduced or mildly reduced ejection fraction, and for patients NYHA class III/IV.
We consider the tool an easy and fast first step to identify patients with HF who might benefit from an advance care planning discussion or a referral to palliative care due to limited life expectancy.
Evaluar el EuroSCORE II y el STS score como predictores de la morbilidad y la mortalidad postoperatoria en pacientes que van a la cirugía cardiaca valvular aislada por el abordaje mínimamente ...invasivo.
Estudio observacional de una cohorte retrospectiva de 273 pacientes consecutivos desde noviembre de 2010 hasta noviembre de 2014. A todos se les calculó el EuroSCORE II y el STS score. La discriminación fue medida con el área bajo la curva ROC y la calibración fue evaluada con el test de Hosmer-Lemeshow (HL).
La capacidad discriminatoria fue similar, para el EuroSCORE II con un área bajo la curva ROC fue de 0.68 (IC 95%: 0.512 - 0.856), p=0.039 y la del STS score fue de 0.650 (IC 95%: 0.453 - 0.848), p=0.107. El poder de calibración para la mortalidad general del EuroSCORE II fue de p=0.28 y del STS fue de p=0.27. Ambos puntajes subestimaron el riesgo de la mortalidad. La morbilidad y la mortalidad fue mayor cuando se implementó la técnica mínimamente invasiva y disminuyó progresivamente a 1.4% (n=1) al cuarto año del estudio.
El valor predictivo del EuroSCORE II y el STS fue similar. El desarrollo y la validación de las escalas locales ayudarían a mejorar la estratificación de riesgo en nuestra población y reflejar verdaderamente nuestra práctica clínica. Se requieren estudios multicéntricos con mayor tamaño de la muestra para estimar la utilidad de las escalas disponibles y para proponer una propia para este tipo de intervención.
Assessing EuroSCORE II and STS score values as predictors for postoperative morbidity and mortality in patients undergoing minimally invasive heart valve surgery.
Retrospective cohort study of 273 consecutive patients since November 2010 and November 2014. EuroSCORE II and STS score values were collected for all of them. Discrimination was measured with the area under the ROC curve and calibration was assessed by means of the Hosmer-Lemeshow test (HL).
Discrimination was similar for both tests, EuroSCORE II showed an area under the ROC curve of 0.68 (CI 95%: 0.512-0.856), p=0.039 and STS score was 0.650 (IC 95%: 0.453- 0.848), p=0.107. Calibration power for general mortality was p=0.28 for EuroSCORE II and p=0.27 for STS. Both scores underestimated mortality risks. Morbidity and mortality were higher when the minimally invasive technique was implemented and it was gradually reduced to 1.4% (n=1) by the fourth year of the study.
Predictive value of EuroSCORE II and STS was similar. Development and validation of local scales would help improve risk stratification within our population group and truly reflect our clinical practice. Collaborative studies with larger sample sizes are required in order to estimate the usefulness of the available scales and to suggest a scale of its own for this type of surgery.
To model disease progression, healthcare demand and case fatality rate attributed to COVID-19 pandemic that may occur in Chile in 1-month time, by simulating different scenarios according to diverse ...mitigation measures hypothetically implemented. Furthermore, we aimed to estimate the same outcomes assuming that 70% of the population will be infected by SARS-CoV-2, with no time limit assumption.
We based on the number of confirmed COVID-19 cases in Chile up to April 14th 2020 (8 273 cases and 94 deaths). For the simulated scenarios we assumed basic reproduction numbers ranging from R0=2.5 to R0=1.5. The estimation of the number of patients that would require intensive care and the age-specific case fatality rate were based on data provided by the Imperial College of London and the Instituto Superiore di Sanità en Italia.
If no mitigation measures were applied (R0=2.5), by May 25, Chile would have 2 019 775 cases and 15 068 deaths. If mitigations measures were implemented to decrease R0 to 1.5 (early detection of cases, quarantine, social distancing of elderly), the number of cases and deaths would importantly decrease. Nonetheless, the demand for in-hospital care including intensive care would exceed the available resources. Our age-specific analysis showed that population over 60 years are at higher risk of needing intensive care and death.
Our evidence supports the mitigation measures implemented by the Chilean government. Nevertheless, more stringent measures are needed to prevent the health care system's collapse due to shortfall of resources to confront the COVID-19 pandemic.
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