12 research outputs found
Metabolic syndrome and incident peripheral artery disease - the Multi-Ethnic Study of Atherosclerosis.
Inhibition of fibroblast proliferation in cardiac myocyte cultures by surface microtopography
Telehealth for the Management of Left Ventricular Assist Device Patients: The University of Rochester TeleLVAD Study
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Metabolic syndrome and incident peripheral artery disease - the Multi-Ethnic Study of Atherosclerosis.
ObjectiveWe evaluated whether metabolic syndrome (MetS) is associated with an increased incidence of lower extremity peripheral artery disease (PAD) in community dwelling people free of clinical cardiovascular disease at baseline. We assessed whether higher levels of inflammatory biomarkers may mediate the association of MetS with incident PAD.MethodsMetS was defined at baseline as the presence of three or more of the following components: elevated waist circumference, triglycerides ≥150 mg/dL, reduced high-density lipoprotein (HDL) cholesterol, blood pressure ≥130/85 mm Hg or taking blood pressure medication, and fasting glucose ≥100 mg/dL and <126 mg/dL. People with diabetes were excluded. Incident New PAD was defined among people with a normal ankle brachial index (ABI) at baseline (i.e. baseline ABI of 0.90 to 1.40) and consisted of one of the following outcomes during 3-year follow-up: ABI decline to < 0.90 combined with a decline ≥0.15 or medical record confirmed PAD outcome. Multivariable Poisson regression was used to estimate the association between MetS and incident PAD.ResultsAmong 4817 participants without PAD at baseline, 1382 (29%) had MetS. Adjusting for age, sex, race, smoking, physical activity, low-density lipoprotein cholesterol, baseline ABI, and other confounders, 23/1382 (1.7%) people with MetS developed PAD vs. 30/3435 (0.87%) people without MetS (risk ratio = 1.78 [95% Confidence Interval (CI), 1.04 to 2.82], P = 0.031). Adjusting for C-reactive protein, fibrinogen, or interleukin-6 did not attenuate this association.ConclusionPeople free of clinical cardiovascular disease with MetS are at increased risk for PAD. Our findings suggest that this association is not mediated by inflammation
Temporary mechanical circulatory support after orthotopic heart transplantation: a single-centre experience
Comparison of Effects of Statin Use on Mortality in Patients With Peripheral Arterial Disease With Versus Without Elevated C-Reactive Protein and D-Dimer Levels
Use of a pulmonary artery pressure sensor to manage patients with left ventricular assist devices
Background: Hemodynamic-guided management with a pulmonary artery pressure (PAP) sensor (CardioMEMSTM) is effective in reducing heart failure hospitalization (HFH) in patients with chronic heart failure (HF). This study aims to determine the feasibility and clinical utility of the CardioMEMS HF system to manage patients supported with LVADs. Methods: In this multi-center prospective study, we followed patients with HeartMate IITM (n=52) or HeartMate 3TM (n=49) LVADs and with CardioMEMS PA Sensors, and measured PAP, 6-minute walk distance (6MWD), quality of life (EQ-5D-5L scores), and HFH rates through 6 months. Patients were stratified as responders (R) and non-responders (NR) to reductions in PA diastolic pressure (PAD). Results: There were significant reductions in PAD from baseline to 6 months in R (21.5 to 16.5 mmHg, p\u3c0.001), compared to an increase in NR (18.0 to 20.3, p=0.002). and there was a significant increase in 6MWD among R (266 vs 322 meters, p=0.025) compared to no change in NR. Patients who maintained PAD \u3c 20 compared with PAD ≥ 20 mmHg for more than half the time throughout the study (averaging 15.6 vs 23.3 mmHg) had a statistically significant lower rate of HFH (12.0% vs 38.9%, p=0.005). Conclusions: LVAD patients managed with CardioMEMS with a significant reduction in PAD at 6 months showed improvements in 6MWD. Maintaining PAD \u3c 20 mmHg was associated with fewer HF hospitalizations. Hemodynamic-guided management of LVAD patients with CardioMEMS is feasible and may result in functional and clinical benefits. Prospective evaluation of ambulatory hemodynamic management in LVAD patients is warranted. Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT03247829
Use of a Pulmonary Artery Pressure Sensor to Manage Patients With Left Ventricular Assist Devices.
Background: Hemodynamic-guided management with a pulmonary artery pressure (PAP) sensor (CardioMEMSTM) is effective in reducing heart failure hospitalization (HFH) in patients with chronic heart failure (HF). This study aims to determine the feasibility and clinical utility of the CardioMEMS HF system to manage patients supported with LVADs. Methods: In this multi-center prospective study, we followed patients with HeartMate IITM (n=52) or HeartMate 3TM (n=49) LVADs and with CardioMEMS PA Sensors, and measured PAP, 6-minute walk distance (6MWD), quality of life (EQ-5D-5L scores), and HFH rates through 6 months. Patients were stratified as responders (R) and non-responders (NR) to reductions in PA diastolic pressure (PAD). Results: There were significant reductions in PAD from baseline to 6 months in R (21.5 to 16.5 mmHg, p\u3c0.001), compared to an increase in NR (18.0 to 20.3, p=0.002). and there was a significant increase in 6MWD among R (266 vs 322 meters, p=0.025) compared to no change in NR. Patients who maintained PAD \u3c 20 compared with PAD ≥ 20 mmHg for more than half the time throughout the study (averaging 15.6 vs 23.3 mmHg) had a statistically significant lower rate of HFH (12.0% vs 38.9%, p=0.005). Conclusions: LVAD patients managed with CardioMEMS with a significant reduction in PAD at 6 months showed improvements in 6MWD. Maintaining PAD \u3c 20 mmHg was associated with fewer HF hospitalizations. Hemodynamic-guided management of LVAD patients with CardioMEMS is feasible and may result in functional and clinical benefits. Prospective evaluation of ambulatory hemodynamic management in LVAD patients is warranted. Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT03247829