Highlights From the Circulation Family of Journals
2023; Lippincott Williams & Wilkins; Volume: 147; Issue: 9 Linguagem: Inglês
10.1161/circulationaha.123.063980
ISSN1524-4539
Tópico(s)Cardiovascular Effects of Exercise
ResumoHomeCirculationVol. 147, No. 9Highlights From the Circulation Family of Journals Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBHighlights From the Circulation Family of Journals Originally published27 Feb 2023https://doi.org/10.1161/CIRCULATIONAHA.123.063980Circulation. 2023;147:768–773The December highlights from the Circulation family of journals cover several fascinating topics. The characteristics of patients with recurrent sudden cardiac arrest are described in Circulation Arrhythmia and Electrophysiology. A proof of principle gene therapy for correction of LQT2 and SQT1 syndromes is presented in Circulation: Genomic and Precision Medicine. The impact of food insecurity on heart failure mortality is reported in Circulation: Heart Failure. The associations of hypertension and hypertension treatment with differences in sexual identities are presented in Circulation: Cardiovascular Quality and Outcomes. A multimodality imaging and biomarker strategy to detect early decompensation with chronic aortic regurgitation is reported in Circulation: Cardiovascular Imaging. An analysis of revascularization at the time of transcatheter aortic valve replacement on cardiovascular outcomes is reported in Circulation: Cardiovascular Interventions.Circulation: Arrhythmia and ElectrophysiologyRecurrent Out-of-Hospital Sudden Cardiac Arrest: Prevalence and Clinical FactorsElizabeth P. Held, MD; Kyndaron Reinier, PhD; Harpriya Chugh, BS; Audrey Uy-Evanado, MD; Jonathan Jui, MD; Sumeet S. Chugh, MDCorrespondence to: Sumeet S. Chugh, MD, Smidt Heart Institute, Cedars-Sinai Health System, Advanced Health Sciences Pavilion, Ste A3100, 127 S San Vicente Blvd, Los Angeles, CA 90048. Email sumeet.chugh@cshs.orgBACKGROUND: Despite improvements in management following survival from sudden cardiac arrest (SCA) and wide availability of implantable cardioverter defibrillators for secondary prevention, a subgroup of individuals will suffer multiple distinct episodes of SCA. The objective of this study was to characterize and evaluate the burden of recurrent out-of-hospital SCA among survivors of SCA in a single large US community.METHODS: SCA cases were prospectively ascertained in the Oregon Sudden Unexpected Death Study. Individuals that experienced recurrent SCA were identified both prospectively and retrospectively.RESULTS: We ascertained 6649 individuals with SCA (2002–2020) and 924 (14%) survived to hospital discharge. Of these, 88 survivors (10%) experienced recurrent SCA. Of the nonsurvivors (n=5725), 35 had suffered a recurrent SCA. Of the total 123 SCA cases with recurrent SCA, >60% occurred at least 1 year after the initial SCA (median 23 months, range: 6 days to 31 years). SCA occurred despite a secondary prevention implantable cardioverter defibrillator in 22% (n=26). Prevalence of coronary disease (36% versus 25%), hypertension (69% versus 43%), diabetes (44% versus 21%), and chronic kidney disease (35% versus 14%) was significantly higher in recurrent SCA versus single SCA survivors (n=80, P=0.01). Among individuals with no secondary prevention implantable cardioverter defibrillators before recurrent SCA, the majority had apparently reversible etiologies identified at initial SCA, with one-quarter undergoing coronary revascularization and over half diagnosed with noncoronary cardiac etiologies.CONCLUSIONS: At least 10% of SCA survivors had recurrent SCA, and a large subgroup suffered their repeat SCA despite treatment for an apparently reversible etiology. A renewed focus on careful assessment of cardiac substrate as well as management of coronary disease, hypertension, diabetes, and chronic kidney disease in SCA survivors could reduce recurrent SCA.Circ Arrhythm Electrophysiol. 2022;15:e011018. DOI: 10.1161/CIRCEP.122.011018.Circulation: Genomic and Precision MedicineSuppression and Replacement Gene Therapy for KCNH2-Mediated ArrhythmiasSahej Bains, BS; Wei Zhou, MD; Steven M. Dotzler, BA; Katherine Martinez; C.S. John Kim, PhD; David J. Tester, BS; Dan Ye, MD; Michael J. Ackerman, MD, PhDCorrespondence to: Michael J. Ackerman, MD, PhD, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Guggenheim Building Room 501, 200 First St SW, Rochester, MN 55905. Email ackerman.michael@mayo.eduBACKGROUND: KCNH2-mediated arrhythmia syndromes are caused by loss-of-function (type 2 long QT syndrome [LQT2]) or gain-of-function (type 1 short QT syndrome [SQT1]) pathogenic variants in the KCNH2-encoded Kv11.1 potassium channel, which is essential for the cardiac action potential.METHODS: A dual-component “suppression-and-replacement” (SupRep) KCNH2 gene therapy was created by cloning into a single construct a custom-designed KCNH2 short hairpin RNA with ~80% knockdown (suppression) and a “short hairpin RNA-immune” KCNH2 cDNA (replacement). Induced pluripotent stem cell-derived cardiomyocytes and their CRISPR-Cas9 variant-corrected isogenic control (IC) induced pluripotent stem cell-derived cardiomyocytes were made for 2 LQT2- (G604S, N633S) and 1 SQT1- (N588K) causative variants. All variant lines were treated with KCNH2-SupRep or non-targeting control short hairpin RNA (shCT). The action potential duration (APD) at 90% repolarization (APD90) was measured using FluoVolt voltage dye.RESULTS: KCNH2-SupRep achieved variant-independent rescue of both pathologic phenotypes. For LQT2-causative variants, treatment with KCNH2-SupRep resulted in shortening of the pathologically prolonged APD90 to near curative (IC-like) APD90 levels (G604S IC, 471±25 ms; N633S IC, 405±55 ms) compared with treatment with shCT (G604S: SupRep-treated, 452±76 ms versus shCT-treated, 550±41 ms; P<0.0001; N633S: SupRep-treated, 399±105 ms versus shCT-treated, 577±39 ms, P<0.0001). Conversely, for the SQT1-causative variant, N588K, treatment with KCNH2-SupRep resulted in therapeutic prolongation of the pathologically shortened APD90 (IC: 429±16 ms; SupRep-treated: 396±61 ms; shCT-treated: 274±12 ms).CONCLUSIONS: We provide the first proof-of-principle gene therapy for correction of both LQT2 and SQT1. KCNH2-SupRep gene therapy successfully normalized the pathologic APD90, thereby eliminating the pathognomonic feature of both LQT2 and SQT1.Circ Genom Precis Med. 2022;15:e003719. DOI: 10.1161/CIRCGEN.122.003719.Circulation: Heart FailureHealth of the Food Environment Is Associated With Heart Failure Mortality in the United StatesKeerthi T. Gondi, MD; John Larson, MD; Aaron Sifuentes, MD; Neil B. Alexander, MD, MS; Matthew C. Konerman, MD; Kali S. Thomas, PhD, MA; Scott L. Hummel, MD, MSCorrespondence to: Keerthi T. Gondi, MD, Department of Internal Medicine, University of Michigan Health System, 1500 E Medical Center Dr, TC 311Q SPC 5368, Ann Arbor, MI 48109-5853. Email keerthig@med.umich.eduBACKGROUND: Food environment factors contribute to cardiovascular disease, but their effect on population-level heart failure (HF) mortality is unclear.METHODS: We utilized the National Vital Statistics System and USDA Food Environment Atlas to collect HF mortality rates (MR) and 2 county food environment indices: (1) food insecurity percentage (FI%) and (2) food environment index (FEI), a scaled index (0–10, 10 best) incorporating FI% and access to healthy food. We used linear regression to estimate the association between food environment and HF MR.RESULTS: Mean county FI% and FEI were 13% and 7.8 in 2956 included counties. Counties with FI% above the national median had significantly higher HF MR (30.7 versus 26.7 per 100 000; P<0.001) compared with FI% below the national median. Counties with HF MR above the national median had higher FI%, lower FEI, lower density of grocery stores, poorer access to stores among older adults, and lower Supplemental Nutrition Assistance Program participation rate (P 50%), and sinus rhythm. The echocardiography and MRI images were analyzed centrally in the CoreLab. The study end point was the onset of indication for aortic valve surgery as per current guidelines.RESULTS: The derivative cohort consisted of 127 asymptomatic patients (age 45±14 years, 84% males) with 41 (32%) end points during a median follow-up of 1375 (interquartile range, 1041–1783) days. In multivariable Cox regression analysis, age, BNP, 3-dimensional vena contracta area, MRI left ventricular end-diastolic volume index, regurgitant volume, and a fraction were identified as independent predictors of end point (all P<0.05). However, a combined model including one parameter of AR assessment (MRI regurgitant volume or regurgitant fraction or 3-dimensional vena contracta area), 1 parameter of left ventricular remodeling (MRI left ventricular end-diastolic volume index or echocardiography 2-dimensional global longitudinal strain or E wave), and BNP showed significantly higher predictive accuracy (area under the curve, 0.74–0.81) than any parameter alone (area under the curve, 0.61–0.72). These findings were confirmed in the validation cohort (n=100 patients, 38 end points).CONCLUSIONS: In asymptomatic severe AR, multimodality and multiparametric model combining 2 imaging indices with natriuretic peptides, showed high accuracy to identify early disease decompensation. Further prospective studies are warranted to explore the clinical benefit of implementing these models to guide patient management.Circ Cardiovasc Imaging. 2022;15:e014901. DOI: 10.1161/CIRCIMAGING.122.014901.Circulation: Cardiovascular InterventionsManagement of Myocardial Revascularization in Patients With Stable Coronary Artery Disease Undergoing Transcatheter Aortic Valve ImplantationGiuliano Costa, MD; Thomas Pilgrim, MD; Ignacio J. Amat Santos, MD; Ole De Backer, MD; Won-Keun Kim, MD; Henrique Barbosa Ribeiro, MD; Francesco Saia, MD; Matjaz Bunc, MD; Didier Tchetche, MD; Philippe Garot, MD; Flavio Luciano Ribichini, MD; Darren Mylotte, MD; Francesco Burzotta, MD; Yusuke Watanabe, MD; Federico De Marco, MD; Tullio Tesorio, MD; Tobias Rheude, MD; Marco Tocci, MD; Anna Franzone, MD; Roberto Valvo, MD; Mikko Savontaus, MD; Hendrik Wienemann, MD; Italo Porto, MD; Caterina Gandolfo, MD; Alessandro Iadanza, MD; Alessandro Santo Bortone, MD, PhD; Markus Mach, MD; Azeem Latib, MD; Luigi Biasco, MD; Maurizio Taramasso, MD; Marco Zimarino, MD; Daijiro Tomii, MD; Philippe Nuyens, MD; Lars Sondergaard, PhD; Sergio F. Camara, MD; Tullio Palmerini, MD; Mateusz Orzalkiewicz, MD; Klemen Steblovnik, MD; Bastien Degrelle, MD; Alexandre Gautier, MD; Paolo Alberto Del Sole, MD; Andrea Mainardi, MD; Michele Pighi, MD; Mattia Lunardi, MD, MSc; Hideyuki Kawashima, MD; Enrico Criscione, MD; Vincenzo Cesario, MD; Fausto Biancari, MD; Federico Zanin, MD; Michael Joner, MD; Giovanni Esposito, MD; Matti Adam, MD; Eberhard Grube, PhD; Stephan Baldus, MD; Vincenzo De Marzo, MD; Elisa Piredda, MD; Stefano Cannata, MD; Fortunato Iacovelli, MD; Martin Andreas, MD; Valentina Frittitta, MD; Elena Dipietro, MD; Claudia Reddavid, MD; Orazio Strazzieri, MD; Silvia Motta, MD; Domenico Angellotti, MD; Carmelo Sgroi, MD; Faraj Kargoli, MD; Corrado Tamburino, MD, PhD; Marco Barbanti, MD; for the REVASC-TAVI RegistryCorrespondence to: Marco Barbanti, MD, Division of Cardiology, A.O.U. Policlinico “G. Rodolico – San Marco” Via Santa Sofia 78, 95123, Catania, Italy. Email mbarbanti83@gmail.comBACKGROUND: The best management of stable coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) is still unclear due to the marked inconsistency of the available evidence.METHODS: The REVASC-TAVI registry (Management of Myocardial Revascularization in Patients Undergoing Transcatheter Aortic Valve Implantation With Coronary Artery Disease) collected data from 30 centers worldwide on patients undergoing TAVI who had significant, stable CAD at preprocedural work-up. For the purposes of this analysis, patients with either complete or incomplete myocardial revascularization were compared in a propensity score matched analysis, to take into account of baseline confounders. The primary and co-primary outcomes were all-cause death and the composite of all-cause death, stroke, myocardial infarction, and rehospitalization for heart failure, respectively, at 2 years.RESULTS: Among 2407 patients enrolled, 675 pairs of patients achieving complete or incomplete myocardial revascularization were matched. The primary (21.6% versus 18.2%, hazard ratio‚ 0.88 [95% CI, 0.66–1.18]; P=0.38) and co-primary composite (29.0% versus 27.1%, hazard ratio‚ 0.97 [95% CI, 0.76–1.24]; P=0.83) outcome did not differ between patients achieving complete or incomplete myocardial revascularization, respectively. These results were consistent across different prespecified subgroups of patients (< or >75 years of age, Society of Thoracic Surgeons score > or or 0.10).CONCLUSIONS: The present analysis of the REVASC-TAVI registry showed that, among TAVI patients with significant stable CAD found during the TAVI work-up, completeness of myocardial revascularization achieved either staged or concomitantly with TAVI was similar to a strategy of incomplete revascularization in reducing the risk of all cause death, as well as the risk of death, stroke, myocardial infarction, and rehospitalization for heart failure at 2 years, regardless of the clinical and anatomical situations.Circ Cardiovasc Interv. 2022;15:e012417. DOI: 10.1161/CIRCINTERVENTIONS.122.012417. eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetails February 28, 2023Vol 147, Issue 9 Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.123.063980PMID: 36848413 Originally publishedFebruary 27, 2023 PDF download Advertisement
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