UNASSIGNED: Heart disease is one of the leading causes of death in the United States. Increased education and utilization of BLS by first responders have had a significant impact, but certain populations remain high risk, such as African Americans. Raising awareness among at-risk populations may lead to more bystander CPR performed, improving mortality rates. The influence of celebrity deaths and illnesses is an important driver of public awareness. Therefore, the cardiac arrests of both Bronny James and Damar Hamlin may have influenced cardiac arrest awareness.
UNASSIGNED: Google Trends data was pulled for the following search terms from 8/21/2022-8/14/2023: Cardiac arrest (disease), Cardiopulmonary Resuscitation (topic), Basic Life Support (topic), Myocardial Infarction (disease), Defibrillation (topic) and Automatic External Defibrillator (topic). The average relative search volume (RSV) for each search term was taken for a three-week period encompassing the week of and two weeks following the cardiac arrests of Damar Hamlin and Lebron James Jr., respectively. We used one-way ANOVA and independent sample t-tests to compare the average values of Damar Hamlin\'s and LeBron James Jr.\'s incidents with their respective 12-month averages.
UNASSIGNED: RSV was significantly higher surrounding Hamlin\'s cardiac arrest compared to James Jr.\'s for Cardiopulmonary Resuscitation and Automatic External Defibrillator. RSV for Basic Life Support was increased in LeBron James Jr.\'s time compared to the 12-month average and Damar Hamlin\'s incident. Compared to the 12-month average, Cardiac arrest, Cardiopulmonary Resuscitation, Defibrillation, and Automatic External Defibrillator during Hamlin\'s incident. Myocardial infarction RSV was higher during James Jr.\'s incident compared to baseline. Over the long term, the search terms showed a significant increase after Damar Hamlin\'s incident when compared to before.RSV was significantly higher surrounding Hamlin\'s cardiac arrest compared to James Jr.\'s for \"Cardiopulmonary Resuscitation\" (23.56 vs. 22.0, p < 0.00) and \"Automatic External Defibrillator\" (19.59 vs. 19.4, p < 0.00). RSV for \"Basic Life Support\" was increased in LeBron James Jr.\'s time compared to the 12-month average and Damar Hamlin\'s incident (80.9 vs. 66.88, p = 0.04). Compared to the 12-month average, \"Cardiac arrest,\" \"Cardiopulmonary Resuscitation,\" \"Defibrillation,\" and \"Automatic External Defibrillator\" during Hamlin\'s incident showed significant increases. \"Myocardial infarction\" RSV was higher during James Jr.\'s incident compared to baseline (55 vs. 46.6, p = 0.026). Over the long term, the search terms showed a significant increase after Damar Hamlin\'s incident when compared to before (p < 0.05).
UNASSIGNED: Increases in the search terms for Hamlin\'s cardiac arrest compared to James Jr.\'s cardiac arrest were associated with seeing the event live and increasing cardiac arrest awareness. Hamlins Cardiac Arrest also showed a significant increase in search terms over the long term. The increase in searches for \"Basic Life Support\" during James Jr.\'s cardiac arrest indicates increased awareness. Also, the increase in myocardial infarction searches during both incidents could show confusion between cardiac arrest and myocardial infarction.

BACKGROUND: Cardiovascular complications due to viral infection pose a significant risk in vulnerable patients such as those with congenital heart disease (CHD). Limited data exists regarding the incidence of influenza and its impact on cardiovascular outcomes among this specific patient population.
METHODS: A retrospective cohort study was designed using the Canadian Congenital Heart Disease (CanCHD) database - a pan-Canadian database of CHD patients with up to 35 years of follow-up. CHD patients aged 40 to 65 years with influenza virus-associated hospitalizations between 2010 and 2017 were identified and 1:1 matched with CHD patients with limb fracture hospitalizations on age and calendar time. Our primary endpoint was cardiovascular complications: heart failure, acute myocardial infarction, atrial arrhythmia, ventricular arrhythmia, heart block, myocarditis, and pericarditis.
RESULTS: Of the 303 patients identified with incident influenza virus-associated hospitalizations, 255 were matched to 255 patients with limb fracture hospitalizations. Patients with influenza virus-related hospitalizations showed significantly higher cumulative probability of cardiovascular complications at one year (0.16 vs. 0.03) and five years (0.33 vs. 0.15) compared to patients hospitalized with bone fracture. Time-dependent hazard function modeling demonstrated a significantly higher risk of cardiovascular complications within nine months post-discharge for influenza-related hospitalizations. This association was confirmed by Cox regression model (average hazard ratio throughout follow-up: 2.48; 95% CI: 1.59 - 3.84).
CONCLUSIONS: This pan-Canadian cohort study of adults with CHD demonstrated an association between influenza virus-related hospitalization and risk of cardiovascular complications during the nine months post discharge. This data is essential in planning surveillance strategies to mitigate adverse outcomes and provides insights into interpreting complication rates of other emerging pathogens, such as COVID-19.

Renal denervation (RDN) is a neuromodulation therapy performed in patients with hypertension using an intraarterial catheter. Recent randomized sham-controlled trials have shown that RDN has significant antihypertensive effects that last for more than 3 years. Based on this evidence, the US Food and Drug Administration has approved two devices, the ultrasound-based ReCor ParadiseTM RDN system and the radiofrequency-based Medtronic Symplicity SpyralTM RDN system, as adjunctive therapy for patients with refractory and uncontrolled hypertension. On the other hand, there have been no randomized sham-controlled prospective outcome trials on RDN, and the effects of RDN on cardiovascular events such as myocardial infarction, heart failure, and stroke have not been elucidated. This mini-review summarizes the latest findings focusing on the effects of RDN on organ protection and physiological function and symptoms in both preclinical and clinical studies. Furthermore, the feasibility of using blood pressure as surrogate marker for cardiovascular outcomes is discussed in the context of relevant clinical studies on RDN. A comprehensive understanding of the beneficial effects of RDN on the incidence and severity of cardiovascular diseases with their underlying mechanisms will enhance physicians\' ability to incorporate RDN into clinical strategies to prevent cardiovascular events including myocardial infarction, heart failure, and stroke. This mini-review focuses on the effects of RDN on organ protection and physiological function and symptoms in preclinical and clinical studies. RDN is expected to reduce the onset and progression of cardiovascular diseases including myocardial infarction, heart failure, and stroke in clinical practice. LV left ventricular, LVEF left ventricular ejection fraction, VO2max maximal oxygen uptake, VT ventricular tachycardia, VF ventricular fibrillation, 6MWD 6-min walk distance, NT-proBNP N-terminal pro-B-type natriuretic peptide, NYHA New York Heart Association, BBB blood-brain barrier, BP blood pressure.

BACKGROUND: Possible etiologies of out-of-hospital cardiac arrest (OHCA), including aortic dissection, ruptured aortic aneurysms, and pulmonary embolism, may be classified as non-cardiac causes. We investigated whether cardiac and non-cardiac OHCAs increased following the Kumamoto earthquake and whether the impact on OHCAs extended to regions far from the epicenter.
RESULTS: We prospectively analyzed a nationwide registry of patients who experienced OHCAs between January 2013 and December 2019. Data from cases registered in 7 prefectures, including Kumamoto (Kyushu region; n=82,060), in the All-Japan Utstein Registry were analyzed for OHCAs of cardiac and non-cardiac origin. The numbers of OHCAs before and after the Kumamoto earthquake were compared using an interrupted time series analysis. The incidence of both cardiac (rate ratio [RR] 1.22) and non-cardiac (RR 1.27) OHCAs in Kumamoto Prefecture increased after the earthquake. The difference disappeared when the analysis was limited to patients with non-cardiac OHCAs with a clear cause of cardiac arrest. The number of cardiac and non-cardiac OHCAs did not increase in other prefectures within the Kyushu region.
CONCLUSIONS: The Kumamoto earthquake led to an increase in the incidence of cardiac and non-cardiac OHCAs. However, this was attenuated by increasing distance from the epicenter. Except for cardiac causes, cases complicated by earthquake-related events may include non-cardiac OHCAs due to vascular diseases that might be overlooked.

UNASSIGNED: This study aimed to assess the prognosis of people with chronic kidney disease (CKD) in Japan using the Kidney Disease: Improving Global Outcomes (KDIGO) heatmap.
UNASSIGNED: The prognoses of individuals with estimated glomerular filtration rates (eGFR) <90 mL/min/1.73 m2 were evaluated based on the KDIGO heatmap using an electronic medical record database in Japan. The primary outcome was major adverse cardiovascular events (MACE), a composite of myocardial infarction (MI), stroke, heart failure (HF) hospitalization and in-hospital death (referred to as MACE1). Additionally, ad hoc MACE2 (MI hospitalization, stroke hospitalization, HF hospitalization and in-hospital death) was examined. The secondary outcome was the renal outcome.
UNASSIGNED: Of the 543 606 individuals included, the mean age was 61.6 ± 15.3 years, 50.1% were male and 40.9% lacked urine protein results. The risk of MACEs increased independently with both eGFR decline and increasing proteinuria from the early KDIGO stages: hazard ratios (95% confidence interval) of MACE1 and MACE2, compared with G2A1 were 1.16 (1.12-1.20) and 1.17 (1.11-1.23), respectively, for G3aA1, and 1.17 (1.12-1.21) and 1.35 (1.28-1.43), respectively, for G2A2. This increased up to 2.83 (2.54-3.15) and 3.43 (3.00-3.93), respectively, for G5A3. Risks of renal outcomes also increased with CKD progression.
UNASSIGNED: This study is the first to demonstrate the applicability of the KDIGO heatmap in assessing cardiovascular and renal risk in Japan. The risk increased from the early stages of CKD, indicating the importance of early diagnosis and intervention through appropriate testing.

BACKGROUND: We aimed to determine the association between lower extremity arterial calcification (LEAC) and referral to a closed unit (CU), length of stay, 90-day readmissions, and 1-year mortality in primary total hip arthroplasty (THA) patients.
METHODS: We retrospectively analyzed 705 patients who underwent primary THA, identifying 64 patients (9.13%) who had LEAC and 641 who did not have LEAC. Patients who had LEAC were older (77 ± 10.0 versus 67 ± 11.5 years; P < 0.001) and had more comorbidities, except for a history of thromboembolic and oncologic diseases (P > 0.05). A preoperative antero-posterior pelvic radiograph was used to assess the presence of LEAC. Admission to CU, length of stay, 90-day readmissions, and 1-year mortality were recorded. A logistic regression model was used to identify risk factors for referral to CU.
RESULTS: Patients who had LEAC had a higher incidence of admission to the ICU (8 of 64 [12.5%] versus 8 of 641 [1.09%]; P < 0.001), a longer hospital stay (4.7 ± 1.8 versus 4.2 ± 1.3 days; P = 0.006), more readmissions (16 of 64 [25%] vs. 33 of 641 [5.15%]; P < 0.001), and a higher 1-year mortality rate (6 of 64 [9.3%] versus 0 of 641 [0%]; P < 0.001) than patients who did not have LEAC. Of the patients who had LEAC admitted to CU, only 3 of 8 had a previous indication to do so in the preoperative assessment performed by the Department of Anesthesiology, while all non-LEAC ones referred to CU did so. Logistic regression analysis showed that LEAC was a risk factor for admission to CU (odds ratio [OR] = 4.77; 95% confidence interval [CI]: 1.12 to 20.25, P = 0.034).
CONCLUSIONS: The presence of LEAC was a risk factor for transfer to CU, longer in-hospital stays, more readmissions, and a higher 1-year mortality rate. Identifying patients who have LEAC can aid in the preoperative assessment and risk stratification of patients planned for primary THA.

For many years, clopidogrel has been a commonly utilised antiplatelet drug in the management of coronary artery disease (CAD). It\'s thought that the CYP2C19 loss of function (LoF) polymorphism causes clopidogrel\'s poor metabolism, which eventually leads to resistance. Previous research produced extremely divergent and inconsistent results, making it impossible to draw definitive conclusions. Therefore, current, investigation was carried out to obtain definitive evidence from an updated meta-analysis on the connection between CYP2C19 LoF polymorphism and coronary artery event in patients treated with clopidogrel. 52,542 individuals with coronary artery disease who were receiving clopidogrel treatment were included in 87 carefully chosen trials from reliable databases that we used for our meta-analysis. According to our data, those who carry one or more CYP2C19 LoF alleles worldwide are much more likely to experience composite events and coronary artery events than people who do not carry these alleles, especially in Asian populations. Our meta-analysis observed that the global population, particularly Asians receiving clopidogrel treatment, is at risk of recurrent coronary artery events and composite events if they carry the CYP2C19 LoF alleles. Additional research is essential on alternative antiplatelet therapies for individuals who exhibit poor or intermediate metabolic activity. OBJECTIVES: 1.To systematically analyze the current evidence regarding the association of CYP2C19 variants with coronary artery disease (CAD). 2.To conduct a meta-analysis to investigate the association between loss of function (LoF) CYP2C19 modifications and CAD.

BACKGROUND: Bleeding events are one of the major concerns in patients using oral anticoagulants (OACs). We aimed to evaluate the association between major bleeding and long-term clinical outcomes in atrial fibrillation (AF) patients taking OACs.
METHODS: We analyzed a database comprising two large-scale prospective registries of patients with documented AF: the RAFFINE and SAKURA registries. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), defined as the composite of all-cause death, ischemic stroke, and myocardial infarction. Major bleeding was defined in accordance with the criteria of the International Society on Thrombosis and Hemostasis. Cox multivariate analysis was used to determine the impact of major bleeding on the incidence of MACCE.
RESULTS: The median follow-up period was 39.7 (interquartile range, 33.1-48.1) months. Among 6,633 patients with AF who were taking OAC, 298 (4.5%) had major bleeding and 737 (11.1%) had MACCE. The incidence of MACCE was higher in patients with bleeding than in those without (18.33 and 3.22, respectively, per 100 patient-years; log-rank p < 0.0001). Multivariate logistic regression analysis revealed older age, vitamin K antagonist use, and antiplatelet drug use as independent predictors of major bleeding. Median duration of MACCE occurrence after major bleeding was 41 (interquartile range, 3-300) days. Multivariate Cox hazard regression analysis showed that the risk of MACCE was significantly higher in patients with major bleeding compared to those without (hazard risk, 4.64; 95% confidence interval, 3.62-5.94; p < 0.0001).
CONCLUSIONS: Major bleeding was associated with long-term adverse cardiovascular events among AF patients taking OAC. Therefore, reducing the risk of bleeding is important for improving clinical outcomes in patients with AF.

暂无摘要。

Although angiotensin II receptor blockers (ARBs) are more effective in women for either reduction of blood pressure or heart failure (HF), the gender disparities and the impact of class/drug effects on ARBs in relation to cardiac hypertrophy and HF remain unclear. We aimed to investigate the sex-based and drug-specific differences in left ventricular (LV) mass reduction with ARBs. We employed the cohort of 193 hypertensive patients with HF and an LV ejection fraction of ≥ 45% treated with azilsartan or candesartan once daily for 48 weeks as a sub-analysis of the J-TASTE trial. After exclusion of patients without LV mass data nor the drugs, 170 patients were finally enrolled (azilsartan: male, n = 43, female, n = 39 and candesartan: male, n = 52; female, n = 36). We investigated the sex-based differences of the primary endpoint of the change in LV mass as assessed by echocardiography from baseline to the end of the study (48 weeks), and the secondary endpoint of the incidence of the composite cardiovascular endpoint (death from cardiovascular disease or hospitalization for heart failure). In the male stratum, the ratio of patients with > 10% LV mass reduction at 48 weeks was higher in the azilsartan group than candesartan group (40 vs. 19%, p = 0.029). There was no significant difference in LV mass reduction between two groups in the female stratum. There were no differences of the onset of the secondary endpoints between male and female groups, and azilsartan and candesartan groups. The event-free survival rate of the composite cardiovascular endpoints tended to be lower in patients with ≤ 10% than > 10% LV mass reduction (95.3 vs. 100% at 48 weeks, log-rank p = 0.11). In patients with HF, the effectiveness of either azilsartan or candesartan in achieving > 10% LV mass reduction depends on sex. Male is more sensitive to azilsartan than candesartan to achieve cardiac hypertrophy in HF patients.