American journal of therapeutics最新文献

Background: Adverse metabolic profile manifested as metabolic dysfunction-associated steatotic liver disease (MASLD) and obesity affect the development and prognosis of heart failure (HF).

Study question: Whether treatments targeting metabolic derangements such as sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors) and glucagon-like peptide-1 receptor agonists (GLP-1 receptor agonists) are associated with improved outcomes patients with both HF and MASLD or obesity warrants investigation.

Study design: This retrospective study included 7 propensity score matched cohort analyses using deidentified electronic health record data from the TriNetX global health research network.

Measures and outcomes: We evaluated the associations between MASLD, obesity, and the use of SGLT2 inhibitors or GLP-1 receptor agonists with adverse outcomes in patients with HF. Cohorts were defined based on combinations of comorbidities (HF subtype, MASLD, obesity, diabetes status) and medication exposure. Time-to-event outcomes with the Kaplain-Meier method and with Cox proportional hazards models for the calculation of hazard ratios (HRs) and 95% confidence intervals.

Results: Among patients with HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction, MASLD was consistently linked to increased risk of nonfatal cardiovascular events, including HF (HR = 1.09, P < 0.001 and HR = 1.23, P < 0.001), myocardial infarction (HR = 1.03, P = 0.07 and HR = 1.08, P < 0.001), and stroke (HR = 1.04, P = 0.08 and HR = 1.07, P = 0.07). Use of SGLT2 inhibitors in HFpEF and MASLD patients with or without diabetes was associated with reduced all-cause mortality (HR = 0.76, P < 0.001 and HR = 0.69, P < 0.001) and major cardiovascular events. GLP-1 receptor agonists demonstrated a significant survival benefit (HR = 0.38, P < 0.001) in obese patients with HFpEF and MASLD without diabetes.

Conclusions: In patients with HFpEF, pharmacologic interventions targeting metabolic pathways demonstrate meaningful cardioprotective effects, especially in metabolically vulnerable subgroups.

Background: Utilization of ivabradine in the pediatric population has been centered on the goal of chronotropic control in patients with arrhythmias and heart failure. Tachycardia is known to be detrimental when it impairs hemodynamics by increasing myocardial oxygen demand, increasing ventricular end-diastolic pressures, and decreasing cardiac output in certain patients. The acute hemodynamic effects of ivabradine have not yet been studied in real time.

Study question: This study was performed leveraging the Sickbay platform (Medical Informatics Company, Houston, TX). The primary aim of this study was to characterize the effect of enteral ivabradine on heart rate in patients in a pediatric cardiac intensive care unit within 24 hours of initiation. Secondary aims were to characterize the effects of ivabradine on arterial saturation, respiratory rate, mean arterial blood pressure, central venous pressure, and renal near infrared spectroscopy for the same time frame.

Results: Heart rate decreased approximately 17% in the first 15 hours after ivabradine administration. Changes were seen in the secondary aims that varied depending on time after first and second doses. Specifically, decreases in central venous pressure and increased renal tissue oxygen saturation (rSO2) were observed by the end of the 24 hours.

Conclusions: Ivabradine seems safe in pediatric patients. It is associated with 3 distinct hemodynamic response phases: the first phase is associated with decreased heart rate and unchanged systemic oxygen delivery, the second phase is associated with increased heart rate and worsened systemic oxygen delivery, and the third phase being associated with decreased heart rate and improved systemic oxygen delivery. These phases coincide with the pharmacokinetic properties of ivabradine.

Background: Hospital-based analyses of real-world percutaneous coronary intervention (PCI) practice remain limited.

Study question: How do PCI strategies in non-ST-elevation acute coronary syndromes (ACSs) compare between 2 university hospitals from European countries with different cardiovascular disease burdens, health care systems, and interventional cardiology infrastructures [University and Emergency Hospital, Bucharest, Romania (RO) and University Hospital, Essen, Germany (GER)]?

Study type: Retrospective, observational, all-comers.

Measures and outcomes: All consecutive high- and very high-risk patients with non-ST-elevation ACS undergoing PCI in 2022 were analyzed regarding clinical profiles and revascularization strategies.

Methods and results: A total of 392 patients were included (221 RO, 171 GER). RO patients had a worse cardiovascular risk profile, with higher rates of dyslipidemia, diabetes, prior ACS, and left ventricular ejection fraction (LVEF) ≤40% (all P < 0.05). P2Y12 inhibitor pretreatment was markedly higher in RO (78.3% vs. 1.3%, P < 0.001). Despite younger age in RO (64.3 vs. 71.8 years, P < 0.001), median SYNTAX scores (12 vs. 13), left main disease (10.9% vs. 11.1%), and multivessel disease (64.3% vs. 62.6%) were comparable. Radial access (80.5% RO vs. 73.1% GER), ad hoc culprit PCI (98.6% RO vs. 93.0% GER), and complete anatomical revascularization (residual SYNTAX score ≤8; 83.3% RO vs. 77.2% GER) represented standard practice in both hospitals. Use of adjunctive PCI techniques was higher in GER, with intravascular imaging-guided PCI reported only in the German hospital (29.8% of PCIs). In-hospital major adverse cardiac and cerebrovascular events were comparable (10.4% RO vs. 7.6% GER, P > 0.05) and consistently associated with lower LVEF ( P < 0.001).

Conclusions: Compared with the German cohort, the Romanian cohort had a similar coronary artery disease burden but a worse overall cardiovascular risk profile at a younger age. Arterial access, PCI timing, and revascularization completeness were similar, while adjunctive PCI techniques were used more frequently in GER. In-hospital major adverse cardiac and cerebrovascular events rates were comparable and consistently associated with lower LVEF.

Background: Adjustment disorder with mixed anxiety and depressed mood lacks established treatment protocols, despite its clinical significance. Repetitive transcranial magnetic stimulation (rTMS) has demonstrated efficacy in stress-related conditions, yet its application in adjustment disorder remains limited.

Study question: This retrospective chart review examined the safety and clinical benefit of rTMS for this condition in a Romanian health care context.

Study design: Sixty adults with adjustment disorder with mixed anxiety and depressed mood were identified from outpatient clinic records and grouped by treatment received: rTMS alone (n = 20), rTMS with medication (n = 10), or medication only (n = 30).

Measures and outcomes: Low-frequency 1-Hz stimulation at 110% of the motor threshold was applied to the right dorsolateral prefrontal cortex in 10 sessions over 2 weeks. Depressive and anxiety symptoms were measured at baseline and at day 30 using the Hamilton Depression Rating Scale and the Hamilton Anxiety Scale. Logistic regression analysis was used to identify factors associated with treatment outcomes.

Results and discussion: Significant symptom improvements occurred across all groups ( P < 0.001). Complete remission rates varied substantially: rTMS monotherapy achieved 80% remission, medication alone 40%, and combined treatment 20% (χ 2 = 13.714, P = 0.008). Sixty percent of participants showed clinical response. Treatment modality predicted response, with rTMS monotherapy increasing odds of improvement 5.7-fold versus medication alone ( P = 0.017). Lower baseline anxiety predicted combined remission (OR = 0.779, P = 0.001), while demographic factors showed no predictive value. Adverse events were mild and transient, with no serious complications or discontinuations. Urban residence significantly influenced rTMS uptake ( P = 0.011).

Conclusions: rTMS seems effective and may be considered alongside conventional pharmacotherapy for adjustment disorder with mixed anxiety and depressed mood. The intervention showed good tolerability. Geographic barriers to access warrant attention in service planning. Larger randomized controlled trials with extended follow-up are needed to confirm these findings and establish optimal protocols.