Afterload Hypersensitivity in Patients With Left Bundle Branch Block

ObjectivesThis study sought to investigate the hypothesis that patients with left bundle branch block (LBBB) are hypersensitive to elevated afterload.BackgroundEpidemiological data suggest that LBBB can provoke heart failure in patients with hypertension.MethodsIn 11 asymptomatic patients with isolated LBBB and 11 age-matched control subjects, left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) were measured by echocardiography. Systolic arterial pressure was increased by combining pneumatic extremity constrictors and handgrip exercise. To obtain more insight into mechanisms of afterload response, 8 anesthetized dogs with left ventricular (LV) micromanometer and dimension crystals were studied during acutely induced LBBB and aortic constriction. Regional myocardial work was assessed by LV pressure-dimension analysis.ResultsConsistent with normal afterload dependency, elevation of systolic arterial pressure by 38 ± 12 mm Hg moderately reduced LVEF from 60 ± 4% to 54 ± 6% (p < 0.01) in control subjects. In LBBB patients, however, a similar blood pressure increase caused substantially larger reduction in LVEF (p < 0.01), from 56 ± 6% to 42 ± 7% (p < 0.01). There were similar findings for GLS. In the dog model, aortic constriction abolished septal shortening (p < 0.02), and septal work decreased to negative values (p < 0.01). Therefore, during elevated systolic pressure, the septum made no contribution to global LV work, as indicated by net negative work, and instead absorbed energy from work done by the LV lateral wall.ConclusionsModerate elevation of arterial pressure caused marked reductions in LVEF and GLS in patients with LBBB. This reflects a cardiodepressive effect of elevated afterload in the dyssynchronous ventricle and was attributed to loss of septal function.     

Antithrombotic Therapy and Device-Related Thrombosis Following Endovascular Left Atrial Appendage Closure

ObjectivesThe aim of this study is to review the evidence on the use of antithrombotic therapy and risk of device-related thrombosis after left atrial appendage closure.BackgroundLeft atrial appendage closure (LAAC) is increasingly performed for stroke prevention in patients with nonvalvular atrial fibrillation, especially those who cannot tolerate or are ineligible for oral anticoagulation.MethodsAfter device implantation for LAAC, different antithrombotic regimens with varying duration of therapy are currently used. Such selection depends on patients’ risk for bleeding and physicians’ choice.ResultsDevice-related thrombosis remains an Achilles’ heel of LAAC, and the etiology remains incompletely understood. Dual-antiplatelet therapy, and direct oral anticoagulation may have similar safety and device-related thrombosis occurrence in real-world LAAC registries compared with warfarin and aspirin. Device imaging surveillance should be routinely performed to assess for device-related thrombosis, which if diagnosed should be treated aggressively, as it is associated with higher thromboembolic risks.ConclusionsGiven the uncertainties and therapeutic dilemma, the authors provide an in-depth discussion of the options and rationale for antithrombotic therapy post-LAAC.     

Area reputation as an under-acknowledged determinant of health inequalities: evidence from a systems evaluation of a major community empowerment initiative in England

Background

Area reputation (AR) refers to the ways that geographical localities are portrayed (eg, in media coverage) either positively or negatively. AR is rarely recognised as a social determinant of health inequalities and is not adequately considered in public health interventions. Using residents' accounts from a study of a major community empowerment initiative in England (Big Local), we aimed to map the potential health consequences of AR and see how it can be challenged through resident-led action.

Adipose tissue polyunsaturated fatty acids and metabolic syndrome among adult parents and their children

Background and aims

Polyunsaturated fatty acids (PUFA) may play a role in the etiology of the metabolic syndrome (MetS). The aim of the study was to examine the associations of adipose tissue PUFA biomarkers with MetS among parents and children in Mesoamerica.

3-Dimensional Echocardiography: Latest Developments and Future Directions

The ongoing refinements in 3-dimensional (3D) echocardiography technology continue to expand the scope of this imaging modality in clinical cardiology by offering new features that stem from the ability to image the heart in its complete dimensionality. Over the years, countless publications have described these benefits and tested new frontiers where 3D echocardiographic imaging seemed to offer promising ways to improve patients’ care. These include improved techniques for chamber quantification and novel ways to visualize cardiac valves, including 3D printing, virtual reality, and holography. The aims of this review article are to focus on the most important developments in the field in the recent years, discuss the current utility of 3D echocardiography, and highlight several interesting future directions.     

The treatment of venous thromboembolism in special populations

Anticoagulant therapy for the typical venous thromboembolism patient is straightforward with predictably favorable outcomes. However, for certain patients with venous thromboembolism, there remains uncertainty and controversy about optimal treatment. These controversial areas include venous thromboembolism patients with: heparin resistance, renal insufficiency, morbid obesity, cancer, antiphospholipid antibody syndrome, recurrent thrombosis despite appropriate anticoagulation, and patients with unprovoked VTE who may or may not benefit from thrombophilia testing. This review summarizes the current data for these special patient populations with venous thromboembolism and provides our recommendations for management.     

Autosomal Recessive Hypercholesterolemia: Long-Term Cardiovascular Outcomes

Background

Autosomal recessive hypercholesterolemia (ARH) is a rare lipid disorder characterized by premature atherosclerotic cardiovascular disease (ASCVD). There are sparse data for clinical management and cardiovascular outcomes in ARH.

内分泌治疗对乳腺癌术后子宫内膜病变患者生活质量的临床观察#br#

Objective?To investigate the effect of endocrine therapy on the life quality of patients with endometrial lesions after breast cancer surgery. Methods?A total of 69 cases of breast cancer patients with uterine endometrial lesions after endocrine therapy were selected and divided into two groups randomly: ovarian function suppression (OFS) combined with aromatase inhibitor (AI) group (group A, n=34), OFS combined with Moxifen (TAM) group (group T, n=35). The life quality scores, endometrial changes and adverse reactions were compared between the two groups of patients at different periods. Results?The scores of four dimensions of life quality in group A at 6th and 12th months after treatment were higher than those in group T (P<0.05). The 12-month endocrine symptom scores in group A were higher than those in the group T (P<0.05). The incidence rates of endometrial hyperplasia, endometrial atrophy and endometrial polyps in group A were 41.18%, 20.59%, and 17.65%, respectively, which were lower than those in group T (60.00%, 34.29%, 34.29%) (P<0.05). At the 12th month, the endometrial thickness of patients in group A [(7.87±2.54) mm] was higher than that in group T [(6.23±1.18) mm] (P<0.05). Conclusions?Different endocrine drugs have different effects on the life quality and endometrium of patients. In this study, OFS combined with aromatase inhibitor therapy improved the life quality better than OFS combined with tamoxifen.