Daily Cardiology Research Analysis

BACKGROUND: Previous data suggest dynamic handgrip exercise (DHE) as a potential physiological, needle-free stressor feasible for cardiovascular magnetic resonance (CMR) examinations. DHE-fast Strain-ENCoded imaging (fSENC) is potentially cost-saving, ultra-fast and avoids pharmacological side effects thereby targeting the drawbacks of conventional pharmacological stress CMR. OBJECTIVES: To assess the diagnostic accuracy of DHE-fSENC for detecting ischemia-related wall motion abnormalities in suspected obstructive coronary artery disease (CAD). METHODS: Patients with known or suspected obstructive CAD referred for CMR stress testing were prospectively enrolled. Diagnostic accuracy was assessed in comparison to pharmacological stress CMR and in a subgroup, compared to invasive coronary angiography (ICA). The CMR protocol was extended by both-handed DHE with 80 repetitions per minute over 2 min followed by fSENC short-axis acquisition before pharmacological stress testing. Stress-induced impairment of regional longitudinal strain was graded suspicious for obstructive CAD. RESULTS: Two-hundred sixty individuals with cardiovascular high-risk profile (64±13years, 75% male) were enrolled. DHE-fSENC provided a sensitivity of 79% (95% CI: 64-89) and specificity of 87% (95% CI 82-91) compared to pharmacological stress CMR. In a subgroup of 105 patients with recent ICA, high diagnostic accuracy was found for the detection of obstructive CAD (sensitivity 82% [95% CI: 67-92], specificity 89% [95% CI: 78-95]). Exam duration of DHE-fSENC was significantly reduced compared to conventional CMR stress protocols (DHE-fSENC 207±69 s vs. adenosine-perfusion 287±82 s vs. dobutamine-cine 1132±294 s, all p<0.001). CONCLUSION: DHE-fSENC allows for a reliable and fast detection of obstructive CAD, thereby expanding the applicability of needle-free CMR stress testing.

BACKGROUND: Evidence of an association between sarcopenic obesity (SO) and the risk of long-term atrial fibrillation (AF) is lacking, and the underlying involvement of insulin resistance (IR) and inflammation is not clear. METHODS: This community-based prospective cohort study evaluated sarcopenia, obesity, and baseline clinical characteristics in 4321 non-diabetic older adults between 2007 and 2011. Sarcopenia was identified using skeletal muscle mass/body weight (SMM/BW), appendicular lean mass (ALM)/BW, and handgrip strength (HGS), and obesity was identified by fat mass (FM)/BW. The association of sarcopenia and obesity with AF risk was determined by Kaplan-Meier analysis and a Cox proportional hazards model. Interaction analysis, a restricted cubic splines model, mediation analysis, and a Fine-Gray competing-risk model were also used. RESULTS: Over an average of 10.9 years of follow-up, 546 (11.98 per 1000 person-years) participants developed AF. Low SMM/BW, low ALM/BW, low HGS, high FM/BW, sarcopenia and obesity, were significantly associated with an increased AF risk. There was a significant synergistic relationship between sarcopenia and obesity in the increased AF risk [hazard ratio (HR): 2.029, 95 % confidence interval (CI): 1.639-2.512]. Compared with participants without sarcopenia and obesity, AF risk was the highest in those with SO (HR: 2.669, 95 % CI: 2.110-3.377], followed by sarcopenia alone (HR: 1.980, 95%CI: 1.453-2.699) and obesity (HR: 1.839, 95%CI: 1.475-2.292). Mediation analysis found that estimated glucose disposal rate (a surrogate marker of IR), high-sensitivity C-reactive protein, and galectin-3 were mediating factors in the increased AF risk caused by SO, accounting for 34.87 %, 27.56 %, and 21.05 % of the total effect, respectively. CONCLUSIONS: SO significantly increased AF risk in these non-diabetic older individuals. Sarcopenia and obesity not only acted alone but also exhibit had a synergistic relationship to increase AF risk. IR and inflammation mediated the increased AF risk associated with SO.

BACKGROUND: Survival after out-of-hospital cardiac arrest (OHCA) decreased sharply in 2020 during the COVID-19 pandemic. It is unknown if survival recovered to pre-pandemic levels, or how recovery varied by community racial and ethnic composition. METHODS: We analyzed adults with non-traumatic OHCA from 2015 to 2022 in the Cardiac Arrest Registry to Enhance Survival using multivariable regression models with generalized estimation equations to calculate risk-adjusted rates of survival to discharge during 2015-2019 (pre-pandemic period) versus 2020, 2021, and 2022. We also examined survival rates based on community racial/ethnic composition, defined as predominantly White (≥80% White residents), majority Black or Hispanic (≥50% Black or Hispanic residents), or integrated (neither). RESULTS: The cohort included 506,419 OHCA patients (mean age 61.9y; 64% male, 22% Black race, 7% Hispanic ethnicity). Pre-pandemic survival was 9.9%, with lower survival in majority Black/Hispanic (7.9%) and integrated (10.7%) versus predominantly White communities (11.1%). In 2020, survival decreased to 9.0% overall (relative change -9.1% vs pre-pandemic; P < 0.001), with a larger decrease in majority Black/Hispanic (-16.5%) than predominantly White (-8.1%) or integrated (-6.5%) communities (P for interaction: 0.07). Overall, survival rates remained largely unchanged in 2021-2022 (9.1%), with modest improvements in majority Black/Hispanic communities. However, absolute survival remained lower in these communities at all times compared to other communities. CONCLUSIONS: OHCA survival improved minimally in 2021 and 2022 following a significant decline in 2020. The initial decline was larger in majority Black or Hispanic communities; despite some improvement in 2021 and 2022, absolute survival in these communities remained lower throughout the study period.