Browsing by Subject "Preventive cardiology"

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    CardioMEMS Heart Failure System: An Up-to-Date Review
    (Springer Nature, 2025-01-22) Tolu-Akinnawo, Oluwaremilekun; Akhtar, Naveed; Zalavadia, Nirav; Guglin, Maya; Medicine, School of Medicine
    Heart failure (HF) continues to represent a significant public health concern. While patients with HF with reduced ejection fraction (HFrEF) face a high risk of arrhythmias, both patients with HFrEF and HF with preserved ejection fraction (HFpEF) experience fluid overload, leading to repeated hospitalizations. Traditional monitoring methods have limited ability to manage HF exacerbations preemptively. However, the CardioMEMS™ (Abbott Laboratories, Chicago, IL) HF system, an implantable microelectromechanical sensor, has emerged as an innovative solution, enabling real-time remote monitoring of pulmonary artery pressures (PAPs). CardioMEMS has significantly reduced HF-related hospitalizations and improved patient quality of life (QOL) by facilitating early intervention before clinical symptoms. This article explores the technical specifications, clinical efficacy, integration into clinical practice, and economic impact of the CardioMEMS system. Furthermore, we discuss the challenges and limitations associated with its widespread adoption and propose considerations for future research to enhance its cost-effectiveness and accessibility in diverse healthcare settings.
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    Genetic Risk and First-Trimester Cardiovascular Health Predict Hypertensive Disorders of Pregnancy in Nulliparous Women
    (Elsevier, 2025) Mathew, Vineetha; Khan, Raiyan R.; Jowell, Amanda R.; Yan, Qi; Pe'er, Itsik; Truong, Buu; Natarajan, Pradeep; Yee, Lynn M.; Khan, Sadiya S.; Sharma, Garima; Patel, Aniruddh P.; Cho, So Mi Jemma; Pabon, Maria A.; McNeil, Rebecca B.; Spencer, Jillyn; Silver, Robert M.; Levine, Lisa D.; Grobman, William A.; Catov, Janet M.; Haas, David M.; Honigberg, Michael C.; Obstetrics and Gynecology, School of Medicine
    Background: Hypertensive disorders of pregnancy (HDPs) (preeclampsia/eclampsia and gestational hypertension) are a leading cause of maternal and perinatal morbidity and mortality and are associated with long-term maternal cardiovascular disease. High genetic risk and poor cardiovascular health (CVH) are each associated with HDPs, but whether genetic risk for HDP is modified by CVH status in early pregnancy is unknown. Objectives: In this study, the authors sought to test the independent and joint associations of genetic risk and first-trimester CVH with development of HDP. Methods: We examined genotyped participants from the nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be), a prospective observational cohort that enrolled nulliparous individuals with singleton pregnancies from 2010 to 2013 at 8 U.S. clinical sites. Genetic risk was calculated according to a validated genetic risk score for HDP. A first-trimester CVH score was closely adapted from the American Heart Association Life's Essential 8 model. Genetic risk and CVH were each categorized as low (bottom quintile), intermediate (quintile 2-4), or high (top quintile). The primary outcome was development of HDP. Multivariable-adjusted logistic regression was used to test the independent and joint associations of genetic risk and CVH with development of HDPs. Results: Among 7,499 participants (mean age 27.0 years), the median first-trimester CVH score was 77.1 (Q1-Q3: 67.1-85.7). Overall, 1,032 participants (13.8%) developed an HDP (487 [6.5%] preeclampsia, 545 [7.3%] gestational hypertension). Genetic risk and CVH were each independently and additively associated with HDP (high vs low genetic risk: adjusted OR [aOR]: 2.21 [95% CI: 1.78-2.77; P < 0.001]; low vs high CVH: aOR: 2.92 [95% CI: 2.28-3.74; P < 0.001]). There was no significant interaction between genetic risk and CVH regarding risk of HDPs (Pinteraction > 0.05). HDP incidence ranged from 4.5% (low genetic risk, high CVH) to 25.7% (high genetic risk, low CVH). Compared with low CVH, high CVH was associated with 53%-74% lower risk of HDP across genetic risk strata. Findings were consistent when examining preeclampsia/eclampsia and gestational hypertension separately. Conclusions: Lower genetic risk and higher first-trimester CVH were independently and additively associated with lower risk of developing HDPs in nulliparous individuals. Favorable CVH in early pregnancy may mitigate high genetic risk for HDP.