Journal of Clinical Medicine

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Special Issue Editors

Dr. Jared L. Antevil

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Guest Editor

Department of Cardiothoracic Surgery, Veteran Affairs Medical Center, Washington, DC, USA
Interests: cardiac surgery; veterans health services; coronary artery bypass; thoracic surgery; video-assisted

Dr. Gregory D. Trachiotis

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Guest Editor

Department of Medicine, School of Medicine, Uniformed Services University, Washington, DC, USA
Interests: cardiac surgery; thoracic surgery; veterans health services; coronary artery bypass; video-assisted

Special Issue Information

Dear Colleagues,

We are pleased to be part of this Special Issue which will focus on fresh and innovative approaches to the core conditions treated by contemporary cardiothoracic surgeons. Lung cancer remains without doubt the leading cause of cancer-related mortality, and coronary artery disease is still the number one killer in the developed world. Although the foundations for the surgical treatment of coronary artery disease and lung cancer have not fundamentally changed in decades, newer perspectives may aid in our understanding of these conditions and the impacts of therapy. We are seeking manuscript submissions that provide a “new view” to these “old problems”, highlighting novel considerations for coronary artery bypass and lung cancer resection. In this Special Issue of the Journal of Clinical Medicine, “New Insights into Cardiothoracic Surgery”, we plan to present works for a broad audience. Rather than focusing exclusively on surgical techniques, it is our goal to help bridge the gap between medical and surgical therapies, and provide a method that will improve our collective understanding of these enduring yet challenging diseases.

Dr. Jared L. Antevil
Dr. Gregory D. Trachiotis
Guest Editors

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Keywords

coronary artery bypass
coronary artery disease
non-small-cell lung carcinoma
lung neoplasms
myocardial ischemia

Published Papers (2 papers)

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Research

10 pages, 213 KiB

Open AccessArticle

Pulmonary Hypertension and Survival among Non-Small Cell Lung Cancer Patients: A Retrospective Cohort Study in the U.S. Military Health System

by Joel A. Nations, Jie Lin, Amie B. Park, Craig D. Shriver and Kangmin Zhu

J. Clin. Med. 2024, 13(11), 3217; https://doi.org/10.3390/jcm13113217 - 30 May 2024

Viewed by 232

Abstract

Background: Lung cancer is one of the most lethal cancers with survival being closely related to stage and influenced by comorbid illness. The survival implications of pulmonary hypertension (PH) on patients with non-small cell lung cancer (NSCLC) have only been evaluated in small cohorts, with limited long-term follow-up. Methods: We conducted a retrospective cohort study of 7946 patients with NSCLC diagnosed in the MHS. This study evaluated the survival impact of PH in patients diagnosed with NSCLC in the MHS. Patients were classified as having and not having PH. We stratified PH into those diagnosed before the diagnosis of NSCLC and those diagnosed after NSCLC diagnosis. Results: Relative to patients without PH, patients with PH diagnosed before NSCLC had an increased risk of death (HR = 1.15 [95% CI, 1.02–1.29]). The increased risk of death was more obvious for patients with PH diagnosed after NSCLC compared with those without PH (HR = 2.74 [95% CI, 2.51–2.99]). The results were similar when stratified by patient demographics. Conclusions: In the MHS, PH is associated with worsened NSCLC survival, regardless of when it is diagnosed. When PH is diagnosed after NSCLC, it is associated with a marked reduction in survival, and this finding may suggest a potential role for monitoring pulmonary pressures in NSCLC patients. Furthermore, as specific PH therapy exists, some NSCLC patients with PH may be candidates for therapy. Full article

(This article belongs to the Special Issue New Insights into Cardiothoracic Surgery)

11 pages, 849 KiB

Open AccessArticle

Long-Term Mortality Risk According to Cardiorespiratory Fitness in Patients Undergoing Coronary Artery Bypass Graft Surgery

by John Duggan, Alex Peters, Jared Antevil, Charles Faselis, Immanuel Samuel, Peter Kokkinos and Gregory Trachiotis

J. Clin. Med. 2024, 13(3), 813; https://doi.org/10.3390/jcm13030813 - 31 Jan 2024

Cited by 1 | Viewed by 810

Abstract

The aim of this study was to evaluate the association between cardiorespiratory fitness (CRF) and long-term survival in United States (US) Veterans undergoing CABG. We identified 14,550 US Veterans who underwent CABG at least six months after completing a symptom-limited exercise treadmill test (ETT) with no evidence of cardiovascular disease. During a mean follow-up period of 10.0 ± 5.4 years, 6502 (43.0%) died. To assess the association between CRF and risk of mortality, we formed the following five fitness categories based on peak workload achieved (metabolic equivalents or METs) prior to CABG: Least-Fit (4.3 ± 1.0 METs (n = 4722)), Low-Fit (6.8 ± 0.9 METs (n = 3788)), Moderate-Fit (8.3 ± 1.1 METs (n = 2608)), Fit (10.2 ± 0.8 METs (n = 2613)), and High-Fit (13.0 ± 1.5 METs (n = 819)). Cox proportional hazard models were used to calculate risk across CRF categories. The models were adjusted for age, body mass index, race, cardiovascular disease, percutaneous coronary intervention prior to ETT, cardiovascular medications, and cardiovascular disease risk factors. P-values < 0.05 using two-sided tests were considered statistically significant. The association between cardiorespiratory fitness and mortality was inverse and graded. For every 1-MET increase in exercise capacity, the mortality risk was 11% lower (HR = 0.89; CI: 0.88–0.90; p < 0.001). When compared to the Least-Fit category (referent), mortality risk was 22% lower in Low-Fit individuals (HR = 0.78; CI: 0.73–0.82; p < 0.001), 31% lower in Moderate-Fit individuals (HR = 0.69; CI: 0.64–0.74; p < 0.001), 52% lower in Fit individuals (HR = 0.48; CI: 0.44–0.52; p < 0.001), and 66% lower in High-Fit individuals (HR = 0.34; CI: 0.29–0.40; p < 0.001). Cardiorespiratory fitness is inversely and independently associated with long-term mortality after CABG in Veterans referred for exercise testing. Full article

(This article belongs to the Special Issue New Insights into Cardiothoracic Surgery)

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