Clinical Cardiology最新文献

Background

Chronic kidney disease (CKD) may be associated with fatal cardiovascular diseases (CVDs). We aim to identify CVD-related mortality trends in patients with CKD in the US, examining the variation by sex, race, and region, and compare them to CVD-related mortality trends in general.

Methods

The CDC-WONDER database was used to obtain age-adjusted mortality rates (AAMRs) per 100,000 population. Annual percent change (APC) and average APC (AAPC) in these rates were calculated using Joinpoint regression and comparisons were done using pairwise comparison.

Results

From 1999 to 2020, a total of 605,384 CVD-related deaths were observed in patients with CKD. The AAMR was almost double in males (11.0) than females (6.3). NH (Non-Hispanic) Blacks or African Americans displayed the highest overall AAMR while NH Asians or Pacific Islanders displayed the lowest. AAMRs also varied substantially by region (Midwest: 8.8; West: 8.6; South: 8.0; Northeast: 7.3). States with the highest AAMR was the District of Columbia. Nonmetropolitan regions exhibited a slightly higher AAMR (8.6) than metropolitan regions (8.1). The AAPC for CVD-related deaths in patients with CKD differed significantly from that of the general population for the entire cohort, across both sexes, as well as among NH Whites, NH Black or African Americans, and Hispanics or Latinos. Regional differences were also observed in the Midwest, Northeast, and West.

Conclusion

Significant differences in CVD-related deaths in patients with CKD were observed. These high-risk groups should be the point of focus for targeted interventions to reduce CVD-related mortality in CKD patients.

Introduction

Drug-eluting stent (DES) angioplasty is the gold standard treatment for coronary lesions. Drug-coated balloon (DCB) is an option for in-stent restenosis, and has also shown promise for small-calibre coronary artery disease. We evaluated the 3-year effectiveness of a decision algorithm for percutaneous coronary intervention (PCI) that favoured a stent-less strategy (SLS) in primary angioplasty.

Methods

All patients who underwent angioplasty during 1 year were included in a prospective observational study. Patients eligible for SLS first underwent scoring balloon followed by DCB angioplasty or DES in case of mandatory bailout. Patients not eligible for SLS were unstable patients who underwent conventional drug-eluting stenting. The metal index, stent burden, was calculated by stent length divided by the total lesion length. A 36-month follow-up recorded target lesion revascularization (TLR).

Results

Patients eligible for SLS represented 85% (n = 840) of patients who underwent PCI. TLR was required in 2.6% and 6% of patients in the DCB-only and bailout-DES groups, respectively. Median metal index was 0.25 (IQR: 0.5) in patients with TLR. There was a difference between TLR–free survival distributions in the DCB-only and bailout-DES groups (p = 0.016).

Conclusions

The SLS based on a combination of scoring balloon and DCB was effective at 3 years with a low rate of TLR. This rate was higher in patients with stent burden.

Trial Registration: This study was registered with clinicaltrials. gov (NCT03893396, first posted on March 28, 2019).

Background

Atrial fibrillation (AF) is a leading cause of cardiovascular morbidity and hospitalization worldwide. However, limited data exist on AF readmissions in low-resource and conflict-affected settings. This study investigates the impact of age on 1-year readmission rates among AF patients in a Syrian tertiary hospital.

Methods

This retrospective observational cohort study was conducted at a tertiary Syrian center between June/2021–November/2023. Patients admitted with primary AF were included, while those with secondary AF or missing demographic data were excluded. Patients were stratified into three age groups: 18–50 years (Group 1), 51–70 years (Group 2), and > 70 years (Group 3). The primary outcome was all-cause and cardiovascular-related 1-year readmissions, with secondary outcomes including readmission frequencies.

Results

A total of 657 AF patients were included, with a median age of 60 320 (52%) were males. One-year readmission occurred in 64% of patients, with AF being the most common cause (75%). Group 1 had the highest smoking rates (70%). Group 3 had the highest rates of ischemic heart disease (47%), congestive cardiac failure (CCF) (35%), chronic kidney disease (15%, p < 0.001) and chronic liver disease (20). Older age was significantly associated with increased readmissions (87% in Group 3 vs. 62% in Group 2 and 49% in Group 1, p < 0.001). Frequent readmissions were more prevalent in Group 3 (≥ 3 admissions: 46%).

Conclusion

Older AF patients in a conflict-affected setting experience significantly higher readmission rates. Addressing healthcare resource limitations and optimizing AF management strategies are crucial to improving outcomes in resource-limited settings.

Background

Monitoring lifestyle habits and physiological metrics are essential for improving cardiovascular outcomes and supporting recovery after acute cardiac events. Sleep is acknowledged as a core component of cardiovascular health and a predictive tool of adverse outcomes following acute myocardial infarction (AMI).

Objective

The present study aimed to assess sleep metrics and explore the links between sleep patterns, heart rate variability (HRV) parameters, and traditional cardiovascular risk factors in patients with AMI.

Methods

Sixty male patients with AMI (56.77 ± 8.24 years) participated in this study. Cardiac autonomic function was assessed with short-term HRV analysis during the second week post-AMI. Physical activity level was assessed using accelerometers. Sleep quality and quantity were evaluated objectively using a wrist-worn accelerometer and subjectively by the Pittsburgh Sleep Quality Index. Chronotype was evaluated with the Horne and Otsberg questionnaire.

Results

Twenty post-AMI patients (33.3%) tended to experience poor sleep quality, with a sleep efficiency inferior to 85%. Thirty patients (50%) experienced short sleep duration, 16 (26.7%) had a healthy sleep duration (7−8 h), and 14 (23.3%) slept more than 8 h. Multiple regression analysis revealed that patients with healthy sleep quality and quantity exhibited higher HRV parameters, both in time and frequency domain values (p < 0.05). Low physical activity level was observed in patients with long sleep duration (p = 0.005) and evening chronotype (p = 0.022).

Conclusion

Patients who spent more time performing moderate to vigorous physical activity tended to exhibit good sleep health and increased parasympathetic activity which are considered cardioprotective after AMI.

Trial Registration: PACTR202208834230748.

Background

Utilization of heart failure (HF) guideline-directed medical therapy (GDMT) to target doses is suboptimal, with studies citing adverse effects (AEs), physiological factors, and therapeutic inertia as potential contributing factors. The objective of our study was to explore tolerability and GDMT titration-limiting AEs in a specialized heart failure optimization program implemented at our institution.

Methods

We studied the baseline characteristics of 254 patients who successfully completed our program and analyzed the frequency and severity of the four most common GDMT-related AEs: hypotension, bradycardia, hyperkalemia, and renal dysfunction.

Results

Patients who achieved target doses were younger, more likely to have nonischemic HF, less likely to have a recent HF-related hospitalization, had less coronary artery disease, and were more likely to be obese. Multivariate analyses revealed significant associations between beta blocker suboptimal dosing (< 50% of target dose) and older age (odds ratio [OR]: 1.04; 95% confidence interval [CI]: 1.0–1.07; p = 0.031), presence of atrial fibrillation (OR: 2.57; 95% CI: 1.18–5.58; p = 0.017), and absence of hypertension (OR: 0.39; 95% CI: 0.17–0.89; p = 0.025). For angiotensin converting enzyme inhibitors/angiotensin II receptor blockers/angiotensin receptor neprilysin inhibitors, suboptimal dosing was associated with the presence of atrial fibrillation (OR: 2.08; 95% CI: 1.04–4.17; p = 0.039). Of the patients who completed the program, 59.1% encountered at least one AE that hindered the titration to target GDMT doses.

Conclusion

Our findings highlight the complexities of GDMT optimization within a specialized program and the need for standardized definitions of GDMT-related AEs and management strategies.