Clinical Medicine Insights. Cardiology最新文献

We present the clinical case of a 20-year-old male patient who presented recurrent pneumothorax on 5 occasions; in addition, he revealed a history of skeletal malformations in the hands and joint hypermobility. A genetic panel for connective tissue disorders was performed, in which a heterozygous variant in the gene was detected ABL1: (NM_007313.2): c.199T>C (p.Trp67Arg), which was classified as probably pathogenic, which is why the diagnosis of Heart Defects and Skeletal Malformations Syndrome was confirmed (CHDSKM).

Background: Despite several prediction models to estimate cardiovascular risk (CVR) being available, most have been developed and validated in populations under 70 years of age. To improve this estimation in older adults aged 70 years or older, the SCORE2-OP model was developed; however, its application outside Europe may under- or overestimate true CVR.

Objective: To assess the concordance between the CVR measured by 4 widely used CVR tools (Framingham, ASCVD-2013, SCORE2) and the SCORE2-OP in older adults aged ⩾ 70 years.

Methods: Secondary analysis of adults aged ⩾ 70 years from the SABE Colombia study, which was conducted between April and September 2015. The concordance between the 4 different CVR prediction models and SCORE2-OP was assessed via Cohen's quadratically weighted kappa coefficient and Lin's concordance correlation coefficient.

Results: Among the 23 694 participants in the SABE Colombia study, 23 108 were excluded due to insufficient data to estimate the CVR for any of the tools evaluated. 586 individuals met the inclusion criteria and were analyzed. The concordance between the ASCVD-2013 (weighted kappa 0.24; 95% CI 0.22-0.26) and Framingham algorithms (0.22; 95% CI 0.20-0.24) calibrated to the Colombian population and SCORE2-OP were both classified as fair. In contrast, agreement between SCORE2 calibrated for Colombia and SCORE2-OP reached a moderate level (0.43; 95% CI 0.40-0.46). Higher values were observed compared with the SCORE2-OP model developed for intermediate-risk regions.

Conclusions: Our results suggest that, among adults aged ⩾ 70 years, there is variable agreement between widely used CVR prediction models and SCORE2-OP, with the latter overestimating CVR compared to nationally validated CVR scores. This highlights the need for region-specific validation to ensure accurate estimation of CVR in this population.

Background: Coronary artery disease (CAD) is prevalent among patients undergoing transcatheter aortic valve replacement (TAVR), complicating clinical decision-making regarding optimal timing of percutaneous coronary intervention (PCI). Despite widespread clinical experience, there is ongoing controversy and limited consensus regarding when PCI, before, during, or after TAVR, offers the best risk-benefit balance.

Objective: To synthesize and critically evaluate the current evidence on different PCI timing strategies in patients undergoing TAVR and to identify areas of uncertainty and clinical complexity.

Review: Randomized trials, including ACTIVATION and NOTION-3, have yielded mixed findings, highlighting a modest reduction in ischemic events with pre-TAVR PCI but increased procedural bleeding risks. Observational registries (REVASC-TAVI and the National Readmissions Database) have similarly shown that pre- and peri-TAVR PCI strategies carry heightened risks of complications without clear long-term mortality benefits. Recent meta-analyses reinforce these findings, indicating that no PCI timing strategy conclusively outperforms others in reducing long-term mortality. Key considerations such as anatomical complexity, frailty, bleeding risk, and valve type significantly influence optimal PCI timing.

Conclusion: Current evidence supports a personalized, patient-centered approach to PCI timing in TAVR candidates, emphasizing careful consideration of individual anatomical and clinical factors rather than a standardized timing protocol. Further research exploring advanced risk stratification, imaging modalities, and long-term clinical outcomes is essential to refine current guidelines and practice.

One of the solutions to decrease the frequency of sudden cardiac arrest (SCA) in athletes is cardiovascular screening in the form of pre-participation tests (PPT). It is especially frustrating when SCA affects an athlete who has recently undergone PPT without any alarming findings. In our case, a 44-year-old ambitious amateur duathlete who underwent PPT within a year experienced SCA at home after an intensive weekend of training. It was related to a coincidence of new disease and other risk factors. PPT cannot be viewed as an unconditional green light for training and competition.

Background: Excessive bleeding and coagulopathy frequently occur after cardiac surgery, and Fresh Frozen Plasma (FFP) remains the standard treatment. Prothrombin Complex Concentrates (PCC) present a potential alternative; however, their effectiveness and safety compared to FFP remain uncertain.

Methods: Electronic databases, including PubMed, Cochrane Central, and ScienceDirect, were searched from inception till April 2025. The risk ratios (RR) and mean differences (MD) were pooled using the random-effects model in Review Manager software for the dichotomous and continuous outcomes, respectively. Leave-one-out sensitivity analysis and GRADE assessment were performed to evaluate the cause of heterogeneity and assess the certainty of evidence, respectively. Publication bias was evaluated visually through funnel plots and statistically through Egger's regression test.

Results: This meta-analysis included 9 studies-comprising 4 randomized controlled trials and 5 observational studies-covering a total of 1920 patients. PCC is associated with a significant reduction in chest tube drainage output within 24 hours compared to FFP (MD -170.05, 95% CI, -253.54 to -86.56; P < .0001; I ² = 38%). Similarly, the number of RBC units transfused (MD -1.06, 95% CI, -1.57 to -0.55, P < .0001; I ² = 45%) and number of patients requiring RBC transfusion (RR 0.84, 95% CI, 0.77-0.92; P < .0001; I ² = 47%) within first 24 hours are both reduced significantly in the PCC arm. Other outcomes including stroke (RR 1.03, 95% CI, 0.63-1.69; P = .90; I ² = 0%), thromboembolic events (RR 1.11, 95% CI, 0.76-1.64; P = .59; I ² = 0%), and all-cause mortality within 30 days (RR 1.03, 95% CI 0.73-1.45; P = .87; I ² = 0%) were comparable between both groups.

Conclusion: PCC significantly reduced the chest tube drainage output along with the number of RBC units transfused and the number of patients requiring RBC transfusion within the first 24 hours. In contrast, stroke, other thromboembolic events, and all-cause mortality were comparable between the 2 groups.

Background: Atrial fibrillation (AF) is the most prevalent arrhythmia and a significant cause of morbidity. Artificial intelligence (AI)-based language models represent a novel tool for searching for medical information; however, there is still uncertainty regarding their reliability and readability in different languages.

Objective: To assess the reliability and readability of information provided by AI-based models for patients with AF.

Methods: A cross-sectional study was conducted to assess the reliability and readability of the responses generated by ChatGPT, YouChat, Gemini and Perplexity on AF in English and Spanish. Thirty standardised questions were posed in both languages. The quality of the responses was then assessed by 2 independent reviewers via a standardised tool. Readability was assessed via the Flesch-Szigrist formula. The results were then compared by tool and language.

Results: ChatGPT demonstrated the highest interrater agreement (PA = 0.73 in Spanish, 0.80 in English), followed by Gemini in English (PA = 0.66). In Spanish, ChatGPT generated the highest percentage of complete responses (80%), followed by Perplexity (73%) and Gemini (47%). In English, Perplexity demonstrated the strongest performance, with a score of 93%, followed by ChatGPT, with 73%, and Gemini, with 53%. A readability analysis revealed significant differences between the models (P < .01). The ChatGPT demonstrated the highest performance, although its content was moderately challenging in Spanish and highly challenging in English.

Conclusion: ChatGPT and Perplexity emerged as the most reliable models, although readability remains a concern. There is a clear need for improvements to optimise the accuracy and accessibility of AI-generated medical information.

Atherosclerosis is chronic arterial wall damage, which often results in cardiovascular disease development. Since atherosclerosis is almost asymptomatic, it is difficult to detect this condition, but it is even more difficult to deal with the consequences. The reasons for the development of atherosclerosis are still not completely clear, but the mechanisms involved in atherogenesis are known. Among them, lipid metabolism alterations, oxidative stress, as well as impaired mitochondrial function take pride of place. In our review, we want to dwell in more detail on such a component as lipid metabolism disorders. In particular, triglycerides, their levels, and influence on the development of the disease. Triglycerides provide the second-largest source of energy. In the context of atherosclerosis, the question arises, is an increase in the level of triglycerides in the blood a cause, a biomarker, or a consequence of the processes accompanying atherogenesis?

Background: Non-ischemic dilated cardiomyopathy (NIDCM) remains a significant part of heart failure (HF) origin, requiring more detailed investigation of the whole heart. This study aimed to examine the commonly used biomarkers in clinical practice and their relationship with early alterations in whole-heart myocardial mechanics and morphometry in patients with NIDCM.

Methods: In this prospective single-center study, 98 patients (mean age 49.5 ± 10.1 years; 69.4% male) were included in the final sample during the first phase, when the diagnosis of NIDCM was made. After 1 year, 42 patients were evaluated during the second follow-up phase. The cardiac magnetic resonance was used to analyze whole-heart myocardial mechanics and morphometry. Biomarkers (troponin I, C-reactive protein (CRP), high-sensitivity CRP (hs-CRP), brain natriuretic peptide, suppression of tumorigenicity 2, and neutrophil to lymphocyte were assessed at the time of the diagnosis.

Results: The strongest correlations were observed between hs-CRP levels and left atrial (LA) global longitudinal strain (GLS) changes after 1 year (r = -.659, P < .001). It was revealed that the cut-off value of 3.6 mg/l of hs-CRP can prognosticate to find a reduced LA GLS with a sensitivity of 100% and specificity of 87% (AUC, 0.833; 95% CI, 0.65-1.008; P < .001).Other biomarkers had weaker associations with myocardial mechanics and morphometry; relationships were established only with left heart parameters.

Conclusion: In NIDCM patients, the main biomarkers of HF are related to early changes in left-heart myocardial mechanics and morphometrics. The strongest relationship was between the initial levels of hs-CRP and early changes in LA GLS.

CAD and AF are 2 of the major cardiovascular challenges worldwide, often coexisting and complicating management strategies. PCI has revolutionized the treatment of CAD, reducing mortality and improving recovery. At the same time, AF increases the risk of stroke, thus requiring anticoagulation. The combination of antiplatelet and anticoagulant therapies in patients undergoing PCI is challenging because of increased bleeding risks. This literature review explores the controversies surrounding dual antithrombotic therapy (DAT) and triple antithrombotic therapy (TAT), evaluating their efficacy and safety in mitigating thrombotic and hemorrhagic risks. Key clinical trials and guidelines advocate the use of DAT, especially in patients at high bleeding risk, underlining its role in reducing complications without compromising ischemic protection. Furthermore, advances in stent technologies, personalized medicine tools, and pharmacogenomics have further refined treatment strategies toward tailored approaches. Despite these developments, the optimal duration of therapy remains debated, as do patient selection and the need to balance ischemic and bleeding risks, particularly in complex patients.This review underscores the need for an individualized, evidence-based approach to optimize outcomes and inform future guidelines in managing this high-risk population. Emerging therapies and real-world evidence-such as trials investigating Factor XI inhibitors and bioresorbable scaffolds-are promising, aiming to reduce bleeding risk and improve long-term outcomes in patients with CAD and AF. Additionally, newer DOACs are being evaluated for improved efficacy and safety profiles.

Hypertrophic cardiomyopathy is a genetically inherited cardiac disorder that presents with diverse clinical phenotypes. It is associated with significant adverse outcomes, including arrhythmias and sudden cardiac death. Current gold-standard diagnostic methods include echocardiography and cardiac magnetic resonance imaging. These imaging modalities are the cornerstone in identifying structural abnormalities and aiding risk stratification. However, they fail to capture the preceding cellular and metabolic disturbances that underpin disease progression. Hyperpolarized magnetic resonance imaging (HP-MRI) is an emerging imaging technique that enables non-invasive and non-ionizing visualization of metabolic pathways. HP-MRI enhances the signal of metabolites like [1-¹³C]pyruvate, providing insights into metabolic pathways. Alterations in the metabolic pathways of cardiomyocytes are central to HCM pathophysiology. HP-MRI may be able to delineate the metabolic consequences of sarcomere mutations and distinguish HCM from phenocopies such as glycogen storage disorders or cardiac amyloidosis. More importantly, it has the potential to detect early metabolic shifts and thus play a role in early diagnosis, personalized risk stratification, and monitoring therapeutic response. Although still in experimental stages with technical challenges, HP-MRI has demonstrated considerable potential in preclinical and small-scale studies, exhibiting effectiveness in the diagnosis and monitoring of malignancies across a substantial number of investigations. Further research focusing on larger cohorts and integrating HP-MRI with traditional cardiovascular imaging may pave the way for its clinical use, as well as risk stratification, in HCM.