Clinical Medicine Insights. Cardiology最新文献

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.

Background: The heritability of salt-sensitive hypertension and the heightened susceptibility of offspring to maternal perinatal high salt diet (HSD) indicate that hypertension may originate early in life. However, the mechanism underlying this phenomenon remains unclear. We hypothesized that perinatal exposure of dams to HSD will increase inflammation, impair vascular function and elevate blood pressure (BP) in the adult offspring.

Methods: Pregnant rats were fed a normal (0.3%) or high (8%) salt diet during pregnancy and the offspring from each group were weaned at 4 weeks of age and placed on normal salt diet (NSD) for 12 weeks. BP measurement, vascular reactivity studies, and ELISA assay for C-reactive proteins (CRP), Tumor Necrotic Factor (TNF-α), and Interleukin-6 (IL-6) were carried out. Data were analyzed using student t-test. The significance level was set at P-values ⩽.05.

Results: The offspring of dams exposed to perinatal HSD exhibited elevated BP parameters compared to those from dams on NSD. Although the maximum contractile response to noradrenaline was similar in both groups (P > .05), the maximum relaxation response to acetylcholine was significantly reduced in offspring of HSD-exposed dams (P < .01), indicating impaired endothelial function. Furthermore, perinatal HSD led to increased levels of CRP, TNF-α, and IL-6 in the offspring, indicating heightened systemic and vascular inflammation.

Conclusion: Findings from this study show that maternal perinatal HSD increased biomarkers of inflammation, impaired endothelial function and elevated BP in the adult offspring. These findings suggest maternal perinatal consumption of high dietary salt renders the offspring more susceptible to hypertension in adulthood.

A 50-year-old male had intermittent episodes of dyspnea for 7 days with persistent atrial fibrillation (AF) for 2 years. New York Heart Association (NYHA) functional class is IV status. The echocardiographic evaluation (Philps EPIQ 7C, S5-1 probe, 1.0-5.0 MHz) was performed showing a left ventricular ejection fraction (LVEF) of 48% (measured by the Simpson biplane method). His-Purkinje conduction system pacing (HPCSP) may enhance electrical resynchronization as well as the clinical and echocardiographic outcomes of patients with advanced heart failure (HF) who require resynchronization therapy (CRT). The use of left anterior fascicular areas pacing/left posterior fascicular areas pacing (LAFAP/LPFAP) may offer a significant advantage in patients for whom both biventricular pacing (BVP) and His bundle pacing (HBP) have not delivered substantial therapeutic benefits. In this study, we optimized electrical resynchronization by combining the concept of fused simultaneous pacing of LAFA/LPFA with an atrioventricular node ablation (AVNA) in a patient with HF and atrial fibrillation (AF). The maximal electrical resynchronization presented better hemodynamic and demonstrated comparable clinical and echocardiographic responses.

Background: The effect of Sodium Glucose Co-Transporter 2 inhibitors on cardiovascular, renal, dyslipidemia, and inflammatory markers has not been analyzed simultaneously. The goal is to determine if SGLT2 inhibitors significantly reduce cardiovascular and renal mortality, and improve these health outcomes.

Methods: PubMed, Cochrane Library and MEDLINE databases were used to conduct a comprehensive literature search from inception to September 2023. Randomized control trials with follow-up for at least 8 weeks, with a group taking SGLT2 inhibitors being compared with a group taking either placebo or other medication, in which cardiovascular outcomes, renal outcomes, lipid biomarkers, and inflammatory markers were reported as the primary outcomes were included. The statistical analyses were conducted using Review Manager with a random-effects model.

Results: Thirteen studies comprising 92 920 patients were analyzed for several outcomes. The analysis revealed a significant reduction in overall mortality, death due to heart failure, cardiovascular causes, and renal causes in the SGLT2 inhibitor group as compared to placebo. Pooled results also revealed a significant reduction in the frequency of renal replacement therapy and renal composite endpoint in patients on SGLT2 inhibitors. There was also a significant reduction in IL-6, TNF-a, systolic blood pressure in the same group. On the other hand, Flow Mediated Dilation (FMD), lipid profile, and the incidence of amputations and fractures showed no significant associated SGLT2 inhibitor therapy.

Conclusion: Our analysis indicates that diabetics and non-diabetics suffering from cardiovascular and renal diseases experience a significant reduction in morbidity and mortality from SGLT2 inhibitor therapy, leading to a better prognosis of such conditions in the long-term.

Background: Atrial fibrillation (AF) is the most common arrhythmia and can lead in the long-term to atrial remodelling. Three-dimensional speckle-tracking echocardiography allows evaluation of left atrial function and the magnitude of remodelling processes.

Methods: Echocardiography loops were collected between December 2021 and December 2022. Only valid atrial loops with sinus rhythm during examination were included. The Spearman test was used to establish correlation matrices of left atrial parameters, with uni-, multivariate and binary logistic regression to predict the presence or absence of AF.

Results: A total of 116 patients (50% females) aged 76.9 ± 11.2 years were included in the analysis. Males and females differed in anthropometric and other clinical parameters. Intra- and interobserver variability was 1.12% and 1.85%, respectively. 2D and 3D left atrial volumes correlated significantly (r = .8, P<.0001). Almost all left atrium strain measurements uni- and multivariately predicted the presence of AF, binary logistic regression model identified 2 independent parameters, left atrial longitudinal strain reservoir (LASr, P = .042) and LAS conduit phase (P = .044). LASr was significantly greater in patients without a history of AF than in patient with a history of AF (16 ± 16 and 10.5 ± 7.1, respectively; P = .012). LASr was able to discriminate between a history of paroxysmal AF and its absence with 72% specificity and 68% sensitivity with a cut-off value of 14% (AUC 0.72, 95% CI 0.62-0.82, P < .0001).

Conclusions: Three-dimensional left atrial reservoir function can differentiate patients with paroxysmal AF from patients without a history of this arrhythmia.

Background: Globally, hypertension rates are rising, particularly in low-income nations where access to healthcare and education remains limited. In the Dominican Republic, marginalized Haitian migrant communities, known as Bateyes, face disproportionate burdens. However, limited information exists on their understanding of hypertension and related health risks. This program-based evaluation aimed to explore community knowledge as part of ongoing outreach efforts.

Methods: We conducted a descriptive analysis of responses from 379 adults across three Bateyes in the Puerto Plata region. Participants completed a 15-item hypertension knowledge questionnaire during a routine mobile medical screening program (December 2022-January 2023) coordinated by the Kerolle Initiative. Hierarchical clustering was used to identify knowledge patterns and explore associations with community differences and systolic blood pressure (SBP) levels.

Results: Average BP values were 133/84 mmHg for males and 125/84 mmHg for females, with 27% of respondents meeting the clinical threshold for hypertension. Knowledge levels varied with 44% of participants having insufficient knowledge, and only one participant demonstrating adequate knowledge. Knowledge was associated with education level and household income. Poor awareness of basic concepts emerged as a key driver of variation across Bateyes. Cluster analysis revealed three knowledge patterns: (1) awareness shaped by lived experience of hypertension; (2) gaps due to common misconceptions; and (3) protective behaviors likely influenced by broader public messaging.

Conclusion: Findings from our educational outreach program evaluation suggest variable hypertension awareness across Batey communities. These observations highlight key areas for tailoring future community-centered health education efforts to the local needs of Bateyes.

Introduction: Tricuspid valve prolapse (TVP) is characterized by the tricuspid valve leaflets' displacement beyond the annular plane during midsystole. Although less common than mitral valve prolapse, TVP often coexists with it, sharing similar pathophysiological mechanisms. This case highlights new-onset tricuspid regurgitation (TR) following cavotricuspid isthmus ablation for atrial flutter, stressing the need for vigilant monitoring after such procedures.

Case: A 68-year-old male with atrial flutter, coronary artery disease, and type 2 diabetes underwent cavotricuspid isthmus ablation in August 2023 after failed rate control. By September 2023, he developed a grade 4/6 systolic murmur. Imaging confirmed TVP with mild to moderate TR, though he remained asymptomatic. Conservative management was adopted. Follow-up in October 2024 showed mild TR without prolapse, indicating improvement.

Conclusion: This case underscores the importance of recognizing valvular complications after atrial flutter ablation and conducting thorough post-procedural imaging to enable timely intervention and improved outcomes.

Takayasu arteritis (TA) is a rare granulomatous vasculitis affecting the aorta and its major branches, while systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder known for vascular and serological involvement. Although both diseases share certain immunopathological pathways, their co-occurrence is exceedingly rare. We report a case of a 44-year-old Indian female with a prior diagnosis of SLE who presented with breathlessness, palpitations, and nodular episcleritis. Cardiovascular evaluation revealed carotid bruit, diminished peripheral pulses, blood pressure discrepancies, and murmurs suggestive of valvular dysfunction. Laboratory investigations demonstrated elevated erythrocyte sedimentation rate, hypochromic microcytic anemia, hypocomplementemia, positive antinuclear and anti-dsDNA antibodies, and proteinuria. Imaging confirmed circumferential thickening of the ascending and descending aorta and occlusive disease in the left carotid system. Based on the 2022 ACR/EULAR classification criteria, a diagnosis of concomitant TA was established. Management included corticosteroids and mycophenolate mofetil, chosen over cyclophosphamide due to borderline renal function and fertility considerations. Despite planning for aortic root replacement, the patient deteriorated and succumbed to complications of severe aortic regurgitation. This case highlights the diagnostic complexities of overlapping autoimmune vasculitides and emphasizes the need for early recognition, rigorous application of classification criteria, and individualized immunosuppressive strategies to optimize outcomes in such rare presentations.

Background: Blood pressure (BP) variability has been recognized as a significant risk factor for cardiovascular diseases (CVD). We aim to evaluate the association between mean arterial pressure (MAP) variability and the increased risk of ischemic heart disease (IHD) and ischemic stroke (IS) among hypertensive patients in Thailand.

Methods: We analyzed data from the Thailand DM/HT study, which included hypertensive patients nationwide in 2014 to 2015 and 2018. MAP variability was computed based on the MAP values across 3 visits within 1 year and expressed as standard deviation (SD). We used multivariable log-binomial regression models to evaluate the associations between MAP variability and the risk of IHD and IS.

Results: Among 92 854 individuals, 594 new-onset IHD events (0.64%) and 187 IS incidents among 95 486 individuals (0.20%). Compared to the lowest quartile (Q1), higher quartiles of SD were associated with increased risk of IHD, with adjusted risk ratios (aRRs) of 1.06 (95% confidence interval [CI]: 0.82-1.38) for Q2, 1.35 (95% CI: 1.06-1.72) for Q3, and 1.50 (95% CI: 1.18-1.90) for Q4. Similarly, higher SD quartiles raised the risk of IS, with aRRs of 1.35 (95% CI: 0.83-2.20) for Q2, 1.56 (95% CI: 0.98-2.48) for Q3, and 1.97 (95% CI: 1.26-3.07) for Q4, when compared to Q1.

Conclusion: Our study demonstrated that higher visit-to-visit MAP variability in hypertensive patients was strongly associated with an increased risk of CVD. We emphasize the importance of incorporating BP variability into management strategies to help reduce the risk of CVD in these patients.