Clinical Medicine Insights. Cardiology最新文献

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.

ASCVD is a global concern as it has become central to significant morbidity and mortality. LDL-C is the most important modifiable risk factor in developing ASCVD. Therefore, lowering LDL-C levels is paramount to tackling ASCVD; the lower the LDL-C, the better. Finding the right combination of medications patients are willing to adhere to is necessary for optimal lipid lowering. Inclisiran is a novel LDL-C lowering LLT that has demonstrated around 50% reduction in LDL-C with a low side effect profile. As long-term data is limited for Inclisiran, this retrospective analysis aims to observe whether Inclisiran's benefits are sustained as monotherapy and in combination with other LLTs. After 27 months, the clinic found sustained drops in LDL-C of 59% with good adherence. Only 4% of patients reported experiencing side effects, with 1 individual needing to discontinue the medication due to these effects. Our data indicates that incorporating Inclisiran into a patient's LDL-C treatment plan can provide long-term LDL-C reduction, thereby helping to decrease cardiovascular events.

Introduction: Iatrogenic atrial septal defect (iASD) resulting from MitraClip procedures may cause volume overload and deterioration of right ventricular (RV) function. The concurrent MitraClip procedure, along with an intervention to close iASD appears to yield a potentially favorable impact on the functioning of the right ventricle.

Aim of the study: The study aims to evaluate the effect of iASD closure with an occluder immediately after the MitraClip procedure on RV function, pulmonary resistance, and right ventricle-pulmonary artery coupling (RV-PAc).

Methods: The study group (ASDc) consisted of consecutive patients who underwent concomitant iASD closure with the Amplatzer occluder (n = 10). The control group (n = 9) comprised patients with iASD left untreated (CT group). RV assessment before MitraClip and during follow-up visits was based on transthoracic echocardiography (TTE).

Results: In the CT group, fractional area change (FAC) increased from 33.3 ± 15.6% to 38.2 ± 14.0%; P = .28, and in the ASDc group, from 38.9 ± 11.6% to 40.4 ± 13.7%; P = .76. In the CT group, tricuspid annular plane systolic excursion (TAPSE) decreased from 19.2 ± 4.3 mm to 17.3 ± 3.8 mm; P = .47, and in the ASDc group from 19.1 ± 6.8 mm to 16.5 ± 6.1 mm; P = .04. In the entire group, right ventricular systolic pressure (RVSP) dropped from 52.7 ± 16.0 mmHg to 45.1 ± 8.1 mmHg; P = .01. The reduction in RVSP was 11 mmHg in the ASDc group versus 4 mmHg in the CT group (P = .35). Pulmonary vascular resistance (PVR) itself did not change significantly before and after the procedure. RV-PAc increased respectively by 36% and 9.75% from baseline values in the ASDc and CT groups.

Conclusion: Closure of the iASD results in a greater reduction in RVSP but also TAPSE. RV-PAc, a parameter unaffected by RV preload, reveals notably improved hemodynamic conditions for RV performance after iASD closure.

Background: Transcatheter aortic valve replacement (TAVR) has been widely used to treat patients with aortic stenosis (AS). The anchoring of most transcatheter heart valves (THV) depends on friction with the native aortic valve (AV).

Methods: A total of 9 patients with severe AS accepted TAVR using Xcor system with transapical access in our center. Clinical outcomes were collected at baseline, before discharge, and at the 30-day follow-up.

Results: All patients achieved procedural success, postprocedural transesophageal echocardiography showed that all of the patients had no/trace paravalvular leakage. The mean AV pressure gradient decreased from 50 mmHg (range 18-76 mmHg) to 10 mmHg (range 8-14 mmHg) (P < .001). At the 30-day follow-up, all patients had an improvement of ⩾1 New York Heart Association functional class (P < .001). The average 6-minute walk distance (377.2 [range 330.0-430.0] m vs 276.1 [range 245.0-320.0] m, P < .001) and Kansas City cardiomyopathy questionnaire score (53.4 [range 45.0-62.0] vs 38.9 [range 35.0-43.0], P < .001) were both improved.

Conclusions: Our early experience shows that the Xcor system is safe and feasible in the treatment of patients with severe AS.

Background: We aimed to investigate the incidence of new acute myocardial infarction (AMI), in patients with Coronavirus disease (COVID-19) who had old MI. We hypothesized that COVID-19 increases the rate of repeated AMI in this population regardless of age and gender.

Methods: A retrospective analysis was conducted for adult patients admitted with COVID-19 and developed thromboembolic event (TEE) in 2020. Patients were categorized based on the history of old MI, new MI, age, and gender.

Results: Among 16,903 patients with COVID-19 who were admitted, 210 (1.2%) developed TEE (89% were males, 55% were <55 years old, and 80.5% had an old MI). COVID-19 was severe in 32% of cases. AMI occurred in 160 patients (42.5% STEMI and 57.5% NSTEMI). In patients with prior MI, 92.5% developed another AMI. NSTEMI was higher in patients with severe COVID-19 than STEMI (33% vs 21%). Patients with severe COVID-19 had higher mortality (39.4% vs 5.6%), fewer rates of prior MI (74% vs 83%), hypertension (40% vs 60%), and STEMI (31.8% vs 46.5%) than mild COVID-19 patients. On multivariable analysis, COVID-19 severity was an independent predictor of mortality (OR10; 95%CI 1.62-67.19) after adjustment for age, gender, diabetes mellitus, C-reactive protein, serum Ferritin, Procalcitonin, and Fibrinogen values, and prior or new MI.

Conclusions: Patients with old MI could develop a new AMI in 80% of COVID-19. However, the mortality was higher in patients without a history of MI due to the severity of COVID-19. Attention should be given to patients who possess thrombotic risk factors in pandemics.

Background: The arrhythmic burden and cardiovascular risks of cardiac amyloidosis compared with other types of restrictive cardiomyopathies (RCM), such as hemochromatosis and cardiac sarcoid, have not been well characterized in the literature. An increase in emphasis on screening has resulted in more diagnoses of cardiac amyloidosis and a larger data pool to analyze the cardiovascular outcomes of this cardiomyopathy.

Methods and results: We queried the National Inpatient Sample (NIS) database to identify all adult patients diagnosed with cardiac amyloidosis or other RCM between the years 2016 and 2019. Discharge-weighted analysis using survey regressions accounts for discharge weights and characteristics found to be significantly different between groups. A total sample size of 13 345 patients was obtained, including cardiac amyloidosis (N = 8365; 62.7%) and other RCM (N = 4980; 37.3%). Cardiac amyloidosis was associated with a significantly increased risk of stroke (Odds ratio = 3.91: 95% confidence interval = [2.15, 7.11], P < .001) and ventricular tachycardia (1.98 [1.35-2.91], P < .001). Cardiac amyloidosis had a decreased risk of atrial fibrillation (0.56 [0.47-0.68], P < .001). Significant differences in risk were not observed among the different types of heart block and supraventricular arrhythmias. In-hospital mortality was similar between the 2 groups (P = .72).

Conclusions: Cardiac amyloidosis was associated with an increased risk of stroke and ventricular tachycardia compared to other types of RCM. Significant differences in in-hospital mortality, bundle branch blocks, and supraventricular arrhythmias were not appreciated. A subgroup analysis comparing light chain (AL) and wild-type transthyretin (ATTR) amyloidosis outcomes would further delineate the cardiovascular risks of cardiac amyloidosis.

Infiltrative heart disease (InHD) is a group of diseases characterized by the deposition of abnormal substances in the heart tissue, causing diastolic, less often systolic, dysfunction of the ventricle(s). Their classification still does not exist. In 2013, the MOGE(S) classification of cardiomyopathies was published, taking into account, along with the morphological and functional characteristics of the heart, damage to other organs, the presence of genetic mutations, acquired causes (e.g., myocardial inflammation, autoimmune diseases, storage diseases, amyloidosis), etc. By analogy with it we offer the MORAL-STAGE classification for InHD. It includes ten features: morphofunctional characteristics (M), organ damage (O), risk of cardiac death (R), age of clinical presentation, age of disease-specific therapy initiation (A), localization of the infiltrative process (inside or outside the cell, L), information about the functional class heart failure and stage of infiltrative heart disease (S), treatment (T), abnormal rhythm or conduction (A), genetic or familial nature of inheritance (G), etiology of the process (E). This article summarizes the cornerstones of the MORAL-STAGE classification and its clinical relevance. In addition, new issues are discussed that can be considered in future versions of the MORAL-STAGE classification.

Introduction: The debate remains open as to the difference in prevalence of mortality and occurrence of acute events in patients with Myocardial infarction with non-obstructive coronary arteries (MINOCA) and others with Myocardial infarction with coronary arteries disease (MI-CAD).

Methods: We conducted a 2-year retrospective study for patients admitted for Acute coronary syndrome (ACS) to analyze the clinical and prognostic characteristics of patients with MINOCA versus MI-CAD. We defined 1-year all-cause mortality as the primary outcome, and the secondary outcome as a composite of 1-year readmission for myocardial infarction or acute heart failure (AHF).

Results: Our study included 1077 patients, 95.3% with MI-CAD and 4.7% with MINOCA. At admission, 71.1% patient were diagnosed STEMI and 28.9% with NSTEMI. The difference between the 2 groups was found on age (P < .001), hypertension, diabetes with consecutive P-values of .007 and .001, as well as Ejection fraction (P < .001). For the outcomes studied, the difference was significant between the 2 groups for all events, and MINOCA patients had a better prognosis than MI-CAD patients, with adjusted hazard ratios (HR) for 1-year mortality (HR = 0.601 P = .004), for readmission for ACS (HR = 0.662; P = .002) and for readmission for AHF (HR = 0.539; P = .019).

Conclusion: Despite the ambiguity in the genesis of MINOCA, the short- and long-term prognosis of these patients remains generally favorable.

Background: According to a report from the WHO, an estimated 1.13 billion people worldwide have hypertension. Medication therapy management (MTM) service is a clinical service based on the theoretical and methodological framework of pharmaceutical care practice, which aims to ensure the best therapeutic outcomes for the patient by identifying, preventing, and resolving drug therapy problems (DTPs).

Purpose: The goal of this study was to determine the impact of MTM on hypertension management in Ethiopia.

Methods: A pre-post interventional study design was used. Descriptive statistics, linear regression, and logistic regressions were employed to present and analyze data.

Results: The final analysis included 279 patients out of 304, with a 7.8% attrition rate. The prevalence of drug therapy problems (DTPs) reduced from 63.4% at baseline to 31.5% during the post-intervention phase. Polypharmacy (AOR = 2.46; 95% CI: 1.27-4.77) and complications (AOR = 0.52; 95% CI: 0.27-0.99) were substantially associated with DTPs at the start of the study. The MTM resulted in a significant reduction in mean systolic blood pressure (SBP) (AOR = 5.31, 95% CI (3.50-7.11), P < .001), as well as a significant increase (P < .001) in the number of study patients who reached a target BP. At the end of the MTM intervention, non-adherence was linked with DTP (AOR = 2.40; 95% CI: 1.33-4.334) and living outside Addis Ababa (AOR = 1.73; 95% CI: 1.38-1.88). On average, treatment satisfaction was 86.55% (+SD) 10.34.

Conclusion: To resolve DTPs and improve clinical outcomes, the MTM service was critical. The majority of patients were found to be compliant with a high treatment satisfaction score.

Background: Pulmonary hypertension (PH) is a pulmonary vascular disease characterized by elevated pulmonary vascular pressure. Long-term PH, irrespective of its etiology, leads to increased right ventricular (RV) pressure, RV hypertrophy, and ultimately, RV failure.

Main body: Research indicates that RV failure secondary to hypertrophy remains the primary cause of mortality in pulmonary arterial hypertension (PAH). However, the impact of PH on RV structure and function under increased overload remains incompletely understood. Several mechanisms have been proposed, including extracellular remodeling, RV hypertrophy, metabolic disturbances, inflammation, apoptosis, autophagy, endothelial-to-mesenchymal transition, neurohormonal dysregulation, capillary rarefaction, and ischemia.

Conclusions: Studies have demonstrated the significant role of oxidative stress in the development of RV failure. Understanding the interplay among these mechanisms is crucial for the prevention and management of RV failure in patients with PH.