Clinical Research in Cardiology最新文献

Objective: Lipoprotein(a) [Lp(a)] concentrations have been associated with cardiovascular risk. Recent studies suggested an interaction between systemic inflammation assessed via high-sensitivity C-reactive protein (hsCRP) and Lp(a). This study aimed to evaluate whether Lp(a), hsCRP, and interleukin-6 (IL-6) levels are associated with cardiovascular mortality in a German hospital-based cohort.

Methods: Data were drawn from the Ludwigshafen Risk and Cardiovascular Health (LURIC) study, including 3,316 patients undergoing coronary angiography. Lp(a) was measured by immunoturbidimetry and categorized into three strata (< 50 mg/dL, n = 2668; 50-100 mg/dL, n = 482; > 100 mg/dL, n = 163). HsCRP was measured by immunonephelometry and categorized by intervals (1st < 1 mg/L, 2nd 1-2 mg/L and 3rd interval > 2 mg/L). IL-6 was measured by ELISA and categorized into two groups (1st < 3.2 ng/L, 2nd ≥ 3.2 ng/L). The primary outcome was cardiovascular disease (CVD) mortality, analyzed using Cox proportional hazards models and logistic regression.

Results: Participants were predominantly male, with a mean age of 62.6 years. Extremely high Lp(a) (> 100 mg/dL) was associated with increased cardiovascular mortality (HR 1.5, 95% CI 1.06-2.12) compared to Lp(a) < 50 mg/dl. Both hsCRP (> 2 mg/L, HR 1.39, 95% CI 1.08-1.79 third vs. first interval) and more so IL-6 (HR 1.92, 95% CI 1.64-2.23, upper vs. lower half), were independently associated with higher CVD mortality. While hsCRP did not increase the Lp(a)-CVD mortality in stratified analysis, high IL-6 conferred an increased risk at Lp(a) levels > 100 mg/dL (HR 1.25, 95% CI 1.09-1.44).

Conclusion: HsCRP and IL-6 are associated with cardiovascular mortality. Markedly elevated Lp(a) is associated with an increased risk of cardiovascular mortality in the context of high systemic inflammation. Anti-inflammatory treatments may provide additional therapeutic benefits for individuals with high Lp(a).

Background: Robotic-assisted percutaneous coronary intervention (R-PCI) is an efficacious and safe treatment option for coronary artery disease. However, predictors of manual support during R-PCI are unknown, which we aimed to investigate in a multi-center study.

Methods: We utilized patient-level data from R-PCIs carried out from 2020 to 2022 at four sites in Germany. Manual support was defined as the combination of partial manual assistance, where the procedure is ultimately completed using robotic techniques, and manual conversion. A two-step selection process based on akaike information criteria was used to identify the ideal multivariable model predicting manual support.

Results: In 210 patients (median age 69.0 years; 25.7% female), a total of 231 coronary lesions were treated by R-PCI. Manual support was needed in 46 lesions (19.9%). Procedures requiring manual support were associated with significantly longer procedural times, greater total contrast fluid volumes, longer fluoroscopy times, and higher dose-area products. Amongst the predictors of manual support were lesions in the left anterior descending artery [OR: 1.09 (95%-CI: 0.99-1.20)], aorto-ostial lesions [OR: 1.35 (95%-CI: 1.11-1.64)], chronic total occlusions [OR: 1.78 (95%-CI: 1.38-2.31)], true bifurcations [OR: 1.37 (95%-CI: 1.17-1.59)], and severe calcification [OR: 1.13 (95%-CI: 1.00-1.27)].

Conclusion: Our findings reveal that nearly one out five of patients undergoing R-PCI required manual support, which was linked to longer procedure durations. Predictors of manual support reflected characteristics of more complex coronary lesions. These results highlight the limitations of current R-PCI platforms and underscore the need for technical advancements to address different clinical scenarios.

Background: Impaired renal function can increase cardiac troponin levels due to reduced elimination, potentially affecting its diagnostic utility. Limited data exist on high-sensitivity cardiac troponin I (hs-cTnI) kinetics after cardiac surgery relative to renal function. This study evaluates how impaired renal function influences hs-cTnI kinetics following cardiac surgery, distinguishing between patients with and without postoperative myocardial infarction (PMI).

Methods: We conducted a retrospective analysis of adult patients who underwent elective cardiac surgery at our hospital from January 2013 to May 2019. Serial hs-cTnI measurements were taken from baseline up to 48 h post-surgery. Renal function was assessed using the MDRD formula, defining impaired renal function as a GFR < 60 ml/min. Acute kidney injury (AKI) was based on postoperative creatinine levels, and PMI was defined by ARC-2 criteria. Predictors of long-term all-cause mortality were analyzed using Cox regression.

Results: Out of 14,355 patients (51.4% CABG, 39.4% valvular procedures, 9.2% thoracic aortic procedures), 139 (1.0%) had PMI. Hs-cTnI levels were higher in patients with impaired renal function across the cohort and in those without PMI. However, in patients with PMI, hs-cTnI levels did not vary significantly with renal function. Elevated hs-cTnI ≥ 213 times the upper limit of normal was a significant predictor of long-term mortality regardless of renal function (hazard ratio: 1.28, 95% CI: 1.17-1.40, p < 0.001), but early postoperative hs-cTnI measures held poor discriminatory yield to predict PMI with an AUC of 0.55 (95% confidence intervals: 0.54-0.56).

Conclusion: Renal function and acute kidney injury affect hs-cTnI kinetics post-surgery only in patients without PMI. Elevated hs-cTnI remains a strong predictor of long-term mortality, independent of renal function, but early postoperative detection of PMI requires additional metrics, including ECG, transthoracic echocardiography (TTE), and signs of hemodynamic instability.

Introduction: Data on circumstances of sudden cardiac arrest (SCA) in Germany are limited. The present study aimed to investigate systematically the current pre- and in-hospital circumstances of a SCA cohort at young age (65 years or younger) in Germany.

Methods: In the period from 2010 to 2021, we enrolled 191 consecutive patients with SCA at a university hospital in the Ruhr area, Germany. Clinical baseline characteristics and cardiopulmonary resuscitation (CPR) data were assessed.

Results: A total of 191 patients (median age: 56 years (ranging from 16 to 65 years); 82% males) were included. The median duration of hospitalization was nine days. 97 patients (50.8%) deceased during hospitalization. The patients suffered SCA during non-stressful daily activities (41.4%), while working (14.7%), exercising (12.0%) or resting (8.9%). Patients experienced SCA most often at home (41.9%), in public (31.9%), at work (14.7%), or in the emergency ambulance (6.3%). Bystander-witnessed cardiac arrest was reported in 80.6% of cases. However, lay resuscitation was performed in only 46.1% of cases. The first-monitored rhythm was most frequently ventricular fibrillation (67.0%), followed by asystole (18.3%), ventricular tachycardia (5.8%), pulseless electrical activity (5.2%) and bradycardia (2.1%).

Conclusion: Compared to other studies, we detected lower rates of SCA occurring at home and higher rates in public, at work or during sports. This may be related to the fact that only younger patients under the age of 65 were included in this SCA cohort.

Background: Heart failure (HF) is a heterogeneous clinical syndrome affecting a growing global population. Due to the high incidence of cardiovascular risk factors, a large proportion of the Western population is at risk for heart failure. Oxidative stress and inflammation play a crucial role in the pathophysiology of heart failure with preserved ejection fraction (HFpEF). While previous studies have demonstrated an association between dysfunctional HDL and heart failure, the specific link between oxidized HDL and HF remains unexplored.

Methods: In this cross-sectional observational study, the antioxidant function of HDL was assessed in 366 patients with suspected heart failure. HFpEF assessment was conducted according to current guidelines. A validated cell-free biochemical assay was used to determine reduced HDL antioxidant function as assessed by increased HDL-lipid peroxide content (HDL_ox), normalized by HDL-C levels and the mean value of a pooled serum control from healthy participants (nHDL_ox; no units). Results were expressed as median with interquartile range (IQR).

Results: Participants with HFpEF (n = 88) had 15% higher mean relative levels of nHDL_ox than those without heart failure (n = 180). Using a basic multivariate model adjusted for age, sex, eGFR and a full multivariate model (adjusted for diabetes, hypertension, atrial fibrillation, LDL cholesterol, hsCRP, and coronary artery disease), nHDL_ox was an independent predictor for HFpEF (p < 0.05). An increase in 1-SD in nHDL_ox was associated with a 67% increased risk for HFpEF if compared with participants without heart failure (p = 0.02).

Conclusion: HDL antioxidant function is reduced in patients with HFpEF. Improving HDL function is a promising target for early heart failure treatment.