Clinical Research in Cardiology最新文献

Background: Skin autofluorescence (SAF) is a biomarker of tissue accumulation of advanced glycation end-products, which increase the risk of cardiovascular disease (CVD) and mortality, particularly among individuals with chronic kidney disease (CKD) or diabetes mellitus (DM).

Objective: The aim was to summarise existing evidence and estimate the association between SAF and all-cause mortality, cardiovascular mortality and CVD.

Methods: A search of Medline, Scopus, Web of Science and the Cochrane Library was conducted from inception to June 2025. Observational studies estimating the association between SAF and all-cause mortality, cardiovascular mortality and CVD were included. Meta-analyses of these associations were performed by categorising SAF (high vs. low) and by 1 arbitrary unit (AU) increment of SAF, expressed as hazard ratio (HR) or odds ratio (OR) and their 95% confidence intervals.

Results: Thirty-two studies were included in the systematic review. Elevated SAF was associated with an increased risk of all-cause mortality, cardiovascular mortality and CVD. Per 1 AU increase, an HR of 1.51 (1.35, 1.69) was obtained for all-cause mortality, an HR of 1.48 (1.16, 1.90) for cardiovascular mortality and an HR of 1.25 (1.13, 1.38) for CVD. However, estimates with OR tended to be higher. Finally, the results were similar in CKD and DM.

Conclusions: SAF is a strong predictor of CVD and mortality in general, and in CKD and DM in particular. Integrating SAF measurement into clinical practice could help clinicians implement early and intensive interventions to prevent associated morbidity and mortality, although clinical trials are needed to evaluate its effectiveness.

Background: Both angiography roadmap (RM) and ultrasound (US) are commonly used to obtain femoral arterial access during transfemoral transcatheter aortic valve implantation (TAVI). In this analysis, we sought to evaluate the effect of implementation of an US-guided approach on vascular and bleeding complications.

Methods: Vascular complications and bleeding at the main access site were compared using 4-year data from two experienced TAVI-operators, who changed their practice from an exclusively RM- to an exclusively US-guided technique for access in transfemoral TAVI.

Results: A total of 1026 patients were analyzed (RM: n = 485, US: n = 541) with a mean age of 80.7 ± 6.3 years; 47.7% were female and 37.1% received a balloon-expandable valve. Main access vascular complications, bleedings, or their composite were lower in the US-group (RM vs. US: 16.1% vs. 8.3%, p < 0.001). US was a protective factor for vascular complications, bleeding and their composite (adjusted odds ratio [OR] 0.51, 95%-confidence interval [CI] 0.33-0.77, p = 0.002; adjusted OR 0.46, 95%-CI 0.28-0.78, p = 0.003; and adjusted OR: 0.47; 95% CI 0.32-0.70, p < 0.001, respectively). Fluoroscopy time (14 [interquartile range (IQR) 11 - 20] min vs. 13 [IQR 10 - 17] min, p < 0.001), contrast use (88 [IQR 69 - 111] ml vs. 84 [IQR 65 - 110] ml, p = 0.049) and procedure time (52 [IQR 44 - 67] min vs. 49 [IQR 41 - 62] min, p = 0.02) were lower in the US-group.

Conclusions: US-guided femoral access was associated with significantly fewer complications compared with RM-guidance, supporting its adoption even among operators experienced with angiographic guidance.

Background: Right ventricular-pulmonary artery coupling and the pulmonary artery pulsatility index (PAPi) have emerged as potential prognostic markers in cardiovascular disease. Their utility in patients with degenerative mitral regurgitation (DMR) undergoing transcatheter mitral edge-to-edge repair (M-TEER) remains unclear.

Objectives: To evaluate the prognostic value of RV-PA coupling and PAPi in DMR patients treated with M-TEER.

Methods: This retrospective single-center study included 293 patients with DMR undergoing M-TEER between 2012 and 2022. RV-PA coupling was assessed by echocardiographic tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (sPAP_echo) and, in a subset, invasively (TAPSE/sPAP_invasive). PAPi was calculated as (sPAP-diastolic PAP) / right atrial pressure. The primary endpoint was all-cause mortality at 2 years; the secondary endpoint was a composite of mortality or heart failure hospitalization.

Results: RV-PA uncoupling (TAPSE/sPAP_echo < 0.307 mm/mmHg) was associated with higher 2-year mortality (52.2% vs. 22.2%; HR = 2.64; p < 0.001) and composite events (56.4% vs. 30.1%; HR = 2.22; p = 0.0023). Similar results were observed with invasively derived TAPSE/sPAP (cut-off < 0.315 mm/mmHg). In contrast, PAPi < 3.65 was not associated with outcomes. TAPSE alone showed no prognostic significance.

Conclusion: RV-PA coupling, but not PAPi, predicts mortality and heart failure rehospitalization following M-TEER in DMR patients. These findings highlight the value of RV-PA coupling indices for risk stratification and support their routine use in preprocedural assessment.

Key points: WHAT IS ALREADY KNOWN: • Sex-related differences in cardiovascular disease presentation, management, and outcomes have been increasingly recognized in recent years. • Women with acute cardiovascular conditions often receive less aggressive diagnostic and therapeutic interventions compared to men, particularly in the setting of acute coronary syndromes.

What this study adds: • This study provides a comprehensive evaluation of sex-related differences in a contemporary cohort of patients admitted to the Cardiac Intensive Care Unit (CICU), highlighting distinct admission patterns and management disparities. • Women with cardiovascular disease tend to be older at presentation, exhibit different risk factor profiles, and show distinct clinical manifestations compared to men. • It identifies higher mortality rates for women with STEMI and pulmonary embolism, emphasizing the need for improved recognition and tailored management of sex-specific differences in acute cardiovascular care.

Objectives: This systematic review and meta-analysis aimed to summarize current practices, procedural findings during redo ablations and subsequent recurrence rates.

Background: Catheter ablation is a cornerstone therapy for managing atrial fibrillation (AF). Despite its success in achieving rhythm control, many patients experience arrhythmia recurrence necessitating repeat ablation.

Methods: A systematic search of PubMed/MEDLINE, Web of Science, and Scopus was conducted through December 2023 to identify studies on first redo ablations for AF recurrence. The primary outcome was pooled prevalence estimates of AF recurrence after redo procedures.

Results: Fifty-seven studies including 8,243 patients (median age 61.1 years) were analyzed. The mean duration between initial and redo procedures was 5.6 months. Pulmonary vein (PV) reconnection was observed in 81.9% of patients, with lower rates in those initially treated with cryoballoon ablation (CBA) (72.3%) compared to radiofrequency ablation (RFA) (85.9%). Most redo procedures were performed using RFA (95.4%), often with additional linear ablations such as cavotricuspid isthmus ablation (26.0%), mitral isthmus lines (7.8%), rooflines (8.7%), and posterior wall lines (7.0%). At a median follow-up of 11.5 months, 32.0% of patients experienced AF recurrence. Recurrence rates were significantly lower when the interval between initial and redo ablations was ≤ 12 months (25.5% vs. 33.9%).

Conclusion: Given the high prevalence of PV reconnections in patients with AF recurrence, re-isolation of the PVs remains the primary approach at repeat ablations, while additional ablative strategies are employed less frequently than anticipated. A shorter interval between the initial and redo ablation procedures was associated with reduced subsequent recurrence rates.

Background: There is little evidence regarding mitral transcatheter edge-to-edge repair (TEER) in the setting of severe pulmonary hypertension (PH), defined as an estimated pulmonary arterial systolic pressure (PASP) > 70 mmHg on echocardiography. We sought to explore the prevalence of, and correlates and postprocedural outcomes associated with, severe PH in patients undergoing mitral TEER.

Methods: We retrospectively evaluated a single-center registry of isolated, first-time interventions as a function of severe PH presence at baseline. Outcomes included all-cause mortality, heart failure (HF) hospitalizations, and the persistence of significant mitral regurgitation (MR) and functional impairment during the first postprocedural year.

Results: A total of 1,182 individuals qualified for analysis. Of them, 100 (8.5%) had severe PH, demonstrating a median PASP of 78 (interquartile range, 75-85) mmHg. Compared to subjects free of severe PH, the former exhibited a higher interventional risk, a greater burden of comorbidities, and more severe MR and cardiac dysfunction, and were more likely to undergo an urgent procedure. General interventional features were unaffected by severe PH status, leading in both groups to a high (> 97%) technical success rate and, ultimately, significant improvements in PASP, MR grade and functional capacity. Severe PH was associated with worse residual MR in the total cohort - but not within a 187-patient, propensity score matched sub-cohort. In either, it did not correlate with the rate, cumulative incidence, and risk of mortality and/or HF hospitalizations.

Conclusion: In our experience, severe PH preceding mitral TEER identified higher-risk patients but was unrelated to procedural feasibility, safety, or efficacy.

Background: The natural history of medically treated chronic CAD remains unclear. The current study pools evidence from randomized controlled trials to examine the natural progression and long-term outcomes in the population with chronic CAD.

Methods: Medline, Embase, and Cochrane databases were searched in March 2024 to identify relevant randomized-controlled trials (RCTs) reporting long-term outcomes for chronic CAD individuals on guideline-directed medical therapy (GDMT). A single-arm meta-analysis of proportions and means was performed on the baseline characteristics, primary and secondary endpoints. Individual patient data were reconstructed from Kaplan-Meier estimates published in the included RCTs for all-cause mortality and myocardial infarction (MI).

Results: A total of 29 trials, comprising 51,275 individuals with medically treated chronic CAD, were included. The pooled incidence rates for all-cause mortality, MI and cardiac death were 19.3 (95%CI, 18.0-20.7), 30.0 (95%CI, 27.6-32.6), and 8.6 (95%CI, 5.8-12.7) per 1000 person-years, respectively. Incremental risks in all-cause mortality and MI in chronic CAD were observed across time, at one (0.8% and 2.6%), two (2.0% and 2.3%), three (3.3% and 7.5%), four (4.9% and 5.0%) and five years (10.5% and 8.4%), respectively. The rates of angina and coronary revascularization were 76.1 (95%CI, 31.6 to 183.4) and 37.3 (95%CI, 25.1 to 55.2) events per 1000 person-years.

Conclusion: The reconstructed individual patient data meta-analysis of patients with chronic CAD over 185,455 person-years highlights that the natural progression of chronic CAD is far from stable, with cardiovascular risks more than doubling at ≥ 5 years of follow-up.

Background: Low adherence to lipid-lowering therapy (LLT) after myocardial infarction (MI) is associated with increased risk of recurrent cardiovascular events and death. However, little is known about long-term adherence patterns following treatment interruptions. The aim of this study was to describe adherence trajectories in MI patients following a LLT treatment gap, and model the impact of different adherence trajectories on estimated low-density lipoprotein cholesterol (LDL-C) levels.

Methods: We conducted a retrospective cohort study of 22,124 first-time MI patients in Sweden who dispensed statins and/or ezetimibe within 90 days of their MI. Patients with a treatment gap > 90 days within three years post-MI were identified, and adherence trajectories were evaluated over a five-year period following the treatment gap using group-based trajectory modelling. Associations between adherence trajectories and patient characteristics were analyzed, and the impact on estimated LDL-C levels was simulated based on trajectory-specific adherence.

Results: Patients were categorized in six different adherence trajectories - constant adherent (34%), constant non-adherent (26%), rapidly (7%) and slowly (6%) increasing and rapidly (9%) and slowly (19%) decreasing adherence. Patients with a constant adherent trajectory were more often managed in primary care (compared to hospital care). Lower age and male sex were also associated with a constant adherent trajectory. The average LDL-C level in patients with a constant adherence trajectory was estimated to be 1.0 mmol/L lower compared to patients with a constant non-adherence trajectory.

Conclusions: Suboptimal adherence following a treatment gap is common and has a clinically significant impact on the degree of LDL-C lowering.

Background: Sex-related differences in symptoms, treatment, and outcomes in patients presenting with myocardial infarction have been reported but vary largely between studies. We sought to characterize sex differences in presentation and outcomes of patients with acute ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous intervention (PPCI).

Methods and results: We included 1206 STEMI patients from a clinical cohort and 35,123 STEMI patients obtained from the German health insurance claims. Women, despite being older and thus having a worse cardiovascular risk profile, had greater myocardial salvage and smaller infarct size than men in all patients (median with [interquartile ranges (25th-75th percentiles), IQR]; salvage index: 0.58 [IQR: 0.32-0.91] in females vs. 0.47 [IQR: 0.23-0.77] in males, p < 0.0001; infarct size: 7.0% [IQR: 1.0-22.0%] in females vs. 11.0% [IQR: 3.0-23.0%] of the left ventricle in males, p = 0.002). Same results were shown for propensity score matched pairs (n = 242) (salvage index: 0.60 [IQR: 0.33-0.91] in females vs. 0.44 [IQR: 0.23-0.70] in males, p = 0.0002; infarct size: 7.0% [IQR: 1.0-23.0%] vs. 10% [IQR: 3.0-23.0%] of the left ventricle in males, p = 0.042). Furthermore, women showed a lower risk of 5-year mortality, assessed after propensity score matching, in the health insurance cohort (n = 19,404) (HR = 0.92 [95% CI 0.87-0.97], p = 0.002).

Conclusions: In patients with STEMI, women appear to have better myocardial salvage and smaller infarct size after PPCI and a lower 5-year mortality compared with men, suggesting better ischemic tolerance in female patients.