Clinical Research in Cardiology最新文献

Background and aim: The impact of coronary microvascular dysfunction (CMD) on parameters of systolic and diastolic function, particularly in patients with heart failure and preserved ejection fraction (HFpEF), is poorly understood. Although these conditions often overlap, their combined impact on parameters of systolic and diastolic function remains unexplored.

Methods: Consecutive patients undergoing invasive CMD assessment were enrolled. Systolic function was assessed by global longitudinal strain (GLS), diastolic function by E/E', left atrial reservoir strain (LARS), and non-invasive single-beat pressure-volume relationship stiffness constant (β) estimation.

Results: Of 145 patients, 72 (49.7%) had CMD, 35 (24%) HFpEF, and 23 (16%) both conditions. HFpEF was twice as prevalent in CMD patients as compared to patients without CMD (32% vs. 16%, p = 0.034). Both CMD was associated with parameters of both diastolic (E/E' β = 0.29, p < 0.001, LV stiffness constant β = 0.23; p = 0.006, and LARS β = -0.21, p = 0.02) and systolic function (GLS β = 0.31, p < 0.001). The presence of CMD was associated with an impairment in LV stiffness both in patients with and without HFpEF (p for interaction = 0.044).

Conclusion: HFpEF is highly prevalent in patients with CMD, and CMD is associated with both systolic and diastolic dysfunction. In patients with HFpEF, an additional worsening of diastolic function is observed.

Objective: The study aims to investigate how the radial artery diameter (RAD) predicts post-procedural radial artery occlusion (RAO) in patients undergoing transradial coronary catheterization (TRC).

Background: RAO is the most frequent complication of TRC. However, the cut-off value of RAD for predicting RAO remains uncertain.

Methods: A total of 2073 patients undergoing TRC were consecutively screened, and 1023 were enrolled. The participants were divided into 6 French (Fr) coronary angiography (CAG), 6 Fr percutaneous coronary intervention (PCI), and 7 Fr PCI groups. Ultrasound examination was performed before and after the procedure to measure RAD and to assess RAO. The primary endpoint was the rate of RAO at 12-24 h post-TRC.

Results: RAO was observed in 11.2% (115/1023) of patients. RAO was significantly lower in the 6 Fr PCI group than in the 6 Fr CAG and 7 Fr PCI groups (6.6% vs. 14.3%, P = 0.003, 6.6% vs. 15.4%, P = 0.001, respectively). The RAD cut-off values for predicting RAO were 2.42 mm in the 6 Fr CAG group, 2.38 mm in the 6 Fr PCI group, and 2.85 mm in the 7 Fr PCI group. The larger pre-procedural RAD was an independent protective factor for preventing RAO (odds ratio [OR]: 0.239, 95% confidence interval [CI]: 0.099-0.561, P < 0.001), while 7 Fr sheath (OR: 4.610, 95% CI: 2.159-9.938, P < 0.001) and local complaints at access site (OR: 4.782, 95% CI: 2.815-8.150, P < 0.001) were associated with an increased risk of RAO post-TRC.

Conclusion: Pre-procedural ultrasound measurements of RAD can help to choose an optimal sheath size to prevent RAO after TRC.

Background: Malignant ventricular arrhythmias (MVA)-sustained ventricular tachycardia or fibrillation-remain a major early complication after ST-segment elevation myocardial infarction (STEMI) despite timely reperfusion. The no-reflow phenomenon is a key substrate for arrhythmogenesis. The no-reflow prediction in acute coronary syndrome (NORPACS) score, originally developed to predict no-reflow, may also help identify patients at high arrhythmic risk.

Methods: We retrospectively analyzed 1050 consecutive STEMI patients undergoing successful primary percutaneous coronary intervention (PCI) between January 2020 and December 2024. The primary endpoint was inhospital MVA. Univariable and multivariable logistic regression models were constructed incorporating clinical, laboratory, and angiographic variables. The incremental predictive value of the NORPACS score was assessed using receiver operating characteristic analysis, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Kaplan-Meier and restricted cubic spline analyses evaluated temporal risk patterns.

Results: MVA occurred in 79 patients (7.5%), all within the first 8-h post-PCI. Patients with MVA more often had diabetes, anterior infarcts, lower LVEF, higher inflammatory markers, and no-reflow. The NORPACS score was significantly higher in the MVA group (7.1 ± 1.3 vs. 6.2 ± 1.7, p < 0.001) and independently predicted events across all multivariable models (adjusted OR range: 1.20-1.44, all p < 0.05). Adding NORPACS to clinical-laboratory models improved discrimination (ΔAUC up to 0.07) and yielded significant IDI (0.022-0.024) and NRI (0.10-0.14). Kaplan-Meier curves confirmed earlier arrhythmia onset with higher scores.

Conclusions: The NORPACS score is an independent and incremental predictor of early MVA in STEMI patients undergoing PCI. Its integration into clinical-laboratory risk models enhances risk stratification and may guide intensified monitoring in high-risk patients. Prospective multicenter validation is warranted.

Background: 20 years ago, drug coated balloon (DCB) angioplasty was introduced into the interventionalist's toolbox initially to treat in-stent restenosis. Since then, considerable clinical evidence was generated in patients with de novo lesions. Whether drug-eluting stents (DES) or DCB angioplasty are associated with better clinical outcomes for de novo lesion treatment is still a matter of debate.

Objective: The objective of this post-hoc analysis was to assess the impact of vessel diameter in a real-world, unselected patient population treated with either paclitaxel-coated balloon (PCB) angioplasty or polymer-free sirolimus-eluting stent (PF-SES) implantation based on patient-level data.

Methods: Four all-comers observational studies based on similar protocols were pooled and vessel-diameter matched to study the clinical outcomes following revascularization with either PCB or PF-SES. The primary endpoint in all studies was the accumulated clinically driven target lesion revascularization (TLR) rate at 9-12 months complemented with secondary endpoints such as the rates for major adverse cardiac events (MACE), myocardial infarction (MI) and cardiac death.

Results: In the unmatched patient population, 3035 patients received either PCB (1614 patients) or PF-SES (1421 patients). The 'unmatched' TLR and MACE rates were low with 2.5% (PCB) vs. 2.0% (PF-SES, p = 0.319) and 4.5% (PCB) vs. 5.0% (PF-SES, p = 0.493), respectively. In the large vessel group (≥ 3 mm), 253 patient pairs were matched with reference diameters of 3.19 ± 0.27 mm (PCB) and 3.18 ± 0.27 mm (PF-SES, p = 0.787), and lesion lengths of 17.5 ± 9.8 mm (PCB) and 17.3 ± 7.1 mm (PF-SES, p = 0.839). The accumulated TLR rates were not significantly different (PCB 2.0% vs. PF-SES 2.8%, p = 0.786). Likewise, MACE rates in this large vessel subgroup were similar (5.6% vs. 6.4%, p = 0.723). In the small vessel group (< 3 mm), 420 patient pairs were matched with reference diameters of 2.49 ± 0.18 mm (PCB) and 2.49 ± 0.18 mm (PF-SES, p = .995), and lesion lengths of 16.0 ± 9.0 mm (PCB) and 16.7 ± 7.1 mm (PF-SES, p = 0.665). The accumulated TLR rates were not significantly different (PCB 1.9% vs. PF-SES 2.2%, p = 0.810). Likewise, MACE rates in the small vessel subgroup were similar (4.4% vs. 5.8%, p = 0.346). Individual clinical event rates were low and not significantly different between patients with small and large vessels.

Conclusions: In this real-world experience PCB and PF-SES angioplasty were associated with low clinical event rates. There was no difference in clinical efficacy between PCB and PF-SES in large and small vessel PCI in terms of clinically driven TLR and MACE. Previously reported higher rates for clinical events after DCB angioplasty in large coronary vessels ≥ 3 mm could not be observed.

Background: The renal resistive index (RRI) is increasingly used as a non-invasive marker of cardiorenal interaction. We aimed to determine (i) whether baseline RRI predicts survival after mitral transcatheter edge-to-edge repair (M-TEER) and (ii) whether RRI changes in response to the procedure.

Methods: In this prospective, single-center cohort we enrolled consecutive patients with severe mitral regurgitation who underwent M-TEER between October 2020 and December 2021 (trial registration number 412/20, date of registration 02.09.2020). Baseline demographics, estimated laboratory parameters, comprehensive echocardiography, and Doppler-derived RRI were collected before and 3 months after intervention. The primary endpoint was all-cause mortality. Associations were analyzed with multivariable Cox regression. Renal endpoints were not systematically collected and were therefore not included as clinical outcome measures.

Results: Among 109 patients (53.2% women), the median baseline RRI was 0.71 (IQR 0.67-0.75) and showed no correlation with eGFR, left-ventricular ejection fraction, or echocardiographic measurements of mitral regurgitation at baseline. Higher RRI was associated with all-cause mortality, and in exploratory post hoc analyses an RRI cutoff > 0.70 remained predictive independent of baseline renal function (HR 5.37, p 0.07). RRI improved significantly 3 months after M-TEER (0.67; IQR 0.63-0.70; p < 0.001), particularly in patients with a post-procedural MR reduction of at least 1 grade. However, the change in RRI showed no correlation with mortality or changes in renal function.

Conclusions: A baseline RRI above 0.70 was independently associated with mortality following M-TEER, underscoring its potential prognostic relevance. The marked post-procedural decline in RRI, especially in patients with relevant MR improvement, suggests that RRI reflects hemodynamic rather than renal filtration changes. Given the limited sample size and number of events, these findings should be considered exploratory and hypothesis-generating, requiring validation in larger multicenter cohorts.

Dyslipidaemia, especially elevated low-density lipoprotein cholesterol (LDL-C), is a major modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD). Dyslipidaemia remains underdiagnosed and undertreated. Dyslipidemia is highly prevalent in Germany. Even among patients with high- and very-high cardiovascular risk, LDL-C targets are often not achieved. This paper highlights key lipid parameters beyond LDL-C, such as triglycerides and lipoprotein(a), which contribute to residual cardiovascular risk. Practical guidance to address diagnostic challenges and cardiovascular risk assessment, especially in younger adults and those with risk modifiers, is provided. Lifestyle interventions are the basis of therapy. Statins remain the first-line treatment, with additional options including ezetimibe, bempedoic acid, and PCSK9 inhibitors, alone or in combination. Novel lipid-lowering therapies are currently in development and may offer more individualized treatment options in the future. The most important messages from the 2025 Focused Update of the 2019 ESC/EAS guidelines for the management of dyslipidaemias have been incorporated into the paper. While LDL-C targets remain unchanged, important novel recommendations encompass consideration of cardiovascular risk modifiers such as lipoprotein(a) and CRP/inflammatory diseases. A second important new recommendation is the use of potent early combination therapy after an acute coronary syndrome. Improved awareness, early diagnosis, and evidence-based lipid management are critical for reducing ASCVD burden. This paper is aimed at supporting clinicians in optimizing lipid diagnostics and therapy in daily practice.

Background: Cardiovascular disease (CVD) is a leading cause of death globally, especially in the aging population. As a novel biomarker integrating inflammation and metabolic dysregulation, the C-reactive protein-triglyceride glucose index (CTI) may offer superior risk stratification, but its prognostic value for mortality in the elderly remains unclear.

Methods: This multi-cohort retrospective study analyzed data from the NHANES (1999-2010), the CHARLS, and the regional Gaoyou datasets, focusing on participants aged ≥ 60 years. Associations between CTI quartiles and all-cause/cardiovascular mortality were assessed using Cox proportional hazards models, Kaplan-Meier curves, and restricted cubic splines. The predictive performance of CTI was compared with other metabolic indices (TyG, TyG-WC, etc.) using time-dependent ROC curves and net reclassification improvement (NRI).

Results: Among 11,619 elderly participants, higher CTI levels were significantly associated with increased risks of all-cause and cardiovascular mortality across all three cohorts after full adjustment. A J-shaped nonlinear relationship was identified with an inflection point at CTI = 8.31, and subgroup analyses confirmed consistency across most strata. CTI demonstrated superior predictive performance for mortality (AUCs: 0.8445 for all-cause mortality and 0.8208 for cardiovascular mortality) and significantly improved risk reclassification (NRI > 0, p < 0.05) compared with other indices. The effectiveness of the prediction models was respectively verified in different Chinese databases. Sensitivity analyses on dynamic changes indicated that elevated trajectory of CTI represented higher mortality.

Conclusion: Elevated CTI is a robust and independent predictor of all-cause and cardiovascular mortality in the elderly populations of both the USA and China. Its integration into clinical practice could enhance early risk stratification and guide targeted interventions to mitigate mortality risk in aging adults.

Aim: To compare the reproducibility in reporting of coronary computed tomography angiography (CCTA) or cardiovascular magnetic resonance imaging (CMR) by certified readers for CCTA and CMR by the German Society of Cardiology (DGK) versus that by non-certified readers.

Methods: The study included 40 randomly selected CCTA and vasodilator stress CMR patient datasets. For CCTA, the degree of lumen narrowing, plaque composition, and high-risk plaque features were assessed. For CMR, wall motion and perfusion abnormalities and late gadolinium enhancement (LGE) were rated. All measures were conducted by segments and for individual patients. Intraclass correlation coefficients (ICC) were calculated to assess agreement between non-certified (n = 4) vs. DGK-certified readers (n = 4).

Results: ICC for assessment of luminal narrowing, plaque composition, and high-risk features were, respectively, 0.65 (95% confidence intervals [CI] 0.59-0.69), 0.64 (95%CI 0.45-0.80), and 0.45 (95%CI 0.22-0.66) for non-certified versus 0.78 (95%CI 0.74-0.81), 0.88 (95%CI 0.79-0.93), and 0.89 (95%CI 0.81-0.95) for DGK-certified readers (p < 0.001 for all). ICC for the assessment of wall motion, perfusion, and LGE were, respectively, 0.41 (95%CI 0.35-0.48), 0.27 (95%CI 0.18-0.38), and 0.48 (95%CI 0.41-0.54) for non-certified versus 0.71 (95%CI 0.67-0.75), 0.71 (95%CI 0.67-0.75) and 0.67 (95%CI 0.62-0.71) for DGK-certified readers (p < 0.001 for all). The agreement was excellent among DGK-certified readers for obstructive CAD (≥ 70% lumen narrowing) assessed by CCTA and high for abnormal perfusion and for LGE by CMR in a per-patient analysis (0.88; 95%CI 0.79-0.94 and 0.84; 95%CI 0.71-0.92), respectively.

Conclusion: Substantially better CCTA and CMR reporting was observed for DGK-certified cardiologists, who achieved high agreement for diagnosing the presence or absence of obstructive CAD by CCTA and abnormal perfusion by CMR. Since important clinical decisions may be based on these readings, our data support quality-controlled education programs for advanced cardiac imaging.

Background: Coronary chronic total occlusion (CTO) is a common cause of refractory angina, and impaired quality of life. Coronary sinus reducer (CSR) implantation is a safe and effective therapy for patients with refractory angina.

Aim: To evaluate the clinical efficacy of reducer implantation to relieve angina in patients with CTO.

Methods: Patients with refractory angina and no option for revascularization who underwent Reducer implantation between 2011 and 2023 were included. Angina symptoms, physical capacity, and quality of life were evaluated at baseline, 6 months, and 1 year following reducer implantation. Clinical outcomes were compared between patients with and without CTO.

Results: Overall, 262 patients (70 ± 11 years old, 24% female) underwent reducer implantation, and 131 (50%) had CTO. Among the entire population, 77% of patients had improvement of at least 1 CCS class following reducer implantation, and 42% reported improvement of ≥ 2 grades of CCS at 1 year. Median 6MWT increased from 300 m (IQR 218-382) to 358 m (IQR 275-419) 6 months following reducer implantation, and all 5 domains of the SAQ improved (p < 0.001 for all). The degree of improvement in angina severity as well as in quality of life was similar for patients with and without CTO except for better improvement in 6MWT distance among patients without CTO. Patients with CTO of the right coronary artery showed similar improvement following reducer implantation.

Conclusions: Reducer implantation is similarly beneficial for patients with refractory angina due to both CTO and non-CTO lesions. Randomized prospective studies are needed to evaluate the optimal therapeutic approach in these patients.