Clinical Research in Cardiology最新文献

Background and aims: Tissue remodelling and extracellular matrix (ECM) changes are primary consequences of ST-elevated myocardial infarction (STEMI), leading to an increased risk of developing heart failure and mortality. Collagen type I is the top constituent of the cardiac ECM and is rapidly degraded at sites of tissue injury occurring in STEMI. We aimed to investigate the prognostic potential of a novel biomarker of a collagen type I-derived signalling peptide (C1SIG) shown to be involved in left ventricular remodelling after MI and compare this against another collagen type I fragment quantified by the established C1M assay in a large STEMI cohort.

Methods: Plasma C1SIG and C1M were quantified using specific enzyme-linked immunosorbent assays in 1616 individuals upon admittance to hospital with STEMI. Patients were then followed up for all-cause mortality over 1 year, and survival analyses were performed.

Results: Short-term biomarker changes assessed in a subgroup (n = 140) showed increased circulating C1M and C1SIG in the short period from admission with STEMI up to 12 h post-admission (both, p < 0.0001). High C1M levels, defined by the highest quartile, and high C1SIG levels, defined by the median, were associated with reduced survival probability at 1 year (both, p < 0.0001) post-admission. The association was further supported in univariate and maintained for C1M only in multivariate Cox proportional hazard regression models adjusted for multiple confounders (HR [95% CI] 1.46 [1.15-1.85]). Added value analysis determined the additional predictive value of C1M to the clinically used GRACE risk score for cardiovascular event prediction (p = 0.0002).

Conclusion: C1M and C1SIG are dynamic biomarkers of collagen type I degradation, where C1SIG is also suspected to be a collagen signal. C1M is an independent predictor of all-cause mortality within a year of a MI.

Objectives: To investigate the long-term outcomes and risk factors for morbidity and mortality in patients with Ebstein's anomaly, including the effects of type and timing of valve surgery.

Methods: For this retrospective, record-based study, all patients with Ebstein's anomaly enrolled in the German National Register for Congenital Heart Defects up to June 2021 were eligible for inclusion.

Results: Non-surgical patients (n = 194/49% of 398 patients) had less tricuspid valve regurgitation (p < 0.001) and heart failure symptoms (p < 0.001) than surgical patients (n = 204/51%). Postoperative survival at 10, 20, and 30 years was 97%, 93%, and 80%. Eighty-one (40%) patients underwent multiple surgeries. Re-operation rates were lowest in patients with first valve surgery during adolescence (p = 0.0076). Postoperative NYHA class > I was more frequent with surgery delayed to older age (p < 0.001). Initial corrective surgery was complicated by complete atrioventricular block (CAVB) in 17 (9%) of patients. CAVB was more likely with older age (p = 0.001), and tricuspid valve replacement compared to reconstruction (p = 0.029). CAVB was associated with all-cause death (p < 0.001). Cone reconstruction reduced the risk of CAVB (p = 0.008) and tricuspid valve regurgitation (p < 0.001) compared to monocusp reconstruction.

Conclusions: This registry-based study of Ebstein's anomaly corroborates good surgical long-term results, while re-operation rates remain high. Patients operated before adolescence were at the highest risk of re-operation, while older age at the time of the first surgery increased the risk of CAVB. The cone reconstruction was associated with improved tricuspid valve function and a lower risk of CAVB compared to monocusp reconstructions. Choosing an optimal time window for surgery and use of the cone reconstruction may therefore further improve outcomes.

Background: Heart failure with reduced ejection fraction (HFrEF) causes reduced functional capacity, impaired quality of life, and frequent rehospitalisation. Although guidelines recommend cardiac rehabilitation (CardRehab), referral rates remain low. The MEDIAN Heart Failure Registry evaluated short- and midterm outcomes of inpatient CardRehab in routine practice.

Methods: A prospective multicentre registry included 808 patients with clinically stable HFrEF (LVEF ≤ 40%) undergoing inpatient cardiac rehabilitation across 17 German centres (2019-2020). Clinical outcomes-6-min walk test, bicycle ergometry, echocardiographic LVEF, NYHA class, NT-proBNP (subset), and patient-reported outcomes (KCCQ, HADS)-were assessed at admission, discharge, and 6 months post-discharge. A structured follow-up survey evaluated adherence to lifestyle changes and the sustainability of effects after the 22.8-day inpatient stay.

Results: A total of 808 patients (mean age, 65 years; 16.6% females) showed significant improvements in physical and psychosocial parameters. Mean LVEF increased from 31.1% (SD 9.0) to 35.9% (SD 10.7; p < 0.01), mean 6-min walk distance from 306 m (SD 136) to 388 m (SD 158; p < 0.01), and mean bicycle ergometry from 27.8 W (SD 15.4) to 49.5 W (SD 26.4; p < 0.01). Mean NT-proBNP decreased (p < 0.01). KCCQ and HADS scores improved significantly. Inpatient mortality rate during rehabilitation was 0.6% (5/808), and the rehospitalisation rate due to heart failure was 2.8% (23/808). There were two documented cancellations of rehabilitation. At 6-month follow-up, benefits remained stable with high adherence to recommended behaviours.

Conclusions: Cardiac rehabilitation was associated with improvements in physical capacity, left ventricular function, psychological well-being, and quality of life in patients with chronic heart failure, alongside low observed rehospitalisation rates during follow-up.

Background: Structural remodeling of the left atrium contributes to the progression of heart failure (HF), even in the absence of atrial fibrillation (AF). However, the underlying mechanisms and extent of atrial remodeling across the spectrum of left ventricular ejection fraction (LVEF) remain poorly defined. This study aimed to characterize anatomical and functional left atrial changes using multimodal imaging and biomarker profiling in patients with HF without AF.

Methods: A total of 264 ambulatory patients with HF and no prior AF, all under continuous rhythm monitoring, were prospectively studied. All underwent transthoracic echocardiography with functional analysis of the left atrium and plasma biomarker assessment. Patients were classified according to LVEF into three groups: preserved, mildly reduced, and reduced. Correlations between echocardiographic parameters and circulating biomarkers were analyzed.

Results: Patients with reduced LVEF showed larger atrial volumes, lower reservoir strain, impaired conduit function, and higher atrial stiffness. Biomarker profiling revealed increased levels of natriuretic peptides and extracellular matrix proteins, along with moderate elevations in inflammation-related markers. Atrial strain was significantly correlated with markers of fibrosis, inflammation, and wall stress, particularly in patients with lower LVEF.

Conclusions: In patients with HF without AF, the severity of atrial remodeling increases as LVEF declines and aligns with biomarkers of hemodynamic overload and fibrosis. The integration of imaging and molecular parameters may improve risk stratification and phenotyping in HF.

Background: In 2022, the definition of pulmonary hypertension (PH) in the presence of left heart disease was updated according to the new joint guidelines of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). The impact of the new ESC/ERS definition on the prevalence of post-capillary PH (pc-PH) and its subgroups of isolated post-capillary (Ipc-PH) and combined pre- and post-capillary PH (Cpc-PH) in patients with left heart disease is unclear.

Methods: We retrospectively identified N = 242 patients with left heart disease with available data on right heart catheterisation (RHC) and cardiac magnetic resonance imaging (CMR). The proportion of pc-PH and its subgroups was calculated according to the old and new ESC/ERS PH definition. As the old definition did not allow the exact allocation of all patients with pc-PH into a respective subgroup, unclassifiable patients (Upc-PH) were regarded separately.

Results: Seventy-six out of 242 patients had pc-PH according to the new ESC/ERS definitions, with 72 of these patients also meeting the criteria of the old definition. Using the old definition, 50 patients were diagnosed with Ipc-PH, 4 with Cpc-PH, and 18 with Upc-PH. Applying the new definition, Ipc-PH was diagnosed in 35 patients (4 newly), and Cpc-PH in 41 patients. No CMR parameter allowed differentiating between Ipc-PH and Cpc-PH, regardless of which guideline version was used.

Conclusion: Applying the new ESC/ERS 2022 guideline definitions mildly increased the proportion of patients diagnosed with pc-PH (+ 5.5%) but markedly increased Cpc-PH diagnoses. This effect was driven by the allocation of patients with formerly unclassifiable forms of post-capillary PH to the Cpc-PH subgroup and a significant shift of patients from the Ipc-PH to the Cpc-PH subgroup.

Objectives: To delineate the effects of exposure to air pollution on the risk of venous thromboembolism (VTE).

Background: The association between air pollution and arterial occlusive diseases has been well reported in the literature. VTE is the third most common acute cardiovascular syndrome; however, its relationship with exposure to air pollution has been controversial.

Methods: This study linked data from the Taiwan National Health Insurance Research Database with that from the Taiwan Environmental Protection Administration. Patients who were first admitted for VTE between January 1, 2001, and December 31, 2013, were analyzed. A time-stratified, case-crossover design was employed. Three different exposure periods were defined: exposure for 1 month, one quarter, and 1 year. Four control periods were designated for each exposure period. The association between exposure to air pollutants and the risk of VTE was tested using logistic regression analysis. Subgroup analyses were also performed, stratified by age, sex, type of VTE, the use of hormone therapy, and level of urbanization at the site of residence.

Results: Exposures to particulate matter (PM) smaller than 2.5 µm (PM_2.5) and those smaller than 10 µm (PM₁₀) were associated with higher risks of VTE, with longer exposures associated with higher risk. The concentration of PM_2.5 exposure for 1 month was linearly associated with a greater risk of VTE up to 28.0 µg/m³, beyond which there was no association. PM_2.5 exposure for one quarter or 1 year remained significantly associated with higher risks of VTE at higher concentrations. The increased risk in VTE associated with exposure to PM_2.5 was more prominent in older patients and in patients not under hormone therapy. Similar results were observed for PM₁₀ exposures.

Conclusions: Exposure to PM, particularly PM_2.5, leads to an increased risk of VTE, with possible accumulative effects. With increased PM production in industrializing countries, the effects of PM on VTE occurrence warrant further attention.

Congenital pericardial defects (CPDs) are rare congenital abnormalities characterized by the complete or partial absence of the pericardium. They are often asymptomatic and discovered incidentally through imaging. Some individuals can experience non-specific symptoms, whilst others can have serious complications. The gold standard for diagnosing pericardial defects is cardiac MRI. Management is case-dependent and usually reserved for partial defects. Here, we present a case of a 57-year-old male who presented with recurrent chest pain and was found to have partial pericardial defect, a diagnosis missed on prior imaging, and discuss the diagnosis and management.

Background and aims: Transient increases (overshoot) in respiratory gas analyses have been observed during exercise recovery, but their clinical significance is not clearly understood. An overshoot phenomenon of the respiratory exchange ratio (RER) is commonly observed during recovery from maximal cardiopulmonary exercise testing (CPET), but it has been found reduced in patients with heart failure with reduced ejection fraction (HFrEF). The aim of the study was to analyze the clinical significance of these RER recovery parameters and to understand if these may improve the risk stratification of patients with HFrEF.

Methods: This cross-sectional study includes HFrEF patients who underwent functional evaluation with maximal CPET for the heart transplant checklist at our Sports and Exercise Medicine Division. RER recovery parameters, including RER overshoot as the percentual increase of RER during recovery (RER mag), have been evaluated after CPET with assessment of hard clinical long-term endpoints (MACEs/deaths and transplant/LVAD-free survival).

Results: A total of 190 patients with HFrEF and 103 controls were included (54.6 ± 11.9 years; 73% male). RER recovery parameters were significantly lower in patients with HFrEF compared to healthy subjects (RER mag 24.8 ± 14.5% vs 31.4 ± 13.0%), and they showed significant correlations with prognostically relevant CPET parameters. Thirty-three patients with HFrEF did not present a RER overshoot, showing worse cardiorespiratory fitness and efficiency when compared with those patients who showed a detectable overshoot (VO₂ peak: 11.0 ± 3.1 vs 15.9 ± 5.1 ml/kg/min; VE/VCO₂ slope: 41.5 ± 8.7 vs 32.9 ± 7.9; ΔPETCO₂: 2.75 ± 1.83 vs 4.45 ± 2.69 mmHg, respectively). The presence of RER overshoot was associated with a lower risk of cardiovascular events and longer transplant-free survival.

Conclusion: RER overshoot represents a meaningful cardiorespiratory index to monitor during exercise gas exchange evaluation; it is an easily detectable parameter that could support clinicians to comprehensively interpreting patients' functional impairment and prognosis. CPET recovery analyses should be implemented in the clinical decision-making of advanced HF.