Clinical Research in Cardiology最新文献

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.

Background: Ultrasound-assisted catheter-directed thrombolysis (USAT) is a treatment option for patients with intermediate-high- or high-risk pulmonary embolism (PE). This study aimed to describe the use of USAT and its clinical outcomes.

Methods: In this single-center retrospective cohort study, all USAT procedures performed between May 2019 and June 2022 were included. Data were collected from electronic health records. The primary outcome was reduction in right vs. left ventricular diameter (RV/LV ratio). Secondary outcomes were in-hospital mortality and bleeding.

Results: A total of 107 patients underwent USAT for PE. The median age was 64 (IQR 53-75) years and 59% were male. Technical success of USAT was achieved in 105 (98%) cases. In 32 cases data on RV/LV ratio changes were available. RV/LV ratio decreased by 0.29 ± 0.19 from 1.19 (1.02-1.35) to 0.89 (0.78-1.00). 12 (11%) patients had a fatal outcome. Bleeding complications were observed in 28 (26%) patients, including 14 (13%) major bleedings and 0 (0%) fatal. Both, death and bleeding rates were significantly higher in high-risk patients.

Conclusion: We observed a high technical success of USAT in patients with intermediate-high- and high-risk pulmonary embolism, along with a significant early reduction of RV/LV ratio following treatment.

Background: The role of atherosclerosis in pulmonary embolism (PE) prognosis remains uncertain. Our study assesses characteristics and outcomes of acute PE patients according to the presence and extent of atherosclerotic disease.

Methods: Using data from the RIETE registry, acute PE patients were classified into three groups based on personal history: (1) polyvascular atherosclerosis, (2) single vascular atherosclerosis, and (3) no symptomatic atherosclerosis. Primary outcomes included recurrent PE and venous thromboembolism (VTE), arterial events, major bleeding, and all-cause death. Hazard ratios (HR) and Kaplan-Meier curves for clinical outcomes were estimated using Cox regression models.

Results: Among 47,578 acute PE patients, 1,040 had polyvascular, 6,191 single-vascular, and 40,347 no atherosclerosis. During a median follow-up of 331 days, Adverse outcomes were more frequent in patients with atherosclerosis (vs. no atherosclerosis), rising with the number of affected vascular territories. Recurrent PE rates were 2.8, 1.6, and 1.2 per 100 patient-years in the polyvascular, single-vascular, and no atherosclerosis groups. Multivariable analysis showed a dose-dependent relationship between atherosclerosis and recurrent PE risk, with HRs of 3.2 (95% CI 1.7-5.9) and 1.6 (95% CI 1.1-2.3) for polyvascular and single-vascular disease (vs. no atherosclerosis). The risk of all-cause death followed a similar trend, with HRs of 1.3 (95% CI 1.1-1.6) and 1.2 (95% CI 1.1-1.4), respectively. Major bleeding appeared to be influenced by overall health status and antithrombotic therapy intensity.

Conclusion: Atherosclerosis in acute PE patients may serve as a marker of disease severity and lead independently to adverse outcomes, highlighting the importance of cardiovascular risk stratification.

Background: Bacterial infections are a serious global health problem, especially for older and critically ill patients, who are at increased risk of complications and mortality. Traditional tools like APACHE II and SOFA scores are widely used to predict outcomes in sepsis, but recent attention has focused on the right heart function-specifically, the tricuspid annular plane systolic excursion (TAPSE)-as a simple, bedside marker with potential prognostic value.

Objective: This systematic review and meta-analysis aimed to explore the prognostic value of TAPSE in patients with sepsis or septic shock, focusing on its predictive ability compared to established clinical indices such as APACHE II, SOFA and left ventricular ejection fraction (LVEF).

Methods: A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library and Web of Science up to April 2025. Studies assessing TAPSE in septic patients were included according to predefined criteria. Data on mortality, TAPSE, APACHE II, SOFA and LVEF were extracted and analyzed. Study quality was assessed using the Newcastle-Ottawa Scale.

Results: Ten studies with a total of 1812 patients have been included. The analysis revealed that lower TAPSE values were significantly associated with higher mortality (mean difference -0.50 cm; 95% CI: -0.57 to -0.43; p < 0.00001). Similarly, APACHE II scores were higher in non-survivors (mean difference 4.62; 95% CI: 3.17 to 6.07; p < 0.00001). In contrast, LVEF showed no significant correlation with mortality (mean difference -1.46; p = 0.20). Despite variability among studies, the prognostic value of TAPSE remained consistently evident.

Conclusions: TAPSE emerges as a practical, non-invasive tool for assessing right ventricular function and predicting mortality in patients with sepsis. Its simplicity and bedside availability make it a valuable complement to traditional severity scores like APACHE II. Unlike LVEF, which appears less informative in this setting, TAPSE could enhance early risk stratification and guide clinical decision-making, particularly in vulnerable populations such as the elderly and critically ill.