Clinical Research in Cardiology最新文献

Background

Patients undergoing transcatheter aortic valve implantation (TAVI) for bicuspid aortic stenosis (AS) frequently present with ascending aortic (AAo) dilatation which is left untreated. The objective of this study was to study the natural progression and underlying mechanisms of AAo dilatation after TAVI for bicuspid AS.

Methods

Patients with a native bicuspid AS and a baseline AAo maximum diameter > 40 mm treated by TAVI and in whom post-TAVI computed tomography (CT) scans beyond 1 year were available were included. AAo dilatation was deemed to be either continuous (≥ 2 mm increase) or stable (< 2 mm increase or decrease). Uni- and multivariate logistic regression analysis was utilized in order to identify factors associated with continuous AAo dilatation post-TAVI.

Results

A total of 61 patients with a mean AAo maximum diameter of 45.6 ± 3.9 mm at baseline were evaluated. At a median follow-up of 2.9 years, AAo dimensions remained stable in 85% of patients. Continuous AAo dilatation was observed in 15% of patients at a rate of 1.4 mm/year. Factors associated with continuous AAo dilatation were raphe length/annulus mean diameter ratio (OR 4.09, 95% CI [1.40–16.7], p = 0.022), TAV eccentricity at the leaflet outflow level (OR 2.11, 95%CI [1.12–4.53], p = 0.031) and maximum transprosthetic gradient (OR 1.30, 95%CI [0.99–1.73], p = 0.058).

Conclusions

Ascending aortic dilatation in patients undergoing TAVI for bicuspid AS remains stable in the majority of patients. Factors influencing TAV stent frame geometry and function were identified to be associated with continuous AAo dilatation after TAVI; this should be confirmed in future larger cohort studies.

Graphical Abstract

Background

Ferritin is commonly used to evaluate iron stores and guide therapeutic decisions regarding intravenous iron supplementation. However, in the context of AHF, inflammation-driven upregulation of ferritin might disrupt its correlation with iron stores, restricting iron bioavailability and potentially amplifying the inflammatory response.

Aim

This study aims to assess the clinical and prognostic associations of ferritin levels in an AHF cohort and to determine whether the prognostic value of ferritin is influenced by the presence of infection, inflammatory activation, and other markers of iron deficiency.

Methods

The association between ferritin and clinical outcomes (180 days) in AHF was evaluated in a cohort of 526 patients from the EDIFICA registry.

Results

The median ferritin plasma concentration at admission was 180 pg/mL. Patients with higher ferritin levels at admission were predominantly men, exhibiting a high prevalence of chronic kidney disease and alcohol consumption, and presenting with lower blood pressure and a higher incidence of clinical infection. Higher ferritin levels were associated with increased risk of the composite of heart failure hospitalization or cardiovascular death (Tertile 2: HR 1.75; 95% CI 1.10–2.79; p = 0.017; Tertile 3: HR 1.79; 95% CI 1.08–2.97; p = 0.025), independently of classical HF prognostic factors, inflammatory and iron-related markers. No significant associations were found between admission serum iron or transferrin saturation tertiles, iron status categories, or guideline-defined iron deficiency (ID) criteria and the primary composite outcome. However, at discharge, patients who met the criteria for defective iron utilization, low iron storage, or guideline-defined ID had a lower risk of the composite endpoint compared to those with normal iron utilization or who did not meet the guideline-defined ID criteria, respectively.

Conclusions

Elevated ferritin levels are independently associated with poor prognosis in AHF. Low ferritin levels are associated with a favorable outcome and do not carry significant value in identifying ID in this population.

Background and aims

The role of biomarkers in diagnosing pulmonary hypertension (PH) and distinguishing between pre- and post-capillary PH remains poorly understood. We aimed to identify biomarkers with a strong association with mean pulmonary arterial pressure, mPAP (PH diagnosis) and pulmonary vascular resistance, PVR (pre-capillary component), but not with pulmonary arterial wedge pressure, PAWP (post-capillary component).

Methods

Blood samples were collected in patients undergoing right heart catheterization within a prospective cross-sectional study. Biomarkers measured included BMP10, NT-proBNP, ANG2, ESM1/endocan, FGF23, GDF15, IGFBP7, IL6, MyBPC3, proC3, and proC6/endotrophin. Primary outcomes were mPAP, PVR, and PAWP, while secondary outcomes included PH diagnosis (mPAP > 20 mmHg) and elevated PVR (> 2 Wood units). Multivariable linear and logistic regression models were used to assess the relationship between biomarkers and outcomes.

Results

Of the 127 patients included (age 66 ± 13 years, 54% female), 73% were diagnosed with PH. BMP10, NT-proBNP, ANG2, MyBPC3, and FGF23 showed a strong association with mPAP (p < 0.001). BMP10 and NT-proBNP were strongly associated with PVR (p < 0.001), while NT-proBNP and ANG2 were strongly associated with PAWP (p < 0.001). NT-proBNP had the strongest association with the diagnosis of PH (area under the curve = 0.76). BMP10 was the only biomarker associated with elevated PVR (OR 1.60, 95%CI 1.01–2.54, p = 0.04) but not with PAWP (p = 0.86).

Conclusions

Several biomarkers were strongly associated with mPAP, PAWP, and PVR. BMP10 was the only biomarker strongly associated with mPAP and PVR, but not with PAWP, thus reflecting the pre-capillary PH component. Measurement of BMP10 along with NT-proBNP may aid in diagnosing PH.

Graphical abstract

Background

Distal radial access (DRA) represents a promising alternative to conventional proximal radial access (PRA) for coronary angiography. Substantial advantages regarding safety and efficacy have been suggested for DRA, but the ideal access route remains controversial.

Aims

The aim of this study was to compare safety, efficacy and feasibility of DRA to PRA.

Methods

National Library of Medicine PubMed, Web of Science, clinicaltrials.gov and Cochrane Library were systematically searched for randomized controlled trials and registry studies comparing DRA and PRA that were published between January 1, 2017 and April, 2024. Primary endpoint was the rate of radial artery occlusion (RAO). Secondary endpoints were access failure, access time, procedure time, arterial spasm, hematoma, and hemostasis time. Data extraction was performed by two independent investigators. Relative risks were aggregated using a random effects model. We applied meta-analytic regression to assess study characteristic variables as possible moderators of the study effects.

Results

44 studies with a total of 21,081 patients were included. We found a significantly lower rate of RAO after DRA (DRA 1.28%, PRA 4.76%, p < .001) with a 2.92 times lower risk compared to the proximal approach (Log Risk Ratio = −1.07, p < .001). Conversely, the risk for access failure was 2.42 times higher for DRA compared to PRA (Log Risk Ratio = 0.88, p < .001).

Conclusion

In this largest meta-analysis to date, we were able to show that rates of RAO are reduced with DRA compared to conventional PRA. This suggests DRA is a safe alternative to PRA.

Graphical abstract

Background and aims

Currently, the influence of metabolic syndrome (Mets) on the plaque characteristics and prognosis of patients with acute coronary syndrome (ACS) is poorly understood. Thus, the study aimed to characterize the pancoronay plaques of ACS patients with Mets using optical coherence tomography (OCT) and to evaluate the cohort’s prognosis.

Methods

Between February 2015 and September 2020, 745 ACS patients who underwent OCT imaging of the three coronary arteries were included, divided into Mets (n = 252) and non-Mets (n = 493) groups. The major adverse cardiovascular event (MACE) was a composite of cardiac death, non-fatal myocardial infarction (MI), and revascularization.

Results

Compared to the non-Mets group, the Mets group exhibited a higher proportion of females and cases of multivessel disease. In the Mets group, culprit lesions were found to have a greater degree of stenosis, thinner fibrous cap thickness and more thin-cap fibroatheroma (TCFA). Additionally, nonculprit lesions were more likely to exhibit plaque rupture, high-risk plaque characteristics, TCFA, macrophage infiltration, cholesterol crystals, and layered plaque. After a median follow-up of 2 years, 8.3% of patients experienced MACE, a rate that was higher in the Mets group, primarily attributed to non-fatal myocardial infarction and cardiac death. Multivariate analysis showed that Mets (aHR 1.73, p = 0.037), high-risk plaque (aHR 2.63, p < 0.001), age (aHR 1.03, p = 0.020), and left ventricular ejection fraction (aHR 0.96, p = 0.002) were independent predictors of MACE.

Conclusions

The presence of Mets increased the vulnerability of the entire coronary tree and worsened the prognosis for patients with ACS.

Graphical abstract

Abstract

Blood pressure (BP) variability (BPV) is associated with an increased risk of cardiovascular events, independent of absolute BP values. However, the predictive significance of very short-term BPV, occurring within seconds or minutes, in patients with ischemic heart disease (IHD) has yet to be established. This prospective study involved 206 consecutive hospitalized patients with IHD (mean age 67.6 years, 78.2% male) who underwent pulse transit time (PTT)-based continuous BP recording during the night-time. Very short-term BPV was assessed by standard deviation (SD), coefficient of variation (CV), and variation independent of mean (VIM) of PTT-BP. Clinical outcome data were collected. When the patients were categorized into two groups according to the median value of very short-term BPV, Kaplan–Meier analysis revealed that patients with elevated SD, CV, and VIM of systolic and diastolic PTT-BP were associated with lower event-free survival rates from the composite cardiovascular events including cardiac deaths, worsening heart failure cases, nonfatal myocardial infarctions, unplanned revascularizations, and strokes over a median follow-up of 797 days. In a multivariate Cox proportional hazards analysis adjusting for confounding variables, each parameter as a continuous variable was independently associated with adverse events. Incorporating very short-term BPV into basic models had a significant impact on risk reclassification and integrated discrimination for cardiovascular outcomes. In conclusion, the identification of patients with elevated very short-term BPV during the night-time through a PTT-driven approach helps stratify the future risk in IHD patients.

Graphical Abstract

Background

Empagliflozin administered after acute myocardial infarction proofed to improve cardiometabolic parameters and biomarkers, but the impact on cardiac function is still largely unknown. The aim of this post-hoc echocardiographic sub-analysis of the EMMY trial was to provide in-depth echocardiographic analysis on the effects of empagliflozin versus placebo on standard and novel echocardiographic structural and functional parameters after acute myocardial infarction.

Methods

In this post-hoc analysis of the EMMY trial a subset of 313 patients (157 empagliflozin vs. 156 placebo) was enrolled for post-processing analysis of echocardiographic structural and functional parameters. On top of two-dimensional and Doppler parameters, myocardial deformation analyses were performed to assess ventricular and atrial strain values.

Results

Left ventricular volumes showed significant differences in favor of empagliflozin over the course of the trial (change in left ventricular end-diastolic volume median [interquartile range] 8 [−3;19]% versus 13 [0;29]%, p = 0.048; left ventricular end-systolic volume −3 [−15;12]% versus 4 [−12;18]%, p = 0.044). This effect persisted after adjusting for baseline values, age, and sex. Left ventricular systolic and diastolic function overall improved over the course of the trial and parameters for diastolic function showed a distinct trend between groups but did not meet statistical significance in this cohort.

Conclusion

In this post-hoc analysis among patients with acute myocardial infarction, treatment with empagliflozin resulted in a significant beneficial effect on left ventricular end-diastolic and end-systolic volume, without significantly improving left ventricular or right ventricular functional parameters compared to placebo after 26 weeks.

ClinicalTrials.gov registration

NCT03087773.

Graphical abstract

Background

Left ventricular thrombus (LVT) is associated with high rates of systemic embolism. Vitamin K antagonists (VKAs) are the only approved treatment for LVT. Although evidence suggests direct oral anticoagulant (DOACs) to be at least equally effective in general, the efficacy of individual DOACs remains unclear.

Methods

A literature search was performed in EMBASE, MEDLINE and Web of Science looking for randomized controlled trials (RCTs) and non-randomized controlled studies of interventions (NRSI) comparing individual DOACs to VKAs for the treatment of LVT. Individual patient data was reconstructed and incorporated in a Bayesian network meta-analysis (NMA) and a Cox frailty regression model.

Results

A total of 2545 patients across 19 studies (4 RCTs, 15 NRSI) were included. 1738 received VKAs, 581 received Rivaroxaban, 226 received Apixaban, 82 received Dabigatran and 2 received Edoxaban. LVT resolution was less likely with VKAs compared to Rivaroxaban in the time-to-event analysis (HR 0.66, 95% CI [0.49; 0.91], p = 0.01). There was no difference for other DOACs compared to VKAs. Rivaroxaban reduced ischemic stroke compared to VKAs (OR 0.18, 95% CrI [0.05; 0.49]), other DOACs did not.

Conclusion

In this NMA, Rivaroxaban showed faster LVT resolution and consecutively lower odds of ischemic stroke than VKAs while Apixaban and Dabigatran showed at least equal efficacy. Given the quality and size of the available studies, these differences between individual DOACs should be acknowledged as hypothesis generating only. Future adequately powered randomized controlled trials are needed to assess possible time-varying effects between individual DOACs.

Background

A variety of health-related mobile applications (apps) and wearables often encompass a narrow application area. Our study therefore aims to provide the basis for the development of an app that comprehensively assists patients to deal with their disease in the best possible way and that improves the course of the disease in the long term.

Methods

We conducted a multicenter analysis of patients using a questionnaire study at two German clinics and surveyed 100 patients with cardiovascular disease. For the analysis of the interviews, particularly Likert scales were used.

Results

24.0% were female, median age was 62.5 years. Leading causes for hospitalization were coronary artery disease (40.0%) and heart failure (22.0%). The most frequent pre-existing conditions were arterial hypertension (55.0%), atrial fibrillation or atrial flutter (31.0%), and again coronary artery disease (31.0%). Typical disease associated feelings were fear for life (43.0%) and uncertainty (43.0%). When considering future management of the disease, 75.0% felt motivated, 70.0% felt confident, and 68.0% felt hopeful. Of the patients surveyed, 60.0% indicated a willingness to use the app and another 24.0% were potentially willing to do so. Furthermore, significantly more patients < 63 years stated a willingness or potential willingness to use the app (p = 0.029). For those considering an app usage in general, the most favoured features were a document management (81.8%) and a medication management (65.9%). While only 36.4% indicated that the app could at least partially alleviate their worries, 94.3% expected a reduction in organizational effort. With respect to age groups, there was no significant difference (organizational effort: p = 0.239; worries: p = 0.275).

Conclusions

Particularly younger patients < 63 years with cardiovascular disease show a substantial willingness to use an app as a special health support, particularly in terms of document and medication management. They especially hope for a reduction in organizational effort.

Graphical abstract