Clinical Research in Cardiology最新文献

Background: Atrial fibrillation is associated with cognitive dysfunction. Atrial cardiomyopathy has been correlated with both entities. We aimed to characterize the association of echocardiographic parameters of atrial cardiomyopathy with cognitive function and cerebral changes.

Methods: Participants of the population-based Hamburg City Health Study underwent in-depth transthoracic echocardiography and cognitive function testing, the Animal Naming Test (ANT), the Trail Making Test A (TMT-A) and B (TMT-B), 10-word learning test and cerebral magnetic resonance imaging.

Results: After excluding individuals with stroke or depression, data from 7852 individuals were available. In multi-variable-adjusted regression analyses, the E/e'-ratio was associated with the level of impairment in the ANT (- 0.19 per one standard deviation [SD] increase, 95% confidence interval [CI] - 0.36-[- 0.01]) and the TMT-A (0.01 per one SD increase, 95% CI 0.003-0.020). Left atrial global peak strain was associated with positive performance in the TMT-A and B (-0.01 per one SD increase [95% CI - 0.02-(- 0.002)] and - 0.02 per one SD increase [95% CI - 0.03-(- 0.01)], respectively) and the immediate recall of the 10-word learning test (0.11 per one SD increase, 95% CI 0.02-0.20). The E/e'-ratio was positively associated with the total and periventricular white matter hyperintensity load in age- and sex-adjusted regression analyses though statistical significance was lost after multi-variable adjustment.

Conclusions: Subclinical echocardiographic signs of atrial cardiomyopathy and left ventricular diastolic dysfunction are associated with impaired performance in cognitive tests in the population. Our data provide evidence of the clinically important cardio-cerebral axis, relating cardiac dysfunction with cognitive performance.

Introduction: It is unclear whether the number of sudden cardiac death (SCD) and survived sudden cardiac arrest (SCA) has increased among football players during the COVID-19 pandemic. This study aims to compare the SCD/SCA burden between the pre-pandemic period and COVID-19 pandemic in football players worldwide.

Methods: The COVID-19 pandemic and an equivalent pre-pandemic period (each lasting 1151 days) were analyzed for SCD/SCA by extracting data from the prospective FIFA (Fédération Internationale de Football Association) Sudden Death Registry. Particular focus was placed on cardiac diseases acquired through the novel coronavirus SARS-CoV-2, such as myocarditis and coronary artery disease (CAD), potentially leading to SCD/SCA.

Results: There were 454 SCD/SCA (survival rate: 24%) and 380 SCD/SCA (survival rate: 27%) during the pre-pandemic period and COVID-19 pandemic, respectively (p = 0.27). In the pre-pandemic period, out of 191 confirmed and suspected diagnoses, there were 6 (3%) cases of myocarditis and 69 (36%) cases of CAD and during the pandemic out of 136 confirmed and suspected diagnoses, there was 1 (1%) case of myocarditis and 58 (43%) cases of CAD.

Conclusion: The burden of SCD/SCA, particularly myocarditis and CAD, in football players worldwide seemingly has not been higher during the COVID-19 pandemic than during a comparable period before.

Background: In the past decades, cardiovascular magnetic resonance (CMR) was established as a non-invasive tool supporting the diagnosis of myocarditis and there is often reluctance in performing EMB due to potentially severe complications. We sought to identify patient subgroups that could still benefit from EMB in the CMR era.

Methods: Data of patients presenting with myocarditis between 01/2016 and 06/2023 were analysed according to patient risks. Prespecified risk factors were (i) left ventricular ejection fraction (LVEF) ≤ 30%; (ii) severe arrhythmias; or (iii) pre-existing autoimmune disease. Furthermore, the subgroup of recurrent myocarditis cases was analysed separately.

Results: A total of 137 patients (35.5 ± 14.8 years, 80.3% male) were included. 26/137 patients had a documented LVEF ≤ 30%, 13/137 a LVEF > 30% with at least one other risk factor and 98/137 a LVEF > 30% without risk factors. EMB was performed in 21/26 patients with LVEF ≤ 30% (80.8%), in 7/13 patients with LVEF > 30% and risk factors (53.8%) and in 16/98 (16%) patients without risk factors. EMB led to the initiation of immunosuppressive therapy in 11/28 patients with risk factors (39.3%) and in none of the patients without risk factors (0/16, 0%, p = 0.003). With respect to the subgroup of patients presenting with recurrent myocarditis (n = 10), no specific therapy was initiated.

Conclusions: Due to a high therapeutic yield for initiation of immunosuppressive therapy in non-infectious myocarditis, performing EMB should be considered in all high-risk patients. In patients without clinical risk factors including cases of recurrent or relapsing myocarditis no specific therapy was initiated.

Background: Impaired endothelial function predicts cardiovascular events. The aim of this study was to analyze the effect of evolocumab on endothelial function in patients with cardiovascular disease.

Methods: This was a prospective, double-blinded, randomized, controlled, single center study including patients with cardiovascular disease and treated with statins. Patients were consecutively randomized (1:1) to either evolocumab treatment or placebo. All patients underwent examination of endothelial function at baseline, and after 1, 4 and 8 weeks of treatment by a semi-automatic high-resolution ultrasound system (UNEX EF 18G). Parameters of endothelial function were flow-mediated vasodilation (FMD), low flow-mediated vasoconstriction (L-FMC) and vasoactive range (VAR).

Results: Hundred three patients with a mean age of 66.2 ± 7.7 years and a mean LDL-cholesterol of 98 ± 19.1 mg/dl completed the study. The change in VAR from baseline to week 8 was significantly different with evolocumab compared to placebo (p = 0.045). Moreover, VAR increased after 8 weeks of treatment with evolocumab compared to baseline (p = 0.034). No change has been noticed in FMD and L-FMC after 8 weeks of treatment with evolocumab. In subgroup analyses, VAR improved in patients with age ≤ 67 years, lower systolic blood pressure (≤ 125 mmHg) and higher baseline LDL-cholesterol (> 95 mg/dl), (p = 0.006, p = 0.049 and p = 0.042, respectively) after 8 weeks of evolocumab treatment. No serious adverse event related to study medication occurred during the study.

Conclusion: Our data indicate that endothelial function improved with evolocumab treatment in high-risk patients on statin therapy with preexisting cardiovascular disease. Our results contribute to the mechanistic explanation why lower incidence of the cardiovascular composite endpoint has been demonstrated in the FOURIER study.

Background: The right ventricle to pulmonary artery coupling (RV-PAc) describes the right ventricle's ability to adjust to an increased afterload. In case of transthyretin amyloid cardiomyopathy (ATTR-CM), impaired RV-PAc can result from increased left ventricular diastolic stiffness due to fibril deposition.

Objectives: While RV-PAc is a validated prognostic parameter in pulmonary arterial hypertension (PAH), its prognostic relevance in ATTR-CM remains unknown. We sought to evaluate the prognostic implications of impaired RV-PAc on survival in ATTR-CM.

Methods: In this multicentre study, RV-PAc was investigated by the echocardiographic surrogate of ratio of tricuspid annular plane systolic excursion to estimated pulmonary arterial systolic pressure (TAPSE/PASP) in 418 ATTR-CM patients, all treated with a TTR stabilizer. The primary outcome was all-cause mortality.

Results: Within a median time of 1.52 [IQR 0.72-2.56] years after diagnosis, 49 (11.7%) patients died. In multivariate Cox regression analysis impaired RV-PAc was a strong independent predictor of mortality (Hazard Ratio (HR) 2.16, 95% Confidence Interval (CI) 1.14-4.07, p = 0.018). RV-PAc ratio at first presentation emerged as a robust marker for risk stratification with a determined optimal cut-off of 0.382 mm/mmHg (area under the curve (AUC) 0.73, 95% CI 0.65-0.81). Patients with RV-PAc ratio ≤ 0.382 mm/mmHg exhibited significantly lower survival (HR 4.17, 95% CI 2.21-7.87, p < 0.001) within 3 years of follow up than those with RV-PAc ratio above the cut-off (Graphical Abstract).

Conclusion: Impaired adaptation of the RV to increased afterload is associated with worse outcome in ATTR-CM patients. RV-PAc ratio can serve as an echocardiographic predictor for all-cause mortality. Therefore, the determination of RV-PAc could improve risk stratification for ATTR-CM patients.

Aim: Delirium in patients treated in the intensive care unit (ICU) is linked to adverse outcome, according to previous observations. However, data on patients recovering after cardiac arrest are sparse. The aim of this study was to assess incidence, risk factors, and outcome of patients with delirium after cardiac arrest in the Freiburg Delirium Registry (FDR).

Methods: In this retrospective registry study, all patients after cardiac arrest treated in the Freiburg University Medical Center medical ICU between 08/2016 and 03/2021 were included. Delirium was diagnosed using the Nursing Delirium screening scale (NuDesc), assessed three times daily. Favorable neurological outcome was defined as cerebral performance category (CPC) score at ICU discharge ≤ 2.

Results: Two hundred seventeen patients were included and among them, delirium was detected in one hundred ninety-nine (91.7%) patients. Age was independently associated with the incidence of delirium (p = 0.003), and inversely associated with the number of delirium-free days (p < 0.001). Favorable neurological outcome was present in 145/199 (72.9%) with, and 17/18 (94.4%) patients without delirium (p = 0.048). While the incidence of delirium was not independently associated with a favorable neurologic outcome, the number of delirium-free days strongly predicted the primary endpoint [OR 2.14 (1.73-2.64), p > 0.001].

Conclusion: Delirium complicated the ICU course in almost all patients after cardiac arrest. The number of delirium-free days was associated with favorable outcome while incidence of delirium itself was not.

Backgrounds: Heart rate (HR) and stroke volume (SV)-the components of cardiac output-have a complementary relationship. Poor HR increase during exercise is associated with poor exercise tolerance in heart failure (HF) with preserved ejection fraction (HFpEF), but its prognostic impact remains unclear. Furthermore, whether the compensation for poor HR increase with SV during exercise is associated with prognosis remains unknown.

Methods: We evaluated 129 consecutive hospitalized HF patients with sinus rhythm and left ventricular ejection fractions > 40% who underwent cardiopulmonary exercise testing before discharge from the index hospitalization.

Results: Patients (age: 66 [55-74] years; 73% male) were divided into four groups by median HR reserve (HRR; peak-rest HR: 34 bpm) and O₂ pulse, a surrogate for SV, reserve (peak-rest O₂ pulse: 4.8 mL/beat). During a mean follow-up of 562 [294-961] days, cardiovascular events (cardiovascular death and/or HF rehospitalizations) occurred in 24 patients. Kaplan-Meier analysis identified significant differences in outcomes among the four groups (χ² = 27.3, p < 0.001). Using the preserved HRR/preserved O₂ pulse reserve group (n = 33) as a reference, the impaired HRR/impaired O₂ pulse reserve group (n = 37) was associated with poor outcomes (adjusted hazard ratio: 5.66, 95% CI 1.15-27.74, p = 0.033), whereas the impaired HRR/preserved O₂ pulse reserve group (n = 31) was not (adjusted hazard ratio: 0.38, 95% CI 0.03 to 4.76, p = 0.455).

Conclusion: The overlap of lower increases in HR and O₂ pulse, a surrogate for SV, during exercise was associated with an extremely poor prognosis in HFpEF.

Purpose: This meta-analysis investigates the sex differences in mortality risk between the acute coronary syndrome (ACS) population without standard modifiable risk factors (SMuRF-less) and those with at least one standard modifiable risk factor (SMuRF), and analyses mortality rates between males and females within the SMuRF-less cohort.

Methods: The MEDLINE and Embase databases were searched for cohort studies with sex-stratified outcomes for SMuRF-less versus SMuRF patients with ACS till 15 December 2023. The analysis of variables reported in proportions was carried out by utilizing a meta-analysis with a generalized linear mixed model while continuous variables were analyzed by a meta-analysis of means, using an inverse variance method.

Results: Eight studies were included in the current paper, with 82,395 SMuRF-less ACS patients and 607,558 SMuRF ACS patients. Excess in-hospital mortality found in SMuRF-less ACS, compared to those with SMuRFs, were only observed in females (RR 1.56, 95%CI 1.08-2.25, p = 0.029), but not in males (RR 1.59, 95%CI 0.90-2.80, p = 0.088). On longer follow-up, the 1- and 2-year post-ACS mortality rates were similar across the SMuRF-less and SMuRF cohorts, for both sexes. The subgroup analysis of SMuRF-less ACS individuals revealed that SMuRF-less females had higher in-hospital (RR 1.52, 95%CI 1.30-1.78, p = 0.002), 1-year (RR 1.51, 95%CI 1.34-1.71, p = 0.005) and 2-year mortality risks (RR 1.40, 95%CI 1.13-1.75, p = 0.016) compared to the SMuRF-less male counterparts.

Conclusion: Paradoxical excess mortality in SMuRF-less ACS, compared to those with SMuRFs, was only observed in females. Females without cardiovascular risk factors are at the highest risk of short- and medium-term mortality following ACS.

12-Lead electrocardiography (ECG) is among the most frequently performed tests in medical practice. Despite its pivotal role in diagnostic and treatment decisions, baseline artifacts and errors in lead placement are common. The PATCH (Preferred Attachment Strategy for Optimal Electrocardiograms)-1 study enrolled patients with stable cardiovascular disease and a clinical indication for an ECG. Each participant underwent both a standard (S) 12-lead ECG and a patch (P) ECG (EKG-Patch™) during one routine ambulatory clinic visit. The P-ECG has an all-in-one design with built-in lead wires attached to pre-positioned electrodes. An experienced clinical research coordinator performed all ECGs. Each was interpreted by an experienced cardiologist blinded to the method of ECG. A total of 200 participants (67.4 ± 14.9 years; range: 21-95 years) (women 44%) had P- and S-ECGs. Common clinical indications included coronary artery disease (40.5%), essential hypertension (14.0%), heart failure (10.5%), atrial fibrillation (10.0%) and valvular heart disease (6.5%). Many participants had more than one indication. The P-ECG provided a tracing in 1.4 ± 0.5 min compared to 2.4 ± 0.5 min with the S-ECG (p < 0.001). Most participants either preferred the P-ECG (47%) or did not have a preference (52%). Baseline artifacts that impacted interpretability were detected in 13 (6.5%) P-ECGs and 30 (15.0%) S-ECGs (p = 0.006). Heart rhythm, rate, conduction, axis, intervals (PR, QRS, QT, and QTc) and ST-T wave findings did not differ between P-and S-ECGs. In conclusion, the P-ECG was preferred among participants, had fewer baseline artifacts than the S-ECG, and provided a rapid and reproducible ECG in patients with stable cardiovascular disease in an ambulatory clinic setting.