European journal of preventive cardiology最新文献

Aims: Cardiac rehabilitation (CR) has been shown to improve the prognosis of patients with acute myocardial infarction (AMI). In Japan, the duration of hospitalization has shortened, resulting in a lower participation rate in CR among outpatients. Therefore, we evaluated the effects of CR, stratified into inpatient and outpatient phases, on the prognosis of patients with AMI in Japan.

Methods and results: A multi-centre, retrospective, cohort study in which extracted 4411 AMI patients from 72 institutes throughout Japan who were identified from a Japanese Registry Of All cardiac and vascular Diseases (JROAD) in 2014 was performed. JROAD is a database from Diagnosis Procedure Combination, and we additionally investigated the detailed information about severity, complications, treatment of AMI, the results of examinations, and the 5-year prognosis with respect to CR (JROAD-CR). The patients were divided into four groups, depending on their history of CR as inpatients and outpatients. The percentages of inpatients and outpatients who received CR were 66.1% (n = 2917) and 9.91% (n = 437), respectively. The groups in which only inpatients received CR [In(+)Out(-)] and in which both inpatients and outpatients received CR [In(+)Out(+)] showed significant reduction in all-cause mortality [In(+)Out(-) group; hazard ratio (HR): 0.720, 95% confidence interval (CI) (0.546-0.950) and In(+)Out(+) group; HR: 0.575, 95% CI (0.338-0.977)], although composite major adverse cardiovascular events did not show significant reduction.

Conclusion: This JROAD-CR study newly revealed that even short periods of CR during hospitalization are important, and continuing CR into the outpatient phase may further improve the prognosis of patients with AMI in this early reperfusion and short hospital staying era.

Aims: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are recognized for their cardiovascular benefits. This systematic review and meta-analysis evaluated the impact of SGLT2i on heart failure (HF) outcomes in cancer patients and survivors, focusing on HF hospitalization and new HF diagnoses.

Methods and results: A comprehensive search of PubMed, MEDLINE, and Embase via Ovid, and the Cochrane Library was conducted up to 5 June 2024, focusing on studies involving cancer patients and survivors treated with SGLT2i. The search criterion used was [(SGLT2) OR (Sodium glucose cotransporter 2 inhibitors) OR (canagliflozin) OR (dapagliflozin) OR (empagliflozin) OR (ertugliflozin) AND (cancer)]. The primary outcomes assessed were HF hospitalization and new HF diagnoses. The search yielded 1880 studies, from which 13 studies encompassing 88 273 patients were included. SGLT2i use reduced HF hospitalizations by 51% (RR 0.49, 95% CI 0.36-0.66, I² = 28%, P < 0.01) and new HF diagnoses by 71% (RR 0.29, 95% CI 0.10-0.87, I² = 71%). Multi-variate meta-regression analysis suggested that among breast cancer populations, studies with ≥50% of patients on anthracyclines exhibited a 99% reduction in HF hospitalization risk compared with similar studies that included <50% of patients on anthracyclines (RR 0.0085, 95% CI: 0.0001-0.2645, P = 0.0081).

Conclusion: SGLT2i significantly lower the risk of HF hospitalization and new HF diagnoses among cancer patients and survivors, with particularly pronounced benefits in breast cancer patients receiving anthracycline-based chemotherapy. These findings support the need for prospective trials to further investigate the integration of SGLT2i into cancer patient management to enhance cardiovascular outcomes.

Aims: Chronotropic incompetence (CI) is common in heart failure with preserved ejection fraction (HFpEF) and contributes to reduced exercise tolerance. However, the effects of exercise training on CI in HFpEF remain unknown. We aimed to assess the effect of different exercise training intensities on chronotropic reserve in HFpEF.

Methods and results: This is a subanalysis of the OptimEx-Clin trial. Patients with HFpEF were randomized to high-intensity interval training (HIIT), moderate continuous training (MCT) or guideline control (GC). Chronotropic incompetence was assessed during cardiopulmonary exercise testing at baseline and 3 months. Chronotropic incompetence was defined as a chronotropic index ≤ 0.62 in patients on negative chronotropic medications and ≤0.80 in others. Among 175 patients with HFpEF (66% female, mean age 70 ± 8 years), 144 completed follow-up. Chronotropic incompetence was present in 51% and was associated with lower peak oxygen uptake (16.5 ± 4.2 vs. 21.1 ± 5.2 mL/kg/min, P < 0.001), lower peak workload (89 ± 28 vs. 116 ± 39 W, P < 0.001), and poorer ventilatory efficiency (35.2 ± 7.1 vs. 32.6 ± 6.8, P = 0.014) at baseline. High-intensity interval training and MCT did not improve chronotropic index, %predicted peak heart rate, nor CI prevalence after 3 months (all P > 0.500), and adjusting for negative chronotropic drug use did not change results. Nevertheless, HIIT and MCT improved V̇O2peak and workload (P < 0.001) vs. GC, regardless of the presence of CI.

Conclusion: In elderly patients with HFpEF, neither HIIT nor MCT during 3 months significantly improved chronotropic reserve or reduced CI prevalence, but exercise capacity was improved.

Aims: Circulating ketone bodies (KB) have emerged as a potential adjunctive biomarker for incident heart failure (HF) risk and might provide incremental information beyond established biomarkers. A multi-marker risk score may improve risk stratification of incident HF in the community. The authors aim to develop a risk score using N-terminal proB-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin (hs-cTnT) and a unique systemic biomarker of KB to predict HF among participants without cardiovascular disease.

Methods and results: A multi-marker score was developed incorporating NT-proBNP ≥ 125 pg/mL, hs-cTnT ≥ 14 ng/L, and total KB ≥ 75th percentile (316 μmol/L), with one point allocated for each abnormal marker among Multi-Ethnic Study of Atherosclerosis participants. Multivariable Cox model was used to assess the association between multi-marker risk score and the risk of incident HF. Among 6748 participants, there were 383 incident HF events over a median follow-up of 15.7 years. The three biomarkers exhibited poor correlation with one another (r < 0.06 for all). The addition of KB to NT-proBNP and hs-cTnT to identify incident HF improved 5- and 10-year risk prediction (C-statistic 0.74 vs. 0.77, P = 0.02 and 0.70 vs. 0.73, P = 0.02, respectively). There was no evidence of miscalibration using the multi-marker score for predicting 5- and 10-year HF risk (P > 0.05). A graded association was observed between the multi-marker score and risk of HF independent of established clinical factors.

Conclusion: The addition of plasma KB to a clinical risk score using biomarkers of cardiac injury and stress may further improve the prediction of incident HF.