Future cardiology最新文献

Background: Early identification of cardiotoxicity of chemotherapy is crucial. Gene expression is considered a promising tool.

Aim: To validate the new speckle tracking values, high-sensitive (Hs) troponin and expression of TNNI3K and RyR2 genes for early detection of cardiotoxicity.

Methods: Fifty patients with cancer breast on Anthracycline chemotherapy were subjected to speckle tracking echocardiography and Hs troponin measurement. Relative expression of TNNI3K and RyR2 genes were determined by RT-PCR.

Results: Fifty female patients with age (43.89 ± 6.4) were included. Fourteen patients (28%) developed cardiotoxicity, diagnosed by decrease GLS > 15%. Compared to GLS, Hs-Troponin has sensitivity 73%, specificity 100%, PPV 78.5% and NPV 100%. Cutoff point of GLS > 10% had sensitivity 95%, specificity 78%, PPV 81% and NPV 84%. Using a cutoff of 24% change in TNNI3K Expression; sensitivity 100%, specificity 74%, PPV 79.5% and NPV 100%. Using a cutoff of 25% in RYR-2 expression; sensitivity 67% and specificity 59% with less PPV and NPV (62% and 64%). Adding GLS change >10% to Hs troponin and TNNI3K expression resulted in highest sensitivity (100%) and specificity (95.5%) with 96% PPV and 100% NPV.

Conclusion: Cutoff point of GLS > 10%, Hs-Troponin and TNNI3K gene expression are reliable test for early detection of cardiotoxicity.

Trial registration number (irb): 042024100222.

BRASH stands for Bradycardia, Renal Failure, Atrioventricular (AV) Nodal Blockade, Shock, and Hyperkalemia. It is a relatively new clinical entity. BRASH treatment focuses on managing each component simultaneously while identifying and addressing the underlying cause early to halt the cascade, especially in emergencies. This article will discuss a case series of digoxin-induced BRASH syndrome.

Introduction: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) reduce cardiovascular events, especially in diabetic patients. However, the cardioprotective effects of early SGLT2i administration following acute myocardial infarction (AMI) remain unclear.

Objective: This study aims to investigate the impact of SGLT2is on clinical outcomes in patients post-AMI.

Methods: A comprehensive search was conducted in PubMed, CENTRAL, WOS, Scopus, and EMBASE up to April 2024. Risk ratio (RR) was used for dichotomous outcomes and mean difference (MD) for continuous outcomes, with 95% confidence intervals (CI).

Results: Seven studies with 11,407 patients were included. SGLT2is did not significantly reduce the incidence of major adverse cardiovascular events (MACE) (RR = 0.94, 95% CI [0.68, 1.29], p = 0.69), all-cause mortality (RR = 1.01, 95% CI [0.84, 1.21], p = 0.93), or stroke (RR = 0.61, 95% CI [0.29,1.28], p = 0.19). However, SGLT2is significantly reduced the risk of heart failure (RR = 0.76, 95% CI [0.63, 0.91], p < 0.01) and improved left ventricular ejection fraction (MD = 1.86, 95% CI [1.58, 2.14], p < 0.01).

Conclusion: In post-AMI patients, SGLT2is do not significantly affect MACE or mortality but are associated with reduced heart failure risk and improved ejection fraction.

Protocol registration: PROSPERO identifier number: CRD42024506806.

Around one-third of adults in Algeria have hypertension, but > 40% are unaware they have the disease, and of those receiving treatment, only ~ 20-30% have adequate blood pressure (BP) control. Recommended starting treatment is an angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker plus a calcium channel blocker (CCB) or diuretic. A single-pill combination of perindopril/amlodipine (ACEi/CCB) recently became available in Algeria. Twelve Algerian hypertension experts reviewed the clinical evidence regarding this therapeutic combination to determine its potential role for hypertension management in Algeria. The evidence indicated that this combination reduces cardiovascular outcomes and visit-to-visit BP variability, effectively controls 24-hour BP, and is well tolerated. In conclusion, the perindopril/amlodipine SPC provides a valuable new treatment option for hypertension in Algeria.

Arterial hypertension is one of the most prevalent cardiovascular pathologies worldwide. Considering the increased rates of uncontrolled hypertension and treatment non-adherence, catheter-based methods, with the most prominent being renal denervation, have been recently included in international guidelines for the management of the pathology, naming the method the third pillar in hypertension management. However, sympathetic overactivation is not only a major pathophysiologic driver in hypertension, but in other cardiovascular pathologies as well. Considering the effect of renal denervation in hypertension-mediated target organ damage, as well as the pleotropic effects of this modality, recent evidence have evaluated the modality in coronary microvascular dysfunction (CMD). Interestingly, despite preclinical data showcase a benefit of renal denervation in microcirculatory homeostasis, with enhancement of endothelial-mediated vasodilation and reduction of inflammation, these effects have failed to be translated into clinical benefit, with the limited, to date, non-interventional studies in coronary microcirculation reporting neutral effects. Therefore, this review aims to delineate the pathophysiological processes which relate microvascular dysfunction with hypertension, discuss the effect of the procedure in hypertension-mediated target organ damage, analyze preclinical and clinical data on the safety and efficacy of renal denervation in improving microcirculatory indices, as well as provide future directions for this novel field.

Acute kidney injury (AKI) persists as one of the most common complications after cardiac surgery. Beyond being burdened by high morbidity and mortality rates, effective therapeutic options are still lacking. To date, the management of cardiac surgery-associated AKI (CSA-AKI) mainly focuses on preventive strategies, e.g. the implementation of standardized care bundles. Interestingly, recent experimental studies have suggested a potential nephroprotective role for both amino acids (AA) and proteins. As such, these compounds show multiple beneficial renal effects, spanning enhancement of renal blood flow, improved oxygenation, and recruitment of renal functional reserve. Moreover, clinical studies have investigated the therapeutic potential of single AA, AA combinations, and proteins. A recent large multicenter randomized controlled trial showed reduced AKI incidence in cardiac surgery patients receiving intravenous AA supplementation. However, these interventions have not yet demonstrated beneficial effects on major clinical outcomes, such as survival. Given the well-established AA safety profile and the underlying biological rationale supporting their use, this review summarizes the existing literature on the effects of various formulations and combinations of perioperative AA and protein on renal outcomes when administered in cardiac surgery patients.

Introduction: Decreased left atrial appendage emptying velocity (LAAV) is a marker for thrombus formation. This study evaluates the association between LAAV and inflammatory indices in non-valvular atrial fibrillation (AF) patients.

Methods: The study population was 1428 patients with AF, 875 of whom enrolled. Based on the LAAV, patients were divided into three groups of 262 patients with a velocity of <25 cm/s, 360 patients with a velocity of 25 to 55 cm/s, and 253 patients with a velocity of >55 cm/s to assess and compare in terms of inflammatory indices, including the platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, systemic immune inflammation index, neutrophil - to - platelet ratio and white blood cell-to-platelet ratio (WPR).

Results: There was no statistical difference in the level of inflammatory indices between the three groups, and none of them were related to LAAV (p > .05) except WPR with a weak negative correlation (p = 0.01, r = -0.10). Patients with lower LAAV were found to have a higher age (p = 0.001), decreased left ventricular ejection fraction (p = 0.001) and greater left atrial volume index (p = 0.001).

Conclusion: This study did not show any association between inflammatory indices and LAAV in non-valvular AF patients except for the WPR.

Introduction: The 6-minute walk test (6MWT) is used to assess submaximal exercise capacity in clinical trials. Conducting the 6MWT can be challenging when patients cannot visit the clinic due to physical/travel limitations. This pilot study assessed the feasibility of conducting the 6MWT using wearable sensors for patients with transthyretin amyloid cardiomyopathy.

Methods: Participants were enrolled in the phase 3 ATTRibute-CM trial. Sensors were positioned on patients' feet and lower back during the 6MWT. The 6-minute walk distance (6MWD) was compared with the distance measured by a trained observer during a concurrent conventional test. Pearson and concordance correlation coefficients were estimated.

Results: Twelve participants from five centers participated; 11 had evaluable data. Mean 6MWD was 330.3 m (conventional method) and 335.1 m (wearable sensors); mean difference (SD) was 4.7 m (10.95). Pearson and concordance correlation coefficients for 6MWD were 0.998 (95% CI: 0.992-0.999) and 0.997 (95% CI: 0.991-0.999), respectively.

Conclusions: The 6MWD measured using wearable sensors and by the conventional method were closely correlated. Conducting the 6MWT with wearable sensors may be feasible and as reliable as the conventional method in a monitored clinic setting. Whether at-home 6MWD measured by wearable sensors correlates with in-clinic monitoring deserves further study.

Clinical trial registration: ClinicalTrials.gov identifier is NCT03860935.