Future cardiology最新文献

Background: ALERTS was a pivotal randomized clinical trial (RCT) evaluating an intracardiac monitor with real-time alerting in high-risk acute coronary syndrome patients. The cost-effectiveness however is unknown.

Method: A decision model estimated health effects and costs of implanting a Guardian device in a target patient population, compared to current standard-of-care (SOC). Health and economic outcomes were modeled using ALERTS trial results and relevant literature.

Results: Base-case analysis indicated an incremental lifetime cost of $21,988 with Guardian as compared to SOC (increase of 0.18 life years or 0.37 quality-adjusted life years (QALY)). The incremental cost-effectiveness ratio (ICER) was $121,056/LY or $58,668/QALY.

Conclusion: Real-time intracardiac monitoring with patient alerting was cost-effective using conventional thresholds in acute coronary syndrome (ACS) patients at high-risk for recurrent events.

Background: Infective endocarditis is characterized by the colonization of heart valves by virulent microorganisms. It commonly manifests as involvement of a single heart valve -single-valve infective endocarditis (SIE), while in some patients, two or more heart valves are concomitantly infected -multivalvular infective endocarditis (MIE). The risk of complications and prognosis of MIE as opposed to SIE are unknown.

Methods: We performed a systematic search in MEDLINE and Scopus for studies of patients with MIE and SIE. The outcomes of interest included mortality, heart failure, systemic embolic events, and need for surgery.

Results: Οf 1,124 identified studies, eleven met the inclusion criteria. MIE was reported in 20.4% of the total patients. Compared to SIE, MIE was associated with increased risk of short-term mortality (RR: 1.29, 95% CI: 1.19-1.39), one-year mortality (RR: 1.20, 95% CI: 1.08-1.34), heart failure (RR: 1.31, 95% CI: 1.12-1.54), systemic embolic events (RR: 1.12, 95% CI: 1.02-1.22), and need for subsequent surgical management (RR: 1.22, 95% CI: 1.05-1.41).

Conclusions: Patients with MIE have a higher likelihood of poor prognosis compared to patients with SIE. A high clinical suspicion of this condition and timely diagnosis and management are imperative while managing patients with infective endocarditis.

Protocol registration: PROSPERO CRD42023486674.

Reaching competency in congenital heart surgery (CHS) requires lengthy and rigorous training. Due to patient safety, time limitations, and procedural complexity, the intraoperative setting is not ideal for technical practice. Surgical simulation using synthetic, biological, or virtual models is an increasingly valuable educational tool for technical training and assessment. In particular, three-dimensional (3D) models are especially favorable in CHS education for its high-fidelity demonstration of congenital heart defects. In countries where there is a deficit of local cardiac surgical expertise, simple and inexpensive innovation, such as expanding hands-on technical training programs involving 3D-models and hybrid teaching, may partially address the lack of CHS training opportunities and the consequent unmet need for surgical management of pediatric heart disease.

Background: Group II Pulmonary Hypertension (PH) secondary to Heart Failure with preserved Ejection Fraction (HFpEF) is associated with significant morbidity and mortality. Lipoprotein(a) [Lp(a)] is a novel biomarker implicated in cardiovascular pathology, yet its role in myocardial fibrosis within this population remains underexplored. This study investigates the association between elevated Lp(a) levels and cardiac fibrosis to improve understanding of its prognostic and diagnostic utility.

Methods: This retrospective cohort study included 100 patients with Group II PH secondary to HFpEF. Serum Lp(a) levels were quantified using enzymatic assays, and myocardial fibrosis was assessed using Cardiac Magnetic Resonance Imaging (CMR) techniques, including T1 mapping and late gadolinium enhancement (LGE). Statistical models adjusted for confounding factors.

Results: Elevated Lp(a) levels were significantly associated with increased myocardial extracellular volume (31% vs. 27%, p < 0.01), prolonged native T1 times, and increased odds of myocardial scar formation. Structural cardiac changes correlated with Lp(a) concentrations.

Conclusion: Elevated Lp(a) is a key marker of myocardial fibrosis and structural remodeling in Group II PH secondary to HFpEF. Routine Lp(a) measurement may enhance risk stratification and inform therapeutic strategies.

Background: Implantable cardioverter-defibrillators (ICDs) are essential for reducing sudden cardiac death in patients at risk of ventricular arrhythmias. The choice of ICD lead - single-coil or dual-coil - can influence device performance and patient outcomes. This meta-analysis evaluates the comparative efficacy and safety of single-coil versus dual-coil ICD leads to inform clinical decision-making.

Methods: A systematic search of PubMed, Cochrane Library, and Google Scholar was performed up to October 2024. Only randomized controlled trials (RCTs) comparing single-coil and dual-coil ICD leads were included. Outcomes assessed included defibrillation threshold (DFT), first-shock efficacy, all-cause mortality, cardiovascular mortality, shock impedance, and peak current.

Results: Seven RCTs involving 1,614 patients were analyzed. Single-coil leads demonstrated superior first-shock efficacy (OR: 1.60; p = 0.05), reduced all-cause mortality (RR: 0.63; p = 0.02), and better peak current (MD: -2.29; p = 0.02). DFT and cardiovascular mortality were comparable between groups, while dual-coil leads exhibited lower shock impedance (MD: 18.26; p < 0.00001).

Conclusions: Single-coil ICD leads are associated with improved first-shock efficacy and reduced all-cause mortality, suggesting their potential superiority in certain patient populations. Further research is warranted to refine lead selection criteria.

Approximately 5-10% of patients with hypertension have secondary hypertension. We describe a case of secondary hypertension from bilateral renal artery stenosis (RAS): "Pickering syndrome." This is a case of hypertension secondary to bilateral RAS which provides an opportunity to review secondary hypertension with a specific focus on RAS, in terms of when to consider work up, causes of secondary hypertension, diagnostic testing, and treatment.