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.

The recently introduced concept of 'exposome' emphasizes the impact of non-traditional threats onto cardiovascular health. Among these, air pollutants - particularly fine particulate matter < 2.5 μm (PM2.5) - have emerged as significant environmental risk factors for cardiovascular disease and mortality. PM2.5 exposure has been shown to induce endothelial dysfunction, chronic low-grade inflammation, and cardiometabolic impairment, contributing to the development and destabilization of atherosclerotic plaques. Both short- and long-term exposure to air pollution considerably increase the incidence of ischemic heart disease (IHD)-related events, with clinical evidence linking pollution to higher mortality and adverse prognosis, especially in vulnerable populations. In this review, we explore the mechanistic pathways through which air pollutants exacerbate atherosclerotic cardiovascular disease (ASCVD) and discuss their clinical impact.Furthermore, special attention will be directed to the outcomes and prognosis of patients with pollution-aggravated coronary atherosclerosis, as well as the potential role of targeted public health interventions.

Background: The role of body composition as a risk factor for adverse outcomesduring coronary artery bypass surgery (CABG) has been controversial. The goal of this study was to evaluate the effect of body weight on mortality in patients undergoing CABG.

Method: Using a large NIS database and ICD-10 coding for different bodyweight categories, we evaluated the effect of cachexia, overweight, obesity, and morbid obesity on in-hospital mortality after CABG.  We evaluated the available database containing ICD10 coding from 2016- 2020.

Results: We found that cachexia was the strongest independent predictor of in-hospital mortality whereas obesity had a protective effect. Over the 4-year sample size, patients with cachexia had nearly a 4-fold increase in mortality compared to patients with normal weight despite adjusting for age and comorbidities (4.06 CI 2.7-6.0, p < 0.001). Patients with overweight and Obesity had the lowest mortality (OR = 0.44 CI 0.29-0.66, OR = 0.58 CI 0.52-0.63, p, 001). However, the mortality benefit disappeared in patients with morbid obesity (OR 0.9, CI 0.84-1.03, p = 0.15) with a trend of higher mortality in patients with morbid obesity after multivariate adjustment.

Conclusion: Cachexia is a powerful predictor for in-hospital mortality in patients undergoing CABG. Overweight and obesity have protective effect which disappears with morbid obesity.

The Medina classification separates true bifurcation lesions into three unnecessary groups: 1.1.1, 1.0.1, and 0.1.1. Non-true bifurcation lesions are divided into three unnecessary subgroups called 0.0.1, 0.1.0, and 1.0.0. Furthermore, the Medina classification does not describe any other important features of a given bifurcation lesion, making it useless when comparing complex bifurcation lesions. This has led to confusion in clinical settings and stagnation of bifurcation research. The Movahed bifurcation classification has overcome those problems by summarizing all true bifurcation lesions into one simple relevant category called B2 (B for bifurcation, 2 meaning both main and side branches at bifurcation site have significant lesions) and non-true bifurcation lesions into two simple categories called B1m (B for bifurcation, 1 m meaning only the main branch has significant lesion) and B1S lesions (B for bifurcation and 1 s meaning only the side branch has significant lesion). Moreover, at the same time, additional unlimited suffixes can be added if needed to describe a given bifurcation lesion, making this bifurcation also very comprehensive. In this perspective, the shortcomings of the Medina classification compared to the Movahed classification are discussed in detail.