Future cardiology最新文献

We present the case of a 21-year-old male with chest pain, malaise, and fever, who was initially diagnosed with suspected acute myocarditis. The patient exhibited elevated cardiac troponin levels, occasional premature ventricular complexes, and right ventricular dilation, raising concerns about arrhythmogenic cardiomyopathy. Cardiac magnetic resonance (CMR) imaging showed myocardial edema and subepicardial enhancement in the basal anterolateral segment, confirming myocarditis, but also revealed severe dilation of the right chambers. Advanced imaging sequences identified a previously unrecognized inferior sinus venosus atrial septal defect (SVASD) with partial anomalous pulmonary venous return. This finding led to a significant left-to-right shunt and surgical correction was performed. SVASD, a rare congenital anomaly, often remains undiagnosed due to its subtle clinical presentation and limitations of standard imaging techniques. This case highlights the importance of tailored CMR acquisition protocols, which revealed a congenital heart defect in our patient despite an initial focus on myocarditis. The adjustment in diagnostic approach significantly altered the patient's management and may have improved his long-term prognosis.

Background: Acute Myocardial Infarction (AMI) necessitates timely treatment to improve outcomes. Identifying treatment delays across different South Asian countries can aid in formulating policies to reduce these delays. Objectives: To estimate the average treatment delay in AMI patients in South Asia and identify contributing factors.

Methods: Using the CoCoPop framework (Condition, Context, Population), studies were reviewed on AMI treatment delays in South Asia from 2000 to 2022. Databases searched included PubMed Central, Embase and Google Scholar. Eligible studies were cross-sectional and analytical that reported exact delay times, excluding knowledge, attitude, practice studies, narrative reviews, and case reports.

Results: The search yielded 2954 records, with 42 studies meeting the inclusion criteria. The pooled median prehospital delay was 531 minutes (95% CI: 366-769 minutes). The pooled mean door-to-ECG time was 9.18 minutes (95% CI: 2.52-15.84 minutes). The door-to-needle and door to balloon time among STEMI patients were 37.95 (95% CI: 30.11-45.78 minutes) minutes and 62.92 minutes (95% CI: 45.28-80.56 minutes), respectively with significant heterogeneity. Factors associated with delays included old age, female gender, low literacy, ignorance, financial constraints, and rural location.

Conclusion: Significant treatment delays for AMI patients in South Asia are identified, with socio-economic and logistical barriers contributing to these delays.

Background: Endothelial dysfunction drives infective endocarditis (IE) pathogenesis, yet prognostic biomarkers for critically ill IE patients remain scarce. We assessed the Endothelial Activation and Stress Index (EASIX) for mortality prediction in this population.

Methods: Using MIMIC-IV, 298 adult IE patients were analyzed. Cox regression and Kaplan-Meier survival analyses evaluated EASIX-mortality associations. Restricted cubic splines tested nonlinearity. Subgroup and interaction analyses were conducted to identify potential effect modifiers.

Results: In 298 critically ill IE patients, multivariable regression revealed that the highest EASIX tertile (T3) was associated with increased mortality risk at 28 days (HR 2.56, 95% CI 1.19-5.53) and 180 days (HR 2.12, 95% CI 1.17-3.85). Kaplan-Meier survival curves and restricted cubic splines corroborated these findings. Moreover, subgroup analyses demonstrated generally consistent results across predefined strata.

Conclusions: EASIX strongly predicts short- and long-term mortality in critically ill IE patients, with immediate clinical utility for risk stratification using routine labs.

Cardiovascular-kidney-metabolic (CKM) syndrome represents a complex interaction between cardiovascular (CV) disease, chronic kidney disease (CKD), and metabolic risk factors. Non-steroidal mineralocorticoid receptor antagonists (ns-MRAs) are an emerging therapy showing promise in improving CKM syndrome outcomes. A recent large randomized trial, the FINEARTS-HF study, demonstrated a 16% reduction in the composite endpoint of worsening heart failure (HF) and CV death in patients with mildly reduced and preserved ejection fraction after a median 32-month follow-up. Additionally, two pivotal randomized studies demonstrated the efficacy of finerenone in CKD with diabetes patients. The FIDELIO-DKD trial showed a reduction in the renal composite outcome, including kidney failure and related death, over 2.6 years. Similarly, the FIGARO-DKD trial demonstrated a reduction in composite CV outcomes, including CV death, myocardial infarction, stroke, or HF hospitalization, after a median follow-up of 3.4 years. Evidence from in vitro and in vivo studies suggests that finerenone attenuates cardiac and kidney injury by reducing fibrosis, apoptotic cell death, oxidative stress, and endothelial dysfunction. Despite these advances, further research is necessary to evaluate the efficacy of ns-MRAs in specific CKM subpopulations, including HF with reduced ejection fraction and CKD without diabetes, to expand their indications and improve outcomes for CKM syndrome patients.

Background: The triglyceride - glucose (TyG) index is a surrogate of insulin resistance and may predict vascular risk. We evaluated whether baseline TyG is associated with incident stroke and all-cause mortality in adults with diabetes.

Methods: We analyzed 10,000 UK Biobank participants with diabetes and no baseline cardiovascular disease. TyG was calculated from fasting triglycerides and glucose and categorized into quartiles. Outcomes (stroke; all-cause mortality) were ascertained via hospital and death registries. Cox models estimated hazard ratios (HRs) adjusting for demographic, lifestyle, and clinical covariates.

Results: Over a median 12.8 years, 620 strokes and 688 deaths occurred. Compared with Q1, Q4 had higher risks of stroke (HR 1.45, 95% CI 1.18-1.80) and mortality (HR 1.42, 95% CI 1.17-1.73). Each 1-SD higher TyG was associated with ~ 19% higher stroke risk (HR 1.19, 95% CI 1.07-1.32) and ~ 16% higher mortality risk (HR 1.16, 95% CI 1.05-1.29). Associations were consistent across age, sex, and BMI subgroups and robust in sensitivity analyses, including extended adjustment.

Conclusions: Higher TyG is independently associated with increased risks of stroke and all-cause mortality among individuals with diabetes. As an inexpensive measure derived from routine tests, TyG may aid risk stratification and inform targeted prevention in this high-risk population.

Postpartum cardiomyopathy (PPCM) is a rising research interest in idiopathic cardiomyopathy with heart failure secondary to systolic dysfunction of the left ventricle, diagnosed when no other origin can be established. As the diagnostic possibilities progress, the frequency of PPCM rises, becoming challenging even for the multidisciplinary team. This case goes beyond the rigid definition of PPCM, as it is hard to say with certainty if the PPCM was "only" initial syndrome, or final diagnosis. Two elements of the treatment procedure should be highlighted as crucial for a patient's recovery: effective control of VT and finding the proper anticoagulant therapy (heparin alternative).

Urothelial carcinoma (UC) rarely presents with an inferior vena cava (IVC) tumor thrombus. Herein, we report the case of a patient with UC in whom the thrombus embolized to the right atrium during resection. Intraoperative echocardiography identified the large embolus measuring greater than 4 cm and prolapsing through the tricuspid valve. The tumor thrombus was removed via sternotomy. This case is significant for the following learning points: 1) tumor thrombus should be managed with care during removal as it can embolize; 2) intraoperative transesophageal echocardiography is vital in these cases; and 3) a multidisciplinary approach including cardiac surgery is imperative to ensure optimal outcomes.

Background: Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disorder, with rising hospitalization rates and high comorbidity burden, yet the impact of cardiovascular comorbidities (CVC) on mortality among hospitalized HCM patients remains poorly defined.

Methods: Queried the 2016 to 2020 National Inpatient Sample (NIS) to identify hospitalizations with diagnosed HCM.

Results: Among 278,995 HCM hospitalizations (mean age 64.3 ± 18.4 years; 55.7% female), in-hospital mortality rose from 16.4% to 22.9% throughout the study. Cardiac arrest (41.00%), tamponade (13.70%), and ST-segment elevation myocardial infarction (STEMI) (10.20%) had the highest mortality rates. Atrial fibrillation (AF) (42.10%), heart failure with preserved ejection fraction (HFpEF) (28.10%), and cardiorenal syndrome (16.60%) were the most prevalent comorbidities. Predictors of case-fatality included increasing age (aOR: 1.02, 95% CI: 1.02-1.03, p < 0.0001), Asian/Pacific Islander race (aOR: 1.70, 95% CI: 1.10-2.40, p = 0.007), CVA (aOR: 2.30, 95% CI: 1.70-3.06, p < 0.0001), NSTEMI (aOR: 1.80, 95% CI: 1.30-2.40, p < 0.0001), cardiorenal syndrome (aOR: 1.40, 95% CI: 1.20-1.80, p < 0.001), and cardiac arrest (aOR: 26.60, 95% CI: 20.90-33.90, p < 0.001).

Conclusion: Mortality rate among hospitalized HCM patients has shown a mild upward trend and is driven by age, race, NSTEMI, and cardiorenal syndrome.