Future cardiology最新文献

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.

The European Society of Cardiology (ESC) guidelines provide detailed, evidence-based recommendations for managing cardiovascular diseases. However, their complexity and frequent updates can make them challenging to apply consistently in clinical settings. Artificial intelligence (AI), particularly large language models (LLMs), offers a novel solution by assisting in the interpretation and application of these guidelines more effectively. A narrative review was conducted to assess the role of large language models (LLMs) and related artificial intelligence (AI) systems in supporting the interpretation of ESC guidelines. From 102 records screened, seven studies met the inclusion criteria. Clinical Decision Support Systems (CDSSs) built on ESC guidelines demonstrated improvements in diagnostic accuracy and standardization. Comparative studies revealed that large language models (LLMs), including ChatGPT-4, showed high concordance with expert clinical decisions (up to 86% accuracy for acute coronary syndrome-related questions). Emerging tools, such as MedDoc-Bot, have highlighted the feasibility of direct ESC guideline interpretation by LLMs. LLMs show promise in enhancing clinician understanding and application of ESC guidelines. Although performance is encouraging, further validation and thoughtful integration into clinical practice are necessary to maximize their utility and safety.

Background: Leadless ventricular pacemakers have been developed for single chamber VVIR and AV synchronous pacing applications.

Aim: To assess the device longevity impact of battery/electronics enhancements of next-generation Micra leadless pacemakers, Micra VR2 and AV2, compared to Micra VR and AV.

Methods: Real-world pacing data gathered from the Micra IDE study, Medtronic's CareLink database, and historical pacemaker patient survival data from Medtronic's Device Registry were used to project device longevity and estimate the proportion of patients requiring lifetime device replacements.

Results: Based on data from 644 patients, the median projected longevity of Micra VR was 12.3 years and Micra VR2 was 16.7 years, with 91% of patients requiring a single VR2 device over their lifetime. Based on data from 999 patients, the median projected longevity of Micra AV was 10.8 years and Micra AV2 was 15.6 years, with 80% of patients requiring one AV2 device. The longevity improvements with Micra VR2 projected 8 fewer device replacements would be required across 100 patients. Similarly, 15 devices would be avoided when considering Micra AV versus AV2.

Conclusions: Modeling of the Micra leadless pacemakers projected meaningful improvements in device longevity and an increase in the number of patients served with a single device.

With a significant impact on morbidity and mortality rates worldwide, arrhythmias are a growing global health concern. The most common sustained arrhythmia, atrial fibrillation (AF), affects approximately 2% of the general population, with its prevalence increasing with age. Although significant advancements have been made in non-pharmacological therapies, such as catheter ablation and implantable devices, the basis of arrhythmia management remains antiarrhythmic drugs (AADs). Yet the development of safer and more effective AADs has not kept pace with the increasing burden of arrhythmias. This article aims to briefly explore the current landscape of antiarrhythmic treatment, emerging pharmacological targets, and the potential for innovative drug therapies to reshape clinical practice.

Background: Aortic Stenosis (AS) is a valvular heart disease. Hypertension accelerates stenosis, increasing morbidity and mortality. This study investigates mortality trends in US older adults with AS and hypertension from 1999 to 2020.

Methods: Using the CDC WONDER database, age-adjusted mortality rates (AAMRs) per 100,000 individuals aged 65+ with AS and hypertension were analyzed. Changes in AAMRs were examined through annual percent change (APC) and average APC (AAPC) using Joinpoint regression.

Results: From 1999 to 2020, hypertension caused 99,250 deaths in AS patients in the US, demonstrating an increasing trend (AAPC: 5.51%). Males had higher AAMRs (11.51) than females (9.99). Non-Hispanic (NH) white people (11.32) had the highest AAMRs, followed by Hispanic (7.37), NH Black people (7.27), and NH Asians (6.12). Regionally, the West showed the highest AAMR (13.3), followed by the Midwest (11.38), the Northeast (10.62), and the South (8.53). The states with the highest AAMRs were Vermont and Oregon, while Alabama and Georgia had the lowest. Non-metropolitan areas (11.19) experienced higher mortality than metropolitan areas (10.49).

Conclusion: We report increasing mortality rates in patients with AS and hypertension, especially in males, NH white people, and the West. Target healthcare measures are needed to address the rising mortality.