Future cardiology最新文献

Right ventricular (RV) function is the primary determinant of survival in connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH). A "double hit" hypothesis suggests that RV suffers not only from pressure overload common to all PAH but also from direct insults related to the underlying systemic autoimmunity and inflammation. This likely drives distinct maladaptive remodeling (fibrosis, inflammation) and contributes to the poorer prognosis observed in CTD-PAH compared to idiopathic PAH (IPAH).Comprehensive, multi-modal RV assessment - integrating clinical evaluation, biomarkers, echocardiography, cardiac MRI, and right heart catheterization - is crucial for prognosis and monitoring therapy. RV size, function, and tissue characteristics are key indicators.Current management involves PAH-targeted therapies to reduce RV afterload, optimal CTD control, and supportive care. However, CTD-PAH often shows attenuated treatment responses and worse outcomes, emphasizing the need for therapies directly addressing RV maladaptation. Future research priorities include understanding specific RV injury mechanisms in CTD, refining assessment tools, and developing novel RV-directed strategies. Optimizing outcomes requires a deep understanding of RV pathobiology within the CTD context and integrated, multidisciplinary care.

Aim: To identify factors affecting the health-related quality of life (HR-QOL) of symptomatic patients with hypertrophic cardiomyopathy (HCM) using qualitative interviews exploring patients' experiences and perceptions.

Patients & methods: This cross-sectional observational study was conducted using qualitative web-based or telephone interviews. Adult patients with HCM in Japan who were experiencing burden because of HCM were included. In-depth interviews were conducted using a semi-structured interview guide. The data were analyzed using a thematic analysis approach.

Results: Nineteen patients completed the interview. Ten HR-QOL-related themes were identified. Many patients were unaware that they had HCM symptoms, either no longer noticing them following life adjustments or attributing them to factors other than HCM. HCM affected multiple life aspects, including work, family, and social life. Patients resisted disclosing their disease to others and strongly resisted invasive treatment. Patients highly trusted their physicians but were reluctant to discuss their mental burdens and daily life challenges with them.

Conclusions: This first qualitative study of HR-QOL in patients with HCM in Japan suggests that deeper physician - patient communication is needed to understand patient burden and needs, as patients have difficulty discussing their burdens with physicians and may lack awareness of HCM symptoms.

Clinical trial registration: NCT06181617 (ClinicalTrials.gov).

Carotid artery stenosis (CS) is a critical diagnosis linked to ischemic stroke, a leading cause of morbidity and mortality, affecting about 4% of the general population. Risk factors for CS include age, hypertension, dyslipidemia, diabetes, and smoking, with poly vascular disease seen in 45% of patients with known atherosclerotic disease. Early recognition and management of CS are crucial to prevent stroke by utilizing imaging modalities like Duplex ultrasound (DUS). Management of CS involves complex decision-making that balances the risks and benefits of intervention against the developing diagnostic and therapeutic modalities. This narrative review aims to review and examine the current guidelines for clinicians' approach to CS.

Recent trials underscore the cardiovascular (CV), renal, and metabolic benefits of semaglutide in individuals with and without type 2 diabetes (T2D). In T2D, semaglutide enhances glycemic control, reduces major adverse CV events (MACE), and slows chronic kidney disease (CKD) progression. The SUSTAIN-6 trial demonstrated a 26% MACE reduction (HR 0.74; 95% CI: 0.58-0.95; p = 0.02) in high CV-risk patients with T2D using semaglutide (0.5 or 1.0 mg weekly). Similarly, the FLOW trial showed a 24% reduction in major kidney disease events (HR 0.76; 95% CI: 0.66-0.88; p = 0.002) with weekly 1.0 mg semaglutide in individuals with T2D with CKD. Beyond T2D, the SELECT trial highlighted semaglutide's efficacy in reducing MACE by 20% (HR 0.80; 95% CI: 0.72-0.90; p < 0.001) and slowing kidney function loss in overweight or obese individuals with preexisting CV disease using 2.4 mg weekly. Additionally, semaglutide alleviates heart failure symptoms and reduces hospitalizations in obese individuals regardless of T2D status. These findings underscore semaglutide's role in improving kidney, CV, and survival outcomes among high-risk patients. This review highlights the cardio-kidney-metabolic benefits of semaglutide in individuals with and without T2D to inform cardiologists about its potential to enhance patient care.

Background: Left main (LM) percutaneous coronary intervention (PCI) remains a major interventional challenge, with outcomes influenced by various patient- and procedure-related factors.

Objectives: To analyze procedural characteristics and outcomes of patients who underwent LM PCI over a 15-year period in a single center.

Methods: We retrospectively analyzed data from all consecutive patients who underwent LM PCI between 2006 and 2022. Procedural details, with a focus on stenting technique, were collected. Primary outcome was all-cause mortality at 1 year.

Results: In total 3494 patients were included. The majority (67%) presented with chronic coronary syndrome. Seventy-seven percent of all patients (n = 2690) underwent PCI by single stent (SS) strategy and 23% (n = 804) by double stent (DS) strategy. One-year mortality was significantly lower in SS cases compared to DS (3.5% vs. 5.1%, HR 0.64, 95% CI 0.43-0.96). Intravascular imaging was used in 17% of the cases but showed no significant difference in one-year mortality compared to angio-guided PCI (4.8% vs. 3.7%; HR 1.11, 95% CI 0.71-1.73).

Conclusions: In real-world LM PCI practice, patients for whom a provisional single-stent strategy was feasible had better outcomes than those requiring a double-stent approach.