Future cardiology最新文献

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.

Background: Peripheral arterial disease (PAD) is a condition whereby the peripheral arteries of the body, and particularly the lower limbs, experience atherosclerosis resulting in narrowing of the peripheral arteries. This largely preventable condition is a major cause of cardiovascular morbidity and mortality, affecting over 230 million people worldwide.

Methodology: We conducted a systematic search for randomized control trials on four databases: Medline, CINAHL, PubMed, and Embase. We compared the outcomes of anticoagulation therapy with standard care following PRISMA standards.

Results: 10,051 studies were identified, and through titles and abstract screening followed by full text screening, five studies involving 14,463 individuals were included. One study compared rivaroxaban with dose adjusted warfarin. Two studies compared a combination of rivaroxaban and low dose aspirin with antiplatelet therapy. These three demonstrated a reduction in major adverse cardiovascular events (MACE) and Major adverse limb events (MALE) when combined with Aspirin. However, they noted increased bleeding risk.

Conclusion: Newer-generation direct oral anticoagulants in combination with antiplatelet therapy, may improve cardiovascular outcomes and reduce limb-related complications in patients with PAD. Further randomized controlled trials (RCTs) are needed to determine optimal dosing before guideline implementation.

Aficamten is a novel cardiac myosin inhibitor that has completed a Phase III trial for the treatment of obstructive hypertrophic cardiomyopathy (HCM). Aficamten was developed to optimize pharmacokinetic properties and clinical tolerability relative to its predecessor, mavacamten. Mechanistically, aficamten decreases myocardial contractility by way of reducing cardiac myosin ATPase activity and the number of active actin-myosin cross bridges during the cardiac cycle. Clinically, aficamten improves cardiac hemodynamics and biomarker profiles while promoting favorable cardiac remodeling, augmenting exercise tolerance and improving overall health status. Observed systolic dysfunction was infrequent, mild, reversible, and not associated with serious adverse events. Collectively, the available data suggests that aficamten is a well-tolerated drug that shows strong clinical efficacy across a wide array of clinical parameters. In this review, we provide a comprehensive description of the pharmacology, clinical efficacy, and tolerability of aficamten.