Heart International最新文献

Left bundle branch area pacing has been a breakthrough in pacing therapy and is being increasingly adopted. It delivers a more physiological form of pacing compared with right ventricular and biventricular pacing and also avoids the risk of perforation of the ventricular free wall. However, the therapy comes at the price of new complications related to the transseptal route for placing the lead. This article provides an update on these complications and discusses how to avoid and manage these adverse events.

Background: The use of an implantable closure device with medical therapy to prevent recurrent stroke in patent foramen ovale (PFO)-associated stroke has been shown to be superior to medical therapy alone. Recently, an alternative, suture-based method also has shown promise for effective PFO closure. There has been little published data comparing the outcomes of these two technologies.

Methods: This retrospective study explores the safety and efficacy outcomes of device-based versus suture-based percutaneous PFO intervention. The occurrence of post-procedural atrial fibrillation was of primary interest. Data from 55 single-institution, single-operator PFO closure cases between 1 January 2021 and 8 April 2022 were analyzed. Closure occurred via one of two Food and Drug Administration (FDA)-approved occluders or the NobleStitch™ EL suture-based approach. Data were transcribed into a registered REDCap database for descriptive analysis. Demographics, medical history, imaging, procedural and post-procedural outcomes were the variables collected for each participant.

Results: All patients had successful PFO closure without major adverse outcomes. Overall efficacy was similar between the two groups. No patient had a residual shunt greater than grade 1. Several suture-group patients required multiple sutures for satisfactory closure. Those who had multiple sutures had no anomalous anatomic PFO features. Three patients (5%), all from the device group, developed atrial fibrillation after PFO closure.

Conclusions: This study supports the safety and efficacy of device- and suture-based approaches in PFO closure. Suture-based closure would seem a reasonable option where device-based closure raises concerns. Future studies could further explore the observed disparity of atrial fibrillation occurrence between the two PFO closure strategies.

Introduction: Functional status is a predictor of rehospitalization and mortality in patients with heart failure (HF). The purpose of this study was to test the variables in the Multidimensional Model of Functional Status (MMFS) as determinants of functional status.

Methods: Using structural equation modelling, we analysed data from 520 patients with HF to determine the best multivariate model of functional status. In the MMFS, the potential determinants of functional status include demographic, clinical, psychosocial, behavioural and symptom burden variables. We measured functional status using the Duke Activity Status Index. Other variables were collected by standardized questionnaires and patient interviews.

Results: Patients who were older, less educated, or had greater comorbidity burden or greater symptom burden had worse functional status. Sex, body mass index, depression, anxiety and social support were indirectly associated with functional status mediated by symptom burden. Being married was indirectly associated with better functional status via the pathways of more social support and fewer depressive symptoms through lower symptom burden.

Conclusion: Multidimensional variables proposed in the MMFS were directly and indirectly associated with functional status. Among these variables, symptom burden is the most important mediator. Targeting these variables, especially symptom burden, may improve patients' functional status.

Background: Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality among women, particularly those of childbearing age and middle-aged women, who face heightened risks due to physiological changes, stress and systemic barriers. Women of colour and those from low socioeconomic backgrounds are disproportionately affected.

Aim: This article evaluates the effectiveness of community-based participatory research (CBPR) in reducing CVD risk among midlife women, emphasizing the cultural relevance of interventions as a critical factor for success.

Methodology: Following the PRISMA guidelines, a systematic search of PubMed, Scopus and Web of Science identified 15 studies, including randomized controlled trials, practice-based participatory research (PBPRs) and mixed-methods research. These studies implemented CBPR interventions focusing on diet, physical activity, stress management and community participation for underserved populations. Outcomes measured included systolic and diastolic blood pressure, serum cholesterol, Body Mass Index (BMI) and fasting blood glucose, as well as participants' knowledge, behaviours and perceived community capacity.

Results: The analysis showed reductions in systolic and diastolic blood pressure (7 and 4 mmHg, respectively), low-density lipoprotein cholesterol (10-15 mg/dL) and BMI (0.5-1.2 kg/m²), along with increases in high-density lipoprotein cholesterol (5-8 mg/dL). Culturally tailored interventions, such as dietary adjustments, group exercise and peer support, demonstrated improved compliance and maintenance of behavioural changes. Patterns of cultural relevance, trust and community ownership emerged as key determinants of success. CBPR offers significant potential for addressing health disparities and reducing CVD risk.

Conclusion: Expanding CBPR approaches and conducting long-term interventions can enhance health equity and achieve lasting benefits across diverse populations.

It has been recognized for decades that dissections occur as a mechanism of balloon angioplasty. A successful angioplasty result contains some degree of intimal splitting and disruption, which usually heals well. Nonetheless, some dissections are extensive, leading to serious ischaemic complications. The concept of therapeutic coronary dissection started evolving in the 1970s and seems to be a favourable mechanism for drug delivery in the current era of drug-coated balloons. This article will primarily focus on studies undertaken to understand the mechanism of balloon angioplasty and the morphological changes in the plaque post-balloon angioplasty. In the early days of balloon angioplasty, there was an enormous interest in dissections, mainly to prevent acute vessel closure events and to address the importance of their occurrence in relation to vessel restenosis. We will review the historical background, studies defining the clinical, angiographic and morphological patterns of the dissection spectrum and various currently evolving management strategies.

Tricuspid regurgitation (TR) is a common valvular heart disease that is associated with increased morbidity and mortality. Traditional surgical interventions, though definitive, carry considerable complexities and risks, especially for high-risk patients, with in-hospital mortality rates of ˜9%. This resulted in the undertreatment of many patients with TR, creating a substantial unmet need. This has stimulated the development of transcatheter techniques, such as transcatheter tricuspid valve replacement, tricuspid edge-to-edge repair, tricuspid annuloplasty, caval valve implantation and many others, which offer less-i nvasive alternatives with promising early results and sustained benefits. This review provides a contemporary outlook on different transcatheter tricuspid valve interventions in patients with severe TR and assesses the existing clinical data regarding the safety and effectiveness of these devices in a rapidly expanding space.

Background: Diabetic cardiomyopathy (DC) is a syndrome of heart failure occurring in patients with diabetes mellitus (DM), independent of other risk factors. It is a relatively underdiagnosed condition with a prolonged subclinical phase. There is an abundance of studies put forward to explain the underlying pathogenic mechanisms observed in this condition. This review aims to summarize the evidence available in contemporary medical literature with regard to the molecular mechanisms, abnormalities in signalling and metabolism and structural and functional abnormalities manifesting as DC. Methods: We conducted a literature search using the terms 'diabetic cardiomyopathy', 'heart failure AND Diabetes mellitus', 'Cardiomyopathy AND Diabetes mellitus'. We searched the reference lists of included studies and relevant systematic reviews. Results: In this review, we elucidate all the mechanisms that have been postulated to have a role in the pathogenesis of DC, in addition to insulin resistance, such as inflammation, renin-angiotensin-aldosterone system activation and deranged protein homeostasis. Conclusions: DC is an underrecognized cardiac complication of DM. A comprehensive knowledge of all the pathways and mediators will aid in the development of diagnostic and prognostic markers, screening protocols and novel management strategies.

Leadless pacemakers are considered one of the major technological advancements in cardiology in recent years. Many efforts are made to provide physiological atrio-ventricular (AV) pacing. With the first-generation leadless ventricular, dual, dual (VDD) pacemaker, Micra AV (Medtronic, Inc., Minneapolis, MN, USA), a high variability in AV synchrony was reported. A second generation, Micra AV2, is now available for clinical use, promising smarter and higher automatic AV synchrony. This article reviews the different improvements proposed for this new device.

Background: Radial access is considered the preferred method for coronary angiography (CAG) and percutaneous coronary intervention. Radial artery thrombosis (RAT) stands out as the primary complication associated with trans-radial access. Our objective was to explore the occurrence of RAT and its associated risk factors. Method: A study encompassing 150 patients who underwent coronary interventions via radial access was conducted. Colour Doppler ultrasonography was used to assess proximal and distal radial flow rates 4-6 hours post-procedure. Patients diagnosed with RAT constituted the study group, while those without RAT were designated as controls. Results: Among the 150 patients, 20 (13.3%) developed RAT, with partial occlusions observed in 2.7% and total occlusions in 10.7%. Univariate analysis identified potential correlations between RAT and variables such as female gender, hypertension (HT), history of coronary artery disease, use of anti-thrombocyte medications, duration of compression, indication for CAG, haematocrit levels, neutrophil count, creatinine levels and estimated glomerular filtration rate. However, only HT showed a statistically significant association. Multivariate analysis confirmed HT, anti-thrombocyte drug use, duration of compression, haematocrit levels and creatinine levels as independent predictors of RAT. Conclusion: HT, anti-thrombocyte drug use, duration of compression, haematocrit levels and creatinine levels are identified as independent predictors of RAT. Standard pulse examination may not adequately detect RAT.

[This corrects the article DOI: 10.17925/HI.2024.18.1.5.].