Herz最新文献

People with diabetes mellitus have a significantly increased risk of developing cardiovascular disease as well as chronic kidney disease. The coexistence of these comorbidities has a significant impact on prognosis. In August 2023, the European Society of Cardiology published new guidelines that include specific recommendations for risk reduction in those affected. The key points of these guidelines, as well as recently published data and their respective practical relevance, are presented in this article.

Background: This study aims to compare the midterm outcome of percutaneous edge-to-edge repair (TEER) using the first-generation MitraClip system (Abbott Vascular, Santa Clara, CA) with surgical repair, in patients with severe functional mitral regurgitation (fMR) and reduced left ventricular function (LVEF).

Methods: The data of consecutive patients with severe fMR and LVEF ≤ 45%, who underwent either isolated surgical repair or MitraClip implantation between January 2007 and December 2015, were retrospectively analyzed. Clinical and echocardiographic follow-up data after 12 and 24 months were obtained in both groups. A propensity score matching analysis was performed to adjust for intergroup differences in baseline characteristics.

Results: A total of 167 patients with significant fMR and LVEF ≤ 45% were identified, who underwent either isolated surgical mitral valve repair (n = 83, 49.7%) or MitraClip (n = 84, 50.3%) implantation. Because the two groups had very different risk profiles, propensity scores were calculated for age, sex, EuroSCORE, LVEF, and coronary artery disease, which reduced the number of patients to 74 (38 in the clip group and 36 in the surgical group). There was no significant difference between the two groups in terms of survival, number of reinterventions, heart failure symptoms according to New York Heart Association (NYHA) class, degree of mitral regurgitation, and LVEF.

Conclusion: In this retrospective analysis of patients with severe fMR and LVEF ≤ 45%, the comparison between surgical repair, edge-to-edge repair and a first-generation MitraClip device showed similar midterm outcomes in terms of survival, number of reinterventions, NYHA class, degree of mitral regurgitation, and LVEF.

The recording of mortality after acute myocardial infarction can be based on different data, some of which yield very different results. These differences are due to a number of factors, including the definition of acute myocardial infarction, patient selection and the methods used to determine mortality. While routine data are primarily used for billing purposes, procedural data for coronary angiography and percutaneous coronary intervention (PCI) are used for external quality assurance and therefore only include patients who undergo invasive diagnostic procedures. Registries include patients with a disease, e.g., ST-segment elevation myocardial infarction, according to defined criteria. The mortality data published for Germany differ considerably depending on the source of the data. The manuscript discusses the problems of recording the mortality of myocardial infarction in Germany and attempts to propose solutions for improving data quality in order to be able to evaluate possibilities for optimizing treatment.

Background: Information regarding the association between cardiovascular health (CVH) as assessed using Life's Essential 8 (LE8) approach and all-cause mortality in adults with early-onset cardiovascular diseases (CVDs) is limited.

Objective: In this study, we aimed to assess the association between CVH constructed by the LE8 metrics and all-cause mortality in Chinese individuals with early-onset CVDs, including myocardial infarction, heart failure, atrial fibrillation, ischemic stroke, and hemorrhagic stroke as well as in those who had undergone coronary artery bypass surgery or coronary intervention.

Methods: Data of 3454 participants who were first diagnosed with early-onset CVDs (men aged < 55 years and women aged < 65 years with CVDs) in the Kailuan study from 1 January 2006 to 31 December 2020 were analyzed. Assessment of CVH (score ranging from 0 to 100 points) was made using the LE8 metrics (including diet, physical activity, nicotine exposure, sleep duration, body mass index [BMI], lipid, blood glucose, and blood pressure). All-cause mortality information was collected from provincial vital statistics offices. Cox proportional hazard regression models and restricted cubic splines were utilized to examine associations between the CVH scores and all-cause mortality in adults with early-onset CVDs.

Results: During a mean follow-up of 6.78 years (interquartile range [IQR]: 3.36-10.5 years), 460 deaths were documented. After controlling for demographic variables, lifestyles, and major clinical factors, higher CVH scores were associated with lower risks of all-cause mortality among participants with early-onset CVDs. The corresponding hazard ratios (HRs) with 95% confidence intervals (CIs) were 0.64 (0.49, 0.82) comparing two extreme quartiles of CVH scores and 0.85 (0.77, 0.82) for each 10-point increment in CVH score (p _trend = 0.001). Specifically, significant inverse associations were observed among participants with hemorrhagic stroke (HR _{Q4 vs. Q1} = 0.46, 0.23-0.93) and heart disease (HR _{Q4 vs. Q1} = 0.59, 0.41-0.87).

Conclusion: Our findings supported the beneficial role of higher CVH scores in all-cause mortality among adults with early-onset CVD.

Routine data are very helpful as an instrument for health services research. In German hospitals the input data of the statutory quality assurance (in cardiology: left heart catheterization, cardiac implantable electronic devices and transcatheter aortic valve implantation, TAVI), the data according to § 21 of the Hospital Remuneration Act and mandatory quality assurance reports of hospitals are available. In addition, the health insurance companies also have social data at their disposal. The very restrictive interpretation of data safety in Germany as well as a partition of the data according to the private or statutory health insurance status, outpatient and inpatient forms of treatment and two different remuneration sources exacerbate in the current reality an effective central use of routine data, as is possible in other countries, e.g., Sweden. Routine data are a powerful tool for quality assurance in terms of critical self-reflection and as a basis for peer review by colleagues; however, public reporting of routine data (publication of the results of individual hospitals) is questionable due to methodological limitations, such as data quality and risk adjustment, as it puts hospitals in the pillory without any chance to critically reflect on the validity of the data. Consequently, risk-avoiding behavior in medical services could compromise patient care. The current development of healthcare policies with a structural reform of the hospital landscape and the recommendations of the government committee will increase the demands on the quality assessment based on routine data. Simplified data acquisition, methodological improvements as well as new aspects, such as the quality of indications, assessment of nursing services and patient orientation will be added. In future, a quality-oriented remuneration based on routine data is intended to help control the healthcare system.

Background: The left atrial appendage (LAA) is the primary site of embolism in individuals with atrial fibrillation (AF). We aimed to evaluate the morphological features of the LAA orifice in patients with sinus rhythm, paroxysmal AF, and persistent AF using three-dimensional (3D) transesophageal echocardiography (TOE). We also intended to identify morphometric parameters of the LAA orifice that may be potentially associated with an increased risk of ischemic stroke.

Methods: We prospectively enrolled 106 patients undergoing TOE. Patients were divided into three groups: group 1 (sinus rhythm), group 2 (persistent AF), and group 3 (paroxysmal AF). All patients underwent a comprehensive evaluation through transthoracic echocardiography (TTE) and TOE. Off-line analyses were performed of the recorded images.

Results: The LAA minor orifice area and minimal orifice diameter were greater in patients with persistent AF compared with individuals in sinus rhythm. Patients with persistent AF also had deeper LAAs compared with those in sinus rhythm. None of the LAA orifice morphometric measures were related to ischemic stroke risk. The only independent predictors of ischemic stroke were heart rhythm and the CHA₂DS₂VASc score.

Conclusion: Persistent AF is associated with LAA dilation, increased depth, and larger orifice size. To our knowledge, this is the first study to demonstrate LAA orifice structural remodeling in patients with AF using 3D TOE.

Background: Inflammatory markers have been proposed as prognostic tools for predicting in-hospital mortality in infective endocarditis (IE). Nonetheless, it is unclear whether these markers provide additional prognostic value over established indicators. This study compared nine different inflammation scores to assess their effectiveness in enhancing the prediction of in-hospital mortality.

Methods: Patients with IE diagnosed between 2017 and 2023 at two cardiology centers in Istanbul were included in this study. Pre-treatment inflammatory markers were obtained from the hospital electronic database system. In-hospital mortality prognostication was assessed using Cox proportional hazards models.

Results: A total of 122 patients who were diagnosed with IE were included in the analysis. Overall, 38 patients died during the hospital stay. The patients were categorized into two groups based on their mortality status. The prognostic nutritional index (PNI), platelet-to-lymphocyte ratio (PLR), and modified Glasgow prognostic score (mGPS) were identified as statistically significant predictors of in-hospital mortality. Based on the results of Cox regression analysis, the PNI (hazard ratio [HR]: 0.921, 95% confidence interval [CI]: 0.853-0.994, p = 0.035) emerged as the only independent predictor of in-hospital mortality of IE patients.

Conclusion: Nine inflammatory scores were evaluated in this study. The PNI, PLR, and mGPS were statistically significant predictors of in-hospital mortality in patients with IE. The PNI was identified as the optimal score.

Despite an expensive healthcare system Germany performs poorly with respect to life-expectancy compared to other countries, for which cardiovascular diseases and deficits in cardiovascular prevention in particular are responsible. The basis of cardiovascular prevention is a healthy lifestyle with regular physical exercise, a predominantly plant-based diet, nonsmoking, good sleep and mental health. In many cases additional lipid-lowering, antidiabetic and antihypertensive medications are necessary. Recent studies have proven the prognostic effects of different groups of medications, such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, sodium-glucose transporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists, in the appropriate indication areas. To improve the cardiovascular prevention in Germany, intensified public efforts are crucial. In addition, individual support of patients is effective for long-term preventive measures. To achieve this healthcare professionals must be trained (physicians, cardiovascular prevention assistants), who can sustainably support patients in lifestyle modifications and medicinal prevention.

An effective quality assurance concept with essential benefits for all patients concerned and without bureaucratic overload can only be achieved with all stakeholders working closely together with the inclusion of clinical medical expertise. The calculation of quality results based on routine data alone is not sufficient to reach this goal.