Heart and Vessels最新文献

Red cell distribution width is a prognostic marker of adverse outcomes in adults with heart disease, including congenital heart disease. However, its significance has not been clarified in pediatric patients. We investigated the relationship between red cell distribution width and cardiovascular events in school-age children with congenital heart disease and uniform reference intervals. We performed a retrospective cohort study of pediatric patients with congenital heart disease between January 2018 and March 2023. Children aged 7-15 years were included, and the results of the first blood test during the study period were considered as baseline data. Cardiovascular events were defined as all-cause mortality, non-scheduled hospitalizations for cardiovascular reasons, heart failure, arrhythmias, thromboembolism, and unplanned intervention. In total, 101 children were included. The median red cell distribution width was 12.3% (interquartile range 11.9-12.8%). Cardiovascular events occurred in 15 patients (14.9%) during follow-up. The Kaplan-Meier analysis showed significantly worse cardiovascular event-free survival in the higher red cell distribution width group. Univariate Cox regression revealed that a higher red cell distribution width group (p < 0.001), Fontan circulation (p < 0.001), oxygen saturation (p < 0.001), aspartate aminotransferase (p < 0.001), alanine aminotransferase (p < 0.001), and gamma-glutamyl transpeptidase (p < 0.001) were associated with cardiovascular events. When adjusted for other variables respectively, only a higher red cell distribution width group and Fontan circulation remained independently significant. The red cell distribution width and Fontan circulation were independently associated with cardiovascular events in school-age children with congenital heart disease.

Coronary microvascular dysfunction (CMD) represent a crucial and often underdiagnosed cause of myocardial ischemia and dysfunction. It is closely linked to the prognosis of patients with coronary artery disease. Increased microvascular resistance (whether due to CMD or vascular rarefaction) is more frequent in the setting of coronary chronic total occlusions (CTO). Whether recanalization contributes to the recovery of microvascular function and whether measures of microvascular resistance can potentially be used as prognostic parameter to predict long-term success of CTO recanalization remains unknown. The aim of this study was to investigate CMD in patients with CTO and the effect of successful CTO recanalization. As well, we investigate whether CMD can be identified as a risk factor for restenosis after CTO recanalization. 119 patients underwent successful CTO recanalization at the University Medical Center in Mainz. After a follow-up period of 6 months, invasive control was carried out, in which 79 patients continued to have sufficient revascularization and 40 presented with restenosis. Angiography-based microvascular resistance (Angio-IMR) measurements were performed directly after successful CTO recanalization and at 6 months follow-up offline using a software package (QAngio XA 3D; Medis Medical Imaging Systems). 64% of the patients were male with an average age of 62 ±  9 years. The mean follow-up period was 191 ± 80 days. Median J-CTO Score was 1.8 ± 0.7. The CTO was localized at the RCA in 60%, at the LAD in 20% and at the LCX in 24% of the patients. All included patients had a good result after CTO recanalization confirmed by Quantitative flow ratio (QFR) of 0.94 ± 0.04 directly after PCI. Angio-IMR values immediately after CTO recanalization were pathological (> 25) in 78% of the patients and showed a significant decrease at 6 months follow-up (31.7 ± 7.1 vs. 28.6 ± 5.3¸ p = 0.0024). Post-procedural angio-IMR values did not predict restenosis at 6-month follow-up (31.7 ± 8 vs. 29.8 ± 7.5, p = 0.173). CMD can be detected in a majority of patients after successful CTO PCI. At 6 months follow-up we found significant improved angio-IMR values; CMD was not a predictor of restenosis.

This Letter to the Editor responds to the recent study by Kanejima et al. on the association between health literacy (HL) and behavioral changes during phase I cardiac rehabilitation (CR). While acknowledging the study's valuable contribution, we contest the conclusion that low HL is an inherent barrier to behavioral change. Drawing on recent evidence, we highlight that HL is a modifiable factor that can be improved through targeted interventions, program designs, and the rehabilitation process itself. We present six key arguments: (1) digital health technologies and structured education can enhance HL and foster behavioral adaptation in low-HL populations; (2) non-literacy barriers such as logistical constraints often play a larger role; (3) comparable cardiovascular interventions have shown sustained benefits despite low baseline HL; (4) CR programs themselves can directly improve HL; (5) modern CR designs employ adaptive, individualized approaches effective across HL levels; and (6) nurse-led and home-based strategies can successfully overcome HL limitations. Collectively, these points suggest that low HL should be viewed as a dynamic and addressable factor rather than a fixed constraint. We urge future research to incorporate HL-enhancing interventions and longitudinal follow-up to better understand HL's evolving role in CR outcomes.

Atrial fibrillation (AF) is a common arrhythmia with increasing prevalence, especially in overweight and obese individuals. Pulmonary vein isolation (PVI) using high-power short-duration (HPSD) and very high-power short-duration (vHPSD) ablation has shown effectiveness, but data on the use of these techniques in obese and overweight patients remain limited. This study aimed to evaluate whether body mass index (BMI) influences procedural characteristics, safety, and clinical outcomes of PVI performed using HPSD and vHPSD ablation in patients with symptomatic AF. We retrospectively analyzed 367 patients (119 obese, 138 overweight, 110 normal weight) who underwent HPSD or vHPSD PVI at Ostalb-Klinikum Aalen between 2019 and 2023. Procedural parameters, complications, and 12-month AF recurrence were assessed across BMI groups. Groups were comparable except for age (normal: 68.2 ± 12, overweight: 68 ± 9.7, obese: 64 ± 10.7; p < 0.01), hypertension (54.6%, 70.3%, 73.1%; p < 0.01) and diabetes (12.7%, 11.6%, 22.7%; p = 0.03). Procedure times, fluoroscopy times, and acute PVI success rates (100%) were similar. Base impedance was significantly higher in overweight (122.8 ± 14.1) and obese (123.9 ± 17.6) than in normal weight patients (113.8 ± 21.7; p < 0.01). AF recurrence rates were similar (normal: 20%, overweight: 18.1%, obese: 20.1%; p = 0.9), with no significant BMI correlation (Spearman = - 0.02). Complications were rare (p = 0.54). HPSD and vHPSD ablation are safe and effective in overweight and obese AF patients, with comparable recurrence rates and outcomes to normal-weight patients. Higher base impedance did not impact recurrence or complications.