Heart and Vessels最新文献

In Japan, median waiting time of heart transplantation (HT) is estimated as more than 5 years. Internationally, they report relatively high incidence of right heart failure (RHF) during left ventricular assist device (LVAD) support. However, the analysis based on nationwide survey in Japan is still limited. Therefore, we aimed to clarify the predictor and incidence of RHF after LVAD implantation in contemporary cohort, and its impact on their survival outcomes. Adult patients who underwent LVAD implantation at our institution from 2007 to 2023 were retrospectively reviewed. Those eventually weaned off and those bridged from paracorporeal VAD were excluded, and finally 178 patients were enrolled. We evaluated the incidence of RHF, post-LVAD survival, and predictors of RHF or on-device mortality. Five-year on-device survival was 78.5%. The incidence of early RHF was 3.4% and its cumulative incidence at 5 year was 22.1%. While 91.5% of the cohort underwent LVAD as BTT, post-LVAD survival was not significantly worse with RHF (p = 0.107). Cox regression analyses demonstrated preoperative severe TR and dilated phase of hypertrophic cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy were the independent predictors of RHF and on-device death (hazard ratio (HR) 8.59, 95% confidence interval (CI) 3.68-20.0, HR 2.62, 95% CI 1.08-6.34, respectively). The incidence of early RHF was 3.4% and its cumulative incidence at 5 year was 22.1%, which was relatively low. Although RHF was not significantly associated with worse 5-year survival after LVAD implantation, we would need a large, nation-wide study to further address this issue.

Type 2 diabetes mellitus (DM) is a risk factor for the development of heart failure (HF) and associated with a poor prognosis. However, the impact of DM on clinical outcomes in patients with left ventricular diastolic dysfunction (LVDD) and HF with preserved ejection fraction (EF), which is the phenotype of diabetic cardiomyopathy, remains uncertain. This study aimed to investigate the impact of DM on cardiac functional changes and prognosis in patients with pseudonormal LV diastolic filling pattern (LVDFP) and preserved EF. A total of 413 patients with pseudonormal LVDFP and preserved EF who underwent follow-up echocardiography were enrolled between 2011 and 2020. The primary outcome was major adverse cardiac events (MACE) including all-cause death, non-fatal myocardial infarction, cardiac hospitalization, or stroke. Among the study population, 125 patients (30.3%) had DM. During the follow-up period (median 3.8 years [interquartile range: 2.1 to 5.6 years]), the follow-up EF comparing baseline EF was more significantly decreased in DM patients (67.3 ± 6.3 to 64.8 ± 7.5; p = 0.001) compared with non-DM patients (67.8 ± 5.8 to 66.8 ± 6.9; p = 0.03). Furthermore, compared with the non-DM patients, the DM patients significantly increased the risk of MACE (26.2% vs. 54.7%; adjusted hazard ratio, 1.68; 95% confidence interval, 1.11-2.54; p = 0.015). In patients with pseudonormal LVDFP and preserved EF, the DM was associated with the risk of worse clinical outcomes compared with the non-DM.

Dual antiplatelet therapy is the standard therapy for the secondary prevention of acute and chronic coronary syndromes in patients undergoing percutaneous coronary intervention (PCI). The introduction of more potent antiplatelet agents and understanding of prognostic implications associated with bleeding have led to a substantial evolution in antiplatelet treatment regimens over the past decades. Several investigations have been conducted to better stratify patients undergoing PCI according to their ischemic and bleeding risks and to optimize antithrombotic regimens accordingly. One of the available strategies involves using platelet aggregation tests to determine the most suitable antiplatelet agent to combine with aspirin. Our aim was to evaluate the role of platelet function tests (PFT) in clinical practice in choosing dual antiplatelet therapy for patients undergoing PCI: in this study, we compared the impact on ischemic and hemorrhagic cardiovascular events in a 5 year follow-up between patients treated according to standard guidelines and those treated with a platelet function test guided approach. This study included 490 patients with acute or chronic coronary syndrome who underwent percutaneous angioplasty between 2013 and 2016 and were subsequently treated with dual antiplatelet therapy. Patients whose treatment strategy was based on PFT were 68.4% (n = 335), while others received standard therapy. The primary endpoint of the study was to assess the incidence of net adverse clinical events (NACE), defined as a composite of all-cause mortality, myocardial infarction, stroke, or major bleeding, according to the BARC scale. Follow-up was conducted 5 years after angioplasty by telephone contact or by consulting patients' medical records. Heart failure and stable angina were considered as secondary endpoints. From the univariate analysis, the incidence of NACE was significantly lower in patients who received tailored therapy (33.7% vs. 43.9% in the non-tailored group, p = 0.02). In addition, results showed that total length of implanted stents and left main coronary disease were independent risk factors for net adverse clinical events (NACE). Similarly, an initial diagnosis of N-STEMI or unstable angina was associated with an increased risk of adverse events during follow-up. In patients undergoing PCI, a tailored antithrombotic approach guided by PFT appears safe and effective, may represent a feasible strategy in contemporary practice and should be considered in case of high bleeding risk.

Cardiovascular diseases are strongly associated with poor lifestyle habits. Adopting healthier lifestyle habits is essential for reducing the risks associated with cardiovascular diseases. However, low health literacy (HL) may compromise assessing, using, and understanding health information, making modification of health behavior less likely. This study aimed to clarify the relationship between HL and changes in health behavior in inpatients undergoing cardiac rehabilitation. This was a multicenter cohort study of patients undergoing phase I cardiac rehabilitation. We used the 14-item Health Literacy Scale (HLS-14) to assess HL and the transtheoretical model (TTM) to assess changes in health behavior. Behavioral changes during hospitalization were defined using the stages of the TTM. A total of 428 patients who underwent cardiac rehabilitation (mean age: 73.0 years; males: 71.5%) were included. Evaluation of the behavioral changes exhibited by the participants revealed that the pre-contemplation stage (83.2%) was common at the beginning of rehabilitation, whereas contemplation (50.7%) and preparation (38.1%) stages were common at discharge. Of the 428 participants, 83.6% exhibited behavioral changes during hospitalization. Multivariate analysis revealed that HLS-14 score was a significant explanatory variable associated with changes in health behavior (odds ratio: 1.04; 95% confidence interval: 1.00-1.07). The spline curves modeling the relationship between HLS-14 score and changes in health behavior showed a positive correlation in the low HL group. HL is significantly correlated with changes in health behavior, especially in individuals with a low HL level.