International journal of cardiology最新文献

Background: Heart failure (HF) patients experience elevated sympathetic tone and abnormal peripheral chemoreceptor (PChR) function (elevated sensitivity [PChS] and tonicity [PChT]), which can be attributed to a reduction in cardiac output (CO) and resultant hypoperfusion of the carotid bodies. Left ventricular assist devices (LVADs) are known to increase CO, and can be used as a unique model to examine the impact of acute hemodynamic changes on PChR.

Methods and results: Fourteen HF patients with LVADs underwent assessment of PChS (using the transient hypoxia test) and PChT (using low-dose dopamine infusion) under different LVAD flow parameters, previously determined using right heart catheterization to achieve significantly distinct CO levels. PChS did not differ between the low- vs high-flow conditions (0.61 [0.49;0.74] vs. 0.67 [0.33;0.9] L/min/SpO2%, p = 0.36) as well as PChT (0.97 [-0.36;1.96] vs. 0.81 [-1.67;2.2] L/min-1, p = 0.81).). In 9 patients, central venous pressure (CVP) decreased in response to higher pump speeds. In this group, PChS more frequently increased and was significantly higher than in the remaining patients. ΔCVP was also inversely related to ΔHVR (R = 0.75, p = 0.002).

Conclusions: Acute changes in CO, as well as pulse pressure, did not affect PChS or PChT. Surprisingly, we observed a strong correlation between a decrease in CVP in response to higher LVAD speed and an increase in PChS, which can be explained by the function of low-pressure baroreceptors. These findings provide unique data on PChR function under different hemodynamic conditions in the LVAD population.

Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous condition with variable outcomes. The prognostic value of common clinical risk factors for major adverse cardiac events (MACEs) and all-cause mortality remains unclear. This study systematically evaluates associations between traditional risk factors and adverse outcomes in MINOCA.

Methods: A systematic review and meta-analysis was conducted to assess pooled hazard ratios (HRs) for clinical variables associated with MACEs and all-cause mortality. Eligible studies reporting HRs with at least 6 months of follow-up were included. Random-effects models were used to derive pooled estimates.

Results: Eleven studies including 12,081 patients were analyzed. Over a mean follow-up of 49.2 months, pooled MACEs incidence was 17% (95% CI: 11-26%) and all-cause mortality was 10% (95% CI: 8-14%). Older age increased the risk of MACEs (HR: 1.02; 95% CI: 1.01-1.04), while higher BMI was protective (HR: 0.92; 95% CI: 0.86-0.99). For all-cause mortality, significant predictors included age (HR: 1.04 per year), diabetes (HR: 1.33; 95% CI: 1.07-1.64), creatinine (HR: 1.01; 95% CI: 1.0009-1.02), and STEMI-pattern presentation (HR: 2.85; 95% CI: 1.09-7.44). Higher BMI (HR: 0.89; 95% CI: 0.82-0.98) and dyslipidemia (HR: 0.83; 95% CI: 0.76-0.90) were associated with lower mortality.

Conclusion: Only select clinical variables predict outcomes in MINOCA, while many traditional MI risk factors do not. These findings highlight the need for MINOCA-specific risk models and targeted management strategies.

Background: Coronary vasomotor dysfunction, diagnosed by coronary function testing (CFT), has only recently been recognized as important contributor to chronic coronary syndromes, exposing knowledge gaps on sex and age differences. Therefore, these differences are evaluated in the Dutch national CFT registry (NL-CFT).

Methods: Included were 1008 patients (83% women, 60 ± 9.6 years old) with angina and non-obstructive coronary arteries (ANOCA) undergoing CFT between 2020 and 2024. CFT consisted of coronary vasospasm provocation testing and reduced microvascular vasodilatory capacity assessment, a decreased coronary flow reserve (CFR) and/or increased microvascular resistance (MR). Patients were allocated into three age groups based on quartiles: young (≤54 years, Q1), intermediate (>54 to <67 years, Q2-Q3), and elderly (≥67 years, Q4).

Results: The prevalence of coronary vasomotor dysfunction was high, and similar (76%) between sexes. However, endotype prevalences differed: epicardial spasm was more prevalent in men in young and intermediate age groups (37%vs61%, p = 0.007 and 36%vs54%, p = 0.002), but not in elderly (44%vs32%, p = 0.096). Microvascular spasm was more prevalent in women in younger and intermediate groups (31%vs6%, p = 0.002 and 28%vs10%, p < 0.001), but not in elderly (27%vs22%, p = 0.493). Functional reduced microvascular vasodilatory capacity (abnormal CFR) was more prevalent in women (15%vs9%, p = 0.044), while structural reduced microvascular vasodilatory capacity (abnormal CFR and MR) prevalences were similar between sexes, across age groups.

Conclusion: In ANOCA patients referred for CFT, epicardial spasm was more prevalent among men and microvascular spasm in women Functional reduced microvascular vasodilatory capacity was more common in women in all age groups while structural reduced microvascular vasodilatory capacity was similar between sexes.

Introduction: Blood speckle imaging (BSI) in paediatrics is a promising novel echocardiography technique that allows complex blood flow assessment via qualitative visualization and analysis of vorticity, energy gloss and kinetic energy. However, velocity quantification has scarcely been studied in vivo, albeit in children at the aortic valve level.

Methodology: Comparison of conventional Doppler and BSI velocities at the aortic valve level in healthy children by echocardiography. BSI maximal velocity was extracted via a custom code in Python. Analysis was performed using Pearson correlation and Bland Altman analysis. An inter-observer study variability for BSI analysis was also performed in a randomly selection of subjects.

Results: A total of 77 Doppler acquisitions in 33 patients were obtained. The median age was 84 months, and maximal velocity was 1.19 m/s. Modest correlation (R = 0.53, p-value<0.001) was found between maximal velocity by BSI and Doppler. When age-stratified, the younger subgroup (<6.5 years) showed good correlation (R = 0.59, p-value<0.001) whereas it was not significant in the older subjects. A non-significant trend towards BSI underestimating velocities was found, more marked in the older subgroup. Also, discrepancies between BSI and Doppler were higher in the older subjects. There was good inter-observer reproducibility of BSI analysis (R = 0.7, p-value = 0.006).

Discussion and conclusion: The BSI technique shows moderate correlation with Doppler in healthy children, with better performance at lower body size. A non-significant trend towards greater discrepancies at higher velocities was observed. Good BSI analysis inter-observer variability was found. The BSI echocardiography allows quantification of aortic valve maximum velocity in healthy children.

Background: We aimed to develop a novel cardiac magnetic resonance (CMR)-based method for quantifying myocardial synchrony and evaluate its diagnostic value in detecting myocardial dysfunction of coronary artery disease (CAD).

Methods: Consecutive participants with anatomically/angiographically obstructive CAD (n = 112) and healthy participants (n = 87) undergoing CMR imaging were prospectively enrolled. Myocardial strain was analyzed using feature-tracking, and myocardial synchrony was quantified via Pearson correlation coefficients of segmental strain time series across the cardiac cycle. Machine learning models (strain-only, synchrony-only, combined) were developed and validated in an independent external cohort.

Results: Healthy participants exhibited high left ventricular myocardial synchrony (radial: 0.91 [IQR: 0.88, 0.93]; circumferential: 0.90 ± 0.04; longitudinal: 0.97 ± 0.02), significantly reduced in participants with CAD (radial: 0.84 [IQR: 0.75, 0.89]; circumferential: 0.81 ± 0.12; longitudinal: 0.90 ± 0.08), including those with preserved left ventricular ejection fraction (LVEF ≥50%) (radial: 0.86 [IQR: 0.82, 0.90]; circumferential: 0.86 ± 0.07; longitudinal: 0.91 ± 0.07), all p < 0.001. In model analysis, the combined model significantly outperformed individual models (AUC: 0.94 [95% CI: 0.89-1.00] vs. 0.84 [0.75-0.94] for strain model, p = 0.037; vs. 0.79 [0.68-0.90] for synchrony model, p = 0.001). Superiority persisted in CAD with preserved LVEF (AUC: 0.91 [95% CI: 0.83-1.00]) and external validation (AUC: 0.93 [95% CI: 0.84-1.00]).

Conclusions: This CMR-derived approach demonstrated the high degree of left ventricular synchrony in healthy populations and significant dyssynchrony in CAD, even in those with preserved LVEF. Integrating myocardial synchrony with strain significantly enhanced CAD myocardial dysfunction detection relative to strain alone, with robust diagnostic performance maintained in CAD with preserved LVEF.

Background: Aortic valve calcium scoring (AVCS) via noncontrast Computed Tomography (CT) has emerged as a valuable adjunct to echocardiography in diagnosing aortic stenosis (AS). However, its diagnostic accuracy in patients with chronic kidney disease (CKD) -a population characterized by extensive extra-valvular calcification- remains unclear.

Methods: This retrospective multicenter study included 2909 adults who underwent AVCS and echocardiography between 2015 and 2025 across Mayo Clinic sites. Patients were stratified by glomerular filtration rate (eGFR) to assess AVCS diagnostic performance for severe AS in CKD vs non-CKD cohorts. Receiver operating characteristic (ROC) curves, stratified by sex and eGFR categories, were used to evaluate diagnostic accuracy. Optimal thresholds were derived using Youden's index and compared with guideline-recommended cutoffs.

Results: AVCS demonstrated high diagnostic accuracy in patients with preserved renal function (AUC 0.861), but performance declined with worsening CKD. AUC dropped to 0.791 (eGFR <60), 0.727 (eGFR <45), and 0.691 (eGFR <30). Specificity declined significantly across worsening eGFR, despite stable sensitivity. Sex-stratified analysis revealed similar results.

Conclusion: AVCS remains a reliable tool to rule out severe AS in patients with CKD, but declining specificity with worsening kidney function -likely due to nonvalvular calcification- highlights the risk of false positives. In CKD populations, AVCS thresholds should be interpreted cautiously and integrated with multimodal evaluation and clinical data.

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia with a notable impact on morbidity and mortality. While moderate physical activity is generally protective against cardiovascular disease, the relationship between endurance sports and AF, especially in master athletes (aged ≥45), remains unclear. Some evidence suggests a U-shaped association between exercise intensity and AF risk.

Objective: To investigate the association between endurance sport participation and AF occurrence among master athletes, and to identify potential risk factors or predisposing conditions.

Methods: This observational case-control study enrolled 140 endurance athletes aged ≥45 years, divided into 70 with documented AF (cases) and 70 age- and activity-matched athletes without AF (controls). Data collected included demographic, anthropometric, sports participation, cardiovascular and extracardiac comorbidities, 24-h Holter ECG and echocardiographic parameters. Statistical comparisons were performed to identify differences between groups.

Results: Groups were comparable in age, sex and BMI. Both groups had similar patterns of endurance sport participation. Athletes with AF had a significantly higher burden of cardiovascular risk factors, notably hypertension (73% vs. 21%) and dyslipidaemia (54% vs. 14%), and more extracardiac comorbidities. Echocardiography revealed larger left atrial size and more frequent mitral and tricuspid regurgitation in the AF group. Most AF cases were paroxysmal, with palpitations reported in over 80%.

Conclusions: The main findings of our study suggest that endurance athletes experiencing AF show a higher prevalence of traditional cardiovascular risk factors, particularly hypertension and dyslipidaemia. These findings highlight the need for individualized cardiovascular assessment and risk management in this population. Further longitudinal studies are needed to clarify the causal role of sustained high-intensity exercise in the development of AF.