International heart journal最新文献

Although the efficacy of quadruple therapy-including angiotensin receptor neprilysin inhibitor-in patients with heart failure is well established, the impact of multidisciplinary interventions on its implementation in real-world clinical practice remains unclear.We retrospectively included 90 patients who received multidisciplinary intervention between April 2023 and March 2024 and 94 patients who received conventional care between April 2020 and March 2021. In the multidisciplinary care group, a standardized heart failure checklist was used to confirm the optimization of heart failure treatment. The rates of nutritional counseling, medication education, and rehabilitation introduction, as well as the implementation rate of quadruple therapy during hospitalization for heart failure, were compared between the groups.The mean age of patients was 75.7 years; 58.6% were male, and 45.3% had their first heart failure hospitalization. Background characteristics were not significantly different between the groups. The implementation rates for nutritional instruction, medication instruction, and rehabilitation were 51.2%, 72.0%, and 88.9% in the multidisciplinary intervention group, which were significantly higher than those in the conventional care group (26.3%, 49.5%, and 54.3%, respectively) (all P < 0.001). The rate of quadruple therapy implementation was higher (74.4%) compared to the conventional care group (30.6%) among the individuals with reduced ejection fraction (P < 0.001).In carefully-selected hospitalized patients with heart failure, multidisciplinary intervention was associated with increased utilization of evidence-based therapies, including quadruple therapy, highlighting its potential to enhance the quality of care in real-world clinical settings.

The aim of this study was to construct a residual cholesterol (RC)-based nomogram prediction model and assess its value in predicting the risk of major adverse cardiovascular events (MACE) after emergency percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).Retrospective analysis of patients from Fuyang People's Hospital who underwent emergency PCI for AMI at our hospital between January 2022 and December 2023 was performed, and univariate logistic regression was used to screen the risk factors for the first occurrence of MACE in the patients, while multivariable logistic regression analysis was used to construct a prediction model. Internal validation was performed using 1,000 bootstrap resampling. The predictive effect of the nomogram model was evaluated using the receiver operating characteristic curve (ROC), Hosmer-Lemeshow deviance test, and decision curve analysis (DCA).Logistic regression analysis showed that residual cholesterol, greater than 90 minutes from symptom onset to first medical contact (SO-to-FMC > 90 minutes), number of involved coronary vessels, Killip scale II-IV, and hemoglobin concentration were factors influencing the occurrence of MACE after PCI in these AMI patients (P < 0.05). The area under the curve (ROC-AUC) of the nomogram model for predicting the risk of developing postoperative MACE was 0.780 (0.721-0.839); the result of the Hosmer-Lemeshow test of deviance, χ² = 4.758 (P = 0.783), suggests that the model shows a moderately discriminatory and calibrated decision analysis curve; DCA shows a net clinical benefit with the nomogram model.RC is a promising biomarker for identifying AMI patients at high risk of postoperative MACE, and multivariate models based on RC can be used as quick and easy tools to identify these patients.

Two types of cryoballoon (CB) systems are currently available for catheter ablation of atrial fibrillation (AF). It is not clear how the difference between POLARx (Boston Scientific) and AFA-Pro (Medtronic) relates to myocardial injury and the incidence of early recurrence of fibrillation (ERAF).Patients (n = 137) who underwent catheter ablation for paroxysmal AF by 2 CB devices were included (AFA-Pro in 87; POLARx in 50). We assessed creatine kinase (CK)-MB pre and post-procedure, ERAF, and the number of atrial premature contractions (APCs) at Holter monitoring 1 month and 3 months after the procedure. The change ratio was defined by the following formula: (post-procedure/pre-procedure). ERAF is defined as the recurrence of AF within 90 days after the procedure.The 2 groups did not differ significantly in the number of CB applications or the percentage of touch-up applications by radiofrequency catheter. The CK-MB change ratio was considerably higher in the POLARx group than the AFA-Pro group (19.3 ± 21.6 versus 27.4 ± 21.3; P = 0.036). The incidence of ERAF was similar between the 2 groups (15% versus 24%; P = 0.23). Additionally, there were no significant differences in the number of APCs (120 [39-784] versus 147 [43-1039]; P = 0.70) or AF recurrence (3% versus 12%; P = 0.10).POLARx causes stronger myocardial injury than AFA-Pro but does not increase ERAF and APC numbers.

Diuretics are used to relieve congestive symptoms in patients with severe aortic stenosis (AS). However, the effect of preprocedural diuretic treatment on long-term outcomes in AS patients who undergoing transcatheter aortic valve implantation (TAVI) remains unclear. We prospectively enrolled 4,903 consecutive AS patients who underwent TAVI in 7 Japanese hospitals between April 2010 and June 2024 and evaluated the effect of preprocedural diuretics treatment on clinical outcomes. Patients were divided into 2 groups as follows: the Diuretics group, who received diuretic treatment before TAVI (n = 2,073), and the Non-Diuretics group without diuretic treatment (n = 2,830). The median observation period was 2.1 years. The Diuretics group was older and had higher surgical risk scores and more comorbidities, including prior myocardial infarction, atrial fibrillation/flutter, and peripheral artery disease. The Diuretics group included more patients with New York Heart Association (NYHA) classification III/IV, lower left ventricular ejection fraction, and reduced renal function. They had significantly worse all-cause and cardiovascular mortality than those in the Non-Diuretics group (38% versus 26% and 18% versus 10%, respectively; P < 0.001 by log-rank test). After propensity score matching to minimize the influence of confounding factors, preoperative diuretic treatment was associated with worse all-cause mortality (hazard ratio [HR]: 1.29, 95% confidence interval [CI]: 1.06-1.58, P = 0.012) and cardiovascular mortality (HR: 1.61, 95%CI: 1.15-2.26, P = 0.006). Two fifths of AS patients who undergoing TAVI received preoperative diuretics, and those patients had worse all-cause and cardiovascular mortality. Preprocedural diuretic treatment was an independent predictor of all-cause and cardiovascular mortality after TAVI.

Hematocrit (HCT) has clinical significance in the prognosis of acute heart failure (AHF). This study investigated the association between HCT and 365-day all-cause mortality rate from the MIMIC-IV database. We also explored the specific inflection point for HCT that affects the varying clinical prognoses in patients with AHF.A total of 2,193 patients with AHF were extracted from the MIMIC-IV database. Patients were divided into 3 groups based on HCT levels at admission: low-HCT (< 30%), middle-HCT (30% - 40%), and high-HCT groups (≥ 40%). Ten variables were identified using the least absolute shrinkage and selection operator regression. In multivariable Cox regression, HCT was identified as an independent protective factor for 365-day all-cause mortality in patients with AHF (HR = 0.98, P = 0.004). The restricted cubic spline curve revealed a nonlinear relationship between the 2 (P nonlinear = 0.002), with inflection points at 30. According to the threshold effect analysis of HCT on mortality, patients in the low HCT group had a significantly higher mortality rate (HR = 0.92, P = 0.001). Finally, subgroup analysis revealed no interaction (P > 0.05).A negative association exists between HCT and 365-day all-cause mortality in patients with AHF. Low HCT (< 30%) was significantly associated with a higher mortality rate in patients with AHF.

Heart failure with preserved ejection fraction (HFpEF) has a high prevalence and a low quality of life, and there are limited medications for the treatment of this disease. In recent years, disulfiram (DSF), an FDA-approved drug for the treatment of chronic alcohol addiction, has been found to have anti-inflammatory properties. The present study was designed to investigate the cardioprotective effects of DSF on patients with HFpEF and its mechanism using a model of HFpEF induced in mice fed a high-fat diet (HFD, 60% of calories from fat) and Nω-nitro-L-arginine methyl ester (L-NAME, 0.5 g/L in drinking water). The results showed that DSF effectively reversed the HFD + L-NAME-induced increases in left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), interventricular septal thickness, left ventricular mass, the ratio of peak early mitral diastolic velocity to peak late mitral diastolic velocity, the ratio of early mitral diastolic velocity to early diastolic velocity, as well as the reductions in the absolute value of global longitudinal strain (GLS), without affecting the left ventricular ejection fraction (LVEF). In addition, DSF notably attenuated the HFD + L-NAME-induced increase in blood pressure, exercise intolerance, cardiac hypertrophy, pulmonary edema, and elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. Mechanistically, we found that DSF inhibited myocardial PANoptosis-like cell death, mainly by inhibiting the release of myocardial interleukin 1β (IL-1β), which inhibited transforming growth factor-β-activated kinase 1(TAK1)-mediated PANoptosis. Given the cardioprotective effects of DSF, its clinical use would be a novel strategy for the protection and treatment of cardiac injury in patients with HFpEF.

Myocardial ischemia-reperfusion injury (MI/RI) refers to the deterioration of cardiac function after restoring ischemic myocardium perfusion. Stem cell exosomes have produced unique advantages in treating MI/RI. However, the roles of exosomal microRNA-223-3p (miR-223-3p) from adipose-derived stem cells (ADSCs) on MI/RI are still unclear. This study aimed to investigate the effects of exosomal miR-223-3p from ADSCs on hypoxia/reoxygenation (H/R)-induced H9c2 cell injuries. Our findings indicated that the separated ADSC-derived exosomes (ADSC-Exo) were spherical, with a complete cell membrane, an average diameter of 110 nm, and CD9 and CD63 expression. ADSC-Exo increased the cell viability, proliferation, glutathione (GSH) level, and glutathione peroxidase 4 (GPX4) and miR-223-3p expression and decreased the apoptosis, reactive oxygen species (ROS), malondialdehyde (MDA), and Fe²⁺ levels and acyl-CoA synthetase long chain family member 4 (ACSL4) and transferrin receptor (TFRC) expression of H9c2 cells. Overexpressing exosomal miR-223-3p from ADSCs further strengthened the effects of ADSC-Exo on H9c2 cells. Overexpressing TFRC in H9c2 cells effectively reversed the effects of miR-223-3p overexpressed ADSC-Exo on H9c2 cells. In addition, miR-223-3p targeted and negatively regulated TFRC. This study confirmed that exosomal miR-223-3p from ADSCs alleviated H/R-induced ferroptosis of H9c2 cells by inhibiting TFRC, providing a novel target and pathway for the clinical treatment of MI/RI.