International heart journal最新文献

Takayasu arteritis is a large vessel vasculitis that gives rise to inflammation-induced stenosis of the major branch arteries of the aorta. A 13-year-old girl presented with loss of appetite, palpitation, shortness of breath, and occasional chest pain. Blood examination, electrocardiography, and echocardiography revealed non-specific findings. Shortly after, she experienced severe chest pain and died suddenly. A pathological autopsy revealed severe stenosis localized only at the origin of the coronary artery, which was subsequently diagnosed as Takayasu arteritis.

This study aimed to investigate the combined impact of zinc (Zn) intake and anemia on the atherosclerotic cardiovascular disease (ASCVD) risk score of patients with chronic kidney disease (CKD). A total of 2,612 individuals diagnosed with CKD from the National Health and Nutrition Examination Survey 2007-2018 were included in this study. The 10-year ASCVD risk was the outcome variable, and patients with a risk score of ≥ 20% were categorized as having a high 10-year ASCVD risk, whereas those with a risk score of < 20% were considered to be low risk. We used weighted univariate and multivariate logistic regression models to assess the independent and joint associations of Zn intake and anemia with high 10-year ASCVD risk. After adjusting all covariates, patients with CKD with adequate Zn intake had lower odds of developing high 10-year ASCVD risk [odds ratios = 0.59, 95% confidence intervals: 0.39-0.90] than those with inadequate Zn intake. We noted a significant association between anemia and developing high 10-year ASCVD risk. Considering the adequate Zn intake and non-anemia group as a reference, patients with CKD who had both inadequate Zn intake and non-anemia had higher odds of developing high 10-year ASCVD risk; those who had both adequate Zn intake and anemia had higher odds of developing high 10-year ASCVD risk. patients with CKD with both inadequate Zn intake and anemia exhibited a nearly two-fold higher 10-year ASCVD risk compared with those with both adequate Zn intake and non-anemia. A joint effect of Zn intake and anemia on the high 10-year ASCVD risk was observed.

With the aging of the patient population with heart failure (HF), the length of hospital stay is increasing, contributing to higher healthcare costs. However, factors associated with long-term hospitalization (LTH) in older patients with HF are unknown. Therefore, the aim of the present study was to investigate these factors.Our analysis of the Kochi Registry of Subjects with Acute Decompensated Heart Failure (Kochi YOSACOI study) data of 1,061 patients with acute HF identified demographic, clinical, pre-hospital environment, and social support factors associated with LTH. A decision tree analysis was performed with the identified risk factors and using LTH as the index for risk stratification. Additionally, relationships between risk groups, length of hospital stay, and clinical outcomes were analyzed.Among 1,061 patients, 731 were included in the analysis. Among these 731 patients, 192 patients experienced LTHs (≥ 30 days). Associated factors were the Japanese version of the Cardiovascular Health Study (J-CHS) criteria score, living alone, Geriatric Nutritional Risk Index (GNRI), and systolic blood pressure at admission. Decision tree analysis categorized patients into three risk groups: low-risk (J-CHS score < 3, n = 336), medium-risk (J-CHS score ≥ 3, GNRI > 91.3, n = 395), and high-risk (J-CHS score ≥ 3, GNRI ≤ 91.3, n = 233) groups.Frailty and undernutrition were associated with LTH and worsening clinical outcomes in older patients with HF. Accordingly, the findings of this study may provide important insights into the management of older patients with HF.

Background: Tetrandrine (TET), a bisbenzylisoquinoline alkaloid, has been shown to possess various benefits for cardiovascular diseases and anti-inflammatory activities. However, the role of TET in hypertensive heart failure is not fully known. This study was undertaken to explore whether TET exerts anti-ventricular remodeling effects and to identify the mechanisms involved.

Methods: C57BL/6 mice were subjected to 4-week infusion of angiotensin II (Ang II) or transverse aortic constriction (TAC) surgery to induce ventricular remodeling. The mice received TET (5 mg/kg/day and 10 mg/kg/day) for the last 2 weeks.

Results: We found that TET dose-dependently prevented heart malfunction due to the inhibition of myocardial hypertrophy, cardiac fibrosis, and inflammation without any effect on the systolic blood pressure in Ang II-infusion mice. TET treatment also attenuated TAC-induced myocardial hypertrophy and fibrosis in the mice. The cardioprotective effects of TET were also confirmed in H9C2 cells with Ang II stimulation. TET diminished the inflammatory response in heart tissues and cardiomyocytes by suppressing the Ang II-activated mitogen-activated protein kinase (MAPK) and nuclear factor-κB (NF-κB) pathway. With a combination of JNK and ERK inhibitors and TET, the anti-inflammatory effects and the inhibition of the nuclear translocation of the NF-κB p65 subunit were enhanced in Ang II-stimulated cardiomyocytes.

Conclusions: Taken together, these data strongly suggest that TET attenuated the Ang II-or TAC-induced ventricular remodeling, which was possibly associated with the inhibition of inflammation and activation of the MAPK/NF-κB pathway in mice. These findings suggest a novel pharmacological activity for TET in the treatment of heart failure.

The ratio of uric acid (UA) to high-density lipoprotein cholesterol (HDL-C) is a marker of inflammation. However, whether this ratio is associated with left ventricular (LV) diastolic function remains unknown. This study tested the hypothesis that the UA-to-HDL-C ratio is associated with LV diastolic parameters derived from gated myocardial perfusion single-photon emission computed tomography (SPECT) in patients with no significant perfusion abnormalities.The study population included 204 patients with no significant perfusion abnormalities and a preserved ejection fraction. The peak filling rate (PFR) and one-third mean filling rate (1/3 MFR) were obtained as LV diastolic parameters using gated SPECT. Serum UA and plasma HDL-C levels were also examined.Significant associations were observed between the UA-to-HDL-C ratio and the PFR (r = -0.20; P = 0.005) and 1/3 MFR (r = -0.17; P = 0.018). Multivariate linear regression analysis was performed to determine the factors associated with LV diastolic parameters. Age (β = -0.13; P = 0.046), the LV end-diastolic volume (β = -0.17; P = 0.046), and the UA-to-HDL-C ratio (β = -0.17; P = 0.023) were significantly associated with the PFR. Moreover, age (β = -0.18; P = 0.011), the LV mass index (β = -0.19; P = 0.011), and the UA-to-HDL-C ratio (β = -0.14; P = 0.047) were significantly associated with the 1/3 MFR.These results demonstrated that the UA-to-HDL-C ratio is associated with LV diastolic function derived from gated SPECT in patients with no significant perfusion abnormalities.

The aim of this study was to analyze the correlation between left ventricular mass index (LVMI) and the prognosis of patients with acute myocardial infarction (AMI).The study retrospectively analyzed the Registry of New-onset Atrial Fibrillation Complicating Acute Myocardial Infarction-Shanghai database and included 1957 patients with AMI who were hospitalized from February 2014 to March 2018, with a median follow-up of 2.7 ± 1.3 years; it calculated the number of all-cause mortalities after AMI. Through receiver operating characteristic curve analysis of LVMI, the optimal LVMI cutoff value was obtained, and the enrolled patients were grouped accordingly. The effects of different LVMI levels on the occurrence of cardiovascular and cerebrovascular adverse events were evaluated in patients with AMI. In addition, the risk assessment and prognostic value of the combined application of LVMI and the GRACE score was explored in patients with AMI.The incidences of all-cause mortality, cardiovascular death, heart failure readmission rate, and reinfarction in patients with AMI in LVMI ≥ 98.90 group were significantly higher than those in LVMI < 98.90 group (P< 0.05). The value of LVMI combined with the GRACE score in predicting the risk of post-AMI all-cause mortality as well as cardiovascular death seemed to be better than that of using the GRACE score alone. LVMI, old age, male sex, renal insufficiency, previous heart failure, stroke history, and decreased left ventricular ejection fraction were independent risk factors for all-cause mortality after AMI.High LVMI may be closely associated with all-cause mortality and adverse cardiovascular events after AMI, especially in patients with AMI with LVMI > 98.9. The risk of all-cause mortality after AMI can also be assessed in combination with LVMI and GRACE scores.

The incidence of anthracycline-induced cardiotoxicity typically occurs within the first year after chemotherapy, but the changes in cardiac function and biomarkers beyond this initial year have not been adequately investigated. We analyzed 105 consecutive patients followed for 24 months after anthracycline-containing chemotherapy at Fukushima Medical University Hospital from June 2018 to April 2021. Echocardiography and blood tests for cardiac troponin I and B-type natriuretic peptide (BNP) were conducted at baseline, and 3, 6, 12, and 24 months after chemotherapy initiation. In the whole patient cohort, BNP levels increased from 10.5 [6.3-18.3] pg/mL at baseline to 19.2 [12.1-34.5] pg/mL at 24 months after chemotherapy (P < 0.01). Based on BNP levels at 24 months, the patients were divided into 2 groups: a BNP-elevated group (n = 57) and a BNP-normal group (n = 48). In the BNP-elevated group, time-course changes revealed that BNP levels remained stable until 12 months, but increased at 24 months. Multivariate logistic analysis identified age, total anthracycline dose, and baseline BNP levels as predicting factors for elevated BNP levels at 24 months. Subclinical BNP elevation was observed at 24 months of follow-up after initiation of anthracycline-containing chemotherapy.

The prognostic value of defibrillators in cardiac resynchronization therapy (CRT) for primary prevention remains debatable. Predicting ventricular arrhythmias (VAs) before implantation is useful for deciding whether to add a defibrillator to a CRT device. This study aimed to determine the risk factors for VA events after CRT device implantation and to construct a scoring model. A total of 153 patients who underwent CRT device implantation, with no history of sustained ventricular tachycardia or ventricular fibrillation (including 25 patients with CRT pacemakers) and with follow-up period >1 year after implantation were included. We assessed VA events requiring implantable cardioverter-defibrillator therapy and sustained VA events requiring clinical treatment. During a mean follow-up of 6.3 years, 24 patients (16%) received therapy for VA. Multivariate analysis revealed age ≤ 70 years (hazard ratio [HR] 2.936, P = 0.037), administration of tolvaptan (HR 11.259, P < 0.001), and coronary artery disease (HR 2.444, P = 0.045) were independent predictors for VA events. Risk scores were assigned based on the HR for each predictor, and the population was divided into 3 risk groups (low: 0 points; moderate: 1-3 points; high: 4-5 points). VAs occurred less frequently in the low-risk group than in the other risk groups (low: 8.1%; moderate: 18%; high: 21%) (log-rank, P < 0.001). No significant differences in mortality were observed between the groups, whereas hospitalization for heart failure occurred more frequently in the high-risk group than in the other groups. In conclusion, a scoring system using specific background information may help predict VA events in prophylactic CRT recipients.

This study aimed to evaluate the impact of obesity on in-hospital outcomes of patients with HF undergoing AF catheter ablation. This population-based, retrospective observational study extracted data from the US Nationwide Inpatient Sample (NIS) database 2005-2018. Patients ≥ 20 years with HF and undergoing catheter ablation for AF were eligible for inclusion. Propensity-score matching (PSM) was utilized to balance the baseline characteristics between obese and non-obese groups. Univariate and multivariable regression analyses were used to determine the associations between obese status and other variables with the in-hospital outcomes. These outcomes included non-home discharge, prolonged length of stay (LOS), complications, and a composite outcome that encompassed these outcomes along with in-hospital mortality. A total of 18,751 patients were included. After PSM, 8,014 patients remained in the study sample. The mean age was 64.6 ± 0.1 years. After adjustment, significant association was detected between obesity and greater odds of non-home discharge (adjusted odd ratio [aOR] = 1.18), prolonged LOS (aOR = 1.18), complications (aOR = 1.30), respiratory failure/mechanical ventilation (aOR = 1.56) and acute kidney injury (AKI) (aOR = 1.28), central nervous system and peripheral neuropathy (aOR = 1.33), and transient ischemic attack (aOR = 8.16), as well as poor composite outcome (aOR = 1.28) compared with non-obese patients. In US patients with HF undergoing AF catheter ablation, obesity is associated with a higher risk for non-home discharge, prolonged LOS, and several major complications. Clinicians should exercise heightened vigilance when administering therapy to this subgroup of patients.

There is no consensus on the ideal sweep gas flow volume for achieving targeted blood partial gas pressures during cardiopulmonary bypass (CPB). The sweep gas flow rate is one of the oxygenator's main gas exchange variables. High sweep gas flow rates can lead to respiratory and hypocapnic cerebral alkalosis, which can cause neurological complications.This study included 84 patients aged > 18 years who were scheduled to undergo elective open-heart surgery with CPB. Before rewarming, the participants were randomly assigned to one of the three groups based on their sweep gas flow rates (Group 1, 1.35 L/m²/minute; Group 2, 1.2 L/m²/minute; and Group 3, 1 L/m²/minute). During the surgery, arterial blood gases were sampled at six different time points, and regional cerebral oxygen saturation (rSO₂) levels were monitored bilaterally on the forehead.The study found that all groups experienced a decrease in partial pressure of arterial carbon dioxide (PaCO₂) levels after the onset of hypothermia, which decreased to below the normal range at a moderate hypothermia level of 32°C. During both the baseline and hypothermic periods, the PaCO₂ were similar between the groups; however, after rewarming, Group 3 had significantly higher PaCO₂ than Groups 1 and 2 (P< 0.001). During the same period, Group 3 had significantly higher rSO₂ levels than Groups 1 and 2 (P = 0.005). For all patients, there was a significant correlation between delta-PaCO₂ and delta-rSO₂ levels after rewarming (r = 0.45, P< 0.001).This study demonstrated that low sweep gas flow prevented alkalosis and preserved cerebral autoregulation.