Journal of Cardiovascular Development and Disease最新文献

The prevalence of heart failure, driven significantly by ischemic heart disease, continues to rise globally. Myocardial viability-the potential ability of dysfunctional myocardium to recover contractile function after revascularization-remains an ongoing key area of research in managing ischemic cardiomyopathy. Advances in imaging modalities, including PET/SPECT, cardiac MRI, and dobutamine stress echocardiography, have enabled identification of viable myocardium that can potentially predict their functional recovery following revascularization. Despite these advances, recent evidence from major trials questions the routine reliance on viability testing for revascularization guidance. These studies found a limited correlation between myocardial viability and improved outcomes in key metrics including mortality. Furthermore, they highlighted the effectiveness of guideline-directed medical therapy in improving left ventricular function independent of revascularization. This narrative review explores the concept of myocardial viability, its assessment through contemporary imaging techniques, its clinical utility in decision making for revascularization, and future directions.

In response to the heart failure (HF) pandemic, it is important to introduce appropriate pharmacological and non-pharmacological treatments for HF patients. In addition, self-management of HF, including the continuation of appropriate pharmacological treatment, is also important. There have been many reports on self-management of HF. However, the effectiveness of patient education of HF is not consistent. One of the reasons may be whether the tools used are common or not. Moreover, unified systems of HF patient education and disease management in metropolitan areas are rare. We began joint HF patient education and disease management in the Tokyo southern medical district (JONAN Heart Failure Medical Collaboration: JHFeC). Patients undergo a multidisciplinary HF education program at JHFeC member hospitals to ensure that they are able to adequately record information on the self-management sheet. After discharge, the continuity of self-management will be evaluated, and further education will be provided if necessary. HF patient education is important even in severe HF requiring a left ventricular assist device, and such patient education needs to be provided appropriately in all manner of HF patients with stage A to D.

Background: Gastrointestinal bleeding (GIB) is a common complication of left ventricular assist device (LVAD) support. The UTAH bleeding risk score (UBRS) is the only dedicated GIB prediction model, but its efficacy has not been confirmed in an external validation cohort. Furthermore, the reliability of other bleeding risk scores, such as ARC-HBR and HASBLED, has never been tested in this specific population. This study aims to validate the UBRS and compare its accuracy with the ARC-HBR and HASBLED scores.

Methods: Major adverse events (MAEs) and bleeding events of 75 consecutive patients who had undergone LVAD implantation between 2010 and 2021 at a referral hospital for a heart transplant were retrospectively analyzed. The accuracy of the UBRS, ARC-HBR and HASBLED scores was evaluated using a ROC curve model.

Results: At a mean follow-up of 905.9 ± 724 days, 58 (77.3%) patients had an MAE and 28 (37.3%) had a major bleeding event. Out of the 39 major bleeding events, the majority were GI (43%) and intracranial bleeding (33.3%). Compared with patients without major bleeding, those who experienced major bleeding showed a lower survival probability, regardless of the nature of the bleeding (GIB vs. other bleeding events). The UBRS effectively stratified the bleeding risk with an AUC of 0.86. In contrast, the ARC-HBR and HASBLED scores demonstrated lower discriminatory power, with AUCs of 0.61 and 0.52, respectively.

Conclusions: UBRS accuracy was confirmed in our study population. Gastrointestinal bleeding is a common life-threatening complication and one of the main causes of re-hospitalization during VAD support, leading to a lower patient survival probability.

Advanced heart failure (AHF) represents the terminal stage of heart failure (HF), characterized by persistent symptoms and functional limitations despite optimal guideline-directed medical therapy (GDMT). This review explores the clinical definition, pathophysiology, and therapeutic approaches for AHF. Characterized by severe symptoms, New York Heart Association (NYHA) class III-IV, significant cardiac dysfunction, and frequent hospitalizations, AHF presents substantial challenges in prognosis and management. Pathophysiological mechanisms include neurohormonal activation, ventricular remodeling, and systemic inflammation, leading to reduced cardiac output and organ dysfunction. Therapeutic strategies for AHF involve a multidisciplinary approach, including pharmacological treatments, device-based interventions like ventricular assisted devices, and advanced options such as heart transplantation. Despite progress, AHF management faces limitations, including disparities in access to care and the need for personalized approaches. Novel therapies, artificial intelligence, and remote monitoring technologies offer future opportunities to improve outcomes. Palliative care, which focuses on symptom relief and quality of life, remains crucial for patients ineligible for invasive interventions. Early identification and timely intervention are pivotal for enhancing survival and functional outcomes in this vulnerable population. This review underscores the necessity of integrating innovative technologies, personalized medicine, and robust palliative strategies into AHF management to address its high morbidity and mortality.

We investigated the prevalence, clinical characteristics, and prognostic role of dilated cardiomyopathy (DCM) and non-dilated left ventricular cardiomyopathy (NDLVC) in patients with transfusion-dependent β-thalassemia (β-TDT). We retrospectively included 415 β-TDT patients who underwent cardiovascular magnetic resonance to quantify myocardial iron overload (MIO) and biventricular function parameters and to detect replacement myocardial fibrosis. Demographic and laboratory parameters were comparable among patients with no overt cardiomyopathy (NOCM; n = 294), DCM (n = 12), and NDLVC (n = 109), while cardiac size and systolic function were significantly different. Compared to NOCM patients, DCM and NDLVC patients had a higher prevalence of MIO and replacement myocardial fibrosis. During a mean follow-up of 57.03 ± 18.01 months, cardiac complications occurred in 32 (7.7%) patients: 15 heart failures, 15 supraventricular arrhythmias, and 2 pulmonary hypertensions. Compared to the NOCM group, both the NDLVC and the DCM groups were associated with a significantly increased risk of cardiac complications (hazard ratio = 4.26 and 8.81, respectively). In the multivariate analysis, the independent predictive factors were age, MIO, and the presence of DCM and NDLVC versus the NOCM phenotype. In β-TDT, the detection of NDLVC and DCM phenotypes may hold value in predicting cardiac outcomes.

Background: Sinus bradycardia and first-/second-degree atrioventricular (AV) block in athletes are traditionally considered secondary to increased vagal tone and therefore reversible. However, recent studies have suggested that they may persist even after the cessation of physical activity, and combined with the effects of aging, lead to the earlier onset of clinically significant bradyarrhythmias. Methods: We evaluated the correlation between lifetime sport practice and the age of the onset of premature (≤70 years old) idiopathic sinoatrial node or AV node dysfunction requiring pacemaker (PM) implantation. Results: Of the 1316 patients followed up with at our PM clinic in 2024, we included 79 (6%) who received a PM when they were ≤70 years old for bradyarrhythmias in the absence of secondary causes. Nineteen (24%) had engaged in at least 6 h of sports/week for ≥20 years and were classified as former athletes. For comparison, former athletes who received a PM for idiopathic bradycardia at >70 years old were 6% (p < 0.001). In the group ≤70 years old, the average age of PM implantation was 62.8 years in non-athletes versus 57.9 years in former athletes (p = 0.03). The main reason for PM implantation was AV block in both subgroups. Among former athletes, the correlation between the lifetime volume of sports activity and the age of PM implantation reached borderline statistical significance (p = 0.08). Echocardiography at the time of implant did not reveal significant differences between former athletes and non-athletes. Conclusions: In a cohort of patients who received a PM for bradyarrhythmia before the age of 70 years old in the absence of secondary causes, former athletes were implanted on average ≈5 years before non-athletes. This may suggest a contributing role of cumulative sports activity volume in the development of idiopathic sinus/AV node dysfunction.

Improving clinical prediction of sudden cardiac death is a crucial step in the management of patients with hypertrophic cardiomyopathy. However, finding the optimal method for risk evaluation has been challenging, given the complexity and the wide variation in clinical phenotypes. This is particularly important, as these patients are often of younger age and defibrillator implantation is associated with a low but tangible long-term risk of adverse events. A number of risk factors, including degree of hypertrophy, presence of syncope and family history of sudden cardiac death, have typically been considered to indicate a higher risk. The European risk score for prediction of sudden cardiac death is widely used; however, it may not apply well in patients with specific forms of the condition, such as those with extreme hypertrophy. Increasing evidence suggests that the presence and extent of myocardial fibrosis assessed with cardiac magnetic resonance imaging should be considered in clinical decision-making. Some research suggests that integrating electrophysiological studies into traditional risk assessment models may further optimize risk prediction and significantly improve accuracy in detecting high risk patients. Novel cardiac imaging techniques, better understanding of the genetic substrate and artificial intelligence-based algorithms may prove promising for risk refinement. The present review article provides an updated and in-depth viewpoint.

The impact of atrial fibrillation (AF) on patients with chronic total occlusions (CTOs) at the national level remains unclear. In this study, we conducted a retrospective analysis of data from the National Inpatient Sample to assess the characteristics and in-hospital outcomes of patients with CTO based on the presence or absence of AF. Multiple logistic and linear regressions examined factors associated with AF and evaluated its impact on length of stay (LoS), cost, and mortality. The analysis included 480,180 patients diagnosed with CTO, with AF present in 28.0% of cases. Patients with CTOs and AF were older (median age 73 vs. 66 years, p < 0.001) and exhibited lower female representation (25.0% vs. 27.9%, p < 0.001). Factors most strongly associated with AF included previous heart failure (OR 1.98, 95% CI 1.92-2.05, p < 0.001), liver disease (OR 1.37, 95% CI 1.27-1.48, p < 0.001), and obesity (OR 1.25, 95% CI 1.20-1.30, p < 0.001). AF correlated with increased in-hospital mortality (OR 1.29, 95% CI 1.18-1.40, p < 0.001), ischemic stroke (OR 1.27, 95% CI 1.13-1.42, p < 0.001), and major bleeding (OR 1.38, 95% CI 1.30-1.46). Moreover, AF was associated with a longer LoS (coef 1.58, 95% CI 1.50 to 1.67, p < 0.001) and higher in-hospital costs (coef 6.22, 95% CI 5.81 to 6.63, p < 0.001). Patients with CTOs and AF were older and had more underlying health problems compared to patients without AF. The patients with AF have worse outcomes in terms of mortality, ischemic stroke, major bleeding, length of stay, and costs.

Background/objectives: The frozen elephant trunk (FET) technique was introduced as a possible single-stage procedure for treating aortic arch pathologies. However, up to a third of patients are reported to need subsequent completion (extension). This retrospective analysis aimed to evaluate the impact of early (within 30 days; EC group) versus late (>30 days; LC group) endovascular completion with thoracic endovascular aortic repair (TEVAR) in patients treated with FET.

Methods: A single-center, retrospective analysis of all consecutive patients for the period between June 2017 and December 2023 who underwent FET and received endovascular extension was conducted. Indications for endovascular extension were aneurysms of the descending aorta, aneurysmal progress, endoleak, malperfusion, distal stent-induced new entry (dSINE), and aortic rupture.

Results: A total of 37 of 232 FET patients received endovascular extension (15.9%). Average age at the time of TEVAR was 63.3 ± 10.3 years. There was an increase in the maximum total aortic diameter post-FET from 40.8 ± 9 mm to 45.1 ± 14 mm prior to TEVAR. Only 14 patients (37.8%) had the desired complete occlusion of the false lumen or aneurysm prior to extension; 23 (62.2%) still had relevant perfusion of the false lumen or aneurysm. The EC and LC groups were defined by time between FET and TEVAR: a mean of 4.8 ± 5.2 days in the EC group and 18.4 ± 18 months in the LC group. The EC group had markedly more complex procedures, reflected in intensive care (10.7 ± 6.9 vs. 0.1 ± 0.3 days, p < 0.001) and hospitalization (22.4 ± 14.0 vs. 8.1 ± 5.6 days, p = 0.003) durations. There was one early death due to multiorgan failure in the EC group and there were none in the LC group. There were no major cardiac events in either group. In the EC group, seven patients (50%) suffered from postoperative respiratory failure and four (28.6%) developed acute kidney failure requiring dialysis. Only one patient in the LC group (4.3%) experienced complications. During follow-up, another three patients (21.4%) of the EC group died, but none of the LC group did. Post-extension aortic remodeling was similar in both groups, with complete occlusion achieved in 27 cases (72%) during early follow-up and increased to 90.6% after a mean of 22.0 ± 23.4 months.

Conclusions: Following aortic arch repair using FET, there is still a need for second-stage repair in 16% of patients. Endovascular completion post-FET is safe and feasible with a technical success rate of 100%, but early completion is associated with greater morbidity and mortality. TEVAR extension surgery may be better delayed, if possible, until after recovery from the hybrid arch repair.

Background: Completely thrombosed AAA (th-AAA) has been infrequently described in the literature. The present study evaluated the incidence and report the outcomes of open surgical repair (OSR) of a clinical series of th-AAAs.

Methods: This is a single-center, observational cohort study of consecutive th-AAAs identified between 10 October 1998, and 31 January 2024. Open repair was carried out through a transperitoneal route, and Dacron knitted graft replacement. Follow-up included the clinical visit and duplex ultrasound at 30 days, and annually thereafter. The primary outcome was overall survival. The secondary outcome was the freedom from aorta-related reintervention.

Results: Out of 2237 AAA repairs, we identified 16 (0.7%) th-AAAs. They were all men with a mean age of 74 years ± 8 (range, 54-89). The median of aneurysm diameter was 49 mm (IQR, 46-52). Rupture was the presenting scenario in four (25%) patients. Early mortality and major amputation did not occur. At a mean follow-up of 70 months ± 48 (range, 11-192), the freedom from aorta-related mortality was 100%, and graft-related complications were not observed.

Conclusions: The incidence of th-AAA was <1%. Although rupture was the presenting scenario in nearly 25% of the cases, OSR was safe and effective due to the absence of aorta-related mortality and the long-term durability of the repair.