Journal of Cardiovascular Development and Disease最新文献

Peripheral arterial disease (PAD) affects over 236 million people globally, with endovascular treatment as the predominant mode of revascularization. While pre-procedural lesion assessment typically relies on non-invasive Doppler measurement, invasive physiological assessment offers a promising approach to guide lesion selection and provide real-time evaluation of angioplasty success. This review explores the current methods, challenges, and future directions of invasive physiological assessment in PAD. Sensor-tipped wires, particularly pressure sensor-tipped wires (pressure-wires), enable precise evaluation of stenoses through indices such as peripheral fractional flow reserve (pFFR) measured during hyperaemia. pFFR can identify significant flow-limiting lesions, assess angioplasty efficacy, and predict tissue healing. Additional indices, including Doppler-wire derived flow reserves and resistance measurements, further enhance the understanding of lesion physiology. Early data support the utility of these techniques for guiding treatment decisions, although the variability in methodologies highlights the need for standardization and outcome-driven cut-off values. This review uniquely consolidates evidence on invasive physiological assessment in PAD, addressing critical gaps and providing a framework for future research. By advancing lesion-specific evaluation and procedural optimization, this work underscores the transformative potential of these techniques in improving patient outcomes and redefining PAD management.

Background: An acute aortic dissection (AAD) is a highly lethal condition that demands immediate medical intervention. Survivors often face significant long-term challenges. While immediate survival remains a critical focus in acute care settings, little is known about long-term results, especially with regard to activity levels, post-operative quality of life, and the impact of cultural and ethnic characteristics on recovery. Using data from the Dutch National Aortic Dissection Survivor's Day, this study examines QoL, activity levels, and ethnic diversity among survivors.

Methods: All patients (n = 45) participating in a national awareness meeting for AAD survivors at a teaching hospital were included in our study. Participants completed questionnaires assessing QoL, activity levels, and sociodemographic data, including ethnic background. The EQ-5D and IPAQ surveys were employed to measure health-related QoL and physical activity, respectively.

Results: The mean age of the participants was 59.5 years, with 37.8% identifying as women. Ethnically, 88.9% identified as Dutch. The majority reported good health (mean score of 73/100). However, there was a considerable variation in QoL scores. On average, 22.2% of our study population reported moderate or greater problems across all dimensions, compared to 5.5% in the normative sample. Activity levels were mostly low to moderate, and no significant differences in QoL were found based on activity levels. Sleep quality was generally good.

Conclusions: Our study reveals significant limitations in QoL among AAD survivors. This emphasizes the significance of developing a multimodal rehabilitation program focused on addressing current gaps in recovery. Ultimately, this will enhance overall care following AAD. Future research should focus on assessing long-term QoL.

Blood cell-derived indices are potential predictors of clinical outcomes in coronary artery disease. This study assessed the prognostic value of the pan-immune-inflammatory value (PIV) for predicting 1-year major adverse cardiovascular events (MACEs) in patients with non-ST-segment elevation acute coronary syndrome (ACS). A retrospective cohort of 1651 patients receiving percutaneous coronary intervention was analyzed. PIV, calculated from blood cell counts, was categorized with a cut-off value of 256.3 (sensitivity 60.7%, specificity 59.3%) based on receiver operating characteristic curve analysis. MACEs were operationalized as a composite of all-cause mortality, myocardial infarction (MI), stroke, any revascularization, and rehospitalization for heart failure. The incidence of MACEs was 5.0% in patients with low PIV and 9.7% in those with high PIV (log-rank p < 0.001). Multivariate analysis identified age 65 > years, renal dysfunction (eGFR < 60 mL/min/1.73 m²), and high PIV (>256.3) (HR 1.49, 95% CI 1.01-2.22, p = 0.048) as independent predictors of MACEs. Subgroup analyses revealed no statistically significant interaction between MI status or C-reactive protein levels and PIV. PIV was an independent predictor of 1-year MACEs in patients with non-ST-segment elevation ACS. It may serve as a reliable prognostic marker independently of MI or C-reactive protein levels.

Background: To date, little is known about correlations between liver dysfunction and circulatory and cardiac abnormalities (e.g.,: mitral valve, MV) in patients with chronic liver disease (CLD). This study aimed to assess a potential parallelism between liver dysfunction and cardiovascular involvement and identify the factors associated with structural and functional MV disorders.

Methods: Among 995 patients with CLD, 346 were enrolled and compared with 168 controls without liver disease. According to the degree of liver disease, patients were classified as patients with chronic hepatitis (142) or with liver cirrhosis (Child-A: 70; Child-B: 65; Child-C: 69).

Results: Among the chronic hepatitis group, resting heart rate (HR) and left ventricular (LV) mass were higher than in the control group (p = 0.0008), whereas systemic vascular resistance (SVR) was lower (p = 0.01). Among cirrhotic patients, resting HR, left atrium dimensions/volumes, LV walls thickness, LV mass, cardiac output (CO), isovolumetric relaxation time (IVRT), deceleration time (DT) and prevalence of aortic stenosis were higher than in non-cirrhotic patients (p = 0.02), whereas the e/a ratio and SVR were lower (p = 0.0001). Among Child-B/C, CO, IVRT, DT, prevalence of MV regurgitation and MV calcification score were higher than in the remaining patients (p = 0.02), whereas SVR was lower (p < 0.0001). Among cirrhotic patients with MV regurgitation, Child-Pugh score, liver disease duration, resting HR, left chambers dimensions/mass, CO, IVRT, DT and MV calcification score were higher compared to patients without regurgitation (p < 0.000), whereas mean blood pressure, e/a ratio and SVR were lower (p = 0.008). At multivariate analysis, Child-Pugh score, liver disease duration, left chambers volume/mass and MV calcification score were independently associated with MV regurgitation in cirrhotic patients. Child-Pugh score and MV calcification score strongly correlated in cirrhotic patients (r = 0.68, 95% CI 0.60-0.75, p < 0.0001).

Conclusions: The magnitude of cardiac morpho/functional abnormalities is associated with the severity of liver dysfunction. Structural and functional MV abnormalities could represent a novel sign of cardiac involvement in liver cirrhosis. The severity and duration of liver disease, the enlargement of cardiac chambers and leaflet calcium accumulation could play a key role.

The diagnosis of chronic total occlusion (CTO), characterized by the complete obstruction of a coronary artery for at least three months, remains challenging and can be entirely asymptomatic. Since the indications for performing a recanalization procedure for CTO do not originate from randomized controlled trials, this study aimed to assess the indications, management, and procedural outcomes of patients undergoing percutaneous revascularization (PCI) for a CTO, ensuring that the population was as uniform as possible regarding technologies and methodological approaches. Forty-one consecutive patients who underwent PCI for CTO recanalization were enrolled from January 2021 to 2024. Additional outcomes included mortality, major adverse cardiovascular events, and the presence of residual cardiac symptoms, with a median follow-up of 449 days and an interquartile range of 230-643 days. Our real-life study confirmed that PCI for CTO has a high success rate and a low incidence of major complications.

Aim: Higher exercise blood pressure in adults correlates with many cardiometabolic markers. The aim of this study was to investigate the main determinants of longitudinal variations in exercise blood pressure in young athletes.

Methods: A longitudinal retrospective study was conducted on adolescent athletes who underwent at least two sport-related pre-participation screening visits, including exercise testing with a standardized incremental ramp protocol on treadmill. Blood pressure was assessed at rest (SBP_rest), at the 3rd minute of exercise (SBP_3min), and at peak exercise (SBP_peak). Predictors of blood pressure response (i.e., respective changes vs. baseline (Δ)) were determined by multivariate regression models after adjustment for age, sex, follow-up duration, related baseline SBP values, characteristics of sport, and ΔBMI.

Results: A total of 351 young athletes (mean age at baseline 13 ± 2 years, 54% boys, average follow-up duration 3.4 ± 2.2 years) were enrolled. BMI increased by 1.5 ± 1.8 kg/m² (p < 0.001) during follow-up. At baseline, mean SBP_rest was 103 ± 14 mmHg, mean SBP_3min 124 ± 18 mmHg, and mean SBPpeak 154 ± 23 mmHg. A significant between-visit increase in SBP_rest (ΔSBP_rest 7.0 ± 17.4 mmHg; p < 0.001), ΔSBP_3min (4.8 ± 11 mmHg, p < 0.001), and ΔSBP_peak (11.7 ± 24 mmHg, p < 0.001) was observed. ΔSBP_3min was significantly predicted by male sex (p < 0.01), baseline BMI (p < 0.01), ΔBMI (p < 0.01), and number of practiced sports (p < 0.05), whereas ΔSBP_peak was positively predicted by male gender (p < 0.01), baseline BMI (p < 0.05), and ΔBMI (p < 0.01) and negatively by baseline resting heart rate (p < 0.01). In a logistic regression model, ΔBMI was the only independent determinant of passing from a lower to an upper quartile of SBP_3min (p < 0.001), while ΔBMI and male sex were independent determinants of moving to a higher quartile of SBP_peak (p < 0.001).

Conclusions: Increase in BMI during development and male sex are independent determinants of the increase in exercise blood pressure, both at light and maximal intensity, in a population of adolescent athletes.

Introduction: Inappropriate sinus tachycardia (IST) is a syndrome characterized by unexpectedly fast and prolonged sinus rates at rest or with minimal physical activity. Epidemiologic characteristics are uncertain, but most patients are young and female. When IST occurs in athletes, its management (controlling symptoms and reducing heart rate) can present additional challenges. We designed an observational pilot study to investigate whether a food supplement can be useful in the treatment of IST when standard therapy is refused. Methods: We enrolled 50 consecutive recreational athletes affected by frequent recurrences of IST. Twelve-lead ECG and Holter ECG parameters were recorded at enrollment (T0) and after a 6-month treatment (T1) with the food supplement. Symptoms and quality of life were also evaluated through specific questionnaires. The study population was compared to a historical control group of 25 patients receiving ivabradine as treatment for the same clinical condition. Results: The resting ECG heart rate was 88.7 ± 12.4 bpm (T0) and 73.6 ± 6.6 bpm (T1) (p < 0.00001); Holter average heart rate was 88.4 ± 3.3 bpm and 74.9 ± 4.8 bpm (p < 0.0001). Holter ECG maximum heart rate was 147.1 ± 16.7 bpm and 139.2 ± 16.8 bpm (p = 0.06); Holter minimum heart rate was 49.9 ± 6.5 bpm and 50.5 ± 6.9 bpm (p = 0.33). Finally, the number of sustained episodes decreased from 3.3 ± 1.7 to 0.8 ± 0.8 (p < 0.00001). The following variations in ASTA scores were observed: ASTA symptom scale (range: 0-27) decreased from 14.9 ± 2.1 to 5.8 ± 1.4 (p < 0.00001), while ASTA HR QoL (range: 0-39) decreased from 24.1 ± 2.1 to 10.8 ± 2.3 (p < 0.00001). Conclusions: The findings of our pilot study suggest that this food supplement could play a beneficial role in managing symptoms and improving quality of life in recreational athletes affected by IST who refuse standard medical therapy. These clinical effects appear to correlate with significant improvements in resting ECG parameters and some Holter ECG parameters.

Percutaneous treatment of highly thrombotic coronary lesions is demanding, due to worse acute and long-term clinical outcomes. In this report, we describe a case series of six patients with ST-segment elevation myocardial infarction and high-thrombus-burden coronary lesions. All patients were treated with the AngioJet Solent^® Dista catheter, a rheolytic thrombectomy device designed for peripheral use. The catheter effectively reduced the thrombus burden in all cases, achieving satisfactory final angiographic results. One case of no-reflow was observed following lesion dilatation prior to thrombectomy, but no other major in-hospital adverse events occurred. At mid-term follow-up, all patients remained free from angina. These preliminary findings suggest that this approach could represent a promising option for managing highly thrombotic coronary lesions, but further studies with larger populations and long-term follow-up are needed to confirm these results.

In clinical practice, heart failure (HF) and osteoporosis (OP) are commonly paired conditions. This association is particularly relevant in patients over the age of 50, among whom its prevalence increases dramatically with every decade of life. This can be especially impactful since patient prognosis when facing both conditions is poorer than that of each disease alone. Clinical studies suggest that prior fractures increase the risk for heart failure hospitalization and, conversely, an episode of heart failure increases the risk of subsequent fractures. In other words, the relationship between osteoporosis and heart failure seems to be two-way, meaning that each condition may influence or contribute to the development of the other. However, the details of the pathophysiological relationship between HF and OP have yet to be revealed. The two conditions share multiple pathological mechanisms that seem to be intertwined. Patients affected by OP are more prone to develop HF because of vitamin D deficiency, elevation of parathyroid hormone (PTH) plasma levels, and increased Fibroblast Growth Factor 23 (FGF-23) activity. On the other hand, HF patients are more prone to develop OP and pathological fractures because of low vitamin D level, high PTH, chronic renal failure, alteration of renin-angiotensin-aldosterone system, reduced testosterone level, and metabolic effects derived from commonly used medications. Considering the increasingly aging worldwide population, clinicians can expect to see more often an overlap between these two conditions. Thus, it becomes crucial to recognize how HF and OP mutually influence the patient's clinical condition. Clinicians attending these patients should utilize an integrated approach and, in order to improve prognosis, aim for early diagnosis and treatment initiation. The aim of this paper is to perform a review of the common pathophysiological mechanisms of OP and HF and identify potentially new treatment targets.

Computational fluid dynamics (CFD) is a tool that allows for the analysis of otherwise unobservable blood flow patterns. In the context of medicine, CFD enables researchers to better understand acute and chronic pathophysiology as well as utilize modeling tools to predict blood flow patterns in response to surgical intervention. Such a tool is particularly useful in the field of congenital heart disease (CHD), where complex geometries and patient-specific pathology are common. Research applying CFD to study CHDs has significantly grown in the last twenty years, with new methodologies and recommendations being published at an even faster pace in the last decade. Many currently available reviews are focused on a particular area of progress or on the technical approaches to CFD geared toward the clinician. This review focuses on CFD application within the major domains of CHD research, specifically single ventricle defects and aortic coarctation, reviewing consensus seminal work while highlighting more recent avenues of study. Balancing discussion of CFD parameters with potential clinical implications of study results, this review not only aims to provide cardiovascular professionals context for the technical advancements being made in the field but also a sense of contemporary CFD's utility in clinical practice.