Journal of Cardiovascular Development and Disease最新文献

About 5% of annual access to emergency departments (EDs) and up to 25-30% of hospital admissions involve patients with symptoms suggestive of acute coronary syndrome (ACS). The process of evaluating and treating these patients is highly challenging for clinicians because failing to correctly identify an ACS can result in fatal or life-threatening consequences. However, about 50-60% of these patients who are admitted to the hospital because of chest pain are found to have no ACS. Coronary computed tomographic angiography (CCTA) has emerged as a proposed new frontline test for managing acute chest pain in the ED, particularly for patients with low-to-intermediate risk. This narrative review explores the potential of adopting an early CCTA-based approach in the ED, its significance in the era of high-sensitivity troponins, its application to high-risk patients and its prognostic value concerning atherosclerotic burden and high-risk plaque features. Additionally, we address clinical and technical issues related to CCTA use for triaging acute chest pain in the ED, as well as the role of functional testing. Finally, we aim to provide insight into future perspectives for the clinical application of CCTA in the ED.

The operative field and exposure in minimally invasive cardiac surgery (MICS) are limited. Meticulous preoperative planning and intraoperative visualization are crucial. We present our initial experience with HoloLens^® 2 as an intraoperative guide during MICS procedures: aortic valve replacement (AVR) via right anterior small thoracotomy, coronary artery bypass graft surgery (CABG) via left anterior small thoracotomy (LAST), and pulmonary valve replacement (PVR) via LAST. Three-dimensional (3D) segmentations were performed using the patient's computer tomography (CT) data subsequently rendered into a 3D hologram on the HoloLens^® 2. The holographic image was then superimposed on the patient lying on the operating table, using the xiphoid and the clavicle as landmarks, and was used as a real-time anatomical image guide for the surgery. The incision site marking made using HoloLens^® 2 differed by one intercostal space from the marking made using a conventional surgeon's mental reconstructed image from the patient's preoperative imaging and was found to be a more appropriate site of entry into the chest for the structure of interest. The transparent visor of the HoloLens^® 2 provided unobstructed views of the operating field. A mixed reality (MR) device could contribute to preoperative surgical planning and intraoperative real-time image guidance, which facilitates the understanding of anatomical relationships. MR has the potential to improve surgical precision, decrease risk, and enhance patient safety.

Hypertensive heart disease (HHD) continues to be a leading cause of cardiovascular morbidity and mortality worldwide, necessitating the evolution of evidence-based management strategies. This literature review examines the most recent updates from the 2023 and 2024 hypertension guidelines issued by the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC). These guidelines are compared with previous key recommendations, such as the 2017 American College of Cardiology/American Heart Association guidelines and the 2018 ESC/ESH guidelines. The updated recommendations reflect a paradigm shift in the approach to hypertension diagnosis and management, including a stricter systolic blood pressure (BP) target of 120-129 mmHg, which underscores the importance of early and precise BP control. The difference between the classification of "elevated BP" and hypertension in the ESC versus ESH guidelines, particularly, regarding their implications for early detection and prevention of HHD, are critically examined, highlighting areas of clinical and academic debate. The introduction of a new "elevated BP" category (120-139/70-89 mmHg) highlights a proactive strategy aimed at identifying at-risk individuals earlier in the disease course to prevent progression to HHD. Additionally, the divergent roles of hypertension-mediated organ damage (HMOD), including HHD, in risk stratification as recommended by the ESC and ESH are discussed, emphasising their significance in tailoring management approaches. For patients with resistant hypertension, the 2023 and 2024 updates also endorse innovative therapies, such as renal denervation, an interventional procedure that has demonstrated significant promise in managing treatment-resistant cases. This review synthesises these updates, focusing on their implications for clinical practice in diagnosing and managing HHD. By emphasising aggressive intervention and the integration of novel treatment modalities, the review aims to bridge existing gaps in earlier approaches to hypertension management. The critical evaluation of guideline discrepancies and evolving evidence seeks to provide clinicians with a nuanced understanding to optimise outcomes for patients with HHD, particularly considering emerging therapeutic possibilities and more stringent BP control targets.

Background: Aortic valve replacement (AVR) is the definitive therapy for patients with severe aortic valve stenosis (AoS). The aim of this work is to compare the effect of a mechanical prosthesis (MP) and a bioprosthesis (BP) on the survival of patients aged 50-65 years after AVR.

Methods: The retrospective analysis included 276 patients aged 50 to 65 years who had undergone isolated AVR for AoS; 161 patients were implanted with an MP and 115 with a BP. Patient survival, adjusted for age, gender and risk parameters affecting survival, was assessed. A subgroup analysis was performed on the 208 patients with a modern valve (prosthesis models that are no longer used in clinical practice were removed from the sample).

Results: After adjusting for risk factors for overall survival as well as for age and sex, the implantation of an MP did not have a significant effect on overall survival in comparison to a BP, at a median follow-up of 10.3 years (p = 0.477). The size of the MP had no significant effect on overall survival either (HR: 1.29; 95%CI: 0.16-10.21; p = 0.812). However, the indexed effective orifice area of the BP had a positive effect on overall survival (HR: 0.09; 95%CI: 0.01-0.78; p = 0.029).

Conclusions: The estimated survival of patients aged between 50 and 65 years after implantation of a BP with a sufficiently large indexed effective orifice area may exceed that of patients with an MP.

(1) Background: As the burden of multimorbidity is increasing worldwide, little is known about its prevalence in Lithuania. We aimed to estimate the prevalence of chronic conditions and multimorbidity among Lithuanian adults and assess their impact on healthcare utilization. (2) Methods: A retrospective analysis of the Lithuanian National Health Insurance Fund database was performed in 2019. Multimorbidity was defined as having two or more chronic conditions. (3) Results: Of the Lithuanian population, 1,193,668 (51.5%) had at least one chronic condition, and 717,386 (31.0%) had multimorbidity. Complex multimorbidity (CM) was present in 670,312 (28.9%) patients, with 85.0% having complex cardiac multimorbidity (CCM) and 15.0% having complex non-cardiac multimorbidity (CNM). Multimorbidity increased with age, from 2% at age 18-24 to 77.5% at age 80 and above, and was more prevalent among women (63.3% vs. 36.7%, p < 0.001). One-third of multimorbid patients were hospitalized at least once per year, with half staying for a week or longer. CCM patients were more likely to be hospitalized, rehospitalized, and have more primary care visits (OR: 2.23, 1.60, 4.24, respectively, all p < 0.001). (4) Conclusions: Multimorbidity in Lithuania increases with age and affects women more. Chronic cardiovascular diseases contribute to a higher prevalence of multimorbidity and a more significant burden on the healthcare system.

The ectopic thyroid gland is an abnormal development of the embryo. Most of the ectopic thyroid occurs in the path around the thyroglossal duct or on the lateral side of the neck. However, ectopic thyroid occurs in the heart, which is rare. We report a case of right ventricular ectopic thyroid. This case highlights the imaging characteristics of computed tomography (CT) and cardiac magnetic resonance (CMR) and discusses the underlying mechanisms for a timely diagnosis.

Mitochondria play a crucial role in multiple cellular processes such as energy metabolism, generation of reactive oxygen species, excitation-contraction coupling, cell survival and death. Dysfunction of mitochondria contributes to the development of cancer; neuromuscular, cardiovascular/congenital heart disease; and metabolic diseases, including diabetes. Mitochondrial dysfunction can result in excessive reactive oxygen species, a decrease in energy production, mitophagy and apoptosis. All these processes are known to be dysregulated in cardiovascular diseases. The focus of this review is to summarize our current knowledge of mitochondrial dysfunction, including mitophagy and apoptosis, in pediatric congenital heart disease due to maternal diabetes or due to structural cardiac defects, with a focus on single-ventricle congenital heart disease. We also discuss recent mitochondria-targeted therapies for cardiovascular diseases.

Pregnancy induces significant hemodynamic changes, and cardiovascular diseases (CVDs) are one of the leading causes of non-obstetric maternal morbidity and mortality during pregnancy or the postpartum period in developed countries. The effective diagnosis and management of CVDs in pregnant women require a thorough evaluation that considers the health of both the mother and the fetus. Imaging plays a pivotal role in this evaluation, offering essential insights into the most significant pregnancy-related CVDs. However, due to concerns about fetal exposure, the use of contrast agents and radiation exposure must be carefully managed. Following to the principle of "As Low As Reasonably Achievable" (ALARA), strategies to minimize these risks are crucial for ensuring patient safety while maintaining diagnostic accuracy. This review highlights the contribution of cardiovascular imaging techniques, particularly computed tomography (CT) and magnetic resonance imaging (MRI), in the assessment of common pregnancy-related CVDs, and outlines strategies to reduce radiation exposure and limit contrast agent use when feasible, aiming to increase radiologists' awareness of this crucial topic.

Background: An advanced age elevates risk for COVID-19-related cardiovascular complications and mortality. This study analyzes cardiovascular comorbidities and outcomes in hospitalized COVID-19 patients across age groups to assess its impact.

Methods: The CARDIO COVID 19-20 registry is a prospective, multicenter cohort study of hospitalized SARS-CoV-2 patients across 44 institutions in 14 Latin American countries. Patients were categorized into four age groups, Group 1: under 40 years, Group 2: 40 to 64 years, Group 3: 65 to 79 years, and Group 4: 80 years or older.

Results: A total of 3260 patients were included. A total of 36.8% were women, and key comorbidities included overweight/obesity (49.7% [G1: 48.9%, G2: 56.3%, G3: 45.6%, G4: 32.7%]), and hypertension (49% [G1: 11.3%, G2: 40.3%, G3: 67.9%, G4: 80.4%]). Primary cardiovascular complications during hospitalization were arrhythmias (9.1% [G1: 3.4%, G2: 6.1%, G3: 14.9%, G4: 12.9%]), and acute heart failure (8.5% [G1: 3.6%, G2: 6.1%, G3: 12.1%, and G4: 15.2%]). In our cohort, 53.5% of the patients were admitted to the intensive care unit (G1: 49.2%, G2: 57%, G3: 55.3%, G4: 38.3%). In-hospital mortality rose significantly in patients aged 65 and older; G3: 334 (34.7%) and G4: 156 (45.6%) (p value: <0.001).

Conclusions: In Latin American COVID-19 patients, older age correlates with more comorbidities, cardiovascular complications, and higher in-hospital and 30-day mortality, indicating age as an independent mortality factor.

Approximately 50% of adults with congenital heart defects (ACHD) lack specialised CHD care, increasing the risk of preventable complications and mortality. While there is evidence that psychological factors significantly influence adherence, predictors of attending cardiological routine examinations in ACHD remain understudied. This is the first German study to examine psychological and sociodemographic predictors of adherence in ACHD using the Common-Sense Model of Self-Regulation as a framework. A total of N = 1136 participants from the National Register for Congenital Heart Defects were analysed. Sociodemographic and psychological factors (illness perception, illness identity, emotion regulation and psychological distress) were recorded as predictors of the subjective importance of regular cardiological check-ups and the actual utilisation frequency. The results indicate that of the sociodemographic factors, only age is relevant for the subjective importance, while net income influences the actual utilisation of cardiological examinations. In contrast, several psychological aspects of illness perception, such as perceived treatment benefit, and illness identity play a role for both adherence measures, as do depressive symptoms for the frequency of examinations. Our results highlight the importance of addressing psychological factors and providing clear information about the benefits of cardiological care to improve adherence in ACHD and thereby reduce secondary diseases.