Journal of Cardiovascular Development and Disease最新文献

(1) Background: Lipid accumulation product (LAP) is an anthropometric index of abdominal adiposity that has been associated with increased cardiovascular risk. We aimed to explore the association of LAP with cardiovascular hospitalizations and compare its predictive accuracy with other indices such as body mass index (BMI) and waist circumference. (2) Methods: LAERTES was a prospective, population-based cohort that recruited consecutive patients with stable ischemic heart disease (SIHD) from two Greek hospitals in Athens. Data from 770 participants (13% women, median age 62 years) with a median follow-up of 4.3 years were analyzed in relation to the occurrence of adverse cardiovascular events mandating hospital admission (non-fatal myocardial infarction [MI], non-fatal ischemic stroke and malignant ventricular arrhythmias). (3) Results: A total of 127 (16.5%) of the participants were admitted to cardiology clinics over the follow-up period; 12.4% of them developed MI, 2.6% ventricular arrhythmia and 1.5% ischemic stroke. Patients with cardiovascular hospitalization had higher BMI, larger waist circumference, higher LAP and triglycerides and lower HDL-cholesterol than patients without hospitalization. Upper LAP quartile and hypertension were independent predictors for cardiovascular hospitalization (HR: 2.20, 95% CI: 1.12-4.34, p = 0.02 and HR: 1.57, 95% CI: 1.03-2.39, p = 0.03, respectively). (4) Conclusions: Higher LAP quartiles are predictive of adverse cardiovascular events leading to hospital admission and deserve further evaluation in dedicated studies.

In the original publication [...].

Although the benefits of exercise training have been shown repeatedly in many studies, its relationship with the occurrence of atrial fibrillation (AF) in competitive athletes still remains controversial. In the present review, we sought to demonstrate a comprehensive report of the incidence, pathophysiology, and therapeutic approaches to AF in elite athletes. A 2 to 10 times higher frequency of AF has been shown in many studies in high-intensity endurance athletes compared to individuals who do not exercise. Moreover, a U-shaped relationship between male elite athletes and AF is demonstrated through this finding, while the type and the years of physical activity seem to relate to AF development. A strong correlation seems to exist among the type of exercise (endurance sports), age (>55 years), gender (males), and the time of exercise training, all contributing to an increased risk of AF. The pathophysiology of AF still remains unclear; however, several theories suggest that complex mechanisms are involved, such as bi-atrial dilatation, pulmonary vein stretching, cardiac inflammation, fibrosis, and increased vagal tone. Elite athletes with AF require a comprehensive clinical evaluation and risk factor optimization, similar to the approach taken for nonathletes. Although anticoagulation and rate or rhythm control are cornerstones of AF management, there are still no specific guidelines for elite athletes.

Background: Thoracic aortic aneurysm is a latent disease with a high risk of death. Today, as data are accumulating, an estimation of the differences in thoracic aneurysm in men and women of different age groups is required. The present study evaluated the type of atherosclerotic aortic lesions in males and females at different ages regarding the presence or absence of aortic dissection.

Methods: A retrospective analysis of clinical and morphological data of 43 patients with thoracic aortic aneurysm was carried out. Patients were divided into groups based on the presence or absence of thoracic aneurysm dissection.

Results: Our results of a comparative analysis of the age of study participants showed that patients with aneurysm dissection were younger than patients without dissection. In the subgroup of patients with aortic dissection, the mean age was 50.6 years old, and in patients without aortic dissection, the mean age was 55.0 years old. When conducting a frequency analysis using Fisher's exact test, it was found that in men and women aneurysm dissection was not associated with atherosclerotic lesions of the aorta.

Conclusions: In women and men, aneurysm dissection was not associated with stage of atherosclerotic lesions of the aorta regardless of age; no statistically significant differences were found between the groups with and without aneurysm dissection (p > 0.05). Dissection of the thoracic aneurysm developed in the absence of severe atherosclerosis of the thoracic aorta. Only 18.6% men and women possessed atherosclerotic plaques of types IV and V.

Background: MRI (magnetic resonance imaging) represents the diagnostic image modality of choice in several conditions. With an increasing number of patients requiring MRI for diagnostic purposes, the issue of safety in patients with cardiac implantable electronic devices (CIED) undergoing this imaging modality will play an ever more important role. The purpose of this study was to assess the safety and device function following MRI in an unrestricted real-world cohort of patients with a wide array of cardiac devices.

Methods: We conducted a retrospective single-center study including 1010 MRI studies conducted in adult patients (≥18 years) with an implanted CIED treated in the University Hospital of Munich (LMU) between July 2012 and March 2024. Patients with non-MR conditionally labeled leads, abandoned or epicardial leads, as well as lead fragments, were included for analysis.

Results: Across a total of 1010 MRIs (920 total MR-conditional device generators) performed in patients with an implanted CIED, there were no deaths, reports of discomfort, palpitations, heating, or ventricular arrythmias in the 24 h following MRI. Only 2/1010 MRIs were followed by a reported atrial arrhythmia within 24 h, both in patients with an MR-conditional pacemaker (PM) device without an abandoned lead. No significant changes in device function following MRI from baseline were observed across all included CIEDs. Lastly, no instances of severe malfunction, such as generator failure, loss of capture, electrical reset, or inappropriate inhibition of pacing, were found in post-MRI interrogation reports across all MRI studies.

Conclusions: Based on the analysis of 1010 MRIs undergone by patients with CIEDs, following standardized device interrogation, manufacturer-advised device programming, monitoring of vital function, and manufacturer-advised reprogramming, MRI can be performed safely and without adverse events or changes in device function.

Background: In this study, we examined and compared ex vivo mechanical properties of aortic walls in patients with bicuspid (BAV) and tricuspid (TAV) aortic valve aortopathy to investigate if the anatomical peculiarities in the BAV group are related to an increased frailty of the aortic wall and, therefore, if a different surgical cutoff point for ascending aortic replacement could be reasonable in such patients.

Methods: Ultimate stress tests were performed on fresh aortic wall specimens harvested during elective aortic surgery in BAV (n. 33) and TAV (n. 77) patients. Three mechanical parameters were evaluated at the failure point, under both longitudinal and circumferential forces: the peak strain (Pstr), peak stress (PS), and maximum elastic modulus (EM). The relationships between the three mechanical parameters and preoperative characteristics were evaluated, with a special focus on evaluating potential risk factors for severely impaired mechanical properties, cumulatively and comparatively (BAV vs. TAV groups).

Results: The patient populations were inhomogeneous, as BAV patients reached surgical indication, according to the maximum aortic dilatation, at a younger age (58 ± 15 vs. 64 ± 13; p = 0.0294). The extent of the maximum aortic dilatation was, conversely, similar in the two groups (52 ± 4 vs. 54 ± 7; p = 0.2331), as well as the incidences of different phenotypes of aortic dilatation (with the ascending aorta phenotype being the most frequent in 81% and 66% of the BAV and TAV patients, respectively (p = 0.1134). Cumulatively, the mechanical properties of the aortic wall were influenced mainly by the orientation of the force applied, as both PS and EM were impaired under longitudinal stress. An age of >66 and a maximum dilatation of >52 mm were shown to predict severe Pstr reduction in the overall population. Comparative analysis revealed a trend of increased mechanical properties in the BAV group, regardless of the position, the force orientation, and the phenotype of the aortic dilatation.

Conclusions: BAV aortopathy is not correlated with impaired mechanical properties of the aortic wall as such. Different surgical cutoff points for BAV aortopathy, therefore, seem to be unjustified. An age of >66 and a maximum aortic dilatation of >52 mm, however, seem to significantly influence the mechanical properties of the aortic wall in both groups. These findings, therefore, could suggest the need for more accurate monitoring and evaluation in such conditions.

Systemic sclerosis (SSc) is a multisystemic autoimmune disorder in which cardiac involvement is frequent and portends negative prognosis. Left ventricular (LV) diastolic dysfunction is one of the most common cardiac alterations in these patients, and left atrial (LA) reservoir strain (Ɛ_R) measurement using speckle tracking echocardiography has been proposed as a novel parameter for a better assessment of LV diastolic function. Therefore, the aim of this study was to test the prognostic value of Ɛ_R in a large multicenter cohort of SSc patients. In total, 311 SSc patients (54 ± 14 years, 85% female) were included from two different centers. Echocardiography was performed at the time of first visit, including Ɛ_R measurement. Over a median follow-up of 132 (interquartile range: 110 to 157) months, 67 (21.5%) patients experienced the outcome of all-cause mortality. Spline curve analysis identified an optimal cut-off value of 30% for Ɛ_R, and patients with Ɛ_R ≤ 30% showed a 10-year cumulative survival rate of 71% as compared to 88% for patients with Ɛ_R > 30% (log-rank p < 0.001). At the multivariable Cox regression analysis, Ɛ_R was independently associated with the endpoint (HR 1.830; 95% confidence interval (CI) 1.031-3.246; p = 0.039) together with age (HR 1.071, 95% CI 1.043 to 1.099; p < 0.001), sex (female) (HR 0.444, 95% CI 0.229 to 0.861; p = 0.016), and diffusing lung capacity for carbon monoxide (HR 0.969 95% CI 0.956 to 0.982; p < 0.001). Ɛ_R is of independent prognostic value in SSc and might help optimizing risk stratification in these patients.

Children and adolescents (C&As) with congenital heart defects (CHDs) have decreased functional capacity and executive functioning (EF) due to brain abnormalities and decreased cerebral perfusion. Exercise may improve EF via increased cognitive demands and cerebral blood supply. The purpose of this review was to identify evidence describing the impact of physical activity (PA) interventions on EF in C&As with CHDs. The following databases were searched from 2000 to 2024: MEDLINE, EMBASE, CINAHL, Scopus, CENTRAL, and PsycInfo. The inclusion criteria consisted of participants aged from birth to 18 years with CHD, interventions related to PA, and EF as an outcome measure. Articles were excluded if adults were included, translation to English was impossible, and full access was unavailable. Of 613 initial articles, 3 were analyzed, with only 1 meeting all inclusion criteria. The included study found significant improvements in self-reported cognitive functioning and parent-reported social functioning after 12 weeks of aerobic exercise in children aged 10-15 years with CHDs. Common themes among the reviewed articles indicated that EF remains impaired throughout the lifespan, children have unique interventional and developmental needs, and research remains limited despite theoretical benefits. Further investigation of the effect of PA on EF in C&As with CHDs is needed.

Background: Pulmonary vein isolation (PVI) is a foundational treatment for persistent atrial fibrillation (PeAF), but the effectiveness of adding posterior wall isolation (PWI) and selective complex fractionated atrial electrogram (CFAE) ablation in the roof and anterior wall remains debated. The potential of these additional ablation techniques to improve long-term outcomes for PeAF patients is still uncertain.

Methods: This retrospective study included 151 PeAF patients who underwent first-time catheter ablation at our center. The choice of ablation strategy was based on the operator's clinical judgment, taking into account the patient's specific condition and anatomical features. Patients were divided into two groups: the PVI group, which received PVI alone, and the modified PWI (MPWI) group, which received PVI along with additional PWI and selective CFAEs ablation in the roof and anterior wall. The primary endpoint was the absence of atrial arrhythmia lasting more than 30 s, without antiarrhythmic drugs, at 12 months.

Results: At the 12-month follow-up, 77.3% of the patients in the MPWI group and 52.1% of the patients in the PVI group remained in sinus rhythm without an atrial arrhythmia recurrence (p = 0.001). The BIC-based Cox regression analysis identified the ablation strategy and atrial fibrillation (AF) duration as independent predictors of recurrence across the cohort. It was found that MPWI significantly reduced the risk of recurrence, while a longer AF duration increased it. In the MPWI group, AF duration, left ventricular internal diameter in systole (LVIDs), and moderate or greater tricuspid regurgitation were independent predictors of recurrence. In the PVI group, only the left atrial low voltage area (LVA) index was a significant predictor.

Conclusion: The addition of PWI and selective CFAE ablation to PVI significantly improves 12-month arrhythmia-free survival compared to PVI alone, demonstrating the superiority of this combined approach in improving long-term outcomes for patients with persistent AF.

Background: Prolonged sitting is a risk factor for cardiovascular disease (CVD). We examined whether moderate aerobic exercise prior to prolonged sitting (EX + SIT) has protective effects on peripheral and central cardiovascular and autonomic measures.

Methods: Young women (n = 26; 23.4 ± 4.3 years old; BMI = 23.1 ± 4.3) completed two sessions in random order: (1) EX + SIT, which consisted of 25 min of moderate aerobic exercise followed by a 3 h prolonged sitting bout, and (2) a 3 h prolonged sitting bout only (SIT-only). Seated peripheral and central blood pressure (BP), pulse wave velocity (PWV), and heart rate variability (HRV) were measured at baseline and after 1 h, 2 h, and 3 h of sitting. Generalized linear mixed models with random effects examined the effects of conditions (i.e., EX + SIT vs. SIT) on BP, PWV, and HRV while adjusting for baseline values.

Results: Only peripheral and central diastolic BP (β = 2.18; p = 0.016 and β = 1.99; p = 0.034, respectively) were significantly lower in the EX + SIT condition compared to the SIT-only condition. No differences were detected in other BP, PWV, or HRV variables between the two conditions (p > 0.05 for all).

Conclusions: Performing moderate aerobic exercise in the morning before engaging in prolonged sitting bouts may reduce some of the prolonged-sitting-induced cardiovascular impairments in young women. Further research is needed to confirm these findings in males and middle-aged/older adults.