Journal of cardiology最新文献

Background: Current guidelines strongly recommend the application of primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction; however, information on its efficacy in super-old patients aged >90 years is inadequate. We compared the efficacy of primary PCI and its clinical outcomes in super-old patients with those of old patients in a super-aging society.

Methods: Shimane Acute Coronary Syndrome (ACS) Registry was a multicenter retrospective cohort study. Consecutive patients with ACS who visited all PCI centers in Shimane Prefecture between January and December 2020 were enrolled. Patients were classified into four age categories: non-old (<65 years), pre-old (65-<75 years), old (75-<90 years), and super-old (≥90 years). Primary endpoints were major adverse cardiovascular events (MACE), including all-cause death, recurrent ACS, any stroke, and hospitalization for worsening heart failure.

Results: In total, 454 patients were enrolled: 99 non-old, 124 pre-old, 181 old, and 50 super-old. The application rate of primary PCI decreased with increased age, with 89 % in old age and 78 % in super-old age (p = 0.042). In-hospital mortality rate was significantly higher in super-old age than in old age (22 % vs. 8 %, p = 0.010), particularly in shock cases (67 % vs. 31 %, p = 0.040); no difference was observed between the two groups in non-shock cases (8 % vs. 4 %, p = 0.259) or in cases that received primary PCI (10 % vs. 6 %, p = 0.232). Landmark analysis revealed that MACE after 30th day did not differ between super-old and old age groups.

Conclusions: In the advanced aging society of Shimane Prefecture, more than half of patients with ACS were aged ≥75 years, with super-old patients aged ≥90 years accounting for 11 % of all patients. In-hospital mortality rate among super-old age patients was lower among those who underwent primary PCI. The prognosis for super-old age patients who were discharged alive was similar to that of old age patients.

Background: Residual mitral regurgitation (MR) immediately after mitral valve (MV) repair is a risk factor for late reintervention. This study aimed to determine the feasibility of color 3-dimensional intraoperative transesophageal echocardiography (3D-IOTEE) for clarifying the mechanism of residual MR and its impact on the conversion rate to MV replacement (MVR).

Methods: Among 767 patients who underwent MV repair at our institute, 92 consecutive patients in whom an immediate second cardiopulmonary bypass (CPB) was performed due to MV repair for residual MR were evaluated. The patients were divided into the re-repair group [i.e. those in whom repair required additional procedures, n = 77 (83.7 %)] and the MVR group [i.e. patients who underwent MVR alone, n = 15 (16.3 %)]. All patients underwent 3D-IOTEE to evaluate the mechanisms of residual MR. The pathomechanisms were classified into the following five categories: Category 1, inter-scallop malcoaptation; Category 2, suture dehiscence; Category 3, prolapse; Category 4, systolic anterior motion of the MV; and Category 5, tethering. Clinical background and outcomes were compared between the two groups based on the five categories.

Results: The rate of MVR conversion by etiology of residual MR after the first MV repair was 68.8 % (n = 11/16) in Category 1; 0 % (n = 0/22) in Category 2; 2.4 % (n = 1/41) in Category 3; 20 % (n = 2/10) in Category 4; and 33.3 % (n = 1/3) in Category 5. Among the 63 patients with Category 2 and 3 etiologies, 62 patients had complete MV re-repair with additional procedures [Category 2, 100 % (n = 22/22); Category 3, 97.6 % (n = 40/41)]. Meanwhile, MVR was performed owing to difficulty in MV repair after the second CPB in 11/16 patients (68.8 %) with Category 1 etiology.

Conclusions: In the assessment of MR, 3D-IOTEE is useful for lesion localization and determining the origin and severity of MR, which are key factors in selecting the optimal surgical approach in patients undergoing re-repair.

Background: Diet modification is a mainstay for the successful management of metabolic syndrome and potentially may reduce the risk of cardiovascular disease. Accurate estimation of essential nutrients in daily meals is currently challenging to quantify. HAKARIUM (AstraZeneca Co., Ltd., Osaka, Japan) is a recently introduced artificial intelligence (AI)-based application that can estimate each nutrient component through photographs, although its applicability to real-world practice remains unknown.

Methods: Lunchtime meals served for healthy individuals at a single university cooperative society between September 2023 and February 2024 were analyzed. Nutrient components, including energy in the form of calories, protein, and salts, were estimated by the HAKARIUM application and compared with the actual nutrient values that were officially calculated and presented by the university cooperative society.

Results: A total of 62 meals were included. Actual values of energy, protein, and salt content per meal were 382 (358, 431) kcal, 17.1 (13.9, 18.9) g, and 2.9 (2.6, 3.1) g, respectively. AI-estimated values of energy, protein, and salt content per meal were 636 (493, 835) kcal, 25.7 (19.7, 36.3) g, and 4.2 (3.5, 4.6) g, respectively. Most of the values were within the limits of agreement with significant correlations between the two variables, respectively (r > 0.80, p < 0.05 for all).

Conclusion: AI-based estimation of nutrient components had relatively good agreement with actually calculated values.

Background: Among patients with aortic stenosis, ventricular remodeling by hypertrophy can limit the augmentation of flow with exertion, even after valve intervention. However, the effect of hypertrophy on quality of life (QoL) improvement has not been studied. We aimed to determine the effect of ventricular hypertrophy on QoL outcomes after transcatheter aortic valve replacement (TAVR).

Methods: All patients undergoing TAVR from 2011 to 2021 at our institution were included. Groups were divided into none/mild ventricular hypertrophy (non-remodeled, NR) and moderate/severe left ventricular hypertrophy (VH) according to guideline-recommended cut-offs for left ventricular (LV) wall thickness. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was utilized to assess QoL; primary outcome was KCCQ change <5 from baseline to 30 days and 1 year.

Results: We analyzed 679 patients (NR: N = 389, VH: N = 290). Groups differed by septal thickness (1.12 cm vs. 1.44 cm, p < 0.001), posterior wall thickness (1.08 cm vs. 1.33 cm, p < 0.001), and LV internal diastolic diameter (4.34 cm vs. 4.19 cm, p = 0.006). The primary outcome was similar between NR and VH at 30 days (31.6 % vs. 28.6 %, p = 0.449) and 1 year (27.7 % vs. 21.5 %, p = 0.217). NR and VH experienced similar proportions of worsening, no change, or small, moderate, and large improvements in KCCQ score. Both groups experienced similar domain score changes and New York Heart Association class improvement. A subgroup analysis of VH patients did not reveal interaction with cavity size or stroke volume.

Conclusion: Patients with significant ventricular remodeling by hypertrophy and aortic stenosis have similar QoL changes after intervention compared to patients without significant remodeling.

Purpose: This paper aims to review the research progress in repairing injury caused by acute myocardial infarction, focusing on myocardial regeneration, cardiomyocyte apoptosis, and fibrosis. The goal is to investigate the current research trends and challenges in the field of myocardial injury repair.

Methods: The review delves into the latest research on myocardial regeneration, cardiomyocyte apoptosis, and fibrosis following acute myocardial infarction. It highlights stem cell transplantation and gene therapy as key areas of current research focus, while emphasizing the significance of cardiomyocyte apoptosis and fibrosis in the myocardial injury repair process. Additionally, the review addresses the challenges and unresolved issues that require further investigation in the field of myocardial injury repair.

Summary: Acute myocardial infarction is a prevalent cardiovascular condition that results in myocardial damage necessitating repair. Myocardial regeneration plays a crucial role in repairing myocardial injury, with current research focusing on stem cell transplantation and gene therapy. Cardiomyocyte apoptosis and fibrosis are key factors in the repair process, significantly impacting the restoration of myocardial structure and function. Nonetheless, there remain numerous challenges and unresolved issues that warrant further investigation in the realm of myocardial injury repair.

Background: The region of adipose deposition is an important determinant in the outcomes of patients with heart failure (HF). However, the impact of regional adiposity on HF patients undergoing cardiac resynchronization therapy (CRT) remains unclear.

Methods: A retrospective cohort analysis was conducted on 95 patients from a single-center study, assessing post-CRT outcomes. Multi-slice body composition measurements of chest computed tomography before CRT placement were used for adipose quantification. Patients were stratified based on subcutaneous adiposity, intramuscular adiposity, and hepatic steatosis.

Results/conclusion: Subcutaneous adiposity correlated with higher CRT response rates (44.4 % in subcutaneous adiposity vs 16.7 % in subcutaneous adipopenia, p = 0.009), while intramuscular adiposity was associated with increased pre-frailty (adjusted OR 14.17, 95 % CI 2.24-89.57, p = 0.005). The higher response to CRT in patients with subcutaneous adiposity may be secondary to preferred subcutaneous over ectopic adipose fat deposition, which is potentially protective against cardiomyocyte dysfunction. Thus, intramuscular adiposity could potentially serve as a prognostic tool for frailty in HF patients.

The posterior left atrium (LAPW) is an important substrate for initiation and maintenance of atrial fibrillation (AF). While it has been proposed as a potential target for preventing recurrence of atrial tachyarrhythmias, it remains unclear whether electrical silence of LAPW offers additional benefits over pulmonary vein isolation (PVI) alone. We conducted a systematic review of PubMed, Medline, Embase, and Cochrane databases and identified 21 eligible studies, encompassing 1514 patients assigned to PVI + posterior wall isolation (PWI) group and 1629 patients assigned to PVI group. Over a median follow-up of 12 months, adjunctive PWI significantly improved the atrial tachyarrhythmia-free survival by 14 % in comparison to PVI alone [relative risk (RR): 1.14, 95 % confidence interval (CI): 1.04 to 1.25, p = 0.004]. This improvement was mainly attributed to a pronounced benefit for patients with persistent AF. In addition, patients undergoing PVI + PWI had a longer procedure time [weighted mean difference (WMD): 23.85, 95 % CI: 12.68 to 35.01, p < 0.001], ablation time (WMD: 9.27, 95 % CI: 5.19 to 13.54, p < 0.001), and a nearly negligible increase in fluoroscopic exposure (WMD: 2.69, 95 % CI: -0.23 to 5.62, p = 0.071). There was no increased risk of procedure-related complications between these approaches (RR: 1.06, 95 % CI: 0.71 to 1.57, p = 0.787). Compared with PVI alone, PWI adjunctive to PVI exhibited a higher procedure success of sinus rhythm maintenance in persistent AF during an index catheter ablation. Meanwhile, elongated procedure time and ablation time did not compromise the safety of extensive ablation strategy with additional PWI.

Background: An escalation strategy from intra-aortic balloon pump (IABP) to Impella (AbioMed, Danvers, MA, USA) is proposed in patients with cardiogenic shock (CS) refractory to IABP therapy, but its clinical data are lacking. This study aimed to elucidate the clinical characteristics and short-term outcomes in patients undergoing IABP-Impella escalation.

Methods and results: From the Japanese nationwide registry of Impella (J-PVAD), a total of 2578 patients with CS receiving Impella support were classified into the IABP-Impella group (n = 189) or the Primary Impella group (n = 2389). We applied 1:3 propensity score (PS) matching, selecting 185 patients and 555 patients, respectively. Before matching, the IABP-Impella group presented longer shock-to-Impella time, worse laboratory data, and more frequent inotropes and pulmonary artery catheter use than the Primary Impella group. After matching, the baseline characteristics were well-balanced. Regarding the 30-day clinical outcomes in the PS-matched cohort, there were no significant differences in the rates of mortality and major complications (a composite of bleeding, hemolysis, infection, stroke, myocardial infarction, limb ischemia, and vascular injury) between the groups. However, The IABP-Impella group showed a significantly higher rate of infection (10.3 % vs. 5.6 %, p = 0.042) and additional mechanical circulatory support use (34.1 % vs. 23.8 %, p = 0.008) than the Primary Impella group.

Conclusions: Compared to patients with primary Impella support, those undergoing IABP-Impella escalation showed similar 30-day mortality and major complications despite poorer clinical conditions before Impella support and a more complicated clinical course after Impella insertion.