Journal of cardiology最新文献

Background: Urinary sodium evaluation is promising to guide decongestion in acute decompensated heart failure (ADHF). We aim to assess the efficacy and safety of natriuresis-guided diuretic protocols for ADHF decongestion.

Methods: This was a systematic review and meta-analysis synthesizing evidence from randomized controlled trials and non-randomized studies obtained from PubMed, CENTRAL, Scopus, and WOS until August 2024. We report dichotomous outcomes using risk ratio and continuous outcomes using mean difference (MD), with a 95 % confidence interval (CI).

Results: We included four studies with 831 patients. Natriuresis-guided protocols significantly increased natriuresis after 24 h [MD: 86.71 mmol, 95 % CI (49.95, 123.46), p < 0.01], natriuresis after 48 h [MD: 137.57 mmol, 95 % CI (68.58, 206.56), p < 0.01], diuresis after 24 h [MD: 0.76 L, 95 % CI (0.48, 1.05), p < 0.01], diuresis after 48 h [MD: 1.11 L, 95 % CI (0.57, 1.65), p < 0.01], weight loss after 48 h [MD: -0.45, 95 % CI (-0.79, -0.10), p = 0.01], and significantly reduced the length of stay [MD: -0.93 day, 95 % CI (-1.45, -0.40), p < 0.01] compared with the standard of care. However, both groups had no difference in congestion score change (p = 0.12) and all-cause mortality/HF re-hospitalization (p = 0.8).

Conclusion: Natriuresis-guided decongestion in ADHF resulted in significantly increased natriuresis, diuresis, weight loss, and shorter length of hospitalization. However, this did not reflect significant clinical benefits, with no significant effect on mortality or HF re-hospitalization.

Background: Coronary microvascular dysfunction (CMD) after percutaneous coronary intervention (PCI) is associated with poor prognosis, including periprocedural myocardial infarction, and is often attributed to distal embolization of lipid-rich plaque components. However, whether preprocedural lipid quantification using near-infrared spectroscopy-intravascular ultrasonography (NIRS-IVUS) can predict CMD remains unclear.

Methods: We retrospectively analyzed 147 coronary lesions in 121 patients with coronary artery disease (excluding ST-segment elevation myocardial infarction) who underwent NIRS-IVUS-guided PCI. CMD was defined as an angiography-based index of microcirculatory resistance (angio-IMR) ≥25. Two NIRS-derived lipid parameters were assessed: maximum lipid core burden index >4 mm (maxLCBI_4mm) and a novel index, lipid burden in the stent (LBS = stent diameter × length × LCBI), which was determined by the operator based on the planned stent diameter, planned stent length, and the LCBI within the planned stent implantation segment.

Results: CMD occurred in 36.7 % of lesions and was associated with significantly higher values of both indices (p < 0.01). A stepwise trend between lipid burden and microvascular dysfunction was also observed. Optimal cut-offs were identified as maxLCBI_4mm ≥ 579 and LBS ≥20,384. Both indices independently predicted CMD (odds ratios = 7.253 and 3.181), and CMD risk was highest in lesions exceeding both thresholds.

Conclusions: Higher pre-PCI maxLCBI_4mm and LBS values were independently associated with CMD development after PCI. Further studies are warranted to validate their clinical relevance in optimizing PCI strategies.

Background: Dementia and heart failure (HF) are two major epidemics that adversely influence each other, yet few studies have explored strategies to prevent cognitive decline in HF. The Reducing Cognitive impairment by management of Heart Failure as a Modifiable Risk Factor (Cog-HF) trial is a randomized controlled trial assessing whether a disease management program (DMP) compared to usual care can mitigate cognitive decline in HF patients with mild cognitive impairment (MCI). This report describes the baseline characteristics of patients enrolled in Cog-HF and their comparability to recent Japanese HF registries.

Methods: Patients with HF and MCI, defined as a Montreal Cognitive Assessment (MoCA) <26, were recruited for Cog-HF. Baseline characteristics of patients in Cog-HF were compared to those of the FRAGILE-HF, JROADHF, and CURE-HF cohorts.

Results: Among 176 participants (mean age 79 ± 6 years; 53 % men; body mass index 22.3 ± 3.4 kg/m²), prevalence of hypertension, atrial fibrillation, coronary artery disease, and chronic obstructive pulmonary disease was 68 %, 46 %, 25 %, and 7 %, respectively. Most patients had a preserved ejection fraction (HFpEF, 74 %), were in New York Heart Association class II (61 %), and exhibited lower rates of physical (50 %) and social frailty (35 %). The Cog-HF cohort had similarly high rates of background medical therapy (69 % angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitors, 51 % mineralocorticoid receptor antagonists, and 66 % beta blockers), with a higher rate of sodium glucose cotransporter 2 inhibitors (56 %) compared to those in recent registries.

Conclusions: Patients in Cog-HF were similar to those in recent HF registries and were receiving guideline-recommended HF treatment, supporting the external validity of future trial findings.

Background: Acute kidney injury (AKI) following percutaneous coronary intervention (PCI) is associated with poor outcomes. The National Cardiovascular Data Registry (NCDR) AKI prediction model includes a relatively high number of complex clinical variables. We propose a simplified bedside score including 5 pre-procedural variables from the NCDR model as an effective tool for AKI prediction after PCI.

Methods: The Mayo Clinic Rochester cardiac catheterization laboratory registry, which follows NCDR criteria, was analyzed between Q2 2022 and Q1 2023. Inclusion/exclusion criteria, definitions, and outcome data were based on the NCDR model. Logistic regression models were built to predict AKI, including a simplified integer score comprised of 5 pre-procedural variables: Cardiac arrest, Reduced glomerular filtration rate < 30 ml/min/1.73 m2, Anemia (Hb <10 mg/dl), Shock, and Heart failure history. Model calibration and discrimination were tested.

Results: We identified 840 patients with a mean age of 70 (IQR 61-79), of which 593 (70.6 %) were men. AKI developed in 107 (12.7 %) patients. There was no significant difference between the groups in gender, vascular access, PCI indication, or contrast volume used (median: 150; IQR: 110-200 ml in the non-AKI group and median: 170 IQR: 123-213 ml in the AKI group; p = 0.14). The CRASH score demonstrated a c-statistic of 0.77 (0.60-0.88) and calibration intercept of 0.31 (-0.07-0.69) and slope of 1.03 (0.66-1.39) in the validation data, similar to the NCDR score.

Conclusions: A simplified integer score using 5 pre-procedural variables was an effective tool for risk prediction of post-PCI AKI, with performance similar to the more complex NCDR model.

Background: Hypertrophic cardiomyopathy (HCM) is caused by mutations in sarcomere-related genes, with MYBPC3 being the most common. Documenting potential genotype-phenotype associations may allow for more personalized genetic counselling.

Methods and results: Observational case-control, cohort, and cross-sectional studies reporting genotype-phenotype associations and the occurrence of predefined events were selected from Cochrane and Medline databases. A random- effects meta-analysis was conducted. Twenty-four studies were included, with 3869 patients enrolled. The mean age at diagnosis of HCM associated with mutations in the MYBPC3 gene was 39.8 years (95 % CI 32.96 to 46.55), and the mean maximum left ventricular thickness was 20.4 mm (95 % CI 19.72 to 21.06). Proportion rates were 12.6 % (95 % CI 5.7 to 21.5 %) for septal reduction therapy, 20.4 % (95 % CI 11.9 to 30.2 %) for the development of heart failure New York Heart Association (NYHA) III/IV functional class, 16.1 % (95 % CI 10.3 to 22.6 %) for the occurrence of atrial fibrillation, and 26 % (95 % CI 17.0 to 36.1 %) for ventricular tachycardia. Cardioverter-defibrillators were implanted in 31.4 % (95 % CI 18.6 to 45.6 %) for secondary prevention, and sudden cardiac arrest occurred in 14.7 % (95 % CI 7.8 to 23.0 %) of patients. Cardiovascular death occurred in 8.6 % of patients over a median of 73 months of follow-up.

Conclusion: This is the largest meta-analysis of MYBPC3 HCM patients to date. We were able to obtain data on the proportion rates of events in this population, which allows to answer some questions about the clinical course of HCM disease associated with mutations in the MYBPC3 gene more clearly. We found not only a late disease onset and low mortality risk, but importantly, a non-negligible risk of developing severe heart failure throughout life.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common hepatic disorder that significantly increases cardiovascular risk. However, no established screening method exists for detecting subclinical coronary artery disease (CAD) in this high-risk population. The cardio-ankle vascular index (CAVI), a blood pressure-independent measure of arterial stiffness, may offer a non-invasive tool for early detection of coronary atherosclerosis.

Methods: We retrospectively analyzed 295 patients with MASLD who underwent both CAVI measurement and coronary computed tomography angiography at a single center. Significant CAD was defined as ≥50 % luminal stenosis. Receiver operating characteristic (ROC) analysis was used to evaluate diagnostic performance. Multivariable logistic regression was performed to identify independent associations between elevated CAVI and CAD. The incremental predictive value of CAVI was assessed using net reclassification improvement (NRI).

Results: Of the 295 patients, 110 (37.3 %) had significant CAD. Patients with CAD had significantly higher CAVI values (9.0 vs. 8.7, p = 0.007). The area under the ROC curve for CAVI predicting CAD was 0.614. A CAVI cut-off of 8.6 provided a sensitivity of 66.4 % and a specificity of 56.8 %. CAVI ≥8.0 was independently associated with CAD (OR 3.44, 95 % CI: 1.06-11.2, p = 0.040). Adding CAVI to a conventional risk model improved risk reclassification (NRI 0.4236, p < 0.001), although the C-statistic change was not significant (from 0.724 to 0.725, p = 0.835).

Conclusions: CAVI is independently associated with significant coronary stenosis in MASLD patients and may serve as a non-invasive screening tool to enhance cardiovascular risk stratification. Its moderate diagnostic accuracy suggests utility as a component of a multifactorial risk assessment strategy.