Journal of cardiology最新文献

Background: An enlarged v-wave amplitude and a large v-wave in the pulmonary artery wedge pressure (PAWP) suggest impaired left atrial (LA) reservoir function. This study investigated the clinical importance of enlargement of v-wave amplitude in patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM).

Methods and results: We retrospectively analysed patients with ATTRwt-CM (n = 204) and hypertrophic cardiomyopathy (HCM) (n = 78). The v-wave amplitude of PAWP was higher in the ATTRwt-CM group than in the HCM group (5.6 ± 4.73 mm Hg vs. 3.0 ± 2.50 mm Hg; p < 0.001). We also assessed prognostic impact of v-waves in patients with ATTRwt-CM. Large v-waves were defined as amplitude ≥10 mm Hg. We assigned the patients to groups with (n = 48) and without (n = 156) large v-wave. LA peak longitudinal strain (LS) and LS rate (LSR) were significantly decreased in the group with large v-waves. Large v-waves were also a determinant of all-cause death (log-rank, p = 0.033) and rehospitalization for heart failure (HF) events (log-rank, p = 0.001). The four forced inclusion models significantly associated a large v-wave with increased HF rehospitalization risk in multivariable Cox analysis.

Conclusions: The v-wave amplitude of enlarged PAWP in ATTRwt-CM correlated with declining LA peak LS and LSR and higher risk of all-cause death and HF rehospitalization. Therefore, assessing PAWP waveforms might help to diagnose ATTRwt-CM, and predict LA dysfunction and a poor prognosis.

Fluoropyrimidines can cause angina-like chest pain, often attributed to coronary vasospasm. We retrospectively reviewed 137 patients at Cleveland Clinic (2017-2023) who developed chest pain during 5-fluorouracil or capecitabine treatments. Most events occurred early (75 % within four cycles). Troponin elevation (42 %) and ischemic electrocardiographic changes (43 %) were common, yet most catheterized patients had no obstructive coronary disease. Rechallenge was attempted in 64 % of patients, with recurrence in 36 %, and no predictors of recurrence were identified. Fluoropyrimidine-associated angina is therefore frequent, with high rates of recurrence, and unpredictable, highlighting the need for standardized diagnostic and management strategies.

Background: Cognitive dysfunction is prevalent in patients with heart failure (HF) and predicts poor prognosis. The Six-Item Screener is a brief tool that requires no materials and can be administered easily in a variety of care settings. We evaluated whether this tool detects cognitive dysfunction and predicts all-cause mortality in older HF patients, in comparison with the Mini-Cog.

Methods: We conducted a post-hoc analysis of consecutive patients aged ≥65 years from the multicenter FRAGILE-HF cohort. Cognitive dysfunction at discharge was defined as Six-Item Screener ≤4 and Mini-Cog ≤2. Agreement was quantified using Cohen's kappa. Associations with all-cause mortality were examined with multivariable Cox proportional hazards models. Prognostic capabilities were assessed by the area under the receiver operating characteristic curve (AUC) and compared using the DeLong test.

Results: Of 1332 enrolled patients, 1316 were included in the analysis (median age 81 years; 56.8 % male). The prevalence of cognitive dysfunction was 42.9 % by the Six-Item Screener and 38.5 % by the Mini-Cog, showing moderate agreement (kappa = 0.55). Cognitive dysfunction defined by the Six-Item Screener [hazard ratio (HR), 1.30; 95 % confidence interval (CI), 1.02-1.65; p = 0.034] and by the Mini-Cog (HR, 1.44; 95 % CI, 1.13-1.83; p = 0.003) was associated with higher all-cause mortality. AUCs were similar for the Six-Item Screener (0.553; 95 % CI, 0.515-0.592) and the Mini-Cog (0.556; 95 % CI, 0.519-0.594).

Conclusions: In older patients with HF, the Six-Item Screener identifies cognitive dysfunction and predicts mortality with prognostic performance comparable to the Mini-Cog.

Background: Heart failure (HF) patients who exhibit improvement in systolic function following atrial fibrillation (AF) ablation may experience better outcomes than those who do not. However, the prognostic significance of such improvement compared to originally preserved systolic function remains unclear.

Methods: Among 1538 patients undergoing AF ablation, those meeting HF criteria were included. Patients with systolic dysfunction (n = 272) and those with a high likelihood of HF with preserved ejection fraction (HFA-PEFF score ≥ 5; pEF group, n = 293) were analyzed. The former were further subdivided based on post-procedural left ventricular ejection fraction (LVEF) into improved EF (imp-EF, LVEF ≥50 %) and non-improved EF (non-imp-EF, LVEF <50 %) groups. The primary endpoint was a composite of all-cause mortality and HF hospitalization, comparing the imp-EF and pEF groups.

Results: Among 272 patients with systolic dysfunction, 127 were categorized as imp-EF. After propensity-score matching (101 per group), the imp-EF group had comparable risk of the primary endpoint as the pEF group [HR 0.40 (0.13-1.16), p = 0.09] and similar atrial tachyarrhythmia (ATA) recurrence rates [HR 0.70 (0.37-1.30), p = 0.26] over a median follow-up of 41 (24-71) months. ATA recurrence after the last procedure was associated with adverse events in the imp-EF group, whereas E-wave velocity was the only predictor in the pEF group in univariate analysis.

Conclusions: Patients in both the imp-EF and pEF groups demonstrated comparable prognoses.

Background: Transthyretin-related amyloid cardiomyopathy (ATTR-CM) results from mutations in the TTR gene (vATTR) or conformational changes in wild-type TTR protein (wtATTR). The aim of this study was to characterize the specificities of cardiac involvement in patients with TTR V30M mutation.

Methods: This retrospective study included patients diagnosed with TTR V30M that were referred to a cardiology appointment during 2019 (median follow-up of 57 months). Data on cardiomyopathy (CM), conduction abnormalities, aortic stenosis, and atrial fibrillation (Afib) were collected. V30M ATTR-CM patients were compared to a contemporary cohort with wtATTR-CM.

Results: A total of 238 TTR V30M patients were enrolled: mean age 54 years old, 52 % male, and 69 % with early onset disease. vATTR-CM occurred in 20 % of patients and was associated with male gender, older age at presentation, liver transplantation, ophthalmologic manifestations, and lower creatinine clearance. Age at presentation, male gender, liver transplant, and ophthalmologic manifestations were independent predictors of CM. vATTR-CM was associated with worse outcomes. Significant electric conduction disease was present in 32 % of patients and AFib in 11 %. Patients with vATTR-CM, compared to those without CM, had a higher prevalence of significant electric conduction changes, pacemaker implantation, and AFib when compared to those without CM. Most patients with electric disease had neuropathy and more than 12 years of symptoms. Significant aortic stenosis was rare. Compared to patients with wtATTR-CM, patients with vATTR-CM had a higher prevalence of significant conduction disease, a lower prevalence of AFib, and less severe hypertrophy. In vATRR-CM, age at presentation and male predominance were lower and orthostatic hypotension was more prevalent.

Conclusion: Our findings highlight the need for thorough cardiovascular evaluation in TTR V30M patients due to common conduction issues and the significant impact of CM on outcomes.