Journal of cardiology最新文献

Background: Patients with coronary artery disease who lack any standard modifiable cardiovascular risk factors (SMuRFs; hypertension, diabetes mellitus, dyslipidemia, and smoking) have attracted much attention in recent years due to their unexpectedly poor clinical outcomes. This study aimed to perform optical coherence tomography (OCT)-based evaluation of the characteristics and morphology of coronary culprit lesions of patients with acute myocardial infarction (AMI) but without any SMuRFs, in a prospective multicenter registry.

Methods: Patients with AMI diagnosed within 24 h of symptom onset who underwent OCT-guided emergency percutaneous coronary intervention were enrolled. The primary endpoint of the study was to characterize the coronary artery lesions of patients without any SMuRFs.

Results: A total of 640 AMI patients were enrolled. Of these, 58 (9%) had no SMuRFs and were in poor clinical condition at presentation, including acute heart failure or cardiogenic shock. OCT found no difference in the morphology of the culprit lesions in terms of presence or absence of SMuRFs. Rates of lipid plaque lesions and plaque calcification >180 degrees were lower in patients without SMuRFs. The risk of cardiovascular events at 12 months was higher in patients without SMuRFs than with SMuRFs (adjusted hazard ratio 2.28, 95% confidence interval 1.13-4.23, p = 0.02).

Conclusions: OCT evaluation revealed less lipid plaque and severe calcification in patients without SMuRFs than in those with SMuRFs. This finding indicates that the poor prognosis in the patient group without SMuRFs is due to the poor state of these patients at the time of onset rather than to the morphology of coronary artery lesions.

Background: Immediate administration of beta-blockers is recommended for acute myocardial infarction (AMI). However, the benefit of beta-blockers according to left ventricular ejection fraction (LVEF), especially for preserved LVEF, remains uncertain. This study aimed to examine the efficacy and safety of beta-blockers for patients with mildly reduced or preserved LVEF after AMI.

Methods: We reviewed randomized controlled trials (RCTs) comparing standard therapy with versus without beta-blockers for patients with AMI with LVEF ≥40%. The primary outcome was a composite of all-cause death, myocardial infarction, and hospitalization for heart failure. The safety outcome was hospitalization for a composite of bradycardia, atrioventricular block, and pacemaker implantation. A pairwise meta-analysis was performed to evaluate hazard ratios (HRs) with 95% confidence intervals (CIs) using a random-effect model.

Results: A total of 19,826 participants from four RCTs (9892 received beta-blocker therapy and 9934 received non-beta-blocker therapy) were included. The primary outcome (HR, 0.93; 95% CI, 0.82-1.04) and the safety outcome (HR, 1.06; 95% CI, 0.83-1.34) were comparable between the two groups. Beta-blockers were also not associated with significant different risks of other outcomes, including each component of the primary outcome and stroke.

Conclusions: In patients with AMI with preserved LVEF, beta-blocker therapy was not significantly associated with lower cardiovascular outcomes or higher bradyarrhythmic events compared to non-beta-blocker therapy. Further trials are warranted to clarify the role and necessity of beta-blockers.

Background: Antihypertensive medications are essential for preventing cardiovascular events and have traditionally been taken in the morning. However, recent studies have suggested that taking the medication at bedtime may be more effective in reducing cardiovascular risk. This study aimed to examine the association between dosing time and cardiovascular outcomes.

Methods: Randomized controlled trials were retrieved through a systematic literature review using PubMed and Embase. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of all-cause (or cardiovascular) death, myocardial infarction, stroke, and hospitalization for heart failure. Secondary outcomes included each component of the primary outcome. A random-effects model was applied to calculate the pooled hazard ratio (HR) for each outcome.

Results: Five randomized controlled trials with 46,477 participants (bedtime, 23,178; morning, 23,299) were included. The median follow-up period ranged from 1.1 to 6.3 years, and the mean or median age ranged from 55.6 to 88 years. We found no evidence that bedtime antihypertensives administration was associated with the risk of MACE [HR = 0.71; 95% confidence interval (CI), 0.43-1.16], all-cause death (HR = 0.76; 95% CI, 0.49-1.17), stroke (HR = 0.70; 95% CI, 0.39-1.23), myocardial infarction (HR = 0.88; 95% CI, 0.56-1.38), or hospitalization for heart failure (HR = 0.58; 95% CI, 0.26-1.33), compared to morning administration.

Conclusions: Administration of antihypertensives at bedtime was not significantly associated with a lower incidence of cardiovascular outcomes in comparison with administration in the morning.

ST-segment elevation myocardial infarction remains a leading cause of mortality. Despite the success of primary percutaneous coronary intervention (PCI), outcomes have plateaued, largely due to reperfusion injury and subsequent microvascular obstruction. This review examines the evolving landscape of microbubble-enhanced ultrasound therapy (aka sonothrombolysis/ sonoperfusion), which is a novel strategy aimed at mitigating reperfusion injury and improving myocardial salvage. We summarize the fundamental mechanisms and critically appraise the clinical trial evidence, from early feasibility studies to pivotal randomized controlled trials. The clinical application of this therapy has progressed significantly. While early trials without microbubbles or with suboptimal ultrasound parameters yielded neutral or even negative results, recent studies have demonstrated clear benefits. A critical determinant of success has emerged: the timing of the intervention. Compelling evidence from recent randomized trials indicates that therapy initiated before PCI significantly improves myocardial salvage and reduces infarct size. In contrast, post-PCI application alone appears to offer limited therapeutic benefit once significant microvascular injury is established. Microbubble-enhanced ultrasound therapy, particularly when administered pre-PCI, represents a promising adjunctive treatment to address the persistent challenge of reperfusion injury. Its potential for pre-hospital application could make it a crucial bridging strategy, capable of initiating myocardial salvage at the earliest possible moment. Further research should focus on technological refinement and validating its efficacy in a pre-hospital setting.

Cardiac regenerative medicine is an emerging field that aims to revolutionize the treatment of heart disease through innovative therapies and technologies. This review highlights the key advancements in human induced pluripotent stem cell (hiPSC) therapy that are paving the way for novel approaches to repair and regenerate damaged cardiac tissue. Substantial progress has been made over the past decade, laying a strong foundation for future developments. However, to fully realize the potential of hiPSC-based therapies, it is crucial to address challenges related to safety, scalability, and ethical considerations. As the field evolves, cardiac regenerative medicine promises to transform cardiovascular care by providing more effective, personalized, and sustainable treatments, ultimately improving patient outcomes and quality of life. This review offers a comprehensive overview of the current state and prospects of regenerative therapies for heart disease, emphasizing the opportunities and challenges in this rapidly advancing field.