Journal of Cardiovascular Medicine最新文献

Background: Since the 1970s, only a few studies have evaluated the accuracy of noninvasive screening exercise tests for detecting coronary artery disease (CAD) in symptomatic individuals with mitral valve prolapse (MVP). The present systematic review has been designed to summarize the main findings of these studies and to assess the overall pooled estimates of sensivity and specificity of exercise ECG, exercise myocardial perfusion scintigraphy (MPS) and exercise stress echocardiography (ESE) in diagnosing CAD among MVP individuals.

Methods: All studies examining the specificity and sensitivity of exercise ECG and/or exercise MPS and/or ESE in detecting obstructive CAD in symptomatic MVP patients, selected from PubMed and EMBASE databases, were included. There was no limitation of time period. The risk of bias was assessed by using the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

Results: The full texts of 11 studies with 840 MVP individuals were analyzed. True obstructive CAD was documented in 11.1% of MVP individuals (range 0-31.2%). When used in MVP patients with suspected CAD, exercise ECG, exercise MPS and ESE showed a pooled specificity of 61.9% (range 25-91.7%), 82.3% (range 25-100%) and 89% (range 80.5-97.6%), respectively, and a pooled sensitivity of 80% (range 50-100%), 96.7% (range 90-100%) and 91% (range 82-100%), respectively. The pooled positive predictive value was 33.2% (range 23.1-44.8%) for exercise ECG, 100% for exercise MPS and 80.2% (range 75.8-84.6%) for ESE, whereas the pooled negative predictive value was 80% (range 50-100%) for exercise ECG, 97% for exercise MPS and 99% (range 97.6-100%) for ESE.

Conclusion: ESE appears to be the first-choice screening method for CAD detection in symptomatic MVP individuals. It allows true CAD in symptomatic MVP individuals with false-positive exercise ECG results to be ruled out, without ionizing radiation exposure.

Aims: This study reports on the concerns about myocarditis and pericarditis following COVID-19 vaccination that have been raised worldwide. However, the heterogeneous diagnostic criteria for postvaccination inflammatory heart diseases may result in overestimating incidence rates. The aim of this multicentre Italian registry is to evaluate the impact of COVID-19 vaccines on the incidence of myocarditis and pericarditis in the Italian population.

Methods: Consecutive patients admitted to Italian hospitals for endomyocardial and/or cardiac magnetic resonance proven acute myocarditis and/or pericarditis in the same period (1 June-31 October) of 2019 and 2021 were enrolled, irrespective of the potential association with the COVID-19 vaccines. Acute pericarditis and/or myocarditis were defined as 'vaccine-related' if clinical presentation occurred within 15 days after COVID-19 vaccination, independently of the dose.

Results: There was a comparable incidence rate ratio (IRR) for inflammatory heart diseases in 2019 and 2021 (2019: IRR 0.67 versus 2021: IRR 0.74, P = 0.45). In particular, the IRR did not differ in myocardial involvement (2019: IRR 0.33 versus 2021: IRR 0.33, P = 1) and pericarditis (2019: IRR 0.37 versus 2021: IRR 0.49, P = 0.09) in both periods. Among 125 cases registered in 2021, 32 (25.6%) were 'vaccine-related'. Among those who experienced 'vaccine-related' myocarditis and/or pericarditis, men with age under 40 years were over-represented (53.12%, P = 0.021).

Conclusion: In a nationwide Italian survey comparing pandemic with prepandemic periods, the overall data do not indicate an increase in the incidence of pericarditis and myocarditis, suggesting that the vaccine can be considered well tolerated for these specific conditions.

Objectives: Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) has gained popularity as a less invasive alternative to a redo surgical aortic valve replacement (redo-SAVR); which one is the preferred technique in these cases, however, remains a topic of debate, as the available data refer to retrospective studies with few patients or limited follow-up. The present metanalysis aimed to compare the short-term and long-term outcomes of the two techniques in the setting of a failed surgical bioprosthesis.

Methods: PubMed, MEDLINE, and Embase were searched on 10 November 2023 yielding 355 results (PROSPERO ID: CRD42023490612), of which 27 were suitable for meta-analysis. The primary outcomes were short-term and long-term all-causes and cardiovascular mortality. Logarithmic risk ratio (Log RR) and mean difference were used for categorical and continuous data, respectively.

Results: Both redo-SAVR and ViV-TAVI exhibited similar procedural and short-term mortality. However, ViV-TAVI demonstrated lower 1-year mortality [RR: 0.74, 95% confidence interval (CI) (0.57-0.96), P = 0.02], acute kidney injury (RR: 0.47, P < 0.001), bleeding (RR: 0.44, P < 0.001), stroke (RR: 0.70, P < 0.05), and new pacemaker implantation (RR: 0.69, P < 0.05). Conversely, redo-SAVR demonstrated more favorable mean postoperative aortic valve gradients [mean difference 2.59, 95% CI (0.86-4.31), P < 0.01].

Conclusion: Short-term mortality was similar between the groups, but ViV-TAVI showed better survival at 1 year as well as reduced rates of acute kidney injury, bleeding, stroke, and pacemaker implantation. However, redo-SAVR leads to a better hemodynamic profile. Even if collected data come from retrospective studies, the present results could help to guide the choice of the best approach case-by-case according to the patient's clinical profile.

Cardioneuroablation (CNA) is emerging as an appealing therapeutic option for patients with vasovagal reflex syncope. This review examines key aspects of CNA, including patient selection, procedural aspects and mid-term effects. We critically evaluate procedural results from recent studies and address ongoing challenges, such as the need for standardized procedural protocols and harmonized postprocedural data collection. In addition, we outline current gaps in knowledge concerning long-term pathophysiological effects of the procedure, in particular regarding ventricular arrhythmia susceptibility and exercise capacity.

Last year, the European Society of Cardiology (ESC) published the first guidelines to comprehensively address the management of cardiomyopathies. This document by the Working Group on Myocardial and Pericardial Diseases of the Italian Society of Cardiology aims at highlighting the most relevant messages and novelties introduced by these guidelines for the management of patients affected by cardiomyopathies. Five main messages are summarized: the key role of the phenotype, the new classification of cardiomyopathies provided in the ESC guidelines, the importance given to new techniques such as cardiac magnetic resonance (CMR) and genetic testing, the newly provided recommendations given on sport activities and finally how the importance of follow-up evaluations is highlighted. These five main messages are then further analyzed more in depth so as to inform the reader on all the main novelties of the guidelines and to provide a critical approach to this important document.

Brugada syndrome (BrS) is a genetic condition that increases the risk of life-threatening arrhythmias, which can result in sudden cardiac death (SCD). Implantable loop recorders (ILRs) have become a key tool in managing patients with unexplained syncope, and guidelines advise their use in individuals with recurrent, unexplained syncope or palpitations. However, the role of ILRs in inherited arrhythmic conditions like BrS remains a topic of debate. Most patients newly diagnosed with BrS show no symptoms, but around 30% may experience symptoms such as syncope or palpitations, which can arise from arrhythmic issues or other causes like neurally mediated reflexes. Accurately assessing the cause of these symptoms is crucial to evaluate the risk of SCD. This document aims to examine current evidence on the role of ILR implantation in patients with BrS. The most frequent arrhythmias recorded by ILR are supraventricular arrhythmias and conduction disorders; ventricular arrhythmias, usually nonsustained, are rarely recorded. Symptoms-to-rhythm correlation by ILR can have therapeutic implications in case of recorded arrhythmias (initiation of drug therapy, ablation procedures or defibrillator/pace-maker implantation), provide reassurance in patients without rhythm disorders documented and improve their quality of life. However, given the low rate of detected arrhythmias, the clinical value of ILR in asymptomatic patients needs further evaluation.