Journal of Cardiovascular Medicine最新文献

African populations have traditionally been considered at relatively low risk of cardiovascular diseases (CVD), such as chronic coronary syndrome (CCS), but this is rapidly changing in association with ageing populations, uncontrolled urbanization and lack of control of classical CV risk factors. In sub-Saharan Africa, CVD deaths have increased by more than 50% in the past three decades. For CCS care, limited availability of clinical expertise, diagnostic facilities, and access to optimal medical therapy (OMT), lack or inadequate reimbursement of healthcare costs, and scarcity of universal health coverage (UHC) are major challenges. Cardiologists from 11 African countries, meeting through the AFEX: ACT ON Angina programme, with the endorsement of the World Heart Federation, identified the need to: engage clinicians, patients, and the media to raise awareness of CCS and angina, and encourage lifestyle modification and risk factor control, as well as early referral of high-risk individuals; develop care pathways to address growing demand, including cross-border and online collaboration where local expertise is unavailable; optimize the use of treatment budgets by adapting and implementing international guidelines according to local priorities, and avoiding prescription of nonevidence-based medicines; initiate collaborative research into the nature of CCS in African countries and potential differences in risk factors, presentation, and treatment response compared with Europe and North America whose experience forms the basis of international guidelines. A roadmap is proposed to guide future developments in CCS care and support best practices across Africa.

Aims: Takotsubo syndrome (TTS) is usually triggered by either physical/psychological stressors or comorbidities, neurological among others. The prevalence of amyotrophic lateral sclerosis (ALS) among TTS and whether it has a worse clinical course is not known. We aim to describe ALS prevalence and its impact on clinical presentation, clinical course, and long-term mortality.

Methods: We retrospectively screened the overall TTS population admitted and followed up at our institution between 2007 and 2020. Clinical, electrocardiographic, and echocardiographic data were collected. Kaplan-Meier method was applied for time-to-event analysis to assess the outcome of interest of all-cause death.

Results: Eighty-five patients with TTS were included in our study. Overall, the mean age was 70 ± 12 years, 86% were females. Six patients (7% prevalence) were affected by ALS. At admission, patients with ALS were more likely to present left ventricular systolic dysfunction (P = 0.007). The clinical course of ALS patients was more likely complicated by cardiogenic shock (P = 0.003) which required catecholamines infusion (P = 0.001) and mechanical ventilation (P = 0.009). Despite similar in-hospital mortality rates, ALS patients exhibited significantly elevated all-cause mortality during a median 6-year follow-up (hazard ratio, 19.189, 95% confidence interval 5.639-65.296, log-rank test P < 0.001) with significantly shorter hospitalization to death time (P = 0.039).

Conclusions: Our findings highlight a notable prevalence of ALS among TTS patients, with worse clinical presentation and in-hospital course in ALS-affected individuals. While in-hospital mortality rates were comparable, highlighting the reversible nature of TTS in both groups, long-term follow-up revealed significantly heightened all-cause mortality in ALS patients, emphasizing the impact of ALS on patient prognosis.

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: Some studies about myocarditis and pericarditis following COVID-19 vaccination raised concerns 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 significant concerns about an increased incidence of pericarditis and myocarditis, suggesting that the vaccine is generally 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.