Journal of Cardiovascular Medicine最新文献

Factor XI (FXI) is one of the components of the coagulation cascade, connecting its intrinsic and common pathway. FXI inhibitors have emerged in these few years as interesting therapeutic drugs, with potential advantages over standard anticoagulants in terms of lowering thrombotic risk and limiting bleeding consequences. Better knowledge of the underlying processes of thrombosis led to the design of several clinical trials based on the inhibition of this factor. The discovery of molecules, antibodies, and antisense oligonucleotides capable of binding to this factor is paving the way for new anticoagulation strategies, which will be analyzed in this review.

Cardiometabolic disorders such as hypertension, coronary artery disease, dyslipidaemia, heart failure, and diabetes often cluster together, resulting in patients affected by multiple, related disorders. Therefore, there is a clear need for a multidisciplinary approach when managing these complex patients. Also, therapeutic measures targeting cardiometabolic disorders are expected to influence their common pathogenic mechanisms, such as inflammation and oxidative stress. These were key highlights from a recent forum on cardiometabolic health including various experts across cardiology, endocrinology, and primary care. This consensus document highlights the importance of a combined treatment approach rather than siloed specialties.

Aims: Despite consistent recommendations from clinical guidelines, data from randomized trials on a long-term antithrombotic treatment strategy for patients with oral anticoagulation (OAC) and stabilized coronary artery disease (CAD) are still limited and underpowered for ischaemic events. Therefore, we investigated the safety and efficacy of single vs. dual antithrombotic therapy (SAT vs. DAT) in patients with OAC and stabilized CAD.

Methods: A systematic review and meta-analysis was performed using PubMed to search for randomized clinical trials comparing SAT vs. DAT in patients with OAC and stabilized CAD.

Results: Five trials encompassing 5758 patients (SAT = 2897 vs. DAT = 2861) were included. The predominant indication of OAC was atrial fibrillation (n = 5495, 95.4%). Most of the patients had prior percutaneous coronary intervention (PCI) (81.1%). The primary safety outcome (trial-defined major bleeding) was lower with SAT compared with DAT [hazard ratio 0.58, 95% confidence interval (95% CI) 0.40-0.83; P < 0.001; I2 = 65.9%] as was the composite of major bleeding or clinically relevant nonmajor (CRNM) bleeding (hazard ratio 0.62, 95% CI 0.400.96; P = 0.03; I2 = 54.6%). There were no differences between the groups in terms of all-cause death, myocardial infarction, stroke, and the trial-defined composite of major adverse cardiovascular events. These findings were consistent among sensitivity analyses.

Conclusion: In OAC patients with stabilized CAD, largely due to atrial fibrillation and prior (6-12 months) PCI, SAT is associated with lower major bleeding without increased risk of ischaemic complications compared with DAT.

Aims: While timely reperfusion is known to reduce mortality, the extent to which the severity of heart failure, as classified by the Killip system, influences treatment delays remains unclear. Our study aims to address the existing gap in evidence regarding the relationship between Killip classification at presentation and treatment times in ST-elevation myocardial infarction (STEMI) patients.

Methods: We conducted a correlative analysis using data from patients treated in our hospital and enrolled in the FITT-STEMI Register from 2009 to 2022. We focused on the relation of treatment times allocating patients into the four Killip classes and used an ANOVA test (significance level: P  < 0.05). Killip class and intrahospital mortality were studied via binary logistic regression.

Results: In total, 1264 patients were identified. Door-to-balloon time among Killip I patients was 54 (±35) min (mean ± SD) and 53 (±26) min among Killip II and prolonged up to 77.5 (±46) min for class III and 79.7 (±45) min for class IV (overall P -value < 0.001). This remained statistically significant even after the exclusion of patients with out-of-hospital cardiac arrest (OHCA) (overall P -value: <0.001).Post hoc analysis showed a significant difference between Killip II and III classes for both all-comers ( P  = 0.014) as well as after the exclusion of OHCA patients ( P  = 0.012).Intrahospital mortality increased from <5% for classes I and II up to 10.3% for class III and 35.4% for class IV.

Conclusion: The severity of heart failure among STEMI patients significantly affects the duration of treatment times. Patients presenting with Killip class III and IV demonstrate high intrahospital mortality rates.

Background: With a growing population of breast cancer survivors, it is important to acknowledge long-term consequences of breast cancer treatment, including left ventricular systolic dysfunction (LVSD). Although echocardiography is a reliable technique to diagnose LVSD, its limited accessibility in primary care poses challenges.

Methods: A cross-sectional diagnostic accuracy study among 350 long-term breast cancer survivors, at least 5 years after breast cancer diagnosis, comparing the diagnostic performance of index tests ECG and N-terminal pro B-type natriuretic peptide (NT-proBNP) to the reference test echocardiography. LVSD was defined as left ventricular ejection fraction (LVEF) less than 54% or LVEF less than 50% on echocardiography.

Results: The median age at time of investigation was 63 years (IQR 57-68), with a median follow-up duration since breast cancer diagnosis of 10 years (IQR 7-14). An abnormal ECG demonstrated a sensitivity of 63.0% (IQR 48.7-75.7), a corresponding specificity of 51.7 (IQR 45.8-57.6) and a negative likelihood ratio of 0.7 (IQR 0.5-1.0) for detecting a LVEF less than 54%. An abnormal ECG showed a sensitivity of 75.0 (IQR 47.6-92.7), a corresponding specificity of 50.6 (IQR 45.1-56.2) and a negative likelihood ratio of 0.5 (0.2-1.2) for detecting LVSD defined as LVEF less than 50%. The area under the curve for NT-proBNP was 0.59 (95% confidence interval: 0.50-0.68) for detecting LVEF less than 54% and 0.56 (95% confidence interval: 0.39-0.74) for detecting LVEF less than 50%.

Discussion: ECG and NT-proBNP are inadequate diagnostic tools to screen for LVSD among asymptomatic long-term breast cancer survivors.