Journal of Cardiovascular Medicine最新文献

Aims: Inflammation is a main pathophysiological driver in atherosclerotic cardiovascular diseases (ASCVD). Low-dose long-term colchicine for secondary prevention in patients with established ASCVD has been studied in multiple randomized trials in the last decade.This meta-analysis aimed to evaluate the efficacy and safety of long-term low-dose colchicine for secondary prevention in patients with established ASCVD.

Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines to evaluate studies reporting long-term outcomes in patients with ASCVD. We systematically searched PubMed, EMBASE and Scopus databases for relevant studies up to 1 December 2024. The primary outcome was the occurrence of major adverse cardiovascular events (MACE), a composite of cardiovascular death (CVD), myocardial infarction (MI) and stroke. Random-effects models were used to calculate pooled risk ratios (RRs).

Results: Ten randomized clinical trials enrolling 22 532 patients were identified. Addition of colchicine to standard medical treatment in patients with established ASCVD reduced the risk for MACE by 27% [RR 0.73, 95% confidence interval (CI) 0.57-0.95], with a number needed to treat of 52. Colchicine was found to significantly reduce the risk of MI (RR 0.83, 95% CI 0.72-0.96) and coronary revascularization (RR 0.79, 95% CI 0.65-0.94). There were no significant differences between the two groups concerning cardiovascular and noncardiovascular mortality, risk of serious gastrointestinal events, infections requiring hospitalization and cancer.

Conclusions: These findings support the use of long-term low-dose colchicine for secondary prevention of MACE in clinical practice.

Aims: The implications of obesity on phenotype presentation and outcomes in acute decompensated heart failure (ADHF) are relatively unexplored. The aim of this study was to investigate the characteristics and prognostic implications related to obesity in ADHF, according to left ventricular and right ventricular function.

Methods: Consecutive patients hospitalized for ADHF were retrospectively enrolled. Obesity was defined as BMI at least 30 kg/m2. Patients were classified according to the range of left ventricular ejection fraction (LVEF) and to the presence of right ventricular dysfunction (RVD). The primary outcome was 1-year all-cause mortality or rehospitalization for ADHF (HFH).

Results: Two thousand and ninety-eight patients were enrolled; 27% had BMI at least 30 kg/m2. Obese patients were younger, more frequently men and diabetic, with higher blood pressure and lower natriuretic peptides; they had smaller left ventricular volumes, lower pulmonary arterial systolic pressure, and lower prevalence of mitral or tricuspid regurgitation. In heart failure with reduced LVEF, obese patients were treated with higher dosages of antineurohormonal drugs and diuretics. At multivariable logistic regression analysis, obesity was an independent predictor of heart failure with preserved ejection fraction (HFpEF) phenotype [odds ratio (OR) = 2.046, P = 0.012] and of RVD (OR = 1.711, P = 0.034). At adjusted analysis, obesity was independently associated with a lower risk of 1-year mortality/HFH (hazard ratio = 0.608, P = 0.003), consistently across LVEF subgroups and presence/absence of RVD. RVD was associated with a higher risk of 1-year mortality/HFH in nonobese but not in obese patients.

Conclusion: Obesity was highly prevalent (27%) in ADHF and associated with a lower risk of 1-year mortality or HFH. Obesity was an independent predictor of HFpEF phenotype and of RVD, but RVD was associated with higher mortality/morbidity risk only in nonobese patients.

Background: De-escalation of dual antiplatelet therapy (DAPT) by early discontinuation of one antiplatelet agent has been proposed as an alternative to 12-month DAPT to balance ischemic and bleeding risks in patients with acute coronary syndrome (ACS). However, the efficacy and safety of abbreviated DAPT regimens in ST-elevation myocardial infarction (STEMI) - a subset of ACS with distinct clinical and risk profiles - remain uncertain.

Methods: Randomized trials and sub-analyses of randomized trials comparing DAPT de-escalation by early discontinuation versus 12-month DAPT in patients with STEMI treated with primary angioplasty were included. Co-primary endpoints were major bleeding and major adverse cardiovascular events (MACE). Secondary endpoints included net adverse clinical events (NACE), individual ischemic outcomes, and clinically relevant bleeding. Trial sequential analysis (TSA) and sensitivity analyses were prespecified (CRD42024608709).

Results: Eight randomized trials encompassing 10,216 patients were included. Short DAPT regimens significantly reduced major bleeding [hazard ratio, 0.50; 95% confidence interval (CI), 0.30-0.85; P  = 0.011] compared with standard DAPT. No significant differences were observed in MACE (hazard ratio, 1.21; 95% CI, 0.91-1.64; P  = 0.193) or NACE (hazard ratio, 0.94; 95% CI, 0.80-1.10; P  = 0.427). The results of TSA reinforced these findings. Other secondary outcomes showed no significant differences, but interpretation was limited by the small number of studies reporting these events.

Conclusion: Abbreviated DAPT significantly reduces major bleeding risk in patients with STEMI compared with standard 12-month DAPT, without apparently compromising ischemic protection. However, further research is needed to clarify net clinical outcomes in this high-risk ACS subset.

Protocol registration identifier: CRD42024608709.

Introduction: Approximately two-thirds of patients suffering from hypertrophic cardiomyopathy present with an obstructive (HOCM) physiology. For years, medical therapy has been limited to beta blockers, verapamil and/or disopyramide. Recently, a novel class of drugs, the allosteric inhibitors of the cardiac-specific myosin head adenosine triphosphatase (ATPase), have been demonstrated to be effective in relieving the dynamic obstruction and related clinical condition. In July 2024 the Cardiomyopathies and Pericardial Diseases WG of the Italian Society of Cardiology started with a nationwide multicentre registry aimed at investigating the pathophysiology of dynamic obstruction in real-world patients with HOCM. Based on the medical records, this brief report deals with the proportion of patients who were eligible for Mavacamten based on the Explorer-HCM entry criteria, and then admitted for compassionate use by the end of 2024.

Methods and results: The Hypertrophic Obstructive Physiology Study (HOPS) was designed as a registry on consecutive adult patients admitted to 19 tertiary Cardiac Centres in Italy until June 2024. A total of 424 patients, 53% males, aged 64 ± 13 years, were included. We retrospectively recognized 200 Mavacamten-eligible patients (47.2%) on 5 Explorer-HCM requirements. Forty out of this latter group, along with 15 more patients on 4 criteria, were admitted to the compassionate use programme ( n  = 55, 13% of the whole population). Forty-three showed subaortic obstruction and 12 a mid-ventricular variant. Ethical committee approval items varied among centres and regions.

Discussion: This study confirmed our recent demonstration that approximately half of real-world HOCM patients are suitable for Mavacamten therapy based on the full Explorer-HCM trial entry criteria. Due to the current limitation of compassionate use programmes in Italy, only one in four patients was admitted for treatment.

Aims: Age, estimated glomerular filtration rate and ejection fraction (AGEF) score correlates with mortality in patients with ST-elevation myocardial infarction, yet its relationship with cardiogenic shock mortality remains unknown.

Objectives: This research aims to explore the correlation between AGEF and the probability of all-cause 90-day mortality in patients with cardiogenic shock.

Methods: Our study included 168 cardiogenic shock patients from a multicenter, prospective, observational study. The Cox regression model, subgroup analyses, Kaplan-Meier survival curves, and restricted cubic spline analysis were applied to assess the relationship between AGEF and 90-day mortality. Receiver-operating characteristic curve analysis was performed to evaluate the predictive accuracy of AGEF for 90-day mortality.

Results: High AGEF scores correlated with significantly higher mortality (56.1 vs. 19.7%, P < 0.05). AGEF was significantly associated with 90-day mortality [hazard ratio: 1.33, per 1-point increase, 95% confidence interval (95% CI) 1.03-1.70, P < 0.001; hazard ratio: 1.65, per 1 standard deviation increase, 95% CI 1.27-2.14, P < 0.001]. The high AGEF group had a two-fold higher risk of 90-day mortality (hazard ratio: 3.08, 95% CI 1.48-6.41, P < 0.001). Kaplan-Meier curve analysis revealed a higher probability of 90-day death in the group with higher AGEF scores. The restricted cubic spline analysis also suggested a linear relationship between AGEF and 90-day mortality. The area under the receiver-operating characteristic curve for the AGEF was 0.71 (95% CI 0.633-0.787), indicating moderate discrimination ability.

Conclusion: AGEF is significantly associated with all-cause 90-day mortality in patients experiencing cardiogenic shock, indicating its potential as a prognostic indicator in this patient population.