Journal of Cardiovascular Medicine最新文献

Aim: To assess the impact of hyperkalemia on the optimization of heart failure therapy and clinical outcomes in a specialized tertiary care center.

Methods: We retrospectively analyzed data from 690 heart failure patients, categorized into hyperkalemia and no-hyperkalemia groups based on the occurrence of serum potassium greater than 5 mEq/l at any time during follow-up. Baseline characteristics and long-term therapy patterns were compared. Predictors of hyperkalemia were evaluated through logistic regression analysis. Survival outcomes were assessed using Kaplan-Meier curves and Cox proportional hazards models. Four sensitivity analyses were performed, considering moderate hyperkalemia (K ≥ 5.5 mEq/l), propensity score-matched cohorts, heart failure with reduced ejection fraction (HFrEF), and HFrEF population after the approval of sacubitril/valsartan in Italy.

Results: Hyperkalemia occurred in 16% of patients and was associated with chronic kidney disease and lower ejection fraction. Baseline use of renin-angiotensin-aldosterone system inhibitors (RAASi), beta-blockers, and mineralocorticoid receptor antagonists (MRAs) was similar between groups, with consistent prescription patterns during follow-up. Approximately 75% of patients in both groups maintained stable RAASi therapy, defined as continuous treatment throughout follow-up. Survival curves showed no significant difference between hyperkalemia and no-hyperkalemia patients. However, those maintaining or initiating RAASi therapy had significantly better long-term survival, regardless of hyperkalemia status. Hyperkalemia was not an independent predictor of mortality [hazard ratio 1.04, 95% confidence interval (CI) 0.72-1.52, P = 0.83], while consistent RAASi use was strongly protective (hazard ratio 0.48, 95% CI 0.33-0.71, P < 0.001). Similar results were observed for secondary endpoints, as well as across all sensitivity analyses.

Conclusion: In a structured heart failure outpatient setting, hyperkalemia is not an insurmountable barrier to maintaining guideline-directed therapy. Continued RAASi use confers significant prognostic benefit, highlighting the importance of specialized follow-up.

Background: Temporary mechanical circulatory support (tMCS) is increasingly used in managing cardiogenic shock, yet women remain underrepresented in studies evaluating its role. This analysis aims to clarify sex-specific in-hospital outcomes among cardiogenic shock patients treated with and without tMCS.

Methods: We analyzed consecutive cardiogenic shock patients enrolled from January 2020 to November 2023 in the multicenter Altshock-2 Registry. The primary outcome was in-hospital mortality.

Results: Among 692 patients [162 (23%) women, 530 (77%) men, mean age 65 (SD 14) years], cardiogenic shock was due to myocardial infarction in 50.1% and heart failure in 29.1%. Other causes were more common in females vs. males (30.5 vs. 17.8%, P value 0.03). At presentation, women had higher lactate levels [3.4 (1.7-7.3) vs. 2.6 (1.6-5.3) mmol/l, P value 0.03] and more frequent severe right ventricular dysfunction (61.8 vs. 49.6%, P value 0.02). tMCS was used in 445 (64.7%) patients without significant sex differences (P value 0.5). Intra-aortic balloon pump was the most used device (73% women vs. 82% men, P value 0.06), followed by extra corporeal membrane oxygenation (33.7 vs. 29.7%, P value 0.4) and Impella (18.8 vs. 23.5%, P value 0.3). A not-significant higher in-hospital mortality in women emerged in the overall (41.4 vs. 33.2%, P value 0.06) and in the tMCS (41.6 vs. 32%, P value 0.07) groups. At multivariate Cox regression analysis, female sex was associated with higher in-hospital mortality only in the tMCS group (adjusted hazard ratio 1.59; 95% confidence interval 1.05-2.39; P value 0.03). No differences emerged in terms of MCS-related complications (28 vs. 25%, P value 0.6).

Conclusion: Female sex is associated with a worse in-hospital survival among cardiogenic shock patients treated with tMCS. Future research should ensure adequate female representation to clarify underlying mechanisms.

This paper presents the case of a 65-year-old female patient who was hospitalized with complaints of a persistent burning sensation in the chest. Coronary computed tomography angiography (CCTA) demonstrated a congenital single right coronary artery anomaly accompanied by myocardial bridging. The aim is to enhance people's awareness of this type of coronary artery vascular malformation.

Aims: To evaluate the safety and feasibility of elective electrical cardioversion (ECV) performed under deep sedation with propofol administered exclusively by cardiologists, using predefined clinical criteria in a real-world setting without anesthesiologist involvement.

Methods: This retrospective single-center study included adult patients who underwent elective ECV for atrial fibrillation or atrial flutter, with intravenous sedation performed using propofol administered exclusively by cardiologists without anesthesiology involvement. Clinical, procedural, and sedation-related data were extracted from electronic health records. Sedation-related adverse events were predefined as follows: hypotension (systolic blood pressure <90 mmHg or requiring fluid/vasopressor support), respiratory depression (oxygen desaturation <90% or need for assisted ventilation), and bradycardia (heart rate <40 bpm or requiring atropine). All events were evaluated according to predefined criteria.

Results: A total of 80 patients were included. The mean age was 69.4 ± 7.3 years, and 60 patients (75.0%) were male. The mean weight-adjusted propofol dose was 0.81 ± 0.20 mg/kg. The procedural success rate was 91.2%. Sedation-related adverse events occurred in seven patients (8.8%): hypotension in two (2.5%), respiratory depression in one (1.3%), and bradycardia in four (5.0%). All events were mild, self-limiting, and managed without escalation or anesthesiologist intervention.

Conclusion: Cardiologist led administration of propofol for elective ECV appears safe and feasible. This approach may be particularly useful in healthcare systems with limited access to anesthesiology personnel, supporting a resource efficient model of care.

Aims: Hypokinetic nondilated cardiomyopathy (HNDC) is defined by left ventricular dysfunction without significant dilatation. The distinct features and prognosis of HNDC compared to classical dilated cardiomyopathy (DCM) are partially unexplored. We investigated the differences between HNDC and DCM cohorts from the multicentric Italian IN-HF registry.

Methods: All patients with a diagnosis of DCM enrolled in the registry between 2008 and 2023 were considered. HNDC was defined by a left ventricular end-diastolic diameter of less than 34 mm/m2 in men and less than 31 mm/m2 in women, or a left ventricular end-diastolic volume of 70 ml/m2 or less in men and less than 60 ml/m2 in women. The primary outcome was a composite of all-cause death and heart failure hospitalizations (HFHs).

Results: Of 1748 patients, 568 (32.5%) met the criteria for HNDC. HNDC patients were more likely to be male, with a higher prevalence of obesity and atrial fibrillation. HNDC also showed less advanced disease (less advanced New York Association class, higher left ventricular ejection fraction, lower prevalence of moderate-severe mitral regurgitation, and less atrial dilatation). After a median follow-up of 13 months, the primary outcome occurred less frequently in HNDC compared with DCM [12.5 vs. 17.1%; hazard ratio 0.762, 95% confidence interval (95% CI) 0.581-0.999; P = 0.049]. However, the adjusted prognosis was similar between groups (hazard ratio 1.031, 95% CI 0.771-1.380; P = 0.834). Beta-blockers emerged as the most protective drug for HNDC (hazard ratio 0.462, 95% CI 0.258-0.826; P = 0.009).

Conclusion: HNDC appears as a distinct form of DCM with milder clinical presentation. However, the absence of LV dilation did not independently influence prognosis. Beta-blockers may offer the most consistent benefit in HNDC.

Background: Current sizing in terms of beds and the territorial distribution of acute cardiac care units (ACCUs) is presently defined in Italy by Ministerial Decree 70/2015. The performance of this model of care based on one ACCU with coronary-angioplasty facilities for every 150 000-300 000 inhabitants has been poorly evaluated in the real world so far.

Methods: This study is based on a real-world, single-center, cohort of patients urgently admitted to the ACCU (and annexed cardiology ward) for acute cardiovascular disease: admission diagnosis, hospital stay, and outcome were recorded and compared to the Ministerial Decree 70/2015 model and standards.

Results: A total of 2210 consecutive patients were urgently admitted to the ACCU and annexed cardiology ward for acute cardiovascular disease in the 2 years of the study: 62% were male, mean age of admission was 68 ± 15 years, mortality rate was 4.5%, mean hospital stay was 7.7 ± 7 days.The admission diagnosis was acute coronary syndrome in 42% of cases, acute heart failure in 12.8%, brady-arrhythmias in 7.6%, ventricular tachycardia in 3.9%, and pulmonary embolism in 3.1%. The multivariable logistic regression analysis, age and admission by emergency medical service were significant predictors of mortality.The mean daily admission rate was 3 patients/day, 1.3 for ACS, and 0.55 for ST-elevation acute myocardial infarction; the number of ACCU beds required for ACS (8.1 days of mean hospital stay) was 10.5, and for overall admissions (7.7 days of mean hospital stay) 23.4.

Conclusions: The present ACCU model (beds per ACCU for every 150 000-300 000 inhabitants, Ministerial Decree 70/2015) is undersized for present admission rates and workloads and should be revised.