Journal of Cardiovascular Medicine最新文献

Aims: The impact of sex-related factors on current clinical management and outcomes of chronic coronary syndromes (CCS) are unclear.

Methods: All patients belonging to the prospective, nationwide START registry were included. Their baseline characteristics, diagnostic workup, revascularization strategy, pharmacological treatment and 1-year clinical outcomes were compared with respect to sex overall and in age tertiles.

Results: A total of 5070 consecutive patients were included. Most patients were males (80.1%). As expected, the prevalence of females increased with age. Distribution of risk factors and history of cardiovascular disease were different depending on sex, as well as diagnostic workup, with lower use of exercise stress testing in women (25.1% vs. 36.7%, P < 0.0001). The use of coronary angiography was similar in the two groups. Women had lower rates of multivessel coronary artery disease (CAD) (33.0% vs. 40.6% P < 0.0001) and higher rates of nonobstructive CAD (18.3% vs. 11.3%, P < 0.0001). Rates of myocardial revascularization were similar, but women were more likely to receive percutaneous coronary intervention than men (84.3% vs. 77.8%, P < 0.0001) and less likely to receive surgical/hybrid revascularization (10.0% vs. 15.1%, P < 0.0001). At 12-month follow-up, no differences were observed for the combined endpoint of all-cause mortality, re-hospitalization for myocardial infarction, heart failure, stroke or myocardial revascularization between males and females; however, a significantly worse perceived quality of life was observed in women.

Conclusions: In a large nationwide cohort of patients with CCS, clinical outcomes were not different depending on sex. However, several differences in the diagnostic work-up, treatment strategies and quality of life were found between sexes.

Purpose: The prognostic significance of noninvasive myocardial work (MW) indices in patients undergoing transcatheter aortic valve implantation (TAVI) has not been adequately examined.

Methods: We retrospectively selected 88 consecutive patients (mean age 79.9 ± 6.4 years, 40% males) with severe aortic stenosis scheduled for TAVI enrolled in the EffecTAVI registry. Exclusion criteria were prior valve surgery, atrial fibrillation, and left bundle branch block (LBBB) at baseline. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were measured by echocardiography at baseline and at 30 days. Accuracy of the noninvasive measures was assessed by invasive evaluation of MW.

Results: In the overall population, a significant reduction in GWI (2406 ± 567 vs. 2063 ± 515 mmHg% before and after TAVI respectively, P  < 0.001), GCW (2783 ± 616 vs. 2380 ± 495 mmHg%, P  < 0.001) and GWW (238 ± 203 vs. 186 ± 135 mmHg%, P  = 0.015) was observed at 30 days after TAVI. GWE improved only in patients who did not develop left ventricular dyssynchrony due to new-onset LBBB or pacemaker implantation following TAVI. In a multivariable Cox-regression analysis, GWE after TAVI (hazard ratio 0.892, 95% confidence interval 0.81-0.97; P  = 0.011) was the strongest predictor of adverse events (a composite of all-cause death, worsening of dyspnea, or rehospitalization for cardiovascular events) at 1-year follow-up.

Conclusions: TAVI results in significant changes in MW indices, including an early decrease in GWI, GCW and GWW, and an improvement in GWE in patients without left ventricle dyssynchrony. A GWE equal or less than 92% at 30 days is indicative of poor clinical outcomes at 1 year.

Aims: Considering the limited data regarding clinical outcomes of patients with non-ST-segment on the ECG elevation myocardial infarction (NSTEMI), this study compared the outcomes of patients undergoing percutaneous coronary intervention with newer-generation drug-eluting stents stratified by the presence/absence of complex lesions and symptom-to-balloon time (SBT; <48 h or ≥48 h).

Methods: We enrolled 4373 patients with NSTEMI from the Korea Acute Myocardial Infarction Registry-National Institute of Health dataset and stratified them into the complex group (2106 patients; SBT < 48 h, n  = 1365; SBT ≥48 h, n  = 741) and the noncomplex group (2267 patients; SBT < 48 h, n  = 1573; SBT ≥48 h, n  = 694). The primary outcome was the 3-year all-cause mortality rate. The secondary outcomes were any major adverse cardiac events (MACE), including cardiac death (CD), recurrent myocardial infarction, and stroke.

Results: The incidence of all-cause mortality (adjusted hazard ratio, 0.656; P  = 0.009), CD ( P  = 0.037), and MACE ( P  = 0.047) in the complex group and of stroke in the noncomplex group ( P  = 0.020) were significantly lower in patients with SBT < 48 h than in those with SBT ≥48 h. Among patients with SBT < 48 h, the stroke incidence ( P  = 0.019) was higher in the complex group than in the noncomplex group, while among patients with SBT ≥48 h, the MACE incidence ( P  = 0.011) was higher in the former than in the latter.

Conclusion: SBT reduction effectively decreased the 3-year mortality in patients with NSTEMI in the complex group compared with the noncomplex group.

The knowledge of pericardial diseases has now improved, including prospective and retrospective cohort studies focusing on the pathogenesis, diagnosis, treatment, and outcomes. The complex interplay between genetic predisposition (especially for autoinflammatory conditions), inflammation, and autoimmunity is now known to trigger recurrences of pericarditis. Moreover, diagnostic capabilities have improved with the implementation of multimodality imaging, particularly cardiac magnetic resonance (CMR), to detect and monitor pericardial inflammation, to allow diagnosis in more complicated cases, and tailor the duration of therapy based on objective parameters. A new class of drugs, the anti-IL-1 agents, have been introduced for patients with an inflammatory phenotype of presentation, and not responding to conventional anti-inflammatory therapies, including NSAID, colchicine, and corticosteroids. At present, the clinical management of pericardial diseases is definitely on the road of evidence-based medicine with new ongoing European guidelines focusing on the spectrum of inflammatory myocardial and pericardial syndromes.

Introduction: Nowadays, no clear predictors of atrial fibrillation in patients with embolic stroke of undetermined source (ESUS) are known. Some echocardiographic parameters have been proposed as potential predictors of atrial fibrillation in patients with ESUS. The ratio between left atrial volume and tissue Doppler (TDI) a' provides the left atrial volumetric/mechanical coupling index (LACI) and represents a feasible surrogate for left atrial function, and might be useful to identify atrial fibrillation in this subset of patients.

Methods and results: All consecutive patients having undergone an implantable loop recorder (ILR) for ESUS between 2017 and 2022 were retrospectively enrolled. All patients were followed through remote monitoring and telephone visit for a minimum follow-up of 6 months.A total number of 129 patients (mean age: 72.2 ± 8.8 years; 55% of men) were analyzed. Patients developing atrial fibrillation presented higher baseline LACI (5.53 ± 2.52 vs. 3.25 ± 1.19, P < 0.001). The multivariate analysis showed that LACI was independently and significantly associated with atrial fibrillation (hazard ratio = 1.21, 95% confidence interval 1.09-1.32, P < 0.01). The best cut-off value of LACI was found to be 4.24.

Discussion: Our data confirm that LACI is independently associated with atrial fibrillation in patients with ILR following ESUS, accounting for clinical or echocardiographic factors.