Journal of Cardiovascular Medicine最新文献

Aim: Etiological diagnosis is critical in patients with left ventricular dysfunction, as both dilated cardiomyopathy (DCM) and ischemic heart disease (IHD) can present similarly in the early stages. This study aims to evaluate the discriminative power of global longitudinal strain (GLS) and heart rate variability (HRV) parameters using interpretable machine learning models to differentiate between DCM and IHD patients with left ventricular ejection fraction (LVEF) of between 40% and 50%.

Methods: In this retrospective exploratory study, we included consecutive patients with LVEF 40-50% who had a recent (<3 months) 24-h Holter ECG and no history of acute myocardial infarction or heart failure hospitalization. HRV features and GLS were extracted by the processing of Holter ECG and echocardiographic imaging, respectively. Feature selection was performed through the ReliefF method and interpretable predictive models were produced using HRV features, sex, age, and GLS to differentiate between DCM and IHD patients.

Results: The study population included 97 DCM patients (63 males and 34 females, aged 57 ± 15 years) and 91 IHD patients (73 males and 18 females, aged 71 ± 11 years). The logistic regression model achieved a classification accuracy of 76% in distinguishing the populations with an area under the curve of 83%. Sex, age, mean RR, FD, HFn, GLS, pNN50, SD1/SD2, SD1, and LFn were identified as the most important features in distinguishing between IHD and DCM.

Conclusion: This study highlights the added value of a novel approach based on a predictive model that integrates HRV metrics with myocardial deformation parameters to support the differential diagnosis between DCM and IHD in patients with mildly reduced ejection fraction.

Background: Transcatheter edge-to-edge tricuspid valve repair (T-TEER) has emerged as a well tolerated and efficacious treatment modality among patients with tricuspid valve regurgitation. Right ventricular dysfunction (RVD) has been observed in up to 22% of patients undergoing T-TEER. Currently, the determinants of RVD recovery are not sufficiently understood.

Methods: All patients in four German tertiary cardiac centers scheduled for T-TEER were included for analysis. Patients were divided according to concomitant RVD at the time of T-TEER. RVD was defined as impairment of either tricuspid plane systolic excursion (TAPSE) or right ventricular fractional area change (RV-FAC). The primary endpoint of the study was recovery from RVD during follow-up 3 months after T-TEER. Predictors of RVD recovery were identified via univariable and multivariable logistic regression analyses.

Results: A total of 105 patients were included. Concomitant RVD was present in 43.8% of the patients (46/105). Recovery from RVD was observed in 47.8% (22/46) of patients, particularly in patients with mild RVD at baseline according to the TAPSE. A sufficient reduction in tricuspid valve regurgitation to mild severity likewise constituted a predictor of RVD recovery and emerged as a surrogate parameter of reduced right ventricular volume overload.

Conclusion: Recovery from RVD was most likely in patients who presented with mild RVD and a sufficient reduction in tricuspid valve regurgitation to mild severity according to T-TEER. Early identification and interventional treatment of today's patients with high-grade tricuspid valve regurgitation and RVD represent key factors in providing relief for this particular cohort of patients.

Background: Coronary microvascular dysfunction (CMD) is common in ST-segment elevation myocardial infarction (STEMI) patients despite timely primary percutaneous coronary intervention (PPCI). Angiography-derived microcirculatory resistance (AMR), a novel noninvasive CMD index, offers potential for risk stratification, but its prognostic value in STEMI over mid- and long-term follow-up remains unclear.

Methods: This retrospective study enrolled 278 STEMI patients between May 2023 and May 2024, excluding those with prior coronary artery bypass grafting, severe left main disease, or poor angiographic quality. The primary endpoint was major adverse cardiovascular events (MACE), including cardiac death, nonfatal myocardial infarction, and stroke.

Results: During a mean follow-up of 14.30 ± 6.45 months, 44 patients (15.8%) experienced MACE. AMR ≥300 was strongly associated with higher MACE rates and demonstrated superior predictive value compared with corrected TIMI frame count (area under the receiver operating characteristic curve, 0.705, P < 0.001). Restricted cubic spline analysis revealed a nonlinear relationship between AMR and MACE, with a significant increase in risk at AMR ≥300 (nonlinear P = 0.0142). Multivariable Cox regression identified AMR ≥300, age, white blood cell count, and left ventricular ejection fraction (LVEF) as independent predictors of MACE. Incorporating AMR into traditional risk models significantly improved the predictive performance of the MACE (C-index: 0.659 vs. 0.824, P < 0.001).

Conclusions: AMR ≥300 is an independent predictor of MACE in STEMI patients post-PPCI. Incorporating AMR into risk models improves predictive accuracy, supporting its use in clinical practice.

Aim: The distinctive feature of the analgesia induced by morphine is the profound pain relieving combined with the lack of loss of consciousness. We evaluated the impact of the use of morphine as the first anesthetic drug during the thermal atrial fibrillation (AF) ablation procedure.

Methods: One hundred and nine patients undergoing radiofrequency (RF) or cryoballoon (Cryo) pulmonary vein (PV) isolation using sedation by means of morphine were enrolled (Group 1) and compared with the last consecutive 109 patients treated with thermal ablation using a conscious sedation protocol with midazolam as the first drug used (Group 2). Pain was assessed by means of a numerical rating scale.

Results: No statistically significant differences were observed between the two study groups. All PVs were isolated. No patients required general anesthesia or deep sedation. In Group 1, ablation was carried out under morphine alone in 78 patients with a mean morphine dose/patient of 8.5 ± 2.3 mg. Midazolam was used in 31 (28%, 21 RF, 10 Cryo) patients, and Fentanyl in 2 RF patients. In Group 2, ablation was carried out without any anesthetic drug in 35 (32%) patients. Midazolam was required in 74 (68%) patients with a mean dose/patient of 3.3 ± 1.5 mg. Fentanyl was required in five (5%) patients. There was no difference in the overall pain experience between the two study groups (4.7 ± 1.6 vs. 4.8 ± 1.5, P = 0.58).

Conclusions: Thermal catheter ablation for AF can be performed under conscious sedation using only morphine in most patients without impacting the patient's pain experience.