Journal of Cardiovascular Medicine最新文献

Aims: The PRIORITY (PRedictIng long-term Outcomes afteR Isolated coronary artery bypass surgerY) project was designed to identify preoperative risk factors for 10-year all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE) after isolated coronary artery bypass grafting (CABG).

Methods: PRIORITY is an observational cohort study merging two prospective multicenter studies conducted in 2002-2004 and 2007-2008 on isolated CABG. Follow-up information was obtained through administrative databases and was truncated 10 years after the intervention. The primary endpoint was long-term all-cause mortality and the secondary endpoint was a composite of MACCE.

Results: The study cohort included 10 989 patients with complete 10-year follow-up. Mortality up to 10 years was associated with almost all variables defined by EuroSCORE and the risk factors with higher impact were left ventricular ejection fraction (LVEF) <30% [hazard ratio (HR) 2.29, 95% confidence interval (CI) 1.95-2.69], diabetes (HR 3.17, 95% CI 2.31-4.34), and cirrhosis (HR 3.90, 95% CI 2.09-7.28). Also, 10-year MACCE was affected by preoperative comorbidities defined by EuroSCORE, with different weights compared with 30-day prediction scores. The risk factors with the worst effect on long-term MACCE were LVEF <30% (HR 1.61, 95% CI 1.39-1.86), dialysis (HR 2.52, 95% CI 1.87-3.40), and cirrhosis (HR 1.93, 95% CI 1.09-3.41). Both scores demonstrated good performance in terms of discrimination and calibration.

Conclusion: The PRIORITY study confirms the importance of long-term follow-up for patients who undergo CABG and has led to the design of online risk calculators for predicting all-cause mortality and MACCE up to 10 years to support the clinical management of patients.

Background: Left ventricular global longitudinal strain (LV-GLS) is associated with increased risk of adverse outcomes in nonischemic dilated cardiomyopathy (NIDCM). However, it can be altered by LV afterload. The global myocardial work index (GMWI) accounts for LV afterload and could improve risk discrimination when compared with LV-GLS. We sought to determine whether GMWI outperformed LV-GLS for risk stratification in patients with NIDCM.

Methods and results: We determined the association between GMWI and a combined endpoint of death or heart failure (HF) admission. We included 524 patients with NIDCM (median age 67 years, LVEF 35%), with a median GMWI of 968 mmHg%. Patients with lower GMWI had more frequent history of HF admission, higher E/e' ratio, and worse right ventricular function. During a median follow-up of 3.4 years, 171 had the endpoint. There was a significant and nonlinear relationship between GMWI and the endpoint, with a progressive increase in risk until values below 1000 mmHg% were reached, where the risk of the endpoint plateaued. GMWI was strongly collinear with LV-GLS, and both parameters demonstrated similar performance after adjustment, suggesting that GMWI adds little value in this population if LV-GLS has already been accounted for.

Conclusion: In patients with NIDCM, lower GMWI is associated with previous HF admission, worse echocardiographic parameters and higher risk of subsequent HF admissions and death, but it does not seem to improve discrimination when compared with LV-GLS.

Background: The potential clinical benefit of complex high-risk indicated percutaneous coronary intervention (CHIP-PCI) remains uncertain. Temporary mechanical circulatory support with a microaxial flow pump allows the performance of protected PCI, potentially reducing peri-procedural myocardial injury and enabling a more complete myocardial revascularization. Whether this reflects an improvement in left ventricular (LV) function after PCI remains uncertain.

Methods: We conducted a systematic literature search in PubMed/MEDLINE, Scopus and CENTRAL and performed a one-group meta-analysis using pre- and post-PCI LV ejection fraction (LVEF) data from randomized and observational studies evaluating microaxial flow pump use in CHIP-PCI. The primary outcome was the mean difference (MD) in LVEF between follow-up and baseline.

Results: Nine studies involving 2370 patients were included, with a weighted follow-up period of 154.6  days. Overall, 67.4% of patients had chronic coronary syndrome as the clinical presentation, with a mean SYNTAX score of 32.8 and a mean baseline LVEF of 29.5%. CHIP-PCI assisted by a microaxial flow pump was associated with a significant improvement in LVEF during follow-up (MD, +6.70%; 95% confidence interval, 4.49 to 8.91, P = 0.0001).

Conclusions: Microaxial flow pump-supported CHIP-PCI was associated with significant LVEF increase at follow-up, suggesting its potential beneficial role in LV functional recovery after myocardial revascularization in CHIP patients.

Aims: Lipoprotein(a) [Lp(a)] is a recognized risk factor for atherosclerotic cardiovascular disease. However, its potential association with the risk of recurrent atrial fibrillation (AF) after ablation remains unexplored. This study aimed to investigate whether Lp(a) serum levels are linked to the risk of recurrent AF following pulsed field ablation (PFA).

Methods: A retrospective cohort analysis was conducted on patients who underwent PFA at the Cardiology Clinic of the Ferrara University Hospital from October 2023 to January 2025. Lp(a) percentile groups were established, with the first 50th percentile serving as the reference. Cox proportional hazards modeling was used to assess the relationship between Lp(a) percentile and recurrent AF after PFA.

Results: The study included 133 patients (mean age 59.6 years, 29.3% women). Over a median follow-up of 7.8 months after the blanking period (range: 6.4-9.3 months), 29 patients (21.8%) experienced confirmed recurrent AF. A continuous increase in the hazard of recurrent AF was observed with rising Lp(a) levels. Specifically, individuals in the 51st-70th, 71st-90th, and 91st-100th Lp(a) percentiles had adjusted hazard ratios of 1.13 [95% confidence interval (CI): 1.04-1.22, P < 0.001], 1.21 (95% CI: 1.11-1.31, P < 0.001), and 1.26 (95% CI: 1.13-1.39, P < 0.001), respectively.

Conclusions: Elevated Lp(a) levels are associated with an increased risk of recurrent AF after PFA, suggesting that Lp(a)-lowering therapies may be beneficial for these patients.

Aims: Contrast-induced nephropathy (CIN) remains a significant complication following coronary angiography (CAG) and percutaneous coronary intervention (PCI), particularly among patients with diabetes mellitus. Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have demonstrated renoprotective effects in chronic kidney disease; however, their role in preventing CIN remains unclear.

Methods: In this retrospective, single-center study, 206 patients with diabetes mellitus and acute coronary syndrome (ACS) undergoing CAG or PCI were included. Patients were divided into two groups based on SGLT-2i usage. Lasso penalized regression analysis was performed to identify significant predictors of CIN, followed by multivariate logistic regression analysis to adjust for potential confounders. The predictive performance of the model was assessed using a receiver-operating characteristic curve.

Results: The study included 94 SGLT-2i users and 112 nonusers. CIN occurred less frequently among SGLT-2i users (9.6 vs. 16.1%). Lasso regression identified female sex, SGLT-2i usage, contrast amount, baseline glomerular filtration rate (GFR), and left ventricular ejection fraction (LVEF) as significant predictors of CIN. Multivariate analysis demonstrated that SGLT-2i usage was independently associated with a reduced risk of CIN (odds ratio: 0.24, P = 0.012), while female sex, lower LVEF, worse baseline GFR, and higher contrast volume were associated with increased CIN risk. The final model exhibited excellent discriminative ability (area under the curve: 0.85).

Conclusion: SGLT-2i usage was independently associated with a decreased risk of CIN among diabetic patients with ACS undergoing coronary interventional procedures. Female sex, reduced LVEF, impaired renal function, and greater contrast volume emerged as independent predictors of increased CIN risk.

Aims: Right heart failure (RHF) is associated with increased morbidity and mortality. We aimed to determine differences in baseline characteristics between survivors and nonsurvivors of index RHF admission, identify predictors of in-hospital mortality, and quantify the 30-day readmission rate.

Methods: We used the Nationwide Readmissions Database (NRD) from 2017 to 2020 to identify a cohort of patients with RHF, stratified by in-hospital mortality status during index admission. Baseline characteristics were compared using Pearson chi-square test and two-sample t-test for categorical and continuous variables, respectively. Multivariate analysis using logistic regression models was used to identify independent predictors of in-hospital mortality. Readmission rates within 30 days were determined by calculating the time to readmission for each patient.

Results: There were 12 305 (10.5%) deaths during index admission among 117 633 patients. Nonsurvivors were older (68.7 ± 14.6 years versus 66.5 ± 15.7 years) and more commonly had comorbidities such as major adverse cardiac and cerebrovascular events (MACCE), myocardial infarction, and coronavirus disease 2019 (COVID-19). The strongest predictors of in-hospital mortality (all P < 0.001) were COVID-19 [odds ratio (OR): 5.97 (5.34-6.68)], metastatic cancer [OR: 2.78 (2.52-3.06)], and myocardial infarction [OR: 1.80 (1.71-1.89)]. Over 4 years, 14.5% of index RHF admissions were readmitted within 30 days.

Conclusions: Our study offers insights into patients with RHF who may have a worse prognosis, highlighting the need for evidence-based management of acute and chronic RHF and consideration of advanced therapies. Interventions should be tailored to improve outcomes in RHF.