Journal of Cardiovascular Medicine最新文献

The 2025 Focused Update of the 2019  ESC/EAS Guidelines for the management of dyslipidaemias incorporates significant new evidence from major randomized controlled trials, as well as relevant systematic reviews and meta-analyses published since 2019 and up until 31 March 2025. The Update targets specific areas in which new data on prognostics models, diagnostic accuracy studies and therapeutics, including assessment of risk-benefit ratios, could immediately influence clinical practice, providing revised or new recommendations.

Objective: Air pollution contributes to cardiovascular diseases through oxidative stress, inflammation, autonomic nervous system imbalance, and direct particle translocation. This study examines the relationship between air pollution parameters and risk factors in patients presenting with ST-elevation myocardial infarction (STEMI).

Methods: This prospective, cross-sectional study included STEMI patients aged at least 18 years in a tertiary hospital. Demographics, comorbidities, seasonal variations, comorbidities, vital signs, hourly air pollution and weather parameters on admission, hospital length of stay, treatment modalities, and outcomes were recorded.

Results: Among 1413 patients, 75.1% were men. The median age of female patients [65 (IQR: 58-73)] was significantly higher that of than males [55 (IQR: 50-66), P < 0.001]. Median air quality index (AQI) [53 (IQR: 37-55)] and particulate matter (PM2.5) levels [18 (IQR: 11-27)] on admission were above Environmental Protection Agency limits. Patients with prior coronary artery disease (P = 0.037) and female patients (P = 0.018) had significantly lower PM10 exposure. PM2.5 levels were significantly higher in patients aged >75 years [20.5 (IQR: 13-29)] than in younger patients [18 (IQR: 11-27), P = 0.022]. Those recommended for coronary artery bypass grafting had lower sulfur dioxide levels [6 (IQR: 4-9) vs. 8 (IQR: 5-13), P = 0.003].

Conclusion: When AQI and PM2.5 levels exceed EPA limits, they may interact with cardiovascular risk factors such as age, sex, and comorbidities, contributing to the development of STEMI. Elderly individuals, women, and those with a history of cardiovascular disease may be more susceptible to the adverse effects of air pollution.

Aim: To identify risk factors that may be associated with lack of improvement in quality of life (QoL) in patients undergoing transcatheter aortic valve implantation (TAVI).

Methods: We analyzed data from 116 patients with severe aortic stenosis (AS) undergoing TAVI in a tertiary center. QoL was assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) at baseline and then at 1-3 months (first follow-up with a bounded time frame), 6 months and 12 months after the procedure. The primary outcome was the MLHFQ score, with higher scores indicating worse QoL. Mixed-effects modeling was used to evaluate predictors of longitudinal changes in QoL.

Results: The mean MLHFQ score improved significantly from 41.1 ± 16.6 at baseline to 23.4 ± 10 at 12 months (P < 0.001), indicating enhanced QoL post-TAVI. However, several variables were associated with worse QoL trajectories over time. These included peripheral artery disease (PAD), paravalvular leak (PVL) ≥ grade 2, contrast-induced nephropathy, moderate-to-severe tricuspid regurgitation, pulmonary hypertension (PH), elevated creatinine, lower hemoglobin, reduced left ventricular ejection fraction, and increased left atrial diameter. PAD and PVL were consistent predictors of impaired QoL both early and late after TAVI.

Conclusion: TAVI significantly improves QoL in most patients with severe AS, but certain comorbidities and complications - particularly PAD, PVL, and PH are associated with suboptimal recovery. Identifying these risk factors may help guide individualized follow-up and supportive strategies to optimize patient-centered outcomes.

Introduction: Transcatheter patent foramen ovale (PFO) closure has emerged as the therapeutic gold standard in patients with a PFO-related stroke. New-onset atrial fibrillation appears as an early complication of this procedure. Our study aims to evaluate if the MVP (Morphology-Voltage-P wave duration) ECG risk score calculated before PFO closure might be a valuable predictor of early postprocedural atrial fibrillation occurrence.

Methods: We enrolled all consecutive patients (aged 18-65 years) who underwent percutaneous PFO closure between July 2020 and August 2023. The MVP ECG risk score was calculated. Patients were reassessed with clinical and echocardiographic follow-up at 1 month and 6 months later, to assess the efficacy and safety of the procedure as well as atrial fibrillation occurrence. Patients were then divided into two groups according to the occurrence of early atrial fibrillation after PFO closure.

Results: We enrolled 103 patients, 63.1% male (mean age 48.7 ± 10.6 years). At the end of follow-up, atrial fibrillation occurred in five patients (4.9%). When comparing groups with and without atrial fibrillation diagnosis at follow-up, there was a statistically significant difference in MVP ECG risk scores (3.0 versus 1.0; P  = 0.001). At receiver operating characteristic analysis, the MVP ECG risk score showed good diagnostic accuracy in predicting the diagnosis of atrial fibrillation at follow-up [AUC: 0.90; 95% confidence interval (CI) 0.81-0.98]. In the multivariate Cox proportional hazard model, the MVP ECG risk score remained the only independent predictor of atrial fibrillation onset (hazard ratio 2.96; 95% CI 1.13-7.71; P  = 0.03).

Conclusion: The MVP ECG risk score could be an independent predictor of early atrial fibrillation occurrence in patients undergoing percutaneous PFO closure.