Minerva cardiology and angiology最新文献

Introduction: To assess how gender disparities impact major adverse cardiovascular events during hospitalization, as well as in the short and long term, among patients with ST-elevation myocardial infarction who undergo primary PCI.

Evidence acquisition: PubMed, Scopus and Cochrane database were searched for relevant studies. Studies were included if all comers with STEMI, reported gender specific patient characteristics, treatments and outcomes. Odds ratio and 95% confidence interval were calculated using random effect model.

Evidence synthesis: A total of 23 studies were included for the pooled meta-analysis. Average age of female at presentation was 68.61±3.91 years while in male was 60.83±2.48 years. In unadjusted analysis, female patients were at higher risk for mortality (OR=1.98, 95% CI: 1.71-2.30, P<0.0001, I²=35%) at hospitalization, (OR=2.25, 95% CI=1.75-2.88, P≤0.00001) at short term and (OR=1.76, 95% CI: 1.41-2.21, P<0.000, I²=68%) at long term. The adjusted analysis of major adverse cardiovascular events for short term (OR=1.09, 95% CI: 0.91-1.31, P=0.37, I²=76%) and long term (OR=1.05, 95% CI: 0.98-1.12, P=0.17, I²=37%) were not found significant between both genders. However, it remained significant during hospitalization (OR=1.12, 95% CI: 1.03-1.22, I²=15%, Tau²=0.00).

Conclusions: The findings of this comprehensive meta-analysis indicate higher major adverse cardiac events among women with STEMI who underwent PPCI. After adjusting for comorbidities, the difference between women and men showed insignificant at short term and long term but remained significant at in-hospital. Female patients exhibited a higher prevalence of cardiovascular risk factors than men. Implementing intensive cardiovascular risk reduction strategies in women may offer a pathway to address this gender disparity.

In clinical practice, ventricular ejection fraction (EF) and global longitudinal strain (GLS) are the most often used parameters for evaluating left ventricular systolic function, despite the impact that variable loading conditions have. Alternatively, the myocardial efficiency (ME) of the heart, encompassing cardiac energy formation and dissipation, along with myocardial oxygen consumption (MVO2), is a useful surrogate for assessing myocardial work (MW), a parameter correlated with the pressure-strain loop (PSL), arterial pressure, and cardiac output (CO). This refinement proves especially practical in defining cardiac work across various clinical contexts, including arterial hypertension and heart failure (HF), the primary conditions associated with cardiovascular mortality. In this review, we explore how many invasive and non-invasive studies have shown that MW and consequently ME are correlated with the state of cardiovascular wellbeing and myocardial performance, allowing it to be integrated with other parameters present in clinical practice.

The assessment of myocardial function and its coupling with the arterial system, called ventricular-arterial coupling (VAC), is of paramount importance in many clinical fields, from arterial hypertension, which is the main cause of cardiovascular diseases and death, to heart failure. VAC has been the subject of studies for several decades both from an energetic cost and the impact it can exert on cardiovascular performance. Although more attention has been paid to the relationship between the left ventricle and the left arterial circuit in compromised hemodynamic stages, VAC has aroused interest in many other aspects of study, from its application in pathologies of the right sections of the heart to its clinical impact in prevention and cardiovascular risk factors. In this review we will focus on the importance of the hemodynamic data of the VAC in various clinical contexts and its possible applications in the future as a diagnostic and prognostic parameter in the cardiac clinic.

Introduction: The current meta-analysis aimed to determine the efficacy of propolis supplementation on hypertension.

Evidence acquisition: The systematic review and meta-analysis. were undertaken on five online databases to find clinical trials assessing the effects of propolis on systolic blood pressure (SBP) and diastolic blood pressure (DBP) markers up to October 2023. The pooled estimation of the weighted mean difference (WMD) and the corresponding 95% confidence intervals (CI) were calculated using a fixed-effect model. Egger's regression test was used to assess publication bias.

Evidence synthesis: A significant decrease was observed in SBP levels following propolis supplementation (WMD=-5.58 mmHg, 95% CI: -7.74, -3.42; I²=42.99%, P=0.08). However, no significant change was found in the levels of DBP (WMD=-1.34 mmHg, 95% CI: -6.10, 3.41; I²=75.94%, P<0.01). Moreover, studies with an experimental design (-5.53, 95% CI: -13.24, 2.18) and trials with <30 individuals (-3.96, 95% CI: -7.98, 0.06) did not demonstrate a significant impact of propolis on SBP levels. In trials with an experimental design, a substantial decrease in DBP levels was seen in subgroup analyses after propolis supplementation (-9.29, 95% CI: -12.50, -6.08).

Conclusions: The results of the study revealed the positive effects of propolis supplementation in the context of hypertension, as evidenced by a reduction in SBP levels.

Background: Arterial stiffness, particularly aortic stiffness (AoS), is associated with an increased risk of cardiovascular disease. Endovascular repair for abdominal (EVAR) and thoracic (TEVAR) aortic disease may increase AoS. This study protocol aims to assess changes in AoS before and after interventions for aortic disease.

Methods: Patients scheduled for EVAR or TEVAR during a three-year period will be enrolled. An indirect AoS indicator, carotid-to-femoral pulse wave velocity (cf-PWV) will be measured non-invasively using applanation tonometry and reported with others perioperative data before and after the endovascular treatment. Moreover, cardiological data will be collected through echocardiography.

Results: Fifty EVAR and 50 TEVAR will be enrolled. We will primarily analyze changes in cf-PWV. To ensure the reliability of our findings, we will also include supplementary data such as clinical information, morphological data, and functional echocardiographic data.

Conclusions: By examining AoS modifications before and after endovascular aortic repair, this study aims to enhance our understanding of how arterial stiffness changes following endoprosthesis deployment. The findings from the applied protocol are expected to be informative for innovative graft designs with minimized mechanical mismatch with the aortic wall and with improved vascular hemodynamic, aligning with the current trend in improving patient outcomes. Moreover, understanding these modifications is important for predicting and improving long-term cardiovascular outcomes in patients undergoing such interventions.

Background: Data on predictors of poor hemodynamic presentation and rehospitalizations following transcatheter aortic valve replacement (TAVR) are limited. We evaluate the association between neighborhood socioeconomic status (NSES) on echocardiographic presentation and post-TAVR readmission at a high-volume institution.

Methods: All patients undergoing TAVR at a single institution between 2012 and 2022 were included. Patient addresses, baseline variables including Society of Thoracic Surgeons (STS) preoperative risk of mortality and frailty, and post-procedural outcomes were extracted from electronic health records. Using a validated US Census Bureau Index, the NSES of each patient (1-100) was tabulated, with lower values correlating to increased social deprivation. Patients were separated into four ranked groups based on NSES (rank 1: 1-25, rank 4: 76-100). Multivariable regression was performed to determine variables associated with number of days hospitalized in one-year following index TAVR procedure.

Results: A total of 2031 patients were included. The median NSES was 68 (IQR: 53-80). There was a total of 232 (11.4%) readmissions. The median number of days hospitalized in one year following TAVR was 4 (interquartile range [IQR]: 2-7) After adjusting for baseline variables including STS risk score and patient frailty, compared to patients in the lowest ranked socioeconomic group, patients of higher NSES were associated with lower aortic valve gradients at baselines (Exp[β]=0.997, 95% CI: 0.993-0.999, P=0.049). Additionally, compared to patients in the lowest ranked socioeconomic group, patients of NSES were associated with shorter duration of readmission after risk-factor adjustments (Exp[β]=0.996, 95% CI: 0.992-0.999, P=0.032).

Conclusions: Patients of lower socioeconomic status are associated with higher aortic valve gradient at baseline and more days hospitalized in the first year after their index TAVR procedure after adjusting for other risk factors. As TAVR volume continues to expand, physicians and health systems must consider this independent factor when determining patient prognosis and readmission policies.

This tutorial provides a comprehensive guide on leveraging ChatGPT for systematic literature reviews, leveraging actual applications in cardiovascular research. Systematic reviews, while essential, are resource-intensive, and ChatGPT offers a potential solution to streamline the process. The tutorial covers the entire review process, from preparation to finalization. In the preparation phase, ChatGPT assists in defining research questions and generating search strings. During the screening phase, ChatGPT can efficiently screen titles and abstracts, processing multiple abstracts simultaneously. The tutorial also introduces an intermediate step of generating study summaries that leads to the generation of reliable data extraction tables. For assessing the risk of bias, ChatGPT can be prompted to perform these tasks. Using each tool's explanation document to generate an appropriate prompt is an efficient method of reliable risk of bias assessments using ChatGPT. However, users are cautioned about potential hallucinations in ChatGPT's outputs and the importance of manual validation. The tutorial emphasizes the need for vigilance, continuous refinement, and gaining experience with ChatGPT to ensure accurate and reliable results. The methods presented have been successfully tried in several projects, but they remain in nascent stages, with ample room for improvement and refinement.

Background: Doxorubicin (DOX) is a potent anti-cancer medication that is associated with numerous adverse effects, particularly concerning damage to the heart.

Methods: This study aimed to investigate the impact of sophocarpine (SOP) on DOX-induced heart injury through both in vivo and in vitro experiments. The experimental techniques employed encompassed echocardiography, hematoxylin/eosin (H&E) staining, Masson staining, immunohistochemical staining, western blotting, and so on.

Results: Echocardiography showed that SOP alleviated DOX-induced cardiac dysfunction, as evidenced by the improvements in both left ventricle ejection fraction and left ventricle fractional shortening. DOX caused upregulations of creatine kinase-MB and lactate dehydrogenase, while SOP decreased these indices. Staining methods such as H&E and Masson showed that SOP reversed the pathological changes induced by DOX. DOX elevated the expression levels of fibrosis-associated proteins such as Collagen I, Collagen III, α-SMA, Fibronectin, MMP-2, and MMP-9. However, SOP reversed these changes. Moreover, the study further revealed that SOP inhibited the TGF-β1/Smad3 signaling pathway.

Conclusions: These findings imply that SOP has the potential to mitigate DOX-induced heart injury by suppressing fibrosis. The underlying molecular mechanism may involve the inhibition of the TGF-β1/Smad3 signaling pathway.

Eosinophilic myocarditis (EM) is a rare, potentially life-threatening, form of inflammatory heart disease characterized by eosinophilic infiltration of the myocardium. Different diseases are involved in its etiopathogeneses, such as eosinophilic granulomatosis with polyangiitis (or Churg-Strauss Syndrome), hypereosinophilic syndromes, parasitic infections, drug reactions, paraneoplastic syndromes and primary immunodeficiencies (e.g. Omenn Syndrome). There is a wide spectrum of clinical pictures at presentation ranging from chronic restrictive cardiomyopathy (Loeffler cardiomyopathy) to acute necrotizing myocarditis with cardiogenic shock. The genetic contribution and the environmental interplay, such as SARS-CoV-2 infection and related vaccines, are fields not well studied yet. Many non-invasive tools, mainly echocardiography and cardiac magnetic resonance imaging, along with invasive procedures, such as endomyocardial biopsy, are the crucial steps in the diagnostic workup. The correct diagnosis is a challenge but mandatory for timely and appropriate immunosuppressive therapy.