Minerva cardiology and angiology最新文献

Spontaneous coronary artery dissection (SCAD) is a distinct and increasingly recognized cause of acute coronary syndromes, primarily affecting young and middle-aged women with few cardiovascular risk factors. While SCAD often resolves spontaneously with conservative management, percutaneous coronary intervention (PCI) is sometimes necessary, especially in patients with ongoing ischemia or high-risk anatomical features. This review summarizes the current state of knowledge regarding the interventional approach in SCAD, emphasizing the rationale for conservative treatment, and the indications for and challenges associated with PCI. It also provides practical recommendations, particularly highlighting technical aspects of PCI in SCAD, the critical role of intracoronary imaging, and the modality and timing of post-PCI surveillance.

Charles T. Dotter is a recognized pioneer of interventional cardiology as much as the inventor of the angioplasty balloon himself, Andreas R. Grüntzig. Yet, despite Dotter's pioneering role in developing transluminal angioplasty, a recent survey revealed a significant lack of awareness among younger interventional cardiologists and fellows about his contributions, contrasting sharply with their familiarity with Grüntzig. We thereby shed light on Dotter's innovations and the reasons behind his relative obscurity in contemporary discourse, urging the medical community to embrace the lessons from his journey for future success. We explicitly focus on Dotter's early achievements, including his groundbreaking work in 1964, where he performed the first transluminal angioplasty, laying the groundwork for what would become a cornerstone in vascular intervention and creating the eponymous Dotter effect. Despite the initial resistance and skepticism, Dotter's methods eventually found their way to Europe, influencing Grüntzig and leading to the development of the balloon catheter. We also meticulously trace the evolution of angioplasty from Dotter's early experiments to Grüntzig's refinement of the technique and its application in coronary arteries, underscoring the pivotal moments and challenges encountered along the way. Dotter's obscurity stems from a combination of factors, including his confrontational approach and the reluctance of the medical establishment to embrace his radical ideas. Indeed, Dotter's story offers invaluable lessons on the importance of teamwork, perseverance, and the need for a supportive community to foster innovation in medicine.

Introduction: Takotsubo Syndrome (TTS) is characterized by acute transient left ventricular systolic dysfunction. Despite TTS has been described 30 years ago, its pathogenesis and pathophysiology remain poorly understood and the true prevalence remains uncertain because of its under-recognition.

Evidence acquisition: To provide an update on the current understanding of the clinical features of Takotsubo Syndrome, we searched the PubMed databases by using the medical subject headings Takotsubo Syndrome. Exclusion criteria included case reports, conference abstracts, non-English literature and unrelated studies.

Evidence synthesis: Patients with TTS classically present with acute-onset chest pain, dyspnea, and changes on the ECG occurring in association with an acute stressful event. This presentation mimicking other causes of acute myocardial injury often represents a clinical dilemma; moreover, the lack of evidence-based interventions to treat the acute episode, to prevent major adverse cardiovascular events and to avoid recurrences represents a difficult challenge for the physicians.

Conclusions: At present TTS remains a poorly understood condition with substantial morbidity and mortality and without robust evidence or clinical trials available for the management that need to be addressed. The purpose of this review is to provide an update on the current understanding of the clinical features of this condition, to discuss the latest theories regarding its etiology and pathophysiology, and to highlight the need for future therapeutic interventions.

Background: Atherosclerosis (AS) is the pathological basis of many cardiovascular and cerebrovascular diseases. To further the investigation of treatments for AS, this research analyzed the role of lncRNA MBNL1-AS1.

Methods: MBNL1-AS1 expression in the serum of AS patients and healthy controls were detected by qPCR. Its diagnostic value in AS was assessed by receiver operating characteristic curve (ROC). Additionally, the link between MBNL1-AS1, carotid intima-media thickness (CIMT) and C-reactive protein (CRP) was examined using the Spearman correlation coefficient. The prognostic value of MBNL1-AS1 in AS was assessed using the Kaplan-Meier survival curve and univariate and multivariate Cox regression analysis.

Results: The present study consisted of 103 patients with AS and 92 healthy patients (HC) and comparison of baseline data between the two groups revealed no remarkable difference (P>0.05) except for CRP (P<0.0001). The serum of AS patients exhibited a considerably higher expression of MBNL1-AS1 in comparison to the HC group. Furthermore, MBNL1-AS1 was highly expressed in patients following higher CIMT and CRP values, which was positively linked with both, respectively (r>0.5, P<0.001). Meanwhile. MBNL1-AS1 has enhanced diagnostic accuracy in AS patients (AUC=0.893) and can be utilized as an independent prognostic factor for AS. Patients with high MBNL1-AS1 expression have a higher likelihood of cardiovascular events. (log rang P=0.0025).

Conclusions: Elevated MBNL1-AS1p can be used as a potential marker for the clinical diagnosis of AS and is linked to a poor prognosis of AS.

Background: The aim of this paper was to investigate the diagnostic significance and severity assessment of serum neuron-specific enolase (NSE) combined with homocysteine (Hcy) for patients with coronary atherosclerosis (coronary artery disease, CAD).

Methods: Two hundred sixty-three patients with coronary artery disease were selected as the research group, and 400 healthy individuals who underwent physical examination during the same period were taken as the control group. Electrochemiluminescence immunoassay and biochemical analyzer were employed to detect the serum NSE and Hcy levels of all subjects. The diagnostic value of combined and individual serum NSE and Hcy detection for the combined group was analyzed using the ROC curve.

Results: The serum NSE (19.91±9.98 vs. 11.17±2.35) and Hcy levels (15.76±5.37 vs. 10.17±3.71) in the research group were significantly higher than those in the control group, with a statistically significant difference (P<0.05). The serum NSE (16.67±4.02 vs. 18.63±5.49 vs. 20.29±5.87) and Hcy levels (13.28±2.49 vs. 15.56±2.67 vs. 16.66±3.94) gradually increased across groups A, B, and C, and inter-group comparisons showed statistically significant differences (P<0.05). The AUC value of combined serum NSE and Hcy detection for CAD patients was higher (0.879 vs. 0.724 vs. 0.827) than individual NSE and Hcy testing. The specificity of Hcy for the diagnosis of CAD was the highest, reaching 90.3%. The sensitivity of combined NSE and Hcy (82.9%) was higher than the individual testing sensitivity of the two groups.

Conclusions: The combined detection of serum NSE and Hcy has high diagnostic efficacy for CAD and provides reference value in assessing the severity of the disease.

Background: Atrial fibrillation (AF) is the most common atrial arrhythmia after transcatheter aortic valve implantation (TAVI) and is associated with high mortality. Although some clinical and echocardiographic variables have been defined to predict new-onset atrial fibrillation (NOAF), electrophysiologic (EP) parameters have not been identified yet. We aimed to investigate the impact of atrial refractoriness on NOAF after TAVI.

Methods: Seventy-nine consecutive patients who underwent TAVI were enrolled in this trial. All patients undergoing TAVI were screened for AF.

Results: Fifteen (19%) had AF during the follow-up period. Patients with NOAF were older and had a higher BMI and STS. Left atrial diameter (LAD) was higher, left ventricular ejection fraction (LVEF) was lower, and preprocedural LVEDP was higher in patients with NOAF. As electrophysiologic (EP) parameters, atrial effective refractory periods (AERP) (in high right atrium [AERPHRA], in right posterolateral atrium [AERPRPL], and in distal coronary sinus [AERPDCS]) were lower, difference between atrial effective refractory periods (AERPDISP) and PA intervals were higher in patients with AF than those without AF. The only independent parameter that influenced the development of AF after TAVI was AERPDISP. The Receiver Operating Characteristic (ROC) analysis showed that an AERPDISP>46 msec significantly separated those with AF and those without AF with a sensitivity of 85% and a specificity of 97%.

Conclusions: The current study demonstrates that the only independent variable predicting NOAF is AERPDISP. Therefore, increased AERPDISP values may help predict patients with high risk for NOAF and needing specific therapies.