Minerva cardiology and angiology最新文献

Background: Despite the significant improvement in guidewire technology, in-vivo comparison of workhorse guidewires is lacking. This study aims to assess the feasibility of randomized data collection regarding the wiring time and its variability among three guidewires: Sion Blue, Minamo, and Runthrough, and to identify key lesion characteristics for future guidewire research.

Methods: 45 patients were randomized between February of 2023 and May 2024. Patients undergoing elective percutaneous coronary intervention (PCI) to a bifurcation lesion requiring two guidewires were included. The wiring time was defined from when the tip of the guidewire at the end of the guide catheter until the advancement to the distal target vessel.

Results: The mean wiring time was 55.3 seconds for side branch and 95.8 seconds for main branch. The wiring time was similar for both side-branch wiring (Sion Blue 65.9±79.5, Minamo 41.2±33.4, Runthrough 57.6±88, P=0.65) and the main branch wiring (Sion Blue 44.8±38.9, Minamo 123.8±189.4, Runthrough 119.1±183.6, P=0.3). Use of the torque device, guidewire reshaping, or switching to a second guidewire were uncommon. Lesions requiring longer wiring time had severe stenosis (>90%), severe calcification, or tortuosity. The median crossing time was longer when recrossing stent struts, especially during two-stent strategy (>130 seconds).

Conclusions: Prospective data collection assessing the difference of wiring time as a clinical endpoint is feasible. Our study results can form a basis for future studies comparing different guidewires.

Introduction: Lipoprotein(a) (Lp[a]) is a variant of low-density lipoprotein (LDL) and has been associated with increased risk of vascular inflammation and thrombosis. Coronary artery bypass grafting (CABG) has been associated with local inflammation of the myocardium. It is plausible, therefore, that patients with elevated baseline Lp(a) may be prone to unfavorable clinical outcomes following CABG. We evaluate differences in outcomes between CABG patients with high and low serum Lp(a) in this meta-analysis.

Evidence acquisition: A comprehensive literature search was performed to identify studies reporting outcomes in CABG patients stratified by preoperative Lp(a) level. When possible, the outcomes were pooled in a meta-analysis. We assessed post-operative mortality, major cardiovascular events, stroke occurrence and saphenous graft occlusion.

Evidence synthesis: Eight studies involving 8681 patients were included. Articles used varying cut-offs for high versus low Lp(a), and outcomes varied. In the three studies evaluating mortality, two showed no statistically significant difference between groups while one reported increased mortality associated with high Lp(a) level. Both studies investigating major adverse cardiovascular events reported higher risk in patients with high Lp(a). A study-level meta-analysis of four studies reporting saphenous vein graft occlusion incidence after CABG was performed. High (≥30 mg/dL) preoperative Lp(a) was not associated with an increased risk of graft occlusion compared with low (<30 mg/dL) preoperative Lp(a) (OR=1.88, 95% CI: 0.66-5.36; P=0.15).

Conclusions: Studies evaluating the impact of Lp(a) on outcomes in CABG patients are few, with heterogenous cut-offs and outcomes. In the limited published studies, Lp(a) level was not associated with graft occlusion.

Background: Multiple valvular heart disease (M-VHD) is a common condition, often involving aortic stenosis (AS) plus a mitral or tricuspid valve disease. We aim to evaluate the evolution and prognostic impact of M-VHD in patients undergoing transcatheter aortic valve implantation (TAVI).

Methods: A retrospective cohort study was conducted on patients who underwent TAVI in a tertiary care center between January 2016 and December 2022. Echocardiography was performed before and after TAVI. The primary endpoint was the composite of all-cause mortality and cardiovascular hospitalizations during follow-up.

Results: A total of 159 patients (88 women; mean [SD] age, 80.8 [7.8] years) with severe AS and M-VHD were identified. Seventy-two (45.3%) had mitral regurgitation, 69 (43.4%) had tricuspid regurgitation, and 18 (11.3%) had mitral stenosis. After TAVI, 77 patients (48.4%) experienced an improvement of the concomitant valve disease, while 82 did not. Female gender (OR:0.25, 95%CI:0.11-0.56, P<0.001), pacemaker implantation (OR:0.37, 95%CI:0.14-0.98, P=0.046) and rheumatic etiology (OR:0.25, 95%CI:0.09-0.74, P=0.012) were negatively associated with improvement. At a median follow-up of 31 months (26-51), patients with no improvement had an increased occurrence of the composite endpoint compared to their counterparties, (P=0.028). On multivariable analysis, NYHA class III/IV (HR:2.04, 95%CI:1.02-4.08, P=0.044) and creatinine (HR:1.43, 95%CI:1.06-1.94, P=0.019) were associated with a higher risk of the endpoint, while the improvement of concomitant valve disease emerged as protective factor (HR:0.46, 95%CI:0.25-0.85, P=0.013).

Conclusions: Concomitant valve disease improved in roughly half of M-VHD patients after TAVI. Patients with post-TAVI improvement of the second valve lesion had better clinical outcomes at long-term follow-up.

This review comprehensively explores the multifaceted implications of alcohol consumption on health. While acknowledging the potential cardiovascular benefits of moderate alcohol intake, concerns arise with excessive use, especially related to some specific cancer types. The detailed evidence emphasizes the importance for healthcare professionals to convey a balanced message, advocating moderation for cardiovascular benefits while acknowledging potential cancer risks linked to excessive consumption. Regarding moderate consumption, the overall balance favors intake, supported by studies like the Global Burden of Disease Study 2020. The intricate risk-benefit ratio of alcohol use demands tailored explanations based on individual characteristics and habits, considering overall risk profiles for cardiovascular diseases, alcohol-related cancers (for example, breast cancer has been associated with moderate alcohol consumption, although the evidence is not conclusive), and other health issues. Factors such as age, pregnancy, cognitive tasks, and personal history influencing the likelihood of alcohol abuse should inform personalized advice on moderate alcohol consumption. Collaborative efforts among stakeholders, including government agencies and healthcare organizations are crucial for providing up-to-date, comprehensive information. Clinical guidelines stress the complexities of the alcohol-heart healthy relationship, advocating moderation and individualized advice. Within personalized advice, the significance of moderate alcohol consumption, particularly in the form of wine within a Mediterranean diet, is highlighted. Wine is seen as a fundamental component of a wholesome diet, aligning with healthy dietary patterns, rather than a medicinal remedy. Acknowledging wine's integration into sound nutrition contributes to heart-healthy lifestyles, in line with Mediterranean dietary traditions. Healthcare professionals play a pivotal role in guiding patients on alcohol intake, considering specific health status and risk factors. Public health campaigns focus on educating individuals to make informed choices about alcohol consumption in the broader context of cardiovascular health. In conclusion, achieving cardiovascular health without undue risks necessitates a balanced and personalized approach to alcohol consumption, guided by healthcare professionals and public health recommendations.

Cardiovascular diseases (CVD) remain the leading cause of mortality globally and require innovative strategies for effective prevention and treatment. The polypill concept, which integrates multiple cardioprotective agents into a single dosage form, has emerged as a promising approach to improve adherence and simplify the management of cardiovascular risk factors. We review clinical trials and observational studies evaluating the impact of the polypill on reducing the incidence of major cardiovascular events (MACEs), its influence on medication adherence, and its potential to fill treatment gaps in diverse populations. Also of note are the pharmacoeconomic implications of the widespread use of the polypill, particularly in low- and middle-income countries where the burden of cardiovascular disease is increasing. Although the polypill demonstrates a favorable profile in improving therapeutic compliance and reducing cardiovascular risk factors, debates persist regarding its efficacy compared to individualized treatment regimens. This review summarizes the current evidence on the efficacy, safety, and cost-effectiveness of the polypill in CVD primary and secondary prevention. Furthermore, potential challenges in implementing the polypill strategy include tailoring the components to patient-specific risk profiles and the need for robust evidence from large-scale randomized controlled trials to substantiate its long-term benefits.

Background: The optimal percutaneous coronary intervention (PCI) revascularization strategy in patients presenting with multi-vessel (MV) coronary artery disease (CAD) and acute myocardial infarction (MI) has not been systematically addressed. Accordingly, we performed a frequentist network meta-analysis with the aim of assessing the prognostic impact of different PCI strategies.

Methods: We conducted an electronic research for studies including angiography-guided and functional-guided complete revascularization in patients with acute MI from 2001 to 30^th November 2023. Endpoints of interest were cardiovascular mortality, all-cause mortality, spontaneous MI and any revascularization.

Results: Twelve randomized clinical trials involving 11,581 patients fulfilled the inclusion criteria. Functional-guided complete PCI was associated with lower cardiovascular death compared to culprit-only PCI (incidence rate ratio [IRR] 0.61, 95% confidence interval [CI] 0.39-0.96; P=0.033). Both complete functional- and angio-guided PCI reduced the risk of further revascularization compared to culprit-only PCI (IRR 0.37, 95% CI 0.24-0.55, P<0.001, and IRR 0.33, 95% CI 0.20-0.52, P<0.001, respectively). Both complete functional- and angio-guided PCI resulted in a non-significant reduction of spontaneous MI compared to culprit-only PCI strategy (IRR 0.76, 95% CI 0.50-1.15; P=0.20 and IRR 0.72, 95% CI 0.47-1.12; P=0.15, respectively). No significant differences were found regarding other study endpoints and other comparisons.

Conclusions: In patients with MI and MV CAD, undergoing successful PCI of IRA, a complete revascularization strategy, regardless of the specific approach, was associated with a lower incidence of repeat revascularization compared with a culprit-only strategy. Complete functional-guided revascularization resulted in lower incidence of cardiovascular death, whereas a complete angio-guided approach did not show the same benefit.

Background: Over the last decade, a small number of studies have used speckle tracking echocardiography (STE) or cardiac magnetic resonance (CMR) for measuring left ventricular (LV) mechanics in patients with amyloidosis. This systematic review and meta-analysis aimed at assessing the overall influence of amyloidosis on LV global longitudinal strain (GLS) and regional longitudinal strain at basal (BLS), mid (MLS) and apical (ALS) level, respectively.

Methods: All imaging studies assessing LV-GLS, LV-BLS, LV-MLS and LV-ALS in amyloidosis patients versus healthy controls, selected from PubMed and EMBASE databases, were included. The risk of bias was assessed by using the National Institutes of Health (NIH) Quality Assessment of Case-Control Studies. Continuous data (LV-GLS, LV-BLS, LV-MLS and LV-ALS) were pooled as a standardized mean differences (SMDs) comparing amyloidosis group with healthy controls. The overall SMDs of LV-GLS, LV-BLS, LV-MLS and LV-ALS were calculated using the random-effect model.

Results: The full-texts of 13 studies with 553 amyloidosis patients and 575 healthy controls were analyzed. STE (53.8%) and CMR (46.2%) studies were separately analyzed. Average LV-GLS magnitude was significantly impaired in amyloidosis patients vs. controls in both STE (13.8±3.9 vs. 19.8±2.7%) and CMR (12.3±4 vs. 17.9±3.5%) studies. The impairment of segmental strain detected in amyloidosis patients was prevalent at basal and mid level, with relative "apical sparing." SMDs obtained for LV-GLS (SMD -1.80, 95% CI: -2.35, -1.24, P <0.001), LV-BLS (-1.98; 95% CI: -2.51, -1.45, P <0.001) and LV-MLS (-1.84; 95% CI: -2.46, -1.23, P <0.001) assessment were significantly larger than that obtained for LV-ALS (-0.72; 95% CI: -1.31, -0.13, P=0.02) measurement. Substantial heterogeneity was found among the studies assessing LV-GLS (I²=92.5%), LV-BLS (I²=91.4%), LV-MLS (I²=94.3%) and LV-ALS (I²=94.6%). Egger's test yielded a P value of 0.10, 0.20, 0.09 and 0.55 for LV-GLS, LV-BLS, LV-MLS and LV-ALS assessment respectively, indicating no publication bias. On meta-regression analysis, none of the moderators was significantly associated with effect modification for LV-GLS, LV-BLS, LV-MLS and LV-ALS (all P<0.05).

Conclusions: Amyloidosis has a large negative effect on LV-GLS, primarily related to the deterioration of segmental longitudinal strain at the basal and mid level, with relative apical sparing.