Minerva cardiology and angiology最新文献

Transplant coronary artery disease (TCAD) represents a severe complication after heart transplantation, modulated by hypercholesterolemia. Management of dyslipidemia in this setting is complex due to interactions between statins and immunosuppressants resulting in an increased risk of rhabdomyolysis and the potential of immunosuppressants themselves to elevate LDL and triglyceride levels. Inclisiran, an mRNA inhibitor of PCSK9, has demonstrated high efficacy without reported pharmacokinetic interactions and a favorable administration regimen. We present the first case of treatment with inclisiran after heart transplantation. We report the case of a 67-year-old male patient who underwent heart transplantation in 2011 with a high cardiovascular risk profile and a history of statin intolerance, treated with ezetimibe. In 2022, due to severe TCAD and elevated LDL-C levels (125 mg/dL), treatment with inclisiran (300 mg on days 0 and 90 and then every 6 months) was initiated in addition to ezetimibe. Lipid and immunosuppressant levels were monitored during follow-up visits. After two doses of Inclisiran, at 6 months, LDL-C was reduced to 69 mg/dL, without side effects or significant alterations in immunosuppressant levels. Subsequently, LDL-C levels showed a further reduction to 31 mg/dL and remained controlled (51 mg/dL and 28 mg/dL in subsequent follow-ups). Despite the reduction in LDL-C, the patient showed progression of TCAD, requiring multiple percutaneous revascularizations. This case suggests the potential value of inclisiran in the treatment of dyslipidemia in heart transplant patients with TCAD, especially in the presence of statin intolerance or risk of drug interactions. The infrequent administration regimen is advantageous in such patients with a high medication burden and can be made to coincide with follow-up visits. However, the progression of TCAD despite LDL-C reduction highlights the multifactorial nature of the disease, with a significant immunological component still not effectively controlled by current preventive therapies.

Background: Heart failure (HF) remains a leading cause of hospitalization globally, exerting significant strain on healthcare systems and impacting patients' quality of life. Seasonal changes in climate and temperature are known to affect HF-related outcomes. This study investigates the seasonal variations in hospitalization outcomes among HF patients in the United States.

Methods: We conducted a retrospective analysis of the National Inpatient Sample (NIS) database, focusing on patients aged over 18 years with a primary diagnosis of HF from 2018 to 2020, using the ICD-10-CM codes. Our primary outcomes of interest included trends in clinical characteristics, inpatient mortality rates, and length of hospital stay (LOS). In addition, inflation-adjusted healthcare costs for each patient were also analyzed. Statistical analyses included weighted logistic and linear regression, adjusting for patient-level factors (age, sex, race, comorbidities, insurance type, and median household income) and hospital-level factors (bed size, region, and teaching status). Inpatient mortality, length of stay, and inflation-adjusted hospital costs were analyzed. Mortality risk factors were assessed using multivariate models, with costs converted to 2019 dollars using standardized inflation adjustments.

Results: We identified 3,820,865 weighted HF hospitalizations, with peak admissions in winter (32.20%), followed by spring (29.73%), autumn (28.68%), and summer (9.39%). The mean patient age was highest in winter (69.5±0.06 years) and lowest in summer (68.7±0.07 years), P<0.001. Comorbidities showed seasonal variations, with hypertension, diabetes, and obesity more prevalent in summer, while acute myocardial infarction was more frequent in winter. White, Hispanic, and Asian/Pacific Islander patients experienced higher winter hospitalizations, whereas Black patients had increased admissions in autumn. Hospitalizations were most common among patients in the lowest income quartile (33.23%). The overall in-hospital mortality rate was 2.28%, highest in winter (2.40%) and lowest in summer (2.11%), P<0.001. The average length of stay (LOS) was 5.24 days (95% CI: 5.20-5.28), increasing from 5.19 days (95% CI: 5.12-5.25) in 2018 to 5.31 days (95% CI: 5.25-5.38) in 2020. Inflation-adjusted costs rose from $57,166 in 2018 to $65,961 in 2020, with significant seasonal differences.

Conclusions: Seasonal variations markedly influence HF-related hospitalizations and outcomes, with winter showing the highest hospitalization and mortality rates, especially among White, Hispanic, and Asian/Pacific Islander patients.

Acute coronary syndromes (ACS) are frequently the first manifestation of cardiovascular disease and require timely intervention. Primary percutaneous coronary intervention (pPCI) significantly reduces mortality and major adverse cardiovascular events in patients with ST-elevation myocardial infarction (STEMI). However, despite successful epicardial recanalization, pPCI can be complicated by inadequate myocardial reperfusion, a phenomenon known as coronary no-reflow (NR) or microvascular obstruction (MVO), which is associated with adverse outcomes. The aim is to describe a novel interventional approach - the saline technique - for the treatment of MVO following stent implantation during pPCI. The saline technique consists of a rapid, manual intracoronary injection of 10 mL of saline over 2-4 seconds using a 6-Fr thrombus aspiration catheter positioned distally to the stented segment. The aim is to rapidly increase distal coronary pressure and volume, promoting microvascular recruitment and displacement of micro-emboli and vasoconstrictive agents. A diagnostic step using distal angiography precedes treatment to confirm MVO. Preliminary data from a single-center matched cohort (N.=32) showed that the Saline Technique significantly improved TIMI flow grade and ST-segment resolution compared to standard care. No major complications were observed. Post-procedural Index of Microvascular Resistance (IMR) was reduced in most cases. The saline technique is a safe, cost-effective, and rapidly deployable option for managing coronary NR/MVO. While promising, these findings are hypothesis-generating and require confirmation in larger, randomized trials.

Background: Procedure-related vascular and bleeding complications after transcatheter aortic valve implantation (TAVI) still represents an important issue that impact on patients' mortality and morbidity. The aim of this study was to compare the effectiveness of single or double suture-based devices (SBDs) combined with a plug-based device to obtain large bore arteriotomy hemostasis after transfemoral (TF) TAVI.

Methods: Consecutive patients with available preprocedural computed tomography angiography (CTA) assessment undergoing 14Fr TF-TAVI from February 2018 to May 2023 at our Institution were considered. Patient receiving single or double SBD combined with a plug-based device were compared after propensity score matching. The primary outcomes were major vascular complications and type 2 to 4 bleeding due to endovascular closure system failure according VARC-3 criteria.

Results: Among a total of 490 patients, 130 matched pairs of patients were compared. At 30 days, there was no difference in major vascular complications (0.0% vs. 2.3%, P=0.25) and in type 2 to 4 bleedings (4.6% vs. 6.2%, P=0.78) between two matched groups. No difference in 30-day (1.5% vs. 3.8%, P=0.45) and one-year (12.0% vs. 9.5%, P=0.60) all-cause death was observed.

Conclusions: A simpler strategy with single SBD had comparable safety and effectiveness to the use of double SBD when combined to a plug-base device after 14 Fr TF-TAVI.

Viral heart disease comprises of two cardiovascular entities being evoked by viral infection: acute viral myocarditis and viral cardiomyopathy. Viral myocarditis may completely resolve leaving no traceable sign or cause ongoing inflammation with subsequent development of hypokinetic dilated/non-dilated cardiomyopathy. The exact epidemiology of viral myocarditis remains unknown due to its sometimes asymptomatic course, but according to the Global Burden of Disease Study 2019, the prevalence of myocarditis in young adults is estimated to range between 6.1 per 100,000 in men and 4.4 per 100,000 in women, with the most common viral etiology. According to the literature viral genome can be found in considerable percentage (up to 67,4%) of endomyocardial biopsy specimens obtained from patients with idiopathic left ventricular dysfunction- suggesting viral etiology of the cardiomyopathy. In this review we would like to enlighten most common types of arrhythmias and conduction disorders as well as their prevalence in patients with viral heart disease. Moreover, our paper depicts probable pathological mechanisms in which viruses induce arrhythmias and cardiac conduction system disease in both, acute viral infection and chronic viral disease. We would also like to highlight unresolved problem of sudden death protection in the course of acute myocarditis.

Angiotensin receptor neprilysin inhibitor (ARNI) decreases renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous systems (SNS) activity promoting vasodilation, decreasing myocardial hypertrophy and fibrosis. Beyond the SNS, RAAS and natriuretic peptide systems, ARNI results in increased circulatory and myocardial nitric oxide levels activating cGMP and protein kinase G, which reduces oxidative stress, myocyte hypertrophy, cell death and has anti-thrombotic effects. ARNIs have a class I indication by heart failure (HF) guidelines in HFrEF patients with NYHA class II to III symptoms. Beyond HFrEF, the use of ARNIs has also been expanded to other clinical settings including HF with preserved ejection fraction (EF, HFpEF), acute HF, advanced HF, hypertension, arrhythmias and chronic kidney disease. This paper reviews the clinical benefits of ARNIs in both HF and the aforementioned cardiovascular conditions. We also discuss the combined use of ARNI with SGLT2i and their potential synergistic benefits on cardiovascular outcomes.

Background: The no-reflow phenomenon (NRP) is associated with increased mortality and morbidity in patients with ST-segment elevation myocardial infarction (STEMI). Despite the lack of a definitive treatment for NRP, predicting procedural success remains a challenge. This study aims to evaluate the potential of intracoronary electrocardiography (ic-ECG) in predicting the success of the primary percutaneous coronary intervention (pPCI) in STEMI patients who develop NRP.

Methods: Patients with acute anterior STEMI who underwent pPCI between November 2021 and May 2022 were included in this prospective study. Patients were categorized into two groups based on the thrombolysis in myocardial infarction (TIMI) flow grade, with those having a grade less than 3 defined as NRP. The NRP group was further analyzed to explore the relationship between the percentage of ST-segment resolution (STR) in ic-ECG records taken during pPCI and the recovery of left ventricular ejection fraction (LVEF).

Results: Seventy-one patients with acute anterior STEMI were included in the study, 26 of whom (36.6%) developed the NRP. Baseline characteristics such as peak troponin levels (6267.8±2488.4 vs. 3244.6±3183 ng/mL, P=0.013), low-density lipoprotein cholesterol (LDL-C) levels (104.5±40 vs. 138.8±29.9 mg/dL, P=0.021), and total cholesterol levels (167.5±44.5 vs. 222.7±69.2 mg/dL, P=0.024) were significantly different between patients with and without LVEF recovery in the NRP group. Importantly, the change in ic-ECG STR was significantly higher in the recovery group (65.5±17% vs. 21±22.3%, P<0.001). Multivariate regression analysis confirmed that the percentage change in ic-ECG STR was an independent predictor of LVEF recovery (P=0.035). A cut-off ic-ECG STR change greater than 42% was identified through ROC analysis as a predictor of LVEF recovery with a sensitivity of 100% and specificity of 84.6% (AUC=0.938, P<0.001).

Conclusions: The percentage change in ST-segment resolution measured by ic-ECG is an independent predictor of LVEF recovery in STEMI patients who develop NRP. A greater than 42% change in ic-ECG STR during the procedure is independently associated with improved LVEF, highlighting its value in guiding clinical decision-making and improving patient outcomes.

Eosinophilic myocarditis (EM) is characterized by acute myocardial inflammation due to eosinophilic tissue infiltration. It is a rare and underdiagnosed condition, which may be either idiopathic or secondary to vasculitides, hypereosinophilic syndromes, drugs, or infections. Diagnosis is based on laboratory findings, echocardiography, cardiac magnetic resonance imaging and may sometimes need endomyocardial biopsy. Treatment depends on the underlying cause and often consists of immunosuppressive agents and anticoagulation therapy. This case series includes nine patients with EM, specifically seven cases secondary to eosinophilic granulomatosis with polyangiitis, one case secondary to acute lymphocytic leukemia, and one case of idiopathic EM, and aims to describe and review the diagnostic work-up and tailored treatment of this heterogeneous disease.

Background: The association between epicardial adipose tissue (EAT) and heart failure has garnered significant attention. The objective of this study is to investigate the relationship between EAT and cardiac function across various heart failure phenotypes.

Methods: The study cohort included 33 cases in the control group and 121 cases in the heart failure group, stratified into subgroups: 40 with heart failure with reduced ejection fraction (HFrEF), 38 with heart failure with mid-range ejection fraction (HFmrEF), and 43 with heart failure with preserved ejection fraction (HFpEF). Researchers collected epicardial adipose tissue thickness, clinical data, and echocardiographic parameters from all participants. Left ventricular (LV) systolic function was assessed using global longitudinal strain (GLS), and left atrial (LA) function was evaluated using LA strain during reservoir, conduit, and contraction phases. Fitted curves illustrating the relationship between EAT and LV ejection fraction (LVEF), as well as GLS and LA strain, were constructed. Multivariable linear regression was employed to analyze the correlation between EAT and GLS, LASr, LAScd, and LASct after adjusting for confounding factors.

Results: A nonlinear relationship was observed between EAT and LVEF, GLS, LASr, LAScd, and LASct. EAT thickness varied across groups: HFpEF (7.9±0.8 mm)>Control (5.1±0.6 mm)>HFmrEF (4.6±0.9 mm)>HFrEF (4.0±0.7 mm). After adjusting for age, gender, BMI, and relevant medical history, the correlation coefficients between EAT and GLS were 0.21, 0.17, and -0.12 in HFrEF, HFmrEF, and HFpEF groups, respectively. In the HFrEF group, EAT showed positive correlations with LASr and LAScd (0.1 and 0.1), and negative correlations with LASr, LAScd, and LASct in the HFpEF group (-0.03, -0.06, and -0.07).

Conclusions: EAT thickness follows the order: HFpEF>Control>HFmrEF>HFrEF. Thicker EAT in HFpEF is associated with poorer LV and LA function, while the opposite trend is observed in HFrEF and HFmrEF. LA function is more compromised in HFmrEF and HFrEF compared to HFpEF.