Minerva cardiology and angiology最新文献

Background: The incidence and mortality of coronary heart disease (CHD) are high in the elderly population. CT fractional flow reserve (CT-FFR) is a potential diagnostic technique for cardiovascular diseases. In order to mine valuable biomarkers to combine CT-FFR parameters to improve the diagnostic accuracy of CHD.

Methods: In this study, GEO database was used to screen the key genes of CHD. GraphPad software was used to construct receiver operating characteristic (ROC) curve, and SPSS software was used for logistic regression analysis. Inflammatory cell model was constructed by treating human cardiac microvascular endothelial cells (HMVEC-Cs) with TNF-α to explore the role of RAC2 in this process.

Results: Real time quantitative PCR (RT-qPCR) results showed high-expression of RAC2 in CHD patients, which were reversed after nitric ester drug therapy. The analysis of ROC curves displayed that RAC2 combined with CT-FFR had a higher diagnostic value for CHD (AUC=0.971, 95% CI 0.950-0.992) compared to the single factor, and RAC2 was an independent risk factor for poor prognosis in CHD patients treated with nitric ester drugs (AUC=0.888, 95% CI 0.814-0.961, P<0.001). Overexpression of RAC2 further enhanced the elevated expression levels of NF-κB, NLRP3, IL-1β, and IL-6, induced by TNF-α, and its silence had the opposite effect.

Conclusions: RAC2 promoted the inflammatory response of HMVEC-Cs and predicted a poor prognosis in CHD patients. The combination of RAC2 and CT-FFR parameters was a good classifier for diagnosing CHD.

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: The aim of this paper was to determine whether vitamin D supplementation reduces the incidence of postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass grafting (CABG).

Evidence acquisition: PubMed and Cochrane Central Register of Controlled Trials were systematically searched from inception through May 2023 for randomized controlled trials (RCTs) assessing the effectiveness of Vitamin D in preventing atrial fibrillation among postoperative patients after CABG.

Evidence synthesis: The primary outcome extracted was the incidence of atrial fibrillation after Vitamin D in CABG patients. Secondary outcome included the length of hospital stay. Data were pooled using a random-effect model. A total of 4 RCTs, involving 694 patients, were included in the final analysis. The results showed that Vitamin D supplementation significantly reduced the incidence of POAF in CABG patients (RR: 0.55; 95% CI: 0.40 to 0.76; P=0.0003; I²=1%). However, administration of Vitamin D did not lead to significant reduction in the length of hospital stay (WMD: -0.14; 95% CI: -0.82 to 0.53; P=0.68; I²=34%).

Conclusions: Our updated pooled analysis concludes that vitamin D reduces the incidence of POAF in CABG patients. Future large-scale studies should focus on more diverse patient populations and explore a broader range of outcomes to better understand the full impact of Vitamin D supplementation in this context.

Liraglutide is a key therapeutic agent in managing type 2 diabetes mellitus (T2DM), with benefits extending beyond glycemic control to address cardiovascular and renal comorbidities. As T2DM prevalence rises globally, the need for medications that provide comprehensive health benefits becomes increasingly important. Liraglutide, a GLP-1 receptor agonist, has demonstrated effectiveness in reducing cardiovascular events, especially among patients with high cardiovascular risk, such as those with a prior history of myocardial infarction or stroke. It has shown significant reductions in major adverse cardiovascular events (MACE), including cardiovascular mortality and stroke risk, making it an essential component in secondary prevention for patients with established atherosclerotic cardiovascular disease (ASCVD). Moreover, liraglutide has a favorable safety profile, presenting a lower incidence of hypoglycemia compared to many other glucose-lowering agents, which is crucial for patient safety and adherence. Given these wide-ranging benefits, liraglutide serves as a valuable tool for optimizing health outcomes in diverse diabetic populations, particularly in those with complex comorbidities. To support this narrative review, a search in three electronic databases yielded 44 relevant journal articles and book chapters about liraglutide published from 2010 to 2022, providing a robust foundation for evaluating its cardiovascular impact and clinical utility in T2DM patients with concurrent cardiac conditions.

Background: In the face of numerous studies concerning the technical advances of percutaneous coronary intervention [PCI] and clinical outcomes, only a few studies focus on patients' lived experiences after PCI. This study aims to explore patients' lived experiences after PCI, both in clinical terms and in terms of their perception of their health status, functional capacity, and autonomy at home.

Methods: A qualitative phenomenological, individual, semi-structured survey was conducted on a sample of 18 patients undergoing PCI. Face-to-face interviews were conducted, interviews had a time duration of 7 to 10 minutes, and all conversations were recorded and transcribed. The study assessed the level of satisfaction, concerning the lived experience, in the pre/post-procedure period and the subsequent follow-up.

Results: Patients emphasized the importance of four themes: post-PCI health conditions, activities of daily living, the relationship established with health care providers, and the relationship between patient and family members/caregivers. Patients emphasized the improvement of symptoms, particularly exertional dyspnea, exertional angina, and easy fatigability. As a result, patients reported increased confidence in performing normal daily activities. Patients stressed the importance of establishing a good relationship between patients and healthcare providers. About 72.2% (95% CI 49.1-87.5%) of patients reported that they needed the help of family in the recovery phase. Of this group, 84.6% (95% CI 57.7-95.7%) reported that they never felt like a burden to their loved ones.

Conclusions: Post-PCI follow-up is generally characterized by improvement in the patient's functional capacity and autonomy. There are, however, cases in which at least part of the burden of home care falls on family members.

Background: The primary aim of the study was to assess the relationship between epicardial adipose tissue (EAT) volume and Coronary Calcium Score (CCS), in addition to coronary artery stenosis severity and carotid intima-media thickness (CIMT).

Methods: This single-center retrospective study included patients suspected of ischemic heart disease. All patients underwent computerized tomography coronary angiogram by which their EAT volume, CCS, and coronary stenosis degree were measured. Carotid Doppler ultrasound was used to determine CIMT. Most recent laboratory values, including inflammation markers and lipid profiles, were collected from the hospital database. CCS was calculated by using the Agatston method.

Results: A total of 109 patients were included in the study. The mean age was 51.7±9.7 years, and 38.5% were female. EAT volume, but not CCS, was significantly greater in patients with diabetes mellitus than patients without. CCS was significantly higher in the high EAT volume tertile than in low and moderate EAT volume tertiles. The number of patients with CCS>100 and >400 were significantly more common in high EAT volume tertile compared to other tertiles. EAT volume was significantly increased as the severity of the coronary stenosis increased. EAT volume emerged as an independent associate of CCS in addition to age and sex. CIMT was significantly correlated both with EAT volume and CCS.

Conclusions: EAT volume appeared as a significant and independent associate of CCS. Moreover, both EAT volume and CCS increased as the severity of the atherosclerosis increased.

Background: PCSK9 inhibitors (PCSK9i) in combination with high-dose statins can reduce LDL-cholesterol (LDL-C) levels by 50-60% over statin monotherapy. This analysis investigated biochemical (LDL-C reduction) and economic outcomes in Italian patients treated with PCSK9i or potentially eligible but untreated.

Methods: Administrative databases of healthcare institutions covering around 5 million residents were used to identify patients with PCSK9i prescriptions or potentially eligible-untreated patients between 2017 and Oct-2022. Outcomes were assessed during follow-up in cohorts balanced for baseline covariates by propensity score matching (PSM).

Results: After PSM-balancing, 2649 treated and 2649 potentially eligible-untreated patients were included: mean age 64.4-64.7 years, 70-68% males, 92-93% with hypertension, 24-25% with diabetes, and 87% with previous atherosclerotic/cardiovascular events. During follow-up, PCSK9i-treated patients versus untreated/eligible showed a reduction of LDL-C levels (68.9±43.9 vs. 100.4±34.6 mg/dL, P<0.0001), hospitalization rates for heart attack (4.5% vs. 6.8%, P=0.0069), heart failure (4.5% vs. 6.6%, P=0.010), and lower all-cause mortality (3.2% vs. 9.5%, P<0.0001). The multivariate Cox model confirmed that eligible-untreated patients had a more than doubled mortality risk compared to the PCSK9i-treated ones (HR: 2.291, 95%CI: 1.651-3.178, P<0.0001). Although mean annualized total healthcare costs were higher in PCSK9i-treated versus untreated/eligible patients (€6745 vs. €4343, P<0.0001), because of the higher drug costs, PCSK9i therapy was associated with reduced expenses for hospitalizations (€1113 vs. €1687, P<0.0001) and specialist outpatient services (€386 vs. €787, P<0.0001).

Conclusions: The real-world analysis suggests that therapy with PCSK9i resulted in reduced LDL-C levels, lower mortality rates and cost savings for hospitalizations and specialist services.

Background: Gut microbiota have been linked to atherosclerosis (AS). This study aimed to investigate the differences in gut microbiota between patients with AS and healthy controls using third-generation gene sequencing.

Methods: Full-length 16S rRNA amplicon sequencing was used to compare the composition, abundance, diversity, and differences in intestinal flora between a healthy control group (ASC, N.=20) and an atherosclerotic patient group (ASP, N.=21).

Results: The ASP group showed higher rank richness and an altered microbial community structure compared to the control group. We found 12 phyla and 201 bacterial taxa in our samples, with Firmicutes being the most abundant phylum in both groups. However, several bacterial species, including Lactobacillus fermentum, Escherichia coli, Dialister succinatiphilus, and Fusobacterium varium, were more abundant in the ASP group. Except for Escherichia coli, the other three bacterial species are associated with lipid metabolism. The ASP group exhibited smaller network diameters, lower graph density, and lower average degree than the ASC group, indicating greater correlations and clustering of operational taxonomic units samples. Functional profiling showed significant enrichment in AMPK signaling pathway and glucose metabolism in the ASC group, while bacterial invasion of epithelial cells was enriched in the ASP group.

Conclusions: Our findings aid in enhancing the comprehension of the gut microbiota's role in AS development and provide valuable insights for potential therapeutic interventions.

Background: In heart failure (HF), lower total cholesterol (TC) levels associate with poor outcomes. Whether TC variations portend prognostic implication is unknown. We aimed to evaluate the impact of TC variation in HF.

Methods: We retrospectively analyzed adult outpatients with chronic HF with systolic dysfunction evaluated between January/2012 and December/2020. Patients with no TC measurement at baseline or at the 1-year follow-up visit were excluded. Variation of TC during the first year = [(baseline TC - TC at the 1-year visit)/baseline TC] × 100. Patients were followed-up until five years after the first-year visit. Endpoint: all-cause mortality. A Cox-regression analysis was performed to assess the association of TC variation (cutoff ≥10% decrease) with mortality. A multivariate model was built.

Results: We studied 362 patients, 67.4% male, mean age 69 years, 42.8% presented severe systolic dysfunction; 69.6% were on statin therapy. TC level decreased during the first year: 173 (47) vs. 166 (45) mg/dL respectively (P=0.002). In 127 (35.1%) patients there was a ≥10% decrease in TC. During a median follow-up of 57 (31-60) months, 130 (35.9%) patients died: 41.7% in those with a ≥10% TC decrease versus 32.8% in the remaining (P=0.09). Patients with at least 10% decrease in TC had higher mortality risk, after a multivariate adjustment the HR of all-cause death was 1.71 (1.15-2.55, P=0.008).

Conclusions: Patients with ≥10% decrease in TC had an independent 71% increase in the risk of death. Our results reinforce the cholesterol paradox and further question the use of statins in HF.