Minerva cardiology and angiology最新文献

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.

Cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality worldwide, accounting for significant public health and economic burdens. Cardiac rehabilitation (CR) is a comprehensive, multidisciplinary program designed to aid patients in recovering from cardiac events and to prevent further complications. The aim of CR is to improve their quality of life and prognosis. It involves continued prognostic stratification, clinical stabilization, optimization of pharmacological and non-pharmacological therapy, management of comorbidities, treatment of disabilities, reinforcement of secondary prevention interventions, and maintenance of adherence to therapy. The most recent European Society of Cardiology guidelines for the diagnosis and management of atrial fibrillation (AF) emphasize the importance of cardiorespiratory fitness, recommending that patients engage in moderate-intensity exercise and remain physically active to prevent AF incidence or recurrence. Through this symbiotic relationship, CR addresses all aspect of cardiac fitness in AF management. The program's structured exercise regimens are specifically tailored to address the challenges associated with AF, promoting overall cardiovascular health and reducing the risk for cardiac death. CR is also crucial for emotional well-being, offering support and coping mechanisms for the psychological impact of AF, beyond the physical training program. CR programs involve a multidisciplinary approach that is carried out collaboratively by a team of healthcare professionals, including nurses, physiotherapists, psychologists, and dietitians. Moreover, CR in AF patients aims to carry out comprehensive patient support through clinical stabilization and therapy optimization interventions, prescription and implementation of physical activity, educational support on lifestyle risk factors and social-emotional distress, and periodic assessment of outcomes. This narrative review aims to elucidate the role of CR in AF patients, shedding light on the potential benefits and challenges associated with integrating rehabilitation programs into the care of individuals with AF.

Background: The relationship between Body Mass Index (BMI) and acute heart failure (HF) remains ill-defined. This study aimed to compare the influence of BMI on in-hospital mortality between patients with acute HF with preserved ejection fraction (HFpEF) and those with acute HF with reduced ejection fraction (HFrEF) and to examine the specific phenotypes of HFpEF/HFrEF according to BMI.

Methods: This multicenter retrospective study included 5313 and 6332 consecutive patients with acute HFpEF and HFrEF, respectively. Low, normal, and high BMIs were defined as BMI <18.5, 18.5 ≤BMI <25.0, and BMI ≥25.0, respectively. Overweight/obesity was defined as BMI ≥25.0. Kaplan-Meier survival curves and log-rank tests were used for between-group comparisons of in-hospital mortality. Univariable and multivariable Cox regression analyses were performed to identify significant prognostic factors.

Results: A paradoxical association between overweight/obesity and survival benefits, the so-called obesity paradox exists in HFpEF (log-rank P<0.05 in low BMI vs. normal BMI, low BMI vs. high BMI, and normal BMI vs. high BMI). In HFrEF, a trend towards lower in-hospital mortality was observed in patients with higher BMI. However, the obesity paradox in patients with HFrEF was not as evident as that in patients with HFpEF. Significant differences in the clinical characteristics and prognostic factors for in-hospital mortality were observed among the groups according to BMI.

Conclusions: The obesity paradox was more evident in patients with HFpEF than in those with HFrEF. Specific phenotypes of HFpEF and HFrEF according to BMI were revealed.