Minerva cardiology and angiology最新文献

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.

Background: The aim is of this study to identify genetic single nucleotide polymorphisms associated with cardiovascular (CV) toxicity in patients of oncohematological profile receiving antitumor immune chemotherapy.

Methods: In single-center prospective study were included 34 patients with the diagnosis of non-Hodgkin's B-cell follicular lymphoma. All of them received R-CHOP scheme immune chemotherapy. Patients were divided into two groups up to the appearance of CV toxicity during the treatment: main group - patients with CV toxicity (mean age 42.4±2.8, three men [25%]), control group - without it (mean age 39.8±1.7, of which eight men [36%]). CV toxicity has been defined by the presence of CV symptoms associated to a reduction of left ventricular ejection fraction (LVEF) >10% from baseline or in absolute lower than 53% and/or a decrease in LV longitudinal strain >12% from baseline and/or an increase in NT-proBNP>125 pg/mL.

Results: This study presents the identified genetic features in patients with an oncohematological profile in the context of the occurrence of CV toxicity during the treatment of malignant neoplasms. Variants rs1879257 of the ABCC5 gene, rs13224758 of the PRKAG2 gene, rs10925391 of the RYR2 gene and rs4149178 of the SLC22A7 gene significantly increased the risk of developing CV toxicity in the target group of patients by 5-6 times. In addition, the study showed that the rs2032582 ABCB1 gene and rs3729856 GATA4 gene variants had the opposite effect and reduced the risk of developing CV complications, having a protective effect on the CV system.

Conclusions: The results of this study endorse the possibility of performing a genetic screening before anticancer immunochemotherapy as a future tool for stratifying patients with an oncohematological profile and minimizing CV toxicity. However, further studies are needed to confirm the diagnostic and prognostic role of the above identified genetic variants.

Background: Heart failure (HF) is a clinical syndrome with different signs and symptoms that present in chronic and acute forms. This study aimed to compare acute HF (AHF) and chronic HF (CHF) regarding demographics, baseline characteristics and comorbidities, and clinical outcomes.

Methods: This study is a sub-analysis of the Jordanian HF registry (JoHFR). A total of 21 medical centers representing a diverse range of medical facilities participated in the study. The studied data included demographics, medical history, comorbidities, HF risk factors, and clinical outcomes.

Results: The study involved 2151 HF patients. Patients with AHF were more likely to be to have diabetes (P=0.001), history of premature ASCVD (P<0.001), and treated at university-based hospital (P<0.001) while they were less likely to be males (P<0.001) and have family history of premature ASCVD (P=0.001) compared to patients with CHF. The AHF group had a higher percentage of patients having more than two office visits or hospital admissions related to HF in the last 12 months (17.5% vs. 10.1%; P<0.001). AHF patients also registered higher percentages in mechanical ventilation requirement (6.6% vs. 3.3%; P=0.005) and mortality rates (11.4% vs. 8.7%; P=0.049).

Conclusions: This study revealed significant differences in the characteristics and outcomes of AHF and CHF using data from the largest HF registry in the Middle East providing a solid foundation for future studies aimed to improve heart failure outcomes in the region.

Background: Aortic valve stenosis (AS) often coexists with various comorbidities and concurrent cardiovascular risk factors. However, the clinical impact of obesity, considering sarcopenia, remains unexplored in patients with severe symptomatic AS evaluated by a Heart Team. This study evaluates Body Mass Index (BMI)'s discriminative power and clinical implications regarding adverse clinical events in severe symptomatic AS patients assessed by a Heart Team, while considering sarcopenia.

Methods: This retrospective single-center cohort study included severe symptomatic AS patients evaluated by a Heart Team, analyzing baseline characteristics, anatomo-functional data, biochemical parameters, and adverse clinical events during a 2-year follow-up. The cohort was stratified by BMI and the presence of sarcopenia, determined using the validated SARC-F Questionnaire.

Results: The mean age of the study cohort (N.=278) was 83.25±6.88 years (51.1% female), with a median follow-up of 13.05 months (IQR 5.96-24.50). The AUC for the primary outcome related to BMI was 0.623 ([95% CI 0.543-0.704]; P=0.004), with the optimal BMI threshold at 24.95 kg/m². Patients with a BMI>24.95 kg/m² exhibited improved survival (HR 0.508 [95% CI 0.303-0.853]; P=0.010). Conditional dependence regarding the presence of sarcopenia was observed in the relationship between BMI and adverse clinical events (sarcopenic patients, P=0.015 vs. non-sarcopenic, P=0.618; Cochran-Mantel-Haenszel test P=0.171).

Conclusions: Among severe symptomatic AS patients evaluated by a Heart Team, BMI predicts adverse clinical outcomes. Remarkably, normal-weight patients have higher mortality rates than obese patients. This association was only evident in the absence of sarcopenic obesity.

Background: Aging is a key risk factor for atrial fibrillation (AF), a prevalent cardiac disorder among the elderly. This study aims to elucidate the genetic underpinnings of AF in the context of aging.

Methods: We analyzed 12,403 genes from the GSE2240 database and 279 age-related genes from the CellAge database. Machine learning algorithms, including support vector machines and random forests, were employed to identify genes significantly associated with AF.

Results: Among the genes studied, 76 were found to be potential candidates in the development of AF. Notably, four genes - PTTG1, AR, RAD21, and YAP1 - stood out with a Receiver Operating Characteristic Area Under the Curve (ROC AUC) of 0.9, signifying high predictive power. Logistic regression, validated through 10-fold cross-validation and Bootstrap resampling, was determined as the most suitable model for internal validation.

Conclusions: The discovery of these four genes could improve diagnostic accuracy for AF in the aged population. Additionally, our drug prediction model indicates that bisphenol A and cisplatin, among other substances, could be promising in treating age-associated AF, offering potential pathways for clinical intervention.

Background: Acute myocardial infarction (AMI) remains one of the leading causes of mortality and morbidity worldwide.

Methods: GSE61144 and GSE66360 were the sources of microarray gene expression profiles for acute myocardial infarction patients and were acquired from the Gene Expression Omnibus (GEO) database (https://www.ncbi.nlm.nih.gov/geo/). After merging the datasets, genes that were differentially expressed were chosen.

Results: A total of 234 genes were found to have different expression levels. Of these, 206 genes were upregulated, and 28 genes were downregulated. Five coexpression modules were identified by WGCNA, with the yellow module showing a high correlation with AMI (r=0.65, P=2.0e-15). Ninety-two hub genes were selected in the yellow module by setting a threshold of module membership (MM) greater than 0.8 and gene significance (GS) higher than 0.4. By overlapping these genes with the differentially expressed genes, 81 hub genes were obtained. Five key genes (C5AR1, CXCL1, CXCL2, FPR1, and P2RY13) were identified through PPI analysis. AMI patients exhibited elevated levels of immune cell infiltration, and immune scores in AMI samples were significantly positively correlated with all five key genes. Moreover, the expression levels of these five genes were higher in AMI patients. These five genes possessed area under the curve (AUC) values exceeding 0.8 for diagnosing AMI, thereby demonstrating their efficacy as diagnostic markers.

Conclusions: C5AR1, CXCL1, CXCL2, FPR1, and P2RY13 have the potential to be useful biomarkers in diagnosing AMI and are linked to immune cell infiltration in AMI, opening up new avenues for future research into the pathogenesis of AMI.

Background: This study was to investigate the risk factors for recurrence after radiofrequency ablation (RFCA) in patients with persistent atrial fibrillation (PeAF) and analyse its correlation with plasma microribonucleic acid (miRNA) expression based on ultrasound cardiograms.

Methods: A total of 126 PeAF patients who underwent RFCA were selected as the research subjects (AF group), and 126 healthy subjects matched by gender and age were included as the control (control group). The basic data and biochemical indexes of the included research subjects were collected, and the subjects were followed up for one year after surgery. According to AF recurrence, all research subjects were divided into the recurrence group (45 cases) and the unpredictable group (81 cases). The t-test or Mann-Whitney U Test was adopted to compare B-type natriuretic peptide (BNP), uric acid (UA), glycosylated hemoglobin (HbA1c), and other biochemical indicators among patients in recurrence group and unpredictable group. In addition, left atrial diameter (LAD), left atrial volume (LAV), and left atrial ejection fraction (LAEF) were measured in both groups of patients. Logistic regression analysis was performed to identify the primary risk factors for recurrence among patients with PeAF after RFCA. Furthermore, the receiver operating characteristic (ROC) curve was used to compare the area under the curve (AUC) of the identified risk factors.

Results: AF duration in the recurrence group was shorter than that in the unpredictable group (P<0.01). The proportion of patients with a CHADS2 score of two or above in the recurrence group was significantly higher than that in the unpredictable group (P<0.05) in addition to UA (P<0.05) and BNP (P<0.001). Similarly, the LAD and LAV in the recurrence group were significantly higher (P<0.01), and LAEF was also found to be superior (P<0.05) in comparison to the unpredictable group. The relative expressions of plasma miRNA-150 and miRNA-133 of the patients in the AF group were remarkably reduced compared with those in the control group (P<0.05), while the relative expressions of miRNA-206, miRNA-21, miRNA-31, miRNA-27b, and miRNA-328 were all significantly increased (P<0.05) in contrast to those in the control group, and the plasma miRNA-21 (P<0.001) and miRNA-27b (P<0.05) expression of the patients in the recurrence group were significantly higher than that in the unpredictable group. AF duration (odds ratio (OR) = 1.182, 95% confidence interval (CI): 1.021~1.357), LAD (OR=2.066, 95% CI: 1.203~4.491), miRNA-21 (OR=1.253, 95% CI: 1.012-1.647), and miRNA-27b (OR=1.186, 95% CI: 1.006-1.391) were all correlated with recurrence among patients with PeAF after RFCA (P<0.05). The AUCs of AF duration, LAD, miRNA-21, and miRNA-27b LAD were found to be 0.654, 0.703, 0.795, and 0.815, respectively. The sensitivity values were 0.687, 0.701, 0.734, and 0.789, while the correspo