Minerva cardiology and angiology最新文献

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

Introduction: Transcatheter aortic valve replacement (TAVR) is increasingly performed nowadays, bleeding and vascular complications are not uncommon. Current recommendations for the use of protamine in the post-TAVR setting remain uncertain. This study aimed to evaluate the efficacy and safety of protamine in this setting.

Evidence acquisition: A systematic search using four databases, including PubMed, Embase, Web of Science, and Cochrane CENTRAL, was conducted from inception to October 17^th, 2024, without language restrictions. The inclusion criteria were studies that compared the efficacy or safety of protamine vs control in post-TAVR patients.

Evidence synthesis: There were six studies (two randomized and four non-randomized) included in this meta-analysis, involving 3897 participants. We used a random-effects model for this meta-analysis. Protamine was associated with a lower risk of major bleeding compared to the control group, with an odds ratio (OR) of 0.47 (95% CI 0.30 to 0.74, P<0.01). Additionally, protamine was associated with a lower risk of major vascular complications compared to the control, with an OR of 0.45 (95% CI 0.31 to 0.65, P<0.01). Protamine also reduced the risk of minor bleeding and life-threatening bleeding compared to the control. For the safety outcome, the administration of protamine did not increase the risk of stroke and myocardial infarction.

Conclusions: The administration of protamine demonstrated efficacy in reducing bleeding and vascular complications without increasing the risk of thromboembolic complications in the post-TAVR setting.

In clinical practice, ventricular ejection fraction (EF) and global longitudinal strain (GLS) are the most often used parameters for evaluating left ventricular systolic function, despite the impact that variable loading conditions have. Alternatively, the myocardial efficiency (ME) of the heart, encompassing cardiac energy formation and dissipation, along with myocardial oxygen consumption (MVO2), is a useful surrogate for assessing myocardial work (MW), a parameter correlated with the pressure-strain loop (PSL), arterial pressure, and cardiac output (CO). This refinement proves especially practical in defining cardiac work across various clinical contexts, including arterial hypertension and heart failure (HF), the primary conditions associated with cardiovascular mortality. In this review, we explore how many invasive and non-invasive studies have shown that MW and consequently ME are correlated with the state of cardiovascular wellbeing and myocardial performance, allowing it to be integrated with other parameters present in clinical practice.