Reviews in cardiovascular medicine最新文献

Out-of-hospital cardiac arrest (OHCA) is a leading cause of death worldwide, with a low survival rate of around 7% globally. Key factors for improving survival include witnessed arrest, bystander cardiopulmonary resuscitation (CPR), and early defibrillation. Despite guidelines advocating for the "chain of survival", bystander CPR and defibrillation rates remain suboptimal. Innovative approaches, such as dispatcher-assisted CPR (DA-CPR) and smartphone-based alerts, have emerged to address these challenges. DA-CPR effectively transforms emergency callers into lay rescuers, and smartphone apps are increasingly being used to alert volunteer first responders to OHCA incidents, enhancing response times and increasing survival rates. Smartphone-based systems offer advantages over traditional text messaging by providing real-time guidance and automated external defibrillator (AED) locations. Studies show improved outcomes with app-based alerts, including higher rates of early CPR, increased survival rates and improved neurological outcomes. Additionally, the potential of unmanned aerial vehicles (drones) to deliver AEDs rapidly to OHCA sites has been demonstrated, particularly in rural areas with extended emergency medical services response times. Despite technological advancements, challenges such as ensuring responder training, effective dispatching, and maintaining responder well-being, particularly during the coronavirus disease 19 (COVID-19) pandemic, remain. During the pandemic, some community first responder programs were suspended or modified due to shortages of personal protective equipment (PPE) and increased risks of infection. However, systems that adapted by using PPE and revising protocols generally maintained responder participation and effectiveness. Moving forward, integrating new technology within robust responder systems and support mechanisms will be essential to improving OHCA outcomes and sustaining effective response networks.

Background: Prognosis assessments for transcatheter aortic valve implantation (TAVI) patients remain challenging, particularly as the indications for TAVI expand to lower-risk patients. This study assessed the prognostic value of the tricuspid regurgitation impact on outcomes (TRIO) score in patients after TAVI.

Methods: This single-center study included 530 consecutive patients who underwent TAVI. Patients with a TRIO score >4 were compared to those with a score ≤4. The primary outcome was all-cause mortality, while secondary outcomes included complications defined by the Valve Academic Research Consortium 2 (VARC-2) criteria and major adverse cardiovascular events (MACEs), including mortality, stroke, and heart failure rehospitalization.

Results: Over a mean follow-up period of 22 months, patients with a TRIO score >4 had significantly higher rates of mortality (11.5% vs. 3.1%, p < 0.001) and MACEs (14.9% vs. 3.6%, p < 0.001). Multivariable Cox regression analysis identified a TRIO score >4 as an independent risk factor for all-cause mortality (hazard ratio (HR): 2.41, 95% confidence interval (CI): 1.08-5.37, p = 0.032) and MACEs (HR: 2.78, 95% CI: 1.34-5.75, p = 0.006). Patients with a higher TRIO score also had significantly higher rates of stroke (3.1% vs. 0.5%, p = 0.028), acute kidney injury (10.1% vs. 4.3%, p = 0.011), and MACEs (14.9% vs. 3.6%, p < 0.001) within 30 days after TAVI.

Conclusions: The TRIO score was associated with all-cause mortality and MACEs in patients after a TAVI. The TRIO score could serve as a convenient tool for risk stratification in clinical practice, aiding in identifying high-risk patients.

Background: Cardiovascular diseases (CVD) affect around 7.6 million people in the UK, disproportionately affecting the minority ethnic community. In 2009, the UK's National Health Service (NHS) launched a Health Check (NHSHC) scheme to improve early diagnosis of various clinical conditions, including CVD, by screening patients for associated risk factors. This systematic review investigated the engagement of minority ethnic groups with these services.

Methods: Seven studies identified patient demographics of NHSHC attendees using the Preferred Reporting Items for Systematic And Meta Analysis-Diagnostic Test Accuracy (PRISMA-DTA) guidelines and accessing Ovid (MEDLINE), PubMed and Web of Science databases.

Results: The screening was either by invitation or opportunistic at other appointments with their doctor. Engagement with the service was highest among the South Asian patients (21%-68%), but lowest amongst Chinese patients (12%-61%). Further, engagement was lower among those screened following a formal invitation than those seen opportunistically. However, a greater proportion of patients were screened opportunistically than by invitation.

Conclusions: Overall, we found that the NHSHC is not being utilised adequately for all patients at high risk of CVD, particularly White and Chinese patients. It highlights the critical role of primary care could play to improve patient engagement with the service.

Background: To systematically evaluate risk factors for stress-induced hyperglycemia in patients without diabetes after cardiac surgery.

Methods: Databases including CNKI, WanFang data, VIP, SinoMed, PubMed, Web of Science, Embase, and the Cochrane Library were searched using computer retrieval. The data were subjected to an in-depth meta-analysis using RevMan 5.4 and Stata 15.0 software.

Results: This study involved 11,645 postoperative cardiac surgery patients, including 8 case-control studies and 3 cohort studies, over which 18 risk factors were identified. The results of the meta-analysis indicated that statistically significant risk factors included age >65 years [odds ratios (OR) (95% CI ) = 3.47 (2.61-4.32)], female gender [OR (95%) = 1.54 (1.34-1.76)], combined heart valve and coronary artery bypass surgery [OR (95%) = 1.82 (1.23-2.70)], ejection fraction <40% [OR (95%) = 1.38 (1.17-1.63)], history of heart surgery [OR (95%) = 1.30 (1.06-1.59)], myocardial infarction [OR (95%) = 1.17 (1.05-1.31)], hyperlipidemia [OR (95%) = 0.76 (0.67-0.86)], hypertension [OR (95%) = 1.12 (1.03-1.22)], anticoagulant medication [OR (95%) = 0.77 (0.65-0.90)], cardiopulmonary bypass time >2 hours [OR (95%) = 20.26 (17.03-23.48)] and history of cardiopulmonary bypass [OR (95%) = 1.24 (1.09-1.41)].

Conclusions: Current evidence suggests that there are key risk factors for postoperative stress hyperglycemia in patients without diabetes who have undergone cardiac surgery. These factors can help identify patients at a high risk of perioperative stress hyperglycemia during cardiac surgery. This evidence provides a basis for healthcare professionals to develop predictive management strategies for perioperative stress hyperglycemia in patients without diabetes. However, more high-quality studies are required to address the limitations of the current research.

The prospero registration: CRD42024479215, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=479215.

Background: The fluorescent dye indocyanine green (ICG) has been used to identify anatomical structures intraoperatively in coronary artery bypass grafting (CABG). This study aimed to evaluate the feasibility of using ICG to assess graft patency and territorial distribution of myocardial reperfusion during CABG.

Methods: Porcine arrested hearts (n = 18) were used to evaluate territorial distribution of native coronary arteries and of a coronary bypass constructed with porcine saphenous vein graft (SVG) using ICG. Coronary ostia were dissected and selectively cannulated for ICG injection. Sequential fluorescence was assessed in the epicardial coronary arteries, myocardium and coronary veins using an infrared-sensitive charge-coupled device (CCD) camera system. In a separate set of experiments, SVG was used for anastomosis in end-to-side fashion to a terminal obtuse marginal (OM) branch. This approach was used to avoid bias in the assessment of territorial distribution. The anastomosis was injected with ICG; graft patency and territorial distribution was assessed using an infrared-sensitive CCD camera system from 30 cm above the field, as previously described. Native circulation and SVG grafts were assessed using real-time video recording and fluorescence intensity mapping that was averaged into a graded scoring system. The heart was divided into functional regions: anterior wall, lateral wall, inferior wall and right ventricle. All experiments were performed in triplicates.

Results: After ICG injection into the individual coronary ostia, perfusion of the native coronary artery was visible. Portions of the vessels embedded into the epicardial fat could be easily visualized on the surface of the heart and the dissection facilitated via fluorescence guidance. The territorial distribution reflected the expected regional perfusion. The SVG graft was anastomosed to an OM branch. ICG visualization allowed for assessment of graft patency excluding potential technical anastomosis problems or graft twisting or dissection. The myocardial perfusion observed in real-time confirmed regional distribution to the entire lateral wall and minimally to the inferior wall. These findings were confirmed in all the specimens used in the study.

Conclusions: Besides assisting the identification of intramyocardial vessels, ICG can provide information on the native coronary circulation status and the territorial distribution of the perfusion before and after grafting. It enables visualization of collaterals and the territory of distribution subtended by a graft offering real-time assessment and guidance on the grafting strategy.

Cardiac manifestations in systemic sclerosis (SSc) are variable and are associated with a poor prognosis, frequently resulting in impaired right ventricular function and heart failure. A high proportion of patients with SSc experience pulmonary arterial hypertension (PAH), interstitial lung disease, or myocardial involvement, all of which can lead to exercise intolerance. In this context, cardiopulmonary exercise testing (CPET) is a useful tool for diagnosing exercise intolerance, elucidating its pathophysiology, and assessing its prognosis. CPET can also identify patients with SSc at higher risk of developing PAH. Despite its utility, current guidelines for CPET do not include the evaluation of patients with SSc, nor do standard SSc management guidelines consider CPET in the clinical work-up. This review summarizes the development, supporting evidence, and application of CPET in assessing cardiac involvement in patients with SSc.

Background: Aspirin treatment is recommended as a secondary prevention strategy and could be a potential primary prevention strategy for cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM). However, aspirin resistance is notably common among diabetic patients, compromising the efficacy of aspirin treatment. Hence, our study sought to assess the clinical predictors of aspirin resistance (AR) in T2DM patients.

Methods: We conducted a systematic search of three major medical databases (PubMed, Embase, and Cochrane Library) to identify relevant articles up to September 17, 2024. Details of publications and investigated parameters were extracted from the selected studies. The meta package in the R language software was utilized to synthesize the evidence concerning clinical predictors of AR. We applied either a fixed- or random effects model based on the heterogeneity observed among the included studies. The pooled results were visually displayed using forest plots.

Results: In total, 10 publications were finally included in our study (n = 2113 patients). AR was predominantly linked to specific laboratory parameters, particularly those indicative of heightened insulin resistance and inadequate lipid management. Specifically, the laboratory parameters associated with AR included fasting glucose level (mean difference (MD) = 8.21; 95% confidence interval (CI) = 2.55 to 13.88), glycated hemoglobin (MD = 0.22; 95% CI = 0.06 to 0.38), high-density lipoprotein (HDL) level (MD = -2.02; 95% CI = -3.62 to -0.42), low-density lipoprotein (LDL) level (MD = 7.00; 95% CI = 2.87 to 11.13), total cholesterol level (MD = 9.52; 95% CI = 4.37 to 14.67), and triglyceride levels (MD = 12.51; 95% CI = 3.47 to 21.55).

Conclusions: Markers associated with dyslipidemia and blood glucose levels are robust indicators of AR in individuals with T2DM. These findings imply that assessing lipid and glucose regulation could enhance the development of personalized preventive approaches for vascular complications linked to diabetes.

The prospero registration: CRD42023388170, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=388170.

Background: The relationship between diabetes and heart failure significantly impacts public health. This study assessed the prognostic nutritional index (PNI) as a predictor of heart failure risk in adult diabetic patients.

Methods: An analysis was performed on 1823 diabetic adults using data collected from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2016. Serum albumin levels and lymphocyte counts were combined to calculate the PNI. We used descriptive statistics categorized by PNI quartiles and performed multivariate logistic regression to adjust for variables including age, gender, ethnicity, and coexisting medical conditions.

Results: The median age (mean ± SD) was 59.942 ± 12.171 years, and the mean value ± SD of the PNI was 52.412 ± 5.430. The prevalence of heart failure was 7.405%. In the fully adjusted model, for each 1-unit increase in PNI, the risk of heart failure decreased by 8.2% (odds ratio (OR), 0.918; 95% confidence interval (CI) 0.884, 0.953). Participants in the highest PNI quartile (Q4) had a 63% reduced risk of heart failure compared to those in the lowest quartile (Q1). Tests for interactions did not reveal any statistically significant differences among these stratified subgroups (p for interaction > 0.05).

Conclusions: This study demonstrated that a higher PNI was significantly associated with a decreased prevalence of heart failure in adults with diabetes.

Coronary microvascular dysfunction (CMD) comprises a wide spectrum of structural and/or functional abnormalities of coronary microcirculation that can lead to myocardial ischemia. Emerging evidence has indicated that CMD is a relevant cause of morbidity and mortality and is associated with a high risk of major adverse cardiovascular events (MACEs) and heart failure with preserved ejection fraction as well as poor quality of life. This review aims to elucidate briefly the pathogenesis and diagnostic modalities of CMD and to shed light on contemporary evidence on the prognostic impact of CMD. Finally, we will provide an overview of novel emerging therapeutic strategies for CMD.

Background: Hypertension is one of the most prevalent disorders encountered in medical practice, yet effective pharmacotherapy options for resistant hypertension are limited. In this meta-analysis, we aimed to evaluate the efficacy and safety of aprocitentan in treating hypertension.

Methods: We searched PubMed, Embase, ClinicalTrials.gov, and the Cochrane Library databases from inception to June 3, 2024, for randomized controlled trials (RCTs) that compared the efficacy and safety between aprocitentan and placebo in treating hypertension. According to the dosage of aprocitentan, the study was divided into a low-dose group (10-12.5 mg), medium-dose group (25 mg), and high-dose group (50 mg).

Results: This meta-analysis included five RCTs, which incorporated 1224 patients, and displayed that aprocitentan can reduce the mean sitting systolic blood pressure (msSBP) [(low dose subgroup: mean difference (MD): -3.85 mmHg; 95% confidence interval (CI): -7.47 to -0.23; p = 0.040; medium dose group: MD: -5.56 mmHg; 95% CI: -10.69 to -0.44; p = 0.030)], mean sitting diastolic blood pressure (msDBP) (low dose subgroup: MD: -3.95 mmHg; 95% CI: -4.06 to -3.85; p < 0.001; medium dose group: MD: -4.75 mmHg; 95% CI: -5.91 to -3.60; p < 0.001), 24-hour ambulatory systolic blood pressure (maSBP) (low dose group: MD: -4.18 mmHg; 95% CI: -4.32 to -4.04; p < 0.001; medium dose group: MD: -5.89 mmHg; 95% CI: -6.03 to -5.75; p < 0.001), and 24-hour ambulatory diastolic blood pressure (maDBP) (low dose group: MD: -4.33 mmHg; 95% CI: -4.42 to -4.24; p < 0.001; medium dose group: MD: -5.82 mmHg; 95% CI: -5.91 to -5.73; p < 0.001). In the high-dose group, there was no difference between the aprocitentan and placebo groups in the msSBP (MD: -4.83 mmHg; 95% CI: -11.44 to 1.79; p = 0.150). Meanwhile, the safety profile of aprocitentan was good, and no significant differences in the frequency of adverse events (AEs) and serious adverse events (SAEs) were observed compared to the placebo.

Conclusions: Aprocitentan significantly reduces blood pressure and has a good safety profile. However, it is worth noting that high doses of aprocitentan (50 mg) did not yield better blood pressure-lowering effects.