Reviews in cardiovascular medicine最新文献

Background: The substrates for arrhythmias in myocarditis and ischemic heart disease (IHD) are different, but it is yet to be determined whether there is a difference in outcomes following catheter ablation (CA) for ventricular tachycardia (VT) associated with these two conditions. This study aimed to compare outcomes after CA of VT in patients with myocarditis versus those with IHD.

Methods: Patients undergoing CA for sustained VT confirmed by endomyocardial biopsy as myocarditis, and patients with IHD experiencing sustained VT undergoing CA were retrospectively enrolled from February 2017 to March 2023. Initially, an endocardial approach was employed, reserving epicardial ablation procedures for non-responders. The primary endpoint was VT recurrence during follow up. All-cause mortality, repeat CA for VT and implantable cardioverter-defibrillator (ICD) implantation served as secondary endpoints. Kaplan-Meier curves compared outcomes between patient groups.

Results: This study included 109 patients with IHD and 20 patients with myocarditis who underwent CA for sustained VT, from February 2017 to March 2023. Compared with IHD patients, myocarditis patients had a statistically significant lower complete short-term success rate of CA (60.0% vs. 85.3%, p = 0.013). During a follow-up period of 37 ± 21 months, 8 (40.0%) myocarditis patients experienced VT recurrence compared to 57 (52.3%) IHD patients, with no statistically significant difference between the two groups. During follow-up, 2 (10.0%) myocarditis patients died and 2 (10.0%) underwent repeat CA for VT recurrence, while 9 (8.3%) IHD patients died, 14 (12.8%) underwent a second CA for VT recurrence, and 8 (7.3%) received an ICD implantation. Additionally, there were no notable variations between the two groups regarding all-cause mortality, repeat CA for VT and ICD implantation.

Conclusions: It was demonstrated that the efficacy of CA in sustained VT in myocarditis patients was similar to that in IHD. For myocarditis patients with VT, CA might be equally effective.

Ventricular depolarization refers to the electrical activation and subsequent contraction of the ventricles, visible as the QRS complex on a 12-lead electrocardiogram (ECG). A well-organized and efficient depolarization is critical for cardiac function. Abnormalities in ventricular depolarization may indicate various pathologies and can be present in all leads if the condition is general, or in a subgroup of anatomically contiguous leads if the condition is limited to the corresponding anatomic location of the heart. Furthermore, the assessment of depolarization abnormalities on the ECG may either be identified visually or this may depend on further processing. In recent decades, assessment of depolarization abnormalities has received a lot of attention for cardiac risk stratification. This risk stratification aims to identify patients at high risk of adverse cardiac events, to tailor preventive or therapeutic interventions. In this review, we provide an oversight of different techniques for assessing abnormal ventricular depolarization and their value in diagnosing certain conditions, in risk stratification of adverse events, and in guiding therapeutic decisions. This includes QRS alterations directly corresponding to cardiac conditions, such as bundle branch blocks, or the presence of a delta wave, and also metrics aiming to qualitatively or quantitatively assess myocardial scarring, such as QRS (micro)fragmentation and QRS-scoring, and techniques assessing abnormal late depolarizations, such as signal-averaged ECG. While most established assessments of abnormal depolarization rely on human interpretation and are limited by visual detection, recently introduced analyses, such as QRS micro-fragmentation, aim to tackle these limitations. Besides eliminating bias, these automated analyses bypass the need for human interpretation, thereby paving the way for large population studies.

Background: Neuromodulation has been shown to increase the efficacy of atrial fibrillation (AF) ablation procedures. However, despite its ability to influence the autonomic nervous system (ANS), the exact mechanism of action remains unclear. The activity of the ANS via the intracardiac nervous system (ICNS) can be inferred from heart rate variability (HRV). Therefore, this study aims to investigate the significance of changes in the ICNS prior to the onset of AF by analyzing the evolution of HRV in a large new cohort of patients.

Methods: We selected and annotated recordings with AF and atrial flutter from our database of 95,871 Holter recordings. Each recording included both sinus rhythm and one or more AF episodes. We computed parameters estimating parasympathetic activity (root mean square of successive RR interval differences (RMSSD) and percentage of successive RR intervals that differ by more than 50 ms (pNN50)), as well as HRV frequential parameters a few minutes before AF onset. To allow a minute-by-minute assessment of the parameter changes, we computed their values over 5-minute sliding windows, starting at 35 minutes before AF onset.

Results: The mean age of the whole group of patients was 71.1 ± 11.3 years (range 35-99), the total number of episodes was 1319 on 623 recordings from 570 patients, with an average of 2.1 ± 2.2 episodes per recording (range 1-17) and 2.3 ± 2.6 episodes per patient (range 1-21). The proportion of premature atrial contractions (PACs) increased from 4.8 ± 0.3%, 35 minutes before the onset of AF to 8.3 ± 0.4%, 5 minutes before the AF episode. We measured a statistically significant increase in very-low-frequency (VLF), low-frequency (LF), high-frequency (HF), RMSSD and pNN50 between 35 minutes and 5 minutes before AF onset.

Conclusions: Our data suggest that a significant short-term increase in vagal activity precedes most AF events. Dynamic changes in HRV parameters could be considered when determining the optimal neuromodulation strategies.

Background: This study aimed to analyze the metabolic risk factors for microcirculation disorders in patients with unstable angina (UA) after percutaneous coronary intervention (PCI), evaluating their predictive value for developing microcirculation disorders.

Methods: A single-center retrospective study design was used, which included 553 patients with UA who underwent PCI. The angiographic microcirculatory resistance (AMR) index was calculated based on coronary angiography data. Patients were divided into two groups according to their post-PCI AMR values: a post-PCI AMR ≤2.50 group and a post-PCI AMR >2.50 group. Variables were included in the multivariate regression model through univariate regression and variance inflation factor (VIF) screening. Subgroup analyses were conducted by sex to further evaluate the predictive value of selected variables in the overall sample. The total sample was randomly split into a 7:3 ratio for the training and validation sets. A nomogram based on the training sets was then constructed to visualize these predictions. The discrimination and calibration of the prediction model were evaluated using the receiver operating characteristic (ROC) curve and calibration curve.

Results: The post-PCI AMR >2.50 group had a higher percentage of females, increased incidence of diabetes, and elevated fasting blood glucose (FBG), glycated hemoglobin (HbA1c), triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), and lipoprotein(a) (Lp(a)) levels (p < 0.05). Logistic regression analysis identified HbA1c, TG, LDL-C, and Lp(a) as independent predictors of elevated AMR post-PCI after adjusting for confounders. Subgroup analysis confirmed no significant interaction between the model and sex (p > 0.05). A nomogram was constructed based on the training set, with the area under the curve (AUC) for the ROC of 0.824 in the training set and 0.746 in the validation set. The calibration curves showed a good fit (training set: p = 0.219; validation set: p = 0.258).

Conclusions: HbA1c, TG, LDL-C, and Lp(a) levels are independent risk factors for microcirculation disorders in patients with UA post-PCI. The constructed nomogram provides good predictive accuracy.

Background: To explore the association between gamma-glutamyltransferase (GGT) and in-hospital heart failure (HF) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).

Methods: A total of 412 patients diagnosed with STEMI and treated with primary PCI were included in our study. Univariate and multivariate logistic regression models were used to evaluate the association between GGT and the risk of in-hospital HF in STEMI patients. The receiver operating characteristic (ROC) curve was used to assess the accuracy of GGT in predicting in-hospital HF.

Results: The incidence of HF after STEMI increased significantly with increasing GGT tertiles (the first, second, and third tertile groups were 7.97%, 14.49%, and 18.38%, respectively; p = 0.039). Multivariate logistic regression analysis revealed that the risk of HF in the second and third GGT tertile groups was 2.51 times greater (95% CI, 1.06-5.96) and 2.77 times greater (95% CI, 1.13-6.81), respectively, than that in the first GGT tertile group. Each 1-unit increase in the lnGGT level was related to a 1.88-fold increased risk of HF (odds ratio, OR, 1.88; 95% CI, 1.19-2.96; p = 0.007). Restricted cubic splines suggested a linear relationship between GGT and in-hospital HF (p for nonlinearity = 0.158). The area under the curve was 0.607 (95% CI, 0.558-0.654; p = 0.007) when GGT was used to predict in-hospital HF, with a sensitivity of 57.14% and a specificity of 64.04%. Moreover, the incidence of HF significantly increased in-hospital death risk (OR, 7.75; 95% CI, 1.87-32.12; p = 0.005).

Conclusions: GGT is positively associated with in-hospital HF and is an independent risk factor for in-hospital HF in STEMI patients.

Background: Currently, there are no standardized guidelines for graft allocation in heart transplants (HTxs), particularly when considering organs from marginal donors and donors after cardiocirculatory arrest. This complexity highlights the need for an effective risk analysis tool for primary graft dysfunction (PGD), a severe complication in HTx. Existing score systems for predicting PGD lack superior predictive capability and are often too complex for routine clinical use. This study sought to develop a user-friendly score integrating variables from these systems to enhance the efficacy of the organ allocation process.

Methods: Severe PGD was defined as the need for mechanical circulatory support and/or death from an unknown etiology within the first 24 hours following HTx. We used a meta-analytical approach to create a derivation cohort to identify risk factors. We then applied a logistic regression analysis to generate an equation predicting severe PGD risk. We used our previous experience in HTx to create a validation cohort. Subsequently, we implemented the formula in a smartphone application.

Results: The meta-analysis comprising six studies revealed a 10.5% ( 95% confidence interval (CI): 5.3-12.4) incidence rate of severe PGD and related 30-day mortality of 38.6%. Eleven risk factors were identified: female donors, female donor to male recipient, undersized donor, donor age, recipient on ventricular assist device support, recipient on amiodarone treatment, recipient with diabetes and renal dysfunction, re-sternotomy, graft ischemic time, and bypass time. An equation to predict the risk, including the 11 parameters (GREF-11), was created using logistic regression models and validated based on our experience involving 116 patients. In our series, 29 recipients (25%) required extracorporeal membrane oxygenation support within 24 hours post-HTx. The overall 30-day mortality was 4.3%, 3.4%, and 6.8% in the non-PGD and severe PGD groups, respectively. The area under the receiver operating characteristic (AU-ROC) curve of the model in the validation cohort was 0.804.

Conclusions: The GREF-11 application should offer HTx teams several benefits, including standardized risk assessment and bedside clinical decision support, thereby helping minimize the risk of severe PGD post-HTx.

Background: Hypertension-mediated organ damage (HMOD) is a critical complication of hypertension that can present with cardiac, retinal, and renal manifestations and affect patient outcomes. Serum signal peptide, CUB (complement C1r/C1s, Uegf, and Bmp1) domain, and epidermal growth factor-like domain-containing protein 1 (SCUBE-1), a novel biomarker implicated in vascular pathology, shows promise for detecting HMOD. This study aims to explore the relation between SCUBE-1 levels and HMOD in hypertensive patients.

Methods: This cross-sectional study included 115 participants, comprising 79 hypertensive patients and 36 healthy controls. The hypertensive patients were divided into two groups based on HMOD presence. SCUBE-1 levels were measured to evaluate their diagnostic utility in detecting HMOD.

Results: Hypertensive patients exhibited significantly higher SCUBE-1 levels than controls (160.70 ng/mL vs. 75.64 ng/mL, p < 0.001). Among these patients, those with HMOD (cardiac, retinal, and renal) displayed even higher SCUBE-1 levels (311.27 ng/mL, range 137.86-460 ng/mL) compared to those without HMOD (142.53 ng/mL, range 110.56-178.19 ng/mL). Receiver operating characteristic curve analysis indicated that SCUBE-1 levels have significant diagnostic potential for differentiating between hypertensive patients with and without HMOD with area under the curve values of 0.722 for cardiac, 0.761 for retinal, and 0.707 for renal damage.

Conclusions: Our study has revealed that SCUBE-1 levels are significantly elevated in hypertensive patients, particularly those with HMOD. The findings support the potential of SCUBE-1 as a valuable biomarker for predicting organ damage in hypertensive patients.

Breast arterial calcification (BAC) is a common benign finding on a screening mammogram. Additionally, BAC is a type of medial calcification known as Mönckeberg medial calcific sclerosis, which differs from the intimal calcification seen in patients with coronary artery disease (CAD). Recently, BAC has appeared as a new cardiovascular risk stratification method. Studies have indicated a potential link between BAC and cardiovascular risk factors, particularly coronary artery calcification (CAC), as observed in coronary computed tomography. However, the association between BAC and myocardial ischemia and angiographic-proven CAD remains controversial. The usefulness of BAC during mammography as a potential screening tool for CAD has been the subject of uncertainty and debate for many years. This article reviews the current literature on BAC and its association with CAC, myocardial ischemia, and angiographic-proven CAD on both invasive and coronary computed tomography. Cardiovascular outcomes, current limitations, and future investigation and recommendations are also explored and discussed.

Background: This article focuses on the effect of body mass index (BMI) on cardiac structure and function in cases with non-valvular atrial fibrillation (NVAF). Only a few articles have investigated the relationship between BMI and the incidence of left atrial thrombus (LAT) or spontaneous echo contrast (SEC) in cases with NVAF.

Methods: This single-center retrospective study was conducted at The First People's Hospital of Changzhou. A total of 282 patients who were diagnosed with NVAF and planned to undergo radiofrequency ablation from 2019 to 2022 were enrolled in this study. None of the patients received standardized anticoagulant therapy. The patients were divided into a normal weight group, an overweight group, and an obesity group based on their BMI. The differences in echocardiographic parameters and LAT/SEC incidences among the three groups were compared, and regression analysis was applied to determine the correlation between BMI and the occurrence rates of LAT/SEC. The generalized additive model (GAM) was used to clarify the dose-response association between BMI and LAT/SEC.

Results: Left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), left ventricular ejection fraction (LVEF), right atrial diameter (RAD), and the incidences of LAT/SEC were statistically different among the three groups. Univariate and multivariate logistic regression analyses indicated that BMI was related to the incidences of LAT/SEC. For each 1-unit increase in BMI, the odds of LAT/SEC increased by 12% (odds ratio (OR): 1.12, 95% CI: 1.02, 1.24). A threshold nonlinear relationship was found using the GAM between BMI and the risk of LAT/SEC.

Conclusions: BMI significantly affects multiple echocardiographic parameters in patients with NVAF, and BMI is an independent risk factor for LAT/SEC in cases with NVAF.

Background: Ceramide, a key molecule in sphingolipid metabolism, is recognized as a standalone predictor of long-term major adverse cardiac events (MACE). We explore if integrating the global registry of acute coronary events (GRACE) score with the ceramide risk score (ceramide test 1, CERT1) improves MACE prediction in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).

Methods: This cohort study included 210 participants with ACS undergoing PCI. MACE was defined as the recurrence of non-fatal acute myocardial infarction, repeat coronary revascularization procedures (PCI or coronary artery bypass grafting, CABG), or death excluding the initial event qualifying the patient for the study. The cumulative incidence of MACE was analyzed using the Kaplan-Meier method. Both univariate and multivariate Cox regression analyses identified MACE predictors. The predictive accuracy of combining the GRACE score with the CERT1 score was assessed using the area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI), and net reclassification improvement (NRI).

Results: During the 12-month follow-up period, 35 of the 210 participants experienced a MACE. The Kaplan-Meier analysis revealed a significant variation in MACE incidence stratified by the CERT1 score (χ² = 21.344, p < 0.001). Multivariate Cox regression analysis identified low-density lipoprotein (p = 0.002), quantitative flow ratio (p = 0.013), the CERT1 score (p = 0.005), and the GRACE score (p = 0.007) as independent predictors for MACE. Integrating the GRACE score with the CERT1 score improved prediction accuracy, raising the AUC from 0.733 to 0.834. This adjustment provided a more precise risk reclassification and discrimination between patients likely and unlikely to experience MACE (NRI: 0.526, p = 0.004; IDI: 0.120, p < 0.001).

Conclusions: The CERT1 score independently predicts long-term MACE for individuals diagnosed with ACS undergoing PCI. Including the CERT1 score significantly enhances the GRACE score's capacity to risk-stratify these patients.

Clinical trial registration: Registration number: ChiCTR2300068491 (https://www.chictr.org.cn/showproj.html?proj=180370).