Therapeutic Advances in Cardiovascular Disease最新文献

Background: Guideline-directed medical therapy (GDMT) prolongs survival in patients with heart failure with reduced ejection fraction (HFrEF). However, different countries implement GDMT differently, and many patients are still undertreated. Therefore, this study aimed to assess GDMT utilization in patients with chronic HFrEF at the adult cardiac clinics of three selected hospitals in Addis Ababa, Ethiopia.

Methods: An explanatory sequential mixed-methods (quantitative cross-sectional followed by qualitative phenomenological) study design was used to assess GDMT usage in patients with HFrEF at the study settings from September 25 to November 25, 2022. Simple random and purposive sampling techniques were used to select participants for the quantitative and qualitative studies, respectively. Adherence level was defined as good (adherence score = 1), moderate (0.5 < score <1), and poor (score ⩽0.5). Quantitative data were analyzed using Statistical Package for the Social Sciences (SPSS) version 26.0. Logistic regression model was used to determine the association. Statistical significance was declared at p < 0.05. Qualitative data were analyzed with MAXQDA 2020.

Results: Three hundred forty-one patients were included in the quantitative study. Adherence to GDMT was good in 128 (37.5%) of the patients. Patient parameters, including female gender (adjusted odds ratio (AOR) = 0.55, 95% CI: 0.32-0.93), unable to read and write (AOR = 0.31, 95% CI: 0.11-0.86), primary education (AOR = 0.27, 95% CI: 0.12-0.63), were negatively associated with Physicians' good adherence. Hypertension was associated with lower odds of physicians' good adherence (AOR = 0.41, 95% CI: 0.21-0.78). Absence of comorbidities (other than hypertension; AOR = 2.65, 95% CI: 1.36-5.15) were positive predictors. System, patient, and physician-related factors were reported as barriers to intensifying GDMT.

Conclusion: Nearly one-fourth of eligible patients were on ⩽50% of guidelines-recommended drugs. Female gender, educational level, and comorbidities were the factors associated with adherence to GDMT. System, patient, and physician-related reasons for poor adherence were identified. Multipronged interventions are required to address those adherence barriers.

Pulmonary artery aneurysms (PAAs) are a rare pathology with potentially devastating consequences. In this case series, we describe two cases of clinically isolated pulmonary arteritis and concisely review the literature surrounding this new clinical entity. Two Caucasian women, aged 65 and 73, were referred to our cardiovascular surgery center with incidental PAAs, both growing to over 65 mm in main pulmonary artery diameter. Both participants underwent serial thoracic CT-angiograms to monitor the pulmonary artery aneurysms. Both pulmonary artery aneurysms showed an interval increase in diameter, so they were repaired surgically. The main pulmonary artery was excised in both cases and replaced with a synthetic graft. No pre- or postoperative corticosteroids were administered. Neither of our patients had systemic symptoms of giant cell arteritis or elevated inflammatory markers. In both cases, only the main pulmonary artery was replaced to minimize surgical complexity and risk; however, the left pulmonary artery of one patient began to further dilate 5 years postoperatively. Currently, no reintervention is planned. These cases represent mounting evidence for the existence of clinically isolated pulmonary arteritis leading to a pulmonary artery aneurysm. This entity is analogous to clinically isolated aortitis and may represent a subclinical smoldering vasculitis. These rare aneurysms can progress over time and require surgical intervention. In the absence of guidelines for pulmonary artery aneurysm intervention, the present cases will serve to guide further management of this rare disease.

Background: Despite continuous advances in management over the last two decades for pulmonary embolism (PE), treating intermediate- to high-risk PE remains challenging. There is a critical need to expand our understanding of the clinical spectrum beyond systolic blood pressure (SBP) to inform the intricate decision-making process for initiating advanced treatment in patients with intermediate- to high-risk PE.

Objectives: We aimed to characterize the range of SBP values in patients with intermediate- to high-risk PE undergoing advanced therapy across different clinical settings. The secondary objective included the incidence of bleeding complications (intracranial, major, and minor).

Design: We conducted a systematic review in alignment with PRISMA guidelines. The review involves a comprehensive, structured search of multiple electronic databases.

Data sources and methods: We created two groups: Group 1, case reports and series, and Group 2, randomized control trials and cohorts with intermediate-risk PE who underwent advanced treatment. In addition, we performed an exploratory analysis in Group 1, created solely for descriptive purposes, to determine the frequency of the previously mentioned impending deterioration factors in the literature and further clarify their potential role in initiating advanced treatment.

Results: We identified 1871 intermediate-high risk PE patients who received advanced therapy, divided into two groups: Group 1 for case reports and series, and Group 2 for randomized controlled trials and cohorts. In total, 77.1% reported SBP; the weighted average was 125.8 and 129.2 mmHg for Groups 1 and 2, respectively. The most common initial clinical presentations were dyspnea, syncope, and chest pain. In the exploratory analysis, we found that borderline SBP (110-120 mmHg), right ventricular dysfunction, and heart rate (⩾120 bpm) were the most frequent impending clinical deterioration factors.

Conclusion: This systematic review shows that the SBP range for advanced treatment (129.2 and 125.8 mmHg) aligns with previous clinical models. However, it is important to recognize that while these SBP ranges may suggest practice variation, causality or definitive clinical instability cannot be inferred from aggregate data without patient-level outcomes. Outside of randomized controlled trials, clinical decision-making regarding advanced treatment may not fully align with international recommendations in real-world scenarios.

Trial registration: Research Registry number: 2065.

Artificial intelligence (AI) and machine learning are rapidly transforming cardiac electrophysiology, offering new avenues for diagnosing, managing, and treating cardiac arrhythmias. These technologies leverage diverse data sources, including clinical records, imaging, and electrical waveforms, to support decision-making and optimize outcomes, particularly in procedures such as cardiac ablation. This scoping review explores the evolving role of AI in cardiology, emphasizing its applications in diagnostics, predictive analytics, and procedural innovations. It also examines the collaborative dynamics of interdisciplinary teams, highlighting how professionals, such as electrophysiologists, computer scientists, clinicians, nurses, perfusionists, and technologists, contribute to identifying and solving key challenges in the field. The integration of AI into cardiology is not only enhancing diagnostic precision and patient outcomes but also streamlining healthcare delivery. As technological capabilities expand, AI is poised to play an increasingly central role in preventive cardiology, enabling more accurate risk assessments, earlier interventions, and the promotion of healthier lifestyles. However, the successful implementation of AI requires thoughtful coordination across disciplines and a clear understanding of its limitations and ethical considerations. This review underscores the importance of fostering interdisciplinary collaboration and aligning AI innovations with clinical needs. It also identifies barriers to adoption and proposes strategies for integrating AI tools into routine practice. Ultimately, the findings aim to guide stakeholders, including researchers, clinicians, and policymakers, in advancing the development and application of AI systems in cardiology. By doing so, the healthcare community can move toward reducing the global burden of cardiovascular disease and improving population health. The insights presented here, after a review of 142 studies, offer a roadmap for future research and clinical integration, ensuring that AI continues to serve as a catalyst for innovation and excellence in cardiac care.

Cardiovascular imaging (CVI) provides an essential and accurate assessment of cardiac anatomy, function, and prognosis, thereby guiding management planning in long-term illnesses. It plays an essential role in modern cardiology in Iraq, where the adoption of advanced CVI technologies has enhanced diagnostic precision and patient care. However, there are some limitations that may interrupt the specialized improvement process, including a shortage of specialized personnel, limited infrastructure, and economic barriers. To address these challenges, the Iraqi Council of Cardiology established a nationally accredited CVI fellowship program in 2019. The key feature to initiate the program is the deliberate integration of diversity, particularly gender and geographic representation, into the training framework. This approach yielded a significantly high participation of women in CVI compared to other cardiology subspecialties in Iraq, which eventually reflected a special regional trend and productive response to workforce gaps. Also, geographic diversity has widened access to expertise across governorates, supporting equitable healthcare delivery. Regardless of these advances, marked progress needs continued investment in infrastructure and alignment with international standards. Furthermore, expanding and strengthening research capacity and fostering international collaborations will be critical to advance the whole process. The Iraqi CVI program has illustrated the framework of policy, training, and workforce planning that will overcome systemic limitations and contribute to the advancement of equitable cardiovascular care in resource-limited settings.

Structural heart disease (SHD) encompasses a wide range of congenital and acquired cardiac abnormalities, increasingly treated with transcatheter interventions. Echocardiography plays a crucial role in optimising these procedures, providing high-resolution imaging for pre-procedural planning, real-time guidance and post-intervention assessment. The shift from two-dimensional to advanced three/four-dimensional (3D/4D) echocardiography has significantly enhanced the visualisation of complex cardiac structures, improving procedural success and patient safety. The purpose of this review article is to provide an overview of the vital role of echocardiography in key structural heart interventions, including mitral transcatheter edge-to-edge repair, transcatheter aortic valve replacement, paravalvular leak closure, left atrial appendage occlusion and atrial septal defect closure. It highlights the integration of 3D/4D imaging and advanced Doppler techniques in refining procedural precision, optimising decision-making, and improving patient outcomes. The evolving field of interventional echocardiography continues to shape SHD management, making more minimally invasive treatments available to patients.

Background: Inflammation significantly impacts disease progression and prognosis in acute pulmonary embolism (APE); however, the optimal method to quantify this inflammation for prognostic purposes remains unclear.

Objectives: We aimed to identify the most effective blood-based inflammatory marker for predicting short-term mortality in patients with APE.

Methods: We retrospectively analyzed 301 patients with APE. We compared the predictive performance of nine inflammatory markers for 30-day mortality, focusing on the inflammatory burden index (IBI), and contrasted it with the standard clinical score (sPESI).

Results: After adjusting for potential confounders, a higher IBI was strongly and independently associated with an increased risk of 30-day mortality. IBI demonstrated superior predictive ability compared with all other inflammatory markers and the sPESI score. The relationship between IBI and mortality risk was linear; higher IBI values corresponded to greater mortality risk.

Conclusion: IBI is a robust and independent predictor of short-term survival in patients with APE. Calculated from routine blood tests (C-reactive protein, neutrophil, and lymphocyte counts), it offers a simple, rapid, and cost-effective tool that may enhance early risk stratification and guide personalized treatment decisions in clinical practice. Further validation in independent cohorts is required to confirm its prognostic utility.

Severe burn injuries result in a massive systemic inflammatory and hypermetabolic response, often disrupting multiple organ systems, including the cardiovascular system. Cardiac troponins are frequently elevated in burn patients, but the interpretation of these elevations is hardly straightforward. Sometimes, elevated troponin means type 1 myocardial infarction (MI) due to an acute coronary event, but it might also reflect type 2 MI due to an imbalance between body oxygen demand and supply, or even non-ischemic myocardial injury from things like overwhelming inflammation, sepsis, or direct thermal effects on the heart itself. This narrative review explores the prevalence, underlying pathophysiological mechanisms, diagnostic challenges, and prognostic implications of troponin elevation in burn patients. We discussed the limitations of applying conventional MI diagnostic criteria in this unique population. The role of electrocardiographic and echocardiographic assessment, as well as the potential utility of high-sensitivity troponin assays, is also discussed. Understanding of how burn pathophysiology relates to myocardial injury is essential for accurate diagnosis, improved management, and better outcomes in this highly vulnerable group of patients.

Background: Heart failure (HF) remains a major public health challenge in India, with a need for effective and well-tolerated therapeutic strategies.

Objective: The RESTORE-HF study evaluated the real-world effectiveness and safety of torsemide-spironolactone fixed-dose combination (FDC) in Indian patients with HF.

Design: Prospective, multicenter, observational study.

Methods: This study was conducted across 101 sites in India. Patients aged 18-75 years with HF with reduced ejection fraction and signs of congestion were enrolled and initiated on the torsemide-spironolactone FDC. Participants were followed over 3 weeks from baseline. The primary objective was the change in body weight. Secondary endpoints included changes in New York Heart Association (NYHA) functional class, edema, occurrence of adverse events (AEs), and physician and patient assessments of efficacy and tolerability.

Results: Of the 1841 patients screened, 1752 were enrolled, and 1520 completed the study. The mean (SD) age of participants was 58.61 (9.45) years, of whom 61.05% were male. The study showed a significant reduction in mean body weight was observed from 75.54 kg at baseline to 73.13 kg at week 3 (mean difference: 2.41 kg; p < 0.0001). Additionally, an improvement in NYHA functional class and edema was observed over 3 weeks from baseline. Overall, 22.11% patients achieved no-edema stage. Only three mild AEs related to loose stools were reported, and no serious AEs or deaths occurred. Over 98% of physicians and patients rated the therapy favorably.

Conclusion: The RESTORE-HF study demonstrated that the torsemide-spironolactone FDC may be associated with a mean body weight reduction of 2.41 kg and may be generally well-tolerated in Indian heart failure patients. Furthermore, the FDC may be linked to significant symptomatic improvement over 3 weeks in real-world clinical practice.

This review aims to describe the sex differences in heart failure (HF) patients, with a particular emphasis on the effect of cardiovascular ageing. Additionally, it takes into consideration the sex-related variation in cardiovascular health and physiology and the role ageing plays in HF and its implications in drug therapy. The pharmacokinetics and pharmacodynamics of the common HF medications, classified according to the established sub-types, are summarised with respect to sex-specific documented findings. Despite numerous studies confirming significant differences in HF outcomes according to sex, there are no current guidelines that consider patients' sex in medical therapy of HF. Moreover, females are significantly under-represented in research trials, as well as under-treated in clinical practice, which hinders our understanding of HF in this demographic. Most of the current knowledge on sex-specific HF therapies is driven by secondary analyses of studies not primarily undertaking sex-specific analyses. Therefore, we propose a multi-faceted approach, including increased awareness among healthcare providers and more inclusive research to create a personalised care plan accounting for sex differences in HF management. Given the highlighted knowledge gaps, it is paramount for new research efforts to account for the different sex phenotypes in HF.