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.

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.

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.

Background: Different accessible and low-cost biomarkers have been investigated to stratify patients with acute heart failure (AHF). One of them is the red cell distribution width (RDW), which proved to be a greater prognostic marker of mortality than other conventional markers.

Objective: Therefore, the objective of our study is to determine whether the anemic status modifies the magnitude of association between high RDW and 1-year mortality in patients with AHF.

Design: Observational, analytical, retrospective cohort study.

Methods: We included participants ⩾18 years old hospitalized with a diagnosis of AHF. As an association measure, a crude and adjusted generalized linear model of the Poisson family calculated the risk ratio (RR) with a 95% confidence interval (95% CI).

Results: In all, 709 participants with an average age of 73.48 years were included. At 1 year, the risk of dying was three times higher with high RDW (RR = 3.05, 95% CI: 1.39-6.66; p < 0.01). In anemic participants, the risk of dying at 1 year is two times greater with high RDW (RR = 2.18, 95% CI: 0.91-5.22; p = 0.07), while in non-anemic participants, the risk of dying increased almost seven times (RR = 6.95, 95% CI: 1.65-29.23; p < 0.01).

Conclusion: High RDW is a risk factor for mortality at 1 year in patients with AHF. A greater magnitude of association was found in non-anemic patients.

Background: Rapid interpretation of electrocardiography (ECGs) is essential for reducing patient mortality and morbidity associated with heart conditions. Despite its significance, many healthcare providers struggle to achieve proficiency in ECG interpretation.

Objective: This study assessed nurses' knowledge, practices, and associated factors regarding ECG interpretation in the emergency and intensive care units of selected public hospitals in Addis Ababa, Ethiopia.

Methods: A cross-sectional study was conducted to evaluate nurses' knowledge, practices, and factors related to ECG interpretation in selected public hospitals of emergency and intensive care units in Addis Ababa, Ethiopia. Data were collected using structured, self-administered questionnaires and analyzed using SPSS version 26. Binary logistic regression models were employed to identify associations between the dependent and independent variables.

Results: Among 255 of the study participants, only 60 (23.5%) and 69 (27.1%) of them demonstrated good knowledge and practice in ECG strip interpretation, respectively. The most frequently recognized ECG strip was asystole. Factors associated with good knowledge and practice encompassed holding a master's degree, receiving ECG training, and working in intensive care units.

Conclusion: This study identified the lack of knowledge and practice among nurses in ECG interpretation. The findings highlight the need for training programs and experience-sharing initiatives to enhance nurses' proficiency in ECG interpretation which might ultimately improve patient outcomes.