Therapeutic Advances in Cardiovascular Disease最新文献

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.

Background: It is crucial to timely recognize individuals presenting high-risk characteristics indicative of acute myocardial infarction.

Objectives: Our study aimed to analyze the significance of evaluating ST-segment depression in patients with acute inferior myocardial infarction (MI). We assessed precordial ST-T changes as an indicator of ongoing ischemia, examined their correlation with the extent of coronary artery involvement, and potential association with both early and late cardiac outcomes.

Methods: We enrolled 200 hospitalized patients with acute inferior MI who displayed ST depression in their precordial leads and underwent angiography. Individuals were divided into three groups based on the location of ST depression (V1-V3, V4-V6, and V1-V6). Demographic and echocardiographic data were extracted, and cardiac outcomes were assessed during hospitalization and follow-ups.

Results: The findings revealed significant associations between ST depression in leads V1-V6 and V4-V6 with left ventricular systolic dysfunction, mitral regurgitation severity, and the extent of coronary artery stenosis in comparison with ST depression in V1-V3 (p < 0.05). Furthermore, a notable connection was found between the involved vessels and the degree of ST depression in precordial leads (p < 0.05). Moreover, individuals with prominent ST depression in V1-V6 and V1-V3 exhibited poorer outcomes (p < 0.05).

Conclusion: Greater ST-segment depression in V1-V6 and V4-V6 in comparison with V1-V3 may signal multivessel disease, severe ischemia. Adverse outcomes like heart failure showed in V1-V6 especially V1-V3 versus V4-V6. This ST depression in acute inferior MI patients could indicate simultaneous ischemia or necrosis in other left ventricle regions, worsening cardiac function and prognosis. Thus, timely interventions are crucial.

Carotid blowout syndrome (CBS) is a potentially fatal condition requiring prompt diagnosis and intervention. CBS primarily affects patients with a history of surgery or irradiation for head and neck malignancies. In this report, we describe a case of CBS in which the carotid artery ruptured 2 months after carotid artery stenting in a patient with a previous history of surgery and irradiation for pharyngeal cancer. Although the distance between the orifice of the common carotid artery and the ruptured site was short, the "no-touch" technique-using the Newton-shaped stiff inner catheter (Newton-T^®, Medikit) during the guiding catheter navigation-and snare fixation enabled a stable procedure. Two self-expanding covered stents (GORE^® VIABAHN^®, Gore) covered the ruptured site. Despite adverse conditions, the combination of these techniques led to effective management of impending CBS, a potentially fatal disease. This case report highlights the feasibility of covered stents for CBS and the techniques used for guiding catheter navigation and stabilization throughout the procedure.

Background: Patients post-coronary artery bypass graft (CABG) can re-present with acute coronary syndrome (ACS); however, culprit lesion identification, as well as revascularization, is often challenging. Furthermore, the impact of revascularization in this patient group is relatively unknown.

Objectives: The purpose of our study was to evaluate the efficacy of percutaneous coronary intervention (PCI) in patients with previous CABG surgery presenting with ACS.

Methods: Using data from the Manitoba Center for Health Policy, we identified patients treated with CABG between April 1979 and March 2018, who subsequently presented with the primary diagnosis of ACS. Patients were divided into four groups: (1) managed medically and not investigated by cardiac catheterization and (2) investigated by cardiac catheterization and treated (2a) medically, (2b) with PCI, and (2c) with redo-CABG. Inverse probability treatment-weighted survival analyses were performed. Ethical approval was obtained from the local research board.

Results: Nearly 20% of patients treated with CABG presented with ACS at a median of 7.2 years (age at the time of CABG: 66 years (interquartile range: 58-73 years); 75.6% male). Patients treated with PCI (N = 929) demonstrated improved survival compared to the patients investigated by catheterization but treated medically (N = 952; hazard ratio 0.87, 95% confidence interval 0.77-0.97, p = 0.02). Patients who underwent redo CABG (N = 171) experienced 13% mortality within the first year, but subsequently, demonstrated a trend toward improved survival.

Conclusion: ACS is not uncommon following CABG. Revascularization is associated with prognostic improvement; however, such could be accounted for by inherent group differences, including comorbidities and coronary anatomy These findings should be validated in a prospective randomized study.

Objective: The goal of this study was to compare the computed tomography angiography scans of the segmentation results from the Cvpilot, 3mensio, and Volume Viewer systems to explore the practicability of the Cvpilot system in the automatic segmentation and technical evaluation of the aortic root before transcatheter aortic valve replacement (TAVR).

Design: A total of 154 patients who underwent TAVR at our center from January 2022 to May 2023 were enrolled, and their computed tomography angiography images were analyzed using the Cvpilot, 3mensio, and Volume Viewer systems, respectively.

Setting: Not applicable.

Participants: Not applicable.

Main outcome measures: The reconstructed computed tomography angiography images were evaluated by experts, and the measurements of the aortic roots were analyzed statistically.

Results: Compared with the 3mensio system, 92.2% of patients (n = 142) evaluated with the Cvpilot system reached grade A, 5.2% of patients (n = 8) reached grade B, and 2.6% of patients (n = 4) reached grade C. Compared with the Volume Viewer system, 90.9% of patients (n = 140) evaluated with the Cvpilot system achieved grade A, 7.1% of patients (n = 11) achieved grade B, and 2.0% of patients (n = 3) achieved grade C. Furthermore, there was no significant difference among the measurement results of the Cvpilot, 3mensio, and Volume Viewer systems (all p > 0.05).

Conclusion: Overall, the Cvpilot system is effective and reliable. It can accurately complete the segmentation and the measurement of aortic root structures, thereby effectively improving the measurement quality before TAVR.

Trial registration: Not applicable.

Background: Extensive surgical resection of the thoracic aorta in patients with type A aortic dissection (TAAD) is thought to reduce the risk of late aortic wall degeneration and the need for repeat aortic operations.

Objectives: We evaluated the early and late outcomes after aortic root replacement and supracoronary ascending aortic replacement in patients with TAAD involving the aortic root.

Design: Retrospective, multicenter cohort study.

Methods: The outcomes after aortic root replacement and supracoronary ascending aortic replacement in patients with TAAD involving the aortic root, that is dissection flap located at least in one of the Valsava segments, were herein evaluated. In-hospital mortality, neurological complications, dialysis as well as 10-year repeat proximal aortic operation, and mortality were the outcomes of this study.

Results: Supracoronary ascending aortic replacement was performed in 198 patients and aortic root replacement in 215 patients. During a mean follow-up of 4.0 ± 4.0 years, 19 patients underwent 22 repeat procedures on the aortic root and/or aortic valve. No operative death occurred after these reinterventions. The risk of proximal aortic reoperation was significantly lower in patients who underwent aortic root replacement (5.5% vs 12.9%, adjusted subdistributional hazard ratio (SHR) 0.085, 95% CI 0.022-0.329). Aortic root replacement was associated with higher rates of in-hospital (14.4% vs 12.1%, adjusted odds ratio 2.192, 95% CI 1.000-4.807) and 10-year mortality (44.5% vs 30.4%, adjusted hazard ratio 2.216, 95% CI 1.338-3.671). Postoperative neurological complications and dialysis rates were comparable in the study groups.

Conclusion: Among patients with TAAD involving the aortic root, its replacement was associated with a significantly lower rate of repeat proximal aortic operation of any type compared to supracoronary aortic replacement. Still, aortic root replacement seems to be associated with an increased risk of mortality in these patients.

ClinicalTrials.gov: NCT04831073 (https://clinicaltrials.gov/study/NCT04831073).

Background: Hereditary transthyretin amyloidosis (hATTR) is caused by mutations in the transthyretin (TTR) gene, which lead to the aggregation of misfolded TTR protein and amyloid accumulation in the peripheral nerves, heart, and gastrointestinal tract. Recently, RNA therapeutics, including small interfering RNAs (siRNAs) and antisense oligonucleotides (ASOs), have been approved for treating patients with hATTR.

Objectives: To assess the neurological efficacy and safety of RNA therapeutics in hATTR patients.

Design: Systematic review and meta-analysis.

Data sources and methods: A systematic literature search was conducted on PubMed, Cochrane, and ClinicalTrials.gov from inception to August 14, 2024. Outcomes included changes from baseline in the Norfolk Quality of Life-Diabetic Neuropathy (Norfolk QOL-DN) score and the modified Neuropathy Impairment Score +7 (mNIS + 7), modified body mass index (mBMI), adverse effects, serious adverse events, and all-cause mortality.

Results: Our study included four RCTs with 842 patients (568 in the RNA therapeutics group and 274 in the placebo group). RNA therapeutics significantly improved Norfolk QoL-DN (mean difference (MD), -18.79; 95% CI, -22.32 to -15.25; p < 0.00001; I² = 28%) and mNIS + 7 scores (MD, -26.90; 95% CI, -31.67 to -22.13; p < 0.00001; I² = 61%), with significant preservation of mBMI (MD, 114.98; 95% CI, 90.64-139.32; p < 0.00001; I² = 59%) compared to placebo. There were no significant differences between the two groups regarding the risk of adverse effects (risk ratio (RR), 0.89; 95% CI, 0.69-1.15; p = 0.36; I² = 34%), serious adverse effects (RR, 0.70; 95% CI, 0.31-1.58; p = 0.39; I² = 20%), and all-cause mortality (RR, 0.70; 95% CI, 0.31 to 1.58; p = 0.39; I² = 20%).

Conclusion: RNA therapeutics are effective and well-tolerated in patients with hATTR, significantly improving quality of life and the progression of neurological impairment. siRNAs demonstrate better outcomes compared to ASOs.

Trial registration: PROSPERO (CRD42024568346).