Background: The use of apixaban in chronic hemodialysis (HD) patients for non-valvular atrial fibrillation (NVAF) is still controversial regarding benefit of stroke protection vs risk of bleeding. Rotational thromboelastometry (ROTEM) is a point of care method that evaluates clot formation in whole blood and has been used as an evaluation tool for bleeding risk assessment in non-HD apixaban users.
Aim: To determine whether bleeding risk can be predicted using ROTEM activated with tissue factor (EXTEM) in HD patients receiving apixaban for NVAF.
Methods: Nineteen HD patients with NVAF treated with apixaban for at least 8 days were enrolled. Four dosing regimens were recorded as prescribed by their physician, from 2.5 mg once daily on a non-dialysis day to 5 mg twice daily. Standard coagulation tests, along with ROTEM and apixaban drug levels (using liquid anti-Xa assay) were performed once on a non-dialysis day before and two hours after apixaban morning pill administration. Patients were subsequently monitored for thrombotic/bleeding events and all-cause mortality.
Results: Over a median follow-up period of 36 months, six patients experienced a bleeding event (group A) and 13 remained free of bleeding (group B). Six deaths were recorded: Three due to major bleeding, one from thrombotic stroke, and two unrelated to coagulopathy. EXTEM clotting time (CT)-post was the only parameter that significantly differed between group A and group B (P = 0.013). Each 1-second increase in CT-post was linked to an 8% higher likelihood of a bleeding event (odds ratio = 1.08, 95% confidence interval: 1.0-1.17; P = 0.048). A significant progressive increase was observed with the drug's trough and peak levels (P < 0.05) across the four dosing regimens but no significant relationship was found between CT and apixaban dose groups.
Conclusion: Early detection of bleeding risk in HD patients with NVAF on Apixaban maybe be effectively achieved through frequent monitoring using ROTEM EXTEM post CT, thereby helping to reduce associated morbidity.
Background: Cardiac sarcoidosis (CS) is an infiltrative disease with manifestations such as non-sustained ventricular tachycardia (NSVT) and heart failure (HF). Antiphospholipid syndrome (APS) and antiphospholipid positivity (APP) are prothrombotic phenomena which elevate risk for thromboembolism. CS with active systemic sarcoid and APS/APP is a rare combination of diseases.
Case summary: A 54 year old male with HF presented with several cardiopulmonary symptoms. Chest imaging showed bilateral patchy and reticulonodular infiltrates. Subsequent lung biopsy confirmed pulmonary sarcoidosis. Positron emission tomography revealed active systemic sarcoidosis (SS) and fibrotic CS. Positive antiphospholipid antibodies without thromboembolism confirmed APP. HF and APP were managed with medical therapy. Fibrotic CS and NSVT required permanent cardiac device and antiarrhythmic therapy. SS was managed with early taper of steroids and transition to biologics.
Conclusion: Fibrotic CS with active SS and APS/APP has not been previously described in literature. This case utilized a modified approach for the management of this combination of diseases. As immunosuppressants such as steroids have limited utility in fibrotic sarcoidosis and a potential for thromboembolic complications in the presence of APP, an accelerated transition to non-thrombotic immunosuppressants can be advantageous in the long term treatment of this combination of diseases.
The rapid evolution of cardiovascular (CV) research demands innovative strategies to enhance risk stratification, diagnosis, and management. While traditional biomarkers, such as natriuretic peptides and troponins, remain essential, they often fall short due to suboptimal sensitivity and specificity, particularly in complex or early-stage cases. Emerging biomarkers are central to advancing personalized medicine by enabling earlier, more accurate detection of CV diseases and enhancing predictive algorithms, including those powered by artificial intelligence and machine learning. Among these novel biomarkers, dipeptidyl peptidase 3 (DPP3) has recently garnered attention as a highly specific indicator of cardiogenic shock, offering both prognostic value and therapeutic target potential. Released during cellular stress, circulating DPP3 (cDPP3) plays a mechanistic role in myocardial depression and blood pressure regulation, positioning it as a compelling candidate for inclusion in multi-marker panels. Its integration into predictive models could further refine therapeutic decision-making and patient stratification in acute cardiac care. This editorial discusses the clinical value of incorporating cDPP3 into CV biomarker research and advocates its inclusion in next-generation predictive algorithms and real-time decision-support tools. Continued exploration of such biomarkers may enable tailored interventions and improve outcomes in complex CV cases.
Background: As cardiovascular mortality continues to increase globally, percutaneous coronary intervention (PCI) with stent placement stands out as a cutting-edge and highly effective treatment for severe cardiovascular diseases. However, the inherent invasiveness of any endovascular procedure introduces the risk of coronary vessel and myocardial damage.
Aim: To evaluate the utility of a novel electrocardiographic metric in detecting subtle myocardial injuries after coronary stenting.
Methods: This investigation was conducted in 2021 at the Kyiv Heart Institute of the Ministry of Healthcare of Ukraine. The study involved 23 patients who underwent PCI, each subjected to a meticulous preoperative examination. A paired measurement approach was employed, encompassing 3-minutes electrocardiogram (ECG) recordings both before and several hours following the operation, using a compact ECG device. Each pair of ECG underwent a thorough analysis, scrutinizing 240 primary and computed ECG parameters.
Results: The analysis delineated a distinct subgroup exhibiting significant myocardial damage post-stenting. This subgroup was characterized by an older average age and more stents than their counterparts. Notably, a concurrent reduction in the psychoemotional state index was observed alongside the ECG alterations in these patients, suggesting a correlation between myocardial damage and psychoemotional distress. Introducing a new electrocardiographic index has illuminated the often-subtle myocardial damage incurred during PCI.
Conclusion: The newly devised electrocardiographic metric is a significant advancement in the early detection of myocardial damage following PCI, able to capture not only physiological but also psychoemotional changes.
Physical exercise is a cornerstone of cardiac rehabilitation, with resistance training increasingly recognized as essential due to the "muscular hypothesis" in cardiac-related frailty. However, many patients are unable to achieve the required training intensities to gain the associated benefits, highlighting the need for alternative approaches. Blood flow restriction (BFR) training has recently emerged as a promising strategy for this population. This qualitative mini-review explores the acute effects and long-term adaptations of BFR training in patients undergoing cardiac rehabilitation, aiming to provide insights into its potential as a viable and effective intervention in health-related outcomes.
Lysosomal acid lipase-deficiency (LAL-D) is a rare and systemic condition, secondary to lipase A gene mutations, responsible for lysosomal accumulation of cholesteryl esters and triglycerides in many tissues. It is a very heterogeneous disease in terms of the age of onset, severity, and the type of clinical and radiological manifestations. Dyslipidemia, hepatomegaly, and hepatosteatosis with increased levels of transaminases are the most common features. In association with liver dysfunction and evolution to cirrhosis, there is an increased risk of premature atherosclerosis and cardiovascular disorders, secondary to a generalized alteration of lipid profile and lipoprotein dysfunction associated with LAL-D. Therefore, we provide an update on the frequently under-recognized LAL-D, focusing on the late-onset form: Cholesteryl ester storage disease.
Background: Postmenopausal women face an increased risk of cardiovascular disease (CVD) due to estrogen withdrawal, which exacerbates traditional cardiovascular risk factors such as dyslipidemia, glucose intolerance, and hypertension. Coronary Artery Calcium Score (CACS), a well-established marker of subclinical atherosclerosis, has emerged as a key predictor of adverse cardiovascular events. Despite the recognized association between menopause and heightened CVD risk, there remains a paucity of literature exploring the specific role of menopause in influencing CACS and its implications for cardiovascular morbidity and mortality.
Aim: To examine the interplay between menopause, CACS, and cardiovascular health by synthesizing existing literature.
Methods: A comprehensive literature search was conducted using PubMed and Google Scholar, focusing on studies that analyzed CACS in postmenopausal women, including the influence of factors such as hormone therapy, Triglyceride-Glucose index, bone mineral density, lipid metabolism, and type-1 diabetes. Data extraction and synthesis emphasized key patterns, metabolic influences, and potential mechanisms driving coronary calcification in menopause.
Results: Findings suggest that menopause contributes to increased CACS through multiple pathways, including altered lipid metabolism, insulin resistance, and arterial stiffness. Additionally, premature menopause is associated with higher CACS and elevated CVD risk. While hormone replacement therapy (HRT) appears to have a protective effect against coronary calcification, further research is needed to clarify its long-term benefits and risks.
Conclusion: We introduce a novel framework combining CACS with metabolic and hormonal markers, and discuss estrogen-driven mechanisms and HRT considerations in postmenopausal cardiovascular risk. This review underscores the need for targeted cardiovascular risk assessment in postmenopausal women, integrating CACS with other metabolic markers to improve early detection and prevention of CVD in this high-risk population.
Neurocardiology is an interdisciplinary field that studies the interactions between the nervous and cardiovascular systems, encompassing research across the entire spectrum, from molecular mechanisms to clinical diagnosis and treatment. The disease types in neurocardiology include several major categories: Involvement of the nervous and cardiovascular systems caused by common factors, involvement of the cardiovascular system caused by neuropsychiatric abnormalities, and involvement of the nervous system caused by cardiovascular abnormalities. Routine and special examinations are needed during the diagnostic process. The simultaneous management of brain and heart conditions is the core strategy, which advocates multidisciplinary collaboration, communication, and interaction. Herein, we review studies on the pathophysiological mechanisms, clinical manifestations, and new advances in diagnosis and treatment in the field of neurocardiology, particularly the latest research progress of traditional Chinese medicine, and further propose the construction of an integrated healthcare service system for future research.
Cardiac sarcoidosis (CS) is a rare but serious manifestation of sarcoidosis that can lead to significant morbidity and mortality due to arrhythmias and heart failure. The inflammatory process in CS is characterized by the formation of non-caseating granulomas in the myocardium, which can disrupt normal cardiac function and conduction. Corticosteroids are the primary therapeutic agents used to manage CS, particularly during the acute inflammatory phase, as they help reduce inflammation and improve cardiac function. However, the long-term use of steroids poses risks, including opportunistic infections and metabolic complications. Advanced imaging techniques, such as cardiac magnetic resonance imaging and positron emission tomography, play a crucial role in diagnosing CS and assessing myocardial involvement. These imaging modalities also aid in risk stratification for arrhythmic events, guiding therapeutic decisions such as the initiation of steroid therapy and the potential placement of implantable cardioverter-defibrillators. This review synthesizes current evidence regarding the role of steroid therapy in managing CS and its implications for cardiac arrhythmias, emphasizing the need for individualized treatment strategies to optimize patient outcomes.
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