JRSM Cardiovascular Disease最新文献

Objectives: Heart failure (HF) is a significant global health problem that continues to increase in prevalence, morbidity, and mortality, particularly in aging populations. Relative wall thickness (RWT), an echocardiographic parameter reflecting geometric remodeling of the heart, is easily measurable and may possess prognostic value. This study aimed to evaluate the predictive power of RWT for 5-year mortality in patients with HF.

Methods: In this retrospective observational analysis, a total of 232 individuals diagnosed with acute decompensated heart failure were enrolled. RWT values were calculated using echocardiographic measurements. In this single retrospective cohort, participants were stratified into two subgroups based on their 5-year survival status. Demographic, clinical, laboratory, and echocardiographic parameters were compared between these subgroups.

Results: After 5 years of follow-up, 133 patients had died. Patients in the mortality group were significantly older (p = 0.001). The mortality cohort demonstrated a higher prevalence of chronic renal failure, atrial fibrillation, and mitral regurgitation compared with survivors. Echocardiographically, elevated systolic pulmonary artery pressure (sPAP) was associated with mortality (p = 0.009). However, regression analysis did not find sPAP to be statistically significant [95% confidence interval (CI), hazard ratio: 1.047 (0.818-1.340), p:0.7)]. RWT values ​​did not show a significant difference between the groups (0.39 ± 0.13 compared to 0.37 ± 0.06; p = 0.225). Area under the curve for RWT was 0.50 (95% CI: 0.43-0.57), indicating poor predictive power. Kaplan-Meier analysis showed no significant difference in survival between RWT groups (log-Rank:0.984, p: 0.32).

Conclusion: RWT has limited ability to predict 5-year mortality among patients with advanced stages of HF. Age emerged as the strongest independent predictor. RWT should be evaluated in conjunction with multiple clinical and laboratory parameters rather than in isolation when managing HF.

Background: Diastolic wall strain (DWS) is based on linear elastic theory, which shows that impaired diastolic wall thinning reflects resistance to deformation in diastole and thus, increased diastolic myocardial stiffness. We aim to explore the role of DWS in patients with heart failure with preserved ejection fraction (HFpEF) in terms of correlation with indices of HFpEF.

Methods: Study enrolled 53 patients with exertional dyspnoea and normal left ventricular ejection fraction. Forty patients fulfilled the criteria for HFpEF according to ESC 2023 criteria.

Results: Two groups were analysed - Group 1 with criteria of HFpEF fulfilled and Group 2 with those who did not. Echocardiographic indices including relative wall thickness (RWT), left ventricular mass index (LVMI), E/e', left atrial volume index (LAVI) and DWS were numerically different on comparison with group 2, with LVMI, LAVI and E/e' statistically significant. Also mean Global Longitudinal Strain (GLS) was found to be -13.05%. Group 1 was divided into HFpEF with DWS ≤ median and HFpEF with DWS > median. Echocardiographic indices showed statistically higher LVMI and atrial filling fraction. This finding showed that patients with reduced DWS were more likely to have diastolic dysfunction. Also, it was found that DWS had a statistically significant correlation with LVMI, LAVI and RWT. Lower DWS had abnormal GLS. Limitations include small sample size.

Conclusion: Although difference in DWS between HFpEF and controls did not reach statistical significance, stratification by median value showed significant correlation of DWS with myocardial relaxation parameters. Also, with significant correlation with increased atrial filling fraction higher N-terminal pro-B type natriuretic peptide and correlation with impaired GLS, our study supports DWS as a potential research tool in evaluation of HFpEF.

Introduction: Heart failure (HF), a growing public health concern, is primarily driven by metabolic disorders. While the systemic inflammatory response index (SIRI) has demonstrated prognostic value in cardiometabolic diseases, its role in predicting HF remains unclear. Given the link between obesity and inflammation, integrating SIRI with obesity-related measures may enhance the stratification of HF risk. This study aims to examine the association between SIRI, integrated with obesity-related indices, and HF.

Methods: Data from NHANES 2017-2020 were used, including 6572 adults aged 20-80 years with complete data on key indices. HF was defined based on self-reported physician diagnosis. SIRI was calculated as (neutrophil × monocyte)/lymphocyte count. Receiver operating characteristic (ROC) analysis was performed to assess the predictive value of inflammatory and obesity indices on HF risk. Multivariable logistic regression models, restricted cubic spline (RCS) and Interaction tests were used to examine the association between the index of interest and HF.

Results: Of 6572 participants, 170 (2.6%) had HF. The SIRI × BMI × WHR index showed the highest predictive value (AUC: 0.68), improving in non-smokers (AUC: 0.73) and individuals with diabetes (AUC: 0.71). RCS analysis indicated a linear, dose-response relationship, with multivariable logistic regression analysis revealed the strongest association in the fourth quartile (AOR: 2.00, 95% CI: 1.07-3.75), and stronger effects in non-smokers (AOR: 7.25, 95% CI: 2.04-25.76) and those with diabetes (AOR: 5.63, 95% CI: 1.25-25.39).

Conclusion: The SIRI × BMI × WHR index demonstrated predictive ability and an association with HF, particularly among individuals with diabetes and non-smokers. Given its accessibility and cost-effectiveness, this index may serve as a valuable tool for HF screening.

Objectives: To describe trends in chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD)-related mortality in the United States from 1999 to 2020 using data from CDC WONDER.

Methods: This study analyzed mortality data from CDC WONDER, identifying decedents aged 25 years and above using ICD-10 codes. A total of 1,459,562 deaths occurred between 1999 and 2020. Annual crude and age-adjusted mortality rates (AAMRs) per 100,000 were calculated and stratified by age, sex, race, and region. Annual percentage changes (APC) were determined using Joinpoint regression.

Results: The overall AAMR declined from 24.78 in 1999 to 18.5 in 2020, with a gradual decrease from 1999 to 2018 (APC = -2.06 [95% CI: -2.27, -1.90]) and a subsequent rise through 2020 (APC = 4.53 [95% CI: 0.56,6.41]). Males had higher AAMRs (28.2) than females (13.95). Non-Hispanic Whites had the highest AAMRs (21.93). Mortality among adults aged 45-64 was stable until 2008, then increased through 2020. For adults ≥ 65 years, AAMRs declined until 2018 but rose sharply thereafter. Non-metropolitan areas (AAMR: 26.29) had higher mortality than metropolitan areas (AAMR: 18.42). States in the 90th percentile, such as Tennessee and Kentucky, had AAMRs approximately three times higher than those in the 10th percentile, including Arizona and Hawaii.

Conclusions: Substantial demographic and regional disparities persist in COPD and IHD-related mortality, necessitating targeted interventions in high-risk populations.

Severe aortic stenosis typically presents with reduced exercise tolerance, exertional chest pains, or syncope. We report on a case of a young female on therapeutic anticoagulation and a history of nephrotic syndrome, who presented with subacute limb ischaemia resulting from axillary artery thrombus. Urgent echocardiogram demonstrated a bicuspid aortic valve with critical stenosis, and she underwent surgical aortic valve replacement. Her presenting symptoms resolved after three months of warfarin therapy. This case highlights the importance of systemic evaluation of unexplained arterial thrombosis.

Pregnancy poses significant risks for women with congenital heart disease (CHD) due to major cardiovascular changes that can lead to complications which increases the morbidity and mortality rate in these patients. CHD is the leading cause of pregnancy-related deaths in the United States. In this review, we present the steps required to reduce these risks. We cover the changes to the maternal cardiovascular system that occur in pregnancy, and how they can significantly impact the cardiac patient where the disease may lead to poor adaptation in pregnancy. We discuss the epidemiology of this growing challenge and analyse the available the risk stratification models necessary to recognise and mitigate the chance of maternal cardiovascular complications arising in pregnancy. We follow on to discuss the necessity of pre-pregnancy counselling, which is often missed, but allows the potential mother to have a full conversation regarding the implication of pregnancy on her and her baby. We highlight the need to cover topics such as contraception, medication, subfertility, and maternal and fetal risk. Finally, we discuss the need of a pregnancy heart team; what specialist should be involved in the care of these high-risk women and where antenatal and delivery care should take place.

Objectives: Influenza infection may increase the risk of cardiovascular diseases (CVDs), but the extent of this link is uncertain. This systematic review and meta-analysis aimed to quantify the association between influenza infection and CVDs.

Methods: We conducted a comprehensive search of major databases from inception to 2024, identifying studies that investigated the association between influenza infection and CVDs. Eligible studies included cohort, case-control, and randomized controlled trials reporting on cardiovascular outcomes (acute CVDs) following influenza infection or risk of influenza infection in CVD patients (chronic CVDs). Data were extracted and pooled using random-effects models, and heterogeneity was assessed using the I ² statistic.

Results: A total of 11 studies (15 datasets) involving 7327 participants were included in the meta-analysis. Overall, influenza infection was significantly associated with CVDs based on 10 datasets (odds ratio (OR) = 1.76, 95% confidence interval (CI): 1.02-3.03). However, the analysis of the five datasets indicated no significant association between pre-existing CVDs and an increased risk of influenza infection (OR = 0.91, 95% CI: 0.80-1.03). Subgroup analyses and meta-regression highlighted that study quality and design could significantly influence the risk of developing CVDs among patients with influenza.

Conclusions: This meta-analysis provides quantitative evidence that influenza infection could be a potential risk factor for subsequent cardiovascular events. These findings emphasize the need for preventive measures, including vaccination, especially in high-risk populations. Further research is needed to explore the underlying mechanisms and impact of influenza on cardiovascular outcomes.

Background: Acute heart failure (AHF) is a major cause of morbidity and mortality worldwide. Identifying clinical predictors of in-hospital death may help optimize risk stratification and management in emergency settings.

Objective: To evaluate in-hospital mortality and its associated risk factors among patients hospitalized with AHF in a tertiary hospital in Colombia, and to develop a mortality prediction score.

Methods: A retrospective cross-sectional study was conducted including all patients diagnosed with AHF admitted between January 2022 and December 2023. Clinical and laboratory data were collected from electronic medical records. Multivariate logistic regression analyses were performed to identify predictors of in-hospital mortality. A point-based risk score was constructed.

Results: A total of 904 patients were included. In-hospital mortality was 17.1%. Independent predictors of death included: serum creatinine >1.5 mg/dL, hemoglobin <10 g/dL, inferior vena cava diameter ≥23 mm, history of chronic obstructive pulmonary disease, need for ventilatory support, need for vasopressor/inotropic therapy, and a Cold-Wet hemodynamic profile. A mortality prediction risk score was developed with good discriminatory power.

Conclusions: In-hospital mortality in patients with AHF is high. Several easily accessible clinical and laboratory variables were independently associated with death and were incorporated into a simple scoring system. This tool may support early risk stratification and guide decision-making in acute care settings. External validation is warranted.

Background: Acute kidney injury (AKI) is increasingly associated with heart failure (HF), contributing to higher morbidity and mortality. Nonetheless, mortality remains under-explored. This study examines trends in AKI-related HF mortality trends among American adults.

Methods: We sourced data from 1999 to 2023 from the CDC WONDER multiple cause-of-death database for AKI-related HF mortality in adults aged ≥ over 25. We calculated age-adjusted mortality rates (AAMRs) per 1,000,000 persons for year and sex from 1999 to 2023 and from 1999 to 2020 for ethnicity, census region, and urbanization status, analyzing annual percent change across these stratifications.

Results: From 1999 to 2023, 284,599 AKI-related HF deaths occurred, with AAMR rising from 34.42 to 86.53. Between 1999 (34.42) and 2010 (50.5), the AAMRs increased modestly, followed by relative stability until 2019 (46.93); the steepest increase occurred between 2020 (51.52) and 2022 (91.59), with a modest decline observed in 2023 (86.53). Men consistently had higher AAMRs than women. Male AAMRs increased from 43.45 to 108.3, while female rates rose from 29.12 to 69.79. Non-Hispanic (NH) Blacks had the highest AAMR (54.18), followed by NH American Indian/Alaska Natives (52.49), NH Whites (45.74), Hispanics/Latinos (33.38), and NH Asians/Pacific Islanders (26.53). The Midwest had the highest AAMR (49.66), followed by the South (46.24), West (42.85), and Northeast (41.09). Rural areas showed higher AAMRs (56.81) than urban (42.91). North Dakota reported the highest AAMR (69.29), while Florida had the lowest (24.38).

Conclusion: While overall AAMRs were higher in 2023 compared to 1999, the sharpest rise was seen post-2020 after a period of relative stability from 2010 to 2019. AKI-related HF mortality remains disproportionately high among men, NH Blacks, and residents of the Midwestern and rural United States, highlighting the necessity of focused initiatives to address inequities and lower mortality.

Objective: Improved aortic surgery outcomes are linked to a broader comprehension of the pathogenesis of thromboembolic complications. This study aims to evaluate the involvement of cholesterol microcrystals and neutrophil extracellular traps (NETs) in postoperative thrombotic complications following open aortic surgery.

Methods: Aortic blood smears were examined precisely to identify the presence of cholesterol microcrystals (CMs) using polarized light microscopy, Coherent Anti-Stokes Raman spectroscopy (CARS), and fluorescence microscopy to detect NETs. The data obtained, including CMs quantity, perimeter, and NETs quantity, were evaluated as possible predictors of the postoperative complication rate.

Results: Fifty-five patients (85%) had an uneventful postoperative period, while 10 patients (15%) experienced early postoperative complications, there was a statistically significant positive correlation between the average perimeter of the CMs and the number of NETs in the blood smears in patients who experienced a complicated postoperative period (rho = 0.67; p = .03).

Conclusion: In some cases, complications in the early postoperative period after aortae surgery may be caused by CMs embolism (CE) of the distal vascular bed, accompanied by NETs-mediated thrombosis. The protocol for assessing arterial blood allows for the identification and evaluation of CMs and NETs characteristics as predictors of perioperative thromboembolic complications.