JRSM Cardiovascular Disease最新文献

Objectives: This study aimed to evaluate the influence of dual-task (DT) on the spatiotemporal gait parameters of patients with cardiovascular diseases.

Design: This was an observational, cross-sectional, and comparative study. Participants: The study included 28 males, aged between 51 and 77 years, divided into two groups: Cardiovascular Disease Group (CVDG - N = 14) and Control Group (CG - N = 14). Main outcome measures: Participants performed the simple gait task and dual-task activities (including the cognitive and gait tasks) in a motion analysis system. For statistical analysis, it was conducted a mixed analysis of variance (Mixed ANOVA) and for significant main effects (condition or group) or interactions (group × condition) it was performed post-hoc tests with Bonferroni correction. A significance level (alpha) of 0.05 was set.

Results: Group comparisons revealed a significant difference solely in step width, where the CVDG showed lower mean values than the CG (p = 0.001). However, DTs similarly affected both groups, resulting in significant reductions in gait speed (p = 0.000), cadence (p = 0.002), step length (p = 0.000), and stride time (p = 0.007). Regarding the interaction effect, the CVDG exhibited a significantly longer step time during the verbal fluency and arithmetic DT conditions when compared to their own performance in the simple gait condition (p = 0.037).

Conclusions: No significant differences between groups were found in both single-task and DTs gait across most of the analyzed parameters. Additionally, DT activities similarly affected the gait parameters of both groups. Although cardiovascular diseases are commonly associated with motor and cognitive declines, DTs did not affect participants with cardiovascular impairment differently.

Cardiac disease during pregnancy is one of the leading causes of maternal mortality and morbidity in both the UK and the USA. Labour, delivery, and the initial postpartum phase are characterised by significant haemodynamic alterations that play a significant role in the clinical deterioration observed in women with heart disease. Heart failure, arrhythmia, and myocardial ischaemia can occur in women with high-risk cardiac lesions during labour. The cardio-obstetric multidisciplinary team, after risk stratification, should establish an individualised cardiac care plan that incorporates patients' preferences. This care plan should address the location, mode, timing of delivery, monitoring, analgesia, and anaesthetic options for operative intervention, uterotonics that may be administered, emergency contact numbers for relevant personnel along with appropriate postpartum care. High-risk patients need to be delivered in tertiary units. Clear haemodynamic objectives should be established along with a postpartum contraception plan with information cascaded to community midwifery teams and primary care providers to ensure surveillance and continuity of care. Co-ordinated multidisciplinary care can enhance preparedness for obstetric and cardiac emergencies, thereby decreasing morbidity and mortality associated with heart disease in pregnancy during childbirth.

Aortic dissection in pregnancy has a high mortality rate for mother and fetus. Women at risk are largely those with hereditary thoracic aortic disease, that is typically undiagnosed. Existing literature has focussed on characterising the phenotype of these women, but many questions remain about the causes of dissection in pregnancy and how to best manage women antenatally and postnatally. The widespread uptake of genetic testing has allowed us to refine the genotype and we need to use this to better individualise risk. We do not know how often to screen women during pregnancy and postpartum, nor do we know whether beta-blockers affect event rates. We have very little data on the outcomes of women who have undergone aortic surgery who embark on a pregnancy, including those who have residual dissection. Passive vaginal delivery is advised for delivery, but we do not know if this is safer than elective caesarean section and there is a paucity of evidence on the effectiveness of neuraxial anaesthesia in these women. Dissection postpartum can occur days or weeks after delivery. There is little evidence on the postnatal care or blood pressure control of women who have dissected postpartum and no guidelines on best postpartum care. Lastly, we know little of the birth experience of these women and whether birth plans were successful. This paper aims to discuss some of these unanswered questions in the hope that with further research and discussion of best practice we can collectively reduce this devastating event in young women.

Background: Postcardiac injury syndrome (PCIS) includes pleuropericardial inflammation and effusion syndromes after traumatic mesothelial cell injury to the pericardium or pleural cavity. Several triggers have been identified, that can cause PCIS including percutaneous coronary intervention (PCI), cardiac implantable electronic device (CIED) implantation, and cardiac surgical procedures. Though most common form occurs postcardiac surgeries, there are reports of PCIS occurring after PCI.

Case summary: We present one such rare event of right-sided pleural effusion occurring after primary PCI, diagnosed based on ESC guidelines on PCIS, after exclusion of other possible causes.

Discussion: PCIS is a diagnosis of exclusion, typically presenting as new onset pericardial effusion. Although rare, pleural effusion can occur as a part of PCIS with reports of both left- and right-sided pleural effusion. Management being conservative seems relatively simpler, but given the possibility of recurrence, long-term follow up becomes important, which necessitates making the diagnosis of PCIS, though rare. This case is one of the rare events occurring during a commonly performed procedure worldwide. PCIS in diagnosis of unexplained pleural/pericardial effusion occurring after PCI should always be considered. This may be an insight for taking into account, such uncommon events after a common intervention.

Background: Branch pulmonary artery flow patterns in the Fontan circulation manifest oscillations reflecting venous pressure changes. The clinical importance of variation in branch pulmonary artery flow patterns and the relationship with the single ventricle performance is not understood. We describe insights gained from simultaneous hemodynamic and phase contrast magnetic resonance using interventional CMR (iCMR) in these patients.

Method: Twenty-seven patients with Fontan circulation referred for iCMR were studied using phase-contrast velocity mapping. The isovolumetric relaxation period (IVRT) was assessed using standard or velocity-encoded cine imaging of the atrioventricular valve (AVV) and aortic valve. We qualitatively assessed branch pulmonary artery flows considering four patterns: IVRT flow reversal, IVRT flow reaching baseline, and normal - phasic flow or continuous flow. We further collected comprehensive left and right heart iCMR hemodynamic and flow data, including pressures, aortopulmonary collateral (APC) burden, and degree of AVV regurgitation.

Results: Most patients underwent extracardiac Fontan palliation and did not have significant APC burden. Cardiac cycle analysis demonstrated that flow reversal and flow reaching baseline correlated with IVRT (v-wave timing on SVC pressure). Further analysis showed statistically significant difference in pulmonary capillary wedge pressure (PCWp) v-wave (P = .008) among the described groups. Notably, patients with IVRT flow reversal pattern had higher PCWp v-wave and most had severe AVV regurgitation.

Conclusion: Branch pulmonary artery IVRT flow reversal and IVRT baseline patterns in patients with Fontan circulation may represent indirect signs of single ventricle poor performance and severe AVV regurgitation.

Background: Thyroid hormone plays a key role in cardiovascular diseases (CVDs), and stress may impact this relationship by affecting cortisol and triiodothyronine (T3) levels. This study explored the association between stress, indicated by cortisol levels, and thyroid function in cardiovascular patients, particularly those with hypertension.

Methods: A cohort of 87 cardiovascular patients (37 females, 50 males) and 60 healthy controls (28 females, 32 males) was analyzed. Patients included those with coronary artery disease, acute myocardial infarction, and a high proportion with anterior wall myocardial infarction (AWMI, 52%). Anthropometric data and blood samples were collected, and cortisol and T3 levels were measured using the radioimmunoassay method. Blood pressure measurements were also recorded to assess associations with cortisol, thyroid function, and hypertension.

Results: Cardiovascular patients had significantly higher cortisol levels (1065.99 ± 700.54 ng/mL vs 768.35 ± 563.10 ng/mL, p < .001) and lower T3 levels (1.25 ± 0.48 ng/mL vs 1.33 ± 0.46 ng/mL) compared to controls. The prevalence of AWMI was 52%. Blood pressure was significantly higher in cardiovascular patients of both sexes (p < .0007). Additionally, 39% of cardiovascular patients had elevated cortisol, and 38% had reduced T3. No sex-based differences in cortisol levels were observed.

Conclusion: This study found significant associations between elevated cortisol and reduced T3 levels in cardiovascular patients, particularly those with hypertension. Although stress-induced thyroid dysfunction remains a hypothesis, these findings suggest a potential link between cortisol, T3, and CVD. Further longitudinal research is needed to explore causal mechanisms.

Objective: Few studies have compared the prognostic value of the triglyceride glucose (TyG) index and atherogenic index of plasma (AIP) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). We aimed to compare the prognostic value of the TyG index, AIP, and combined diagnosis in patients with ACS undergoing PCI.

Methods: Patients with ACS who underwent PCI were enrolled and divided into two groups according to major adverse cardiovascular and cerebrovascular events (MACCEs). Univariate and multivariate Cox proportional hazard regressions were performed to determine independent risk factors for MACCEs. The area under the receiver operating characteristic curve (AUC) was used to evaluate the diagnostic value of the TyG index, AIP, and combined prediction.

Results: The study included 114 patients. Multivariate Cox regression revealed that the TyG index and AIP were independent predictors of MACCEs. The AUC of the TyG index and AIP were 0.710 (95% confidence interval [CI]: 0.618-0.791) and 0.626 (95% CI: 0.531-0.715), respectively, and the optimal cutoff points were 8.83 and 0.30, respectively. The difference between the TyG index and AIP was not significant. The AUC of the combined diagnosis was 0.706 (95% CI: 0.614-0.788), with no significant improvement compared with the TyG index or AIP.

Conclusion: Both the TyG index and AIP were independent predictors of MACCEs in ACS patients undergoing PCI. The TyG index and AIP had similar predictive values for MACCEs, but the combined prediction did not improve significantly.

Isolated left ventricular apical hypoplasia (ILVAH) is a rare, unclassified cardiomyopathy with typical imaging findings. Cardiac magnetic resonance (CMR) is valuable for identifying heart structural anomalies. This case report describes the detection of significant anatomical abnormalities in the left ventricle (LV) with CMR in a 32-year-old man who presented with sudden dyspnea at authors' institution. This case demonstrates the characteristics of ILVAH under multimodal imaging: A truncated spherical shape of the LV, encircling of the distal LV by the right ventricle, the presence of fat replacement at the apex, and without abnormality in the mitral valve or aorta.

Background: Non-alcoholic fatty liver disease (NAFLD) affects up to nearly a third of the Western population and has been inconsistently associated with cardiovascular diseases (CVDs). Therefore, we conducted a comprehensive meta-analysis to quantify the correlation of NAFLD with all major vascular diseases, acute coronary syndrome (ACS), subclinical atherosclerosis and endothelial dysfunction.

Methods: We searched PubMed and Embase for studies looking at the relationship between NAFLD and cardiovascular diseases published through September 2023. The parameters we used to assess cardiovascular diseases include acute coronary syndrome, brachial flow-mediated dilatation (FMD), serum asymmetric dimethylarginine (ADMA), carotid intima-media thickness (CIMT), and carotid stenosis (>50%). Data from these studies were then collected and meta-analysis was performed using the random effects model. RevMan v5.4 was used for statistical analysis.

Results: We interrogated a total of 114 publications which met our inclusion criteria. NAFLD patients showed statistically significant reduction in FMD% [MD: -4.83 (95% CI: -5.84 to 3.81, p < .00001)] and increased serum ADMA [MD: 0.08 (95% CI: 0.05-0.11, p < .00001)]. Mean CIMT was also increased in NAFLD patients [MD 0.13 (95% CI: 0.12-0.14, p < .00001)]. NAFLD showed a higher prevalence of pathological CIMT [MD: 0.11 (95% CI: 0.10-0.12, p < .00001)] and increased carotid plaques [OR: 2.08 (95% CI: 1.52-2.86, p < .00001)]. Furthermore, we demonstrated statistically significant increase in cardiovascular diseases among NAFLD patients compared to controls [OR: 1.92 (95% CI: 1.53-2.41, p < .00001)].

Conclusion: NAFLD is a strong predictor for endothelial dysfunction, subclinical atherosclerosis and cardiovascular disease. Further studies are required to determine whether incidental findings of fatty liver on abdominal ultrasonography should prompt the need for detailed assessment of other CVD risk factors.

Objectives: Assess whether pre-operative HbA_1c demonstrates positive predictive value relating to outcomes following coronary artery bypass grafting (CABG) in diabetes patients.

Methods: Retrospective analysis of outcomes and mortality following CABG; examining the effects of diabetes and HbA_1c.

Results: Post-operative length of stay (LOS) was prolonged in elective and urgent diabetes patients;7.3 ± 2.1 versus 6.4 ± 1.6 days and 9.0 ± 1.9 versus 7.6 ± 1.8 days, respectively; (p < 0.001). Sternal and leg wound infection rate was higher in elective diabetes group compared to no-diabetes group; 7% versus 3% (p < 0.01) and 3% versus 1% (p < 0.05), respectively. Pneumonia rate increased in elective and urgent diabetes patients; 19% versus 8% (p < 0.001) and 21% versus 15% (p < 0.05), respectively. Diabetes increased new-onset atrial fibrillation; 26% versus 14% (p < 0.001), and doubled blood transfusion rate; 28% versus 14% (p < 0.001) in elective patients; with similar findings in urgent patients. Long-term mortality was higher with diabetes compared to no-diabetes in elective patients; 15% versus 5%, (p < 0.001), and urgent patients; 10% versus 2%, (p < 0.001). Elevated HbA_1c showed significant positive predictive value relating to long-term mortality, and rates of pneumonia, blood transfusion, wound infection in elective and urgent diabetes patients; (p < 0.001). Elevated HbA_1c was an independent predictor of long-term mortality (hazard ratio:5.27, 95% CI:2.53-10.99; p < 0.001), superficial wound infection (odds ratio (OR):18.23, p < 0.001) and delayed discharge (OR:8.15, p < 0.001).

Conclusions: Diabetes patients have prolonged LOS and increased morbidity following CABG. HbA_1c is predictive of morbidity and long-term mortality in diabetes patients, and pre-operative HbA_1c screening is justified in all surgical patients.