JRSM Cardiovascular Disease最新文献

Objectives: Atrial fibrillation (AF) occurs in 15-45% of patients who underwent coronary artery bypass graft (CABG) surgery. Inflammation, myocardial ischemia, and sympathetic activity are the main contributing factors to postoperative atrial fibrillation (POAF) occurrence. POAF causes increased mortality, morbidity, and healthcare costs. Cardiac troponin I (c-TnI) is a sensitive and exclusive biomarker for myocardial injury. We investigated if c-TnI serum level had any correlation with POAF after CABG.

Method: We enrolled 100 stable patients undergoing elective on-pump CABG surgery. We measured c-TnI serum levels preoperative, postoperative, and 72-h post-CABG. All patients were evaluated with 12-lead ECG and continuous cardiac monitoring for 5 days to detect arrhythmias.

Result: Twelve (12%) patients developed AF after the operation. Although the AF group's age and BMI were slightly higher, there was no notable clinical, laboratory, or surgical difference between the groups. In addition, the preoperative, postoperative, and 72-h post-CABG c-TnI levels didn't show a significant difference between the groups. In contrast, the post-operation c-TnI rise was significantly higher in the AF group (p < 0.05). We determined a 1.9 ng/ml cutoff for post-operation c-TnI rise using the ROC curve with 100% sensitivity and 33% specificity.

Conclusion: We discover that post-operation c-TnI rise could be used as a predictive parameter for POAF with full sensitivity.

Purpose: To investigate the incidence of acute limb ischemia (ALI) among patients with femoropopliteal (FP) lesions treated with contemporary endovascular therapy (EVT) and to identify risk factors for ALI after FP-EVT.

Methods: In this retrospective multicenter registry, we analyzed patients with lower extremity artery disease having FP lesions who underwent EVT between 2017 and 2021. We investigated the incident ALI related to the index EVT and its risk factors. We also assessed the prognosis after the incident ALI.

Results: During a median follow-up of 35.3 months, incident ALI was observed in 72 of 3102 patients (2.3%). The Rutherford classification I/IIa/IIb/III was 50.0%, 30.5%, 18.1%, and 1.4%, respectively. Variables independently associated with the incident ALI were chronic limb-threatening ischemia (CLTI; hazard ratio, 1.83; p = 0.015), reference vessel diameter < 6 mm (2.39; p = 0.011), lesion length >25 cm (3.35; p = 0.005) with its time interaction (0.72 per 1 year; p = 0.042), P2/3 segment involvement (2.73; p < 0.001), chronic total occlusion (CTO; 3.40; p < 0.001), and in-stent restenosis/occlusion (3.21; p < 0.001). During a median follow-up of 12.8 months after the ALI event, all-cause mortality was 27.8% and the rate of major amputation was 6.9%.

Conclusions: The FP-EVT showed that the occurrence of ALI was 2.3% during a median follow-up of 35.3 months. The independent predictors of the ALI event were CLTI, small vessels, long lesions, CTO, and in-stent restenosis; however, the impact of lesion length was attenuated over time after the index EVT.

Objectives: The aim of this study was to report the spectrum of genetic variations and clinical phenotype in a Vietnamese cohort with confirmed Brugada syndrome (BrS) using the whole exome sequencing (WES).

Methods: Fifty patients with confirmed BrS were included in this study. Genomic DNA samples were extracted from peripheral blood and conducted for WES. The variants were annotated using ANNOVAR. The variants in the 13 reported genes associated with BrS were filtered, predicted the functional impact using eight computational tools, and classified according to the 2015 ACMG guidelines.

Results: Arrhythmic events were documented in one-fifth of the participants. Twenty-four probands were identified to carry 36 variants in 13 genes. Majority of the variants in our study was SCN5A variants (9/36 variants, 25%), followed by KCNH2 variants (5/36 variants, 14%). The prevalence of SCN5A carriers was 16%; while the prevalence of minor gene carriers was less than 10%. Nine novel missense variants were identified, including four missense SCN5A variants (p.E901D, p.F853L, p.L377F, and p.H184R), two missense ANK2 variants (p.S2845L and V1497L), one missense CACNA1C variant (M1126V), one missense DSP variant (p.K478N), and one intron splicing JUP variant (c.1498-5G>C).

Conclusion: Our study underscores the primary significance of the SCN5A gene in BrS, as indicated by variant prevalence, carrier rates, pathogenicity per ACMG classification, in silico predictions, and its correlation with clinical phenotypes. Longitudinal study with larger sample size, pedigree, Sanger sequence confirmation, and functional analysis is recommended.

Cardiac catheterization for congenital heart disease (CHD) performed under fluoroscopic guidance still lacks definition and requires exposure to ionizing radiation and contrast agents, with most patients needing multiple procedures through their lifetime, leading to cumulative radiation risks. While fusion overlay techniques have been employed in the past to aid, these have been limited to a single plane, while interventions are traditionally performed under biplane fluoroscopy. We describe our initial experience performing cardiac catheterizations guided by an enhanced biplane GuideCCI system^© (Siemens Healthcare, Germany) augmented by 3D magnetic resonance imaging and computed tomography modeling. Twenty-one children and young adults with CHD undergoing catheterization procedures between October 2019 and May 2021 were chosen based on their degree of complexity of cardiac anatomy. 3D stereolithography models were generated, overlayed, and displayed in real time, alongside angiographs in both planes on the screen during these procedures. We report successful implementation of this novel technology for performance of 26 interventions including stent placements, balloon dilations, vessel occlusion and percutaneous valve and transvenous pacemaker implantation all in patients with various complex cardiac anatomies. A statistically significant reduction in radiation and contrast use was noted for coarctation of the aorta stent angioplasty and transcatheter pulmonary valve replacement when compared with national benchmarks and local institutional metrics (with and without single plane overlay). No complications were encountered with the use of this technology. Use of a tracheal registration technique provided very good correlation in most cases. Operators preferred using biplane augmented catheterization over traditional fluoroscopy in patients with complex cardiac anatomy undergoing interventions.

Objectives: To investigate the long-term mortality of acute coronary syndrome (ACS) patients with multivessel disease according to the level of completeness of revascularization (CR) and high-bleeding risk (HBR) status.

Design setting and participants: This retrospective study collected the data of ACS patients with multivessel disease who underwent percutaneous coronary intervention between May 2018 and February 2019. Complete to reasonable revascularization (CR) was defined by the residual Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score (RSS) of 0 to ≤8. The HBR was defined by the PRECISE-DAPT score ≥25.

Main outcome measures: The all-cause death at 36 months according to the CR and HBR status.

Results: A total of 209 patients with 743 lesions were included in the analysis. The median follow-up was 3.6 years. Patients with CR had lower event rates than ICR (4.5 vs. 11.5 per 100 patient-year, HR 0.39, 95% CI 0.22-0.70), p = 0.002). Similar observations were noted when compared between non-HBR and HBR (3.9 vs. 11.1 per 100 patient-year, HR 0.35, 95% CI 0.18-0.64, p < 0.001). Kaplan-Meier analysis revealed that all-cause death was highest among those in the ICR/HBR (40.5%) followed by ICR/non-HBR (28.6%), CR/non-HBR (28.3%) and the lowest among the CR/HBR group (7.1%), log-rank p = <0.001. No significant interaction was observed between the two factors regarding all-cause death (p = 0.10 for interaction).

Conclusions: In ACS patients with MVD, the achievement of CR was associated with reducing mortality rates and consistency irrespective of the HBR status. (Trial Registration: TCTR20211222003).

Objective: There is limited information about the extent of metabolic syndrome (MetS) among subjects with cardiac diseases in Ethiopia. Therefore, this study aimed to determine the prevalence and associated factors of MetS among adults with cardiac diseases.

Methods: A cross-sectional study was conducted at Hawassa University Comprehensive Specialized Hospital in southern-Ethiopia between May 2021 and August 2021. Data pertaining to the study were collected from 319 participants (153 cardiac and 166 non-cardiac groups) using the WHO stepwise approach. The International Diabetes Federation (IDF) and the revised National Cholesterol Education Program: Adult Treatment Panel III (ATP) were used to define MetS.

Results: The prevalence of MetS was 44.2% and 50.2% in IDF and ATP III, respectively. Among the cardiac group, 54.9% had MetS in IDF criteria, compared to 34.3% in the non-cardiac group (p < .001); whereas, it was 60.1% in the cardiac group and 41% in non-cardiac group (p < .001) by ATP III. Age >60 years, waist-height ratio ≥5, high waist-hip ratio, body mass index 25-29.9 and ≥30 kg/m² were significantly associated with higher odds of MetS in both IDF and ATP III. Also, smoking history and monthly income were associated with MetS by ATP III, while being female was associated with higher odds of MetS by IDF.

Conclusion: More than half of the subjects with cardiac diseases developed MetS as compared to non-cardiac controls. Periodic screening and focusing on the identified modifiable high-risk factors such as body weight, smoking, and central adiposity is important to effectively mitigate the risk of further comorbidity and complications in this high-risk population.

Background: Despite being a major global cause of mortality, the exact underlying mechanisms of cardiovascular diseases (CVDs) remain uncertain. This study aimed to elucidate the possible pathological connection between circulating activated immune cell types and the advancement of CVD.

Methods: A two-sample Mendelian randomization analysis was performed on publicly available genetic databases to examine the potential causal relationships among 731 immune phenotypes and CVD risks. The study focused on four distinct immune signatures: relative cell counts (RC), absolute cell counts (AC), morphological parameters (MP), and median fluorescence intensities (MFI). A sensitivity analysis was performed to assess the findings' consistency, robustness, and potential pleiotropic effects.

Results: Significant associations between CVD and various immunophenotypes were observed in this study. Specifically, two phenotypes exhibited protective effects against CVD. The odds ratio (OR) for activated and secretory CD4⁺ regulatory T-cells (Tregs) was 0.757 [95% confidence interval (CI): 0.628-0.913; p = 0.004], whereas that for B-cell activating factor receptor on IgD^-CD38⁺ memory B-cells was 0.654 (95% CI: 0.468-0.915; p = 0.013). Conversely, three major immunophenotypes were linked to heightened risks of CVD: CD80 on myeloid dendritic cells (OR: 1.181; 95% CI: 1.015-1.376; p = 0.032), the proportion of CD28⁺ CD45RA⁺ CD8⁺ T-cells in total T-cell population (OR: 1.064; 95% CI: 1.002-1.128; p = 0.041), and the proportion of CD28^-CD45RA⁺ CD8⁺ T-cells in total T-cell population (OR: 1.005; 95% CI: 1.000-1.011; p = 0.045).

Conclusion: This study underscores significant correlations between specific immune phenotypes and the risks associated with CVD onset, thus providing valuable perspectives for forthcoming clinical inquiries.

Objective: The objective of this study is to identify baseline risk factors in AIS-HF inclusion and exclusion from rtPA therapy and determine whether the baseline factors are different in male and female patients.

Methods: This is a retrospective data analysis of data from the PRISMA Health stroke registry. Logistic regression models were developed to generate odds ratios (OR) that predict risk factors that are associated with male and female AIS-HF patients excluded from rtPA.

Results: A total of 590 AIS-HF were identified. Of this, 76.78% were females while 23.22 were males. Male AIS-HF patients with carotid artery stenosis (CAS) (OR = 0.279, 95% CI, 0.083-0.944, P = 014), were more likely to be excluded from rtPA, while those with higher National Institutes of Health Stroke Scale (NIHSS) scores (OR = 1.096, 95% CI, 0.907-3.526, P < 0.001), were more likely to be included for rtPA. Female AIS-HF patients with chronic renal disease (CRD) (OR = 0.159, 95% CI, 0.050-0.503, P = 002), were likely to be excluded from rtPA therapy, while those on antidepressant use (OR = 5.322, 95%, CI 1.488-19.03, P < 0.001), that presents with higher NIHSS scores (OR = 3.336, CI 1.699-6.950, P < 0.001) were more likely to be included for rtPA.

Conclusions: Our results reveal that male AIS-HF patients with a history of CAS were more likely to be excluded from rtPA therapy, whereas, females who present with CRD were more likely to be excluded from rtPA. These findings indicate the need for the development of management strategies to improve the use of rtPA for male and female AIS-HF patients.

In today's world, high variability of body mass index (BMI) is known as a significant global health problem that can lead to many negative impacts on the cardiovascular system, including atrial fibrillation (AF) and coronary heart disease. The current systematic review aims to elucidate the effect of variability in BMI on the risk of cardiovascular outcomes. Four databases, including PubMed, Scopus, MEDLINE, and CENTRAL, were searched. All related articles up to 10 June 2022, were obtained. Titles, abstracts, and full texts were reviewed. After screening abstracts and full texts, four articles were included in our study. In these four cohort studies, 7,038,873 participants from the USA and South Korea were involved. These articles generally considered the BMI and outcomes including cardiovascular disease, AF, and coronary heart disease. All these articles reported an association between the variability of BMI and increased risk of cardiovascular outcomes. Due to the negative impact of the high variability of BMI on the risk of cardiovascular outcomes, health policymakers and practitioners should pay more attention to the significant role of BMI in health problems and physicians might better check the variability of BMI visits to visit.

Background: Intravascular ultrasonography (IVUS) has become an important complementary tool in interventional cardiology, both for preprocedural planning and for optimizing the performance of percutaneous coronary intervention (PCI). However, this tool is not free of potential complications, because of that it is essential to be aware of them and their management. Over time, new uses of IVUS have emerged, and it is currently a potential tool for predicting the risk of coronary perforation.

Case report: We present the clinical case of a 51-year-old male patient who was admitted in the context of post-infarction angina. During coronary angiography, the patient presented with two acute complications, one of them associated with IVUS and the other associated with severe coronary calcification that predisposed to coronary perforation. Both complications were successfully treated.

Conclusion: IVUS, although a very useful imaging tool before and during PCI, is not without risk. The overall rate of complications with certain or possible relation to IVUS is 3.9%. Vascular spasm is the most frequent complication and acute vascular occlusion, with the need for emergency coronary artery by-pass grafting, the least frequent. On the other hand, IVUS can predict the risk of developing other complications, such as coronary perforation, by means of the C-CAT sign. Knowledge of the possible complications during PCI and the rapid procedure of the hemodynamic team allows adequate management of these potentially fatal complications.