IJC Heart and Vasculature最新文献_第7页

Short‑term effects of ambient air pollution exposure on hospital emergency room visits for atrial fibrillation: a nationwide cohort study 环境空气污染暴露对房颤急诊室就诊的短期影响：一项全国性队列研究

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-09-25 DOI: 10.1016/j.ijcha.2025.101805

Yu-Shan Huang , Li-Wei Lo , Tsung-Ying Tsai , Hsin-Bang Leu , Shih-Ann Chen

Background

Although air pollutants are linked to cardiopulmonary mortality, their impact on cardiac arrhythmias is not well understood. This study examines the short-term effects of air pollution on emergency admissions for acute atrial fibrillation (AF) in Taiwan.

Methods

This study used Taiwan’s National Health Insurance Research Database, including 16,778,374 participants aged 20 and older, residing in the same districts during 10-year follow-ups from 2008 to 2017. Hourly air pollutant exposure data were obtained from the Taiwan Environmental Protection Administration Database. Records of patients with ICD-9 code 427.31 (AF) as the primary diagnosis from emergency departments were extracted. Emergency visits for AF were compared across exposures to pollutants such as particulate matter PM_2.5, PM₁₀, Nitrogen Dioxide (NO₂), Nitrogen Oxide (NO), Nitrogen Oxides (NO_X), Sulphur Dioxide (SO₂), Carbon monoxide (CO) and Ozone (O₃).

Results

In our study cohort of 16,778,374 patients, 129,595 (0.77 %) were admitted to emergency departments for initial AF episodes. Significant associations were found between AF visits and PM_2.5 (1.01 %; CI: 1.00–1.02 %; P = 0.003), PM₁₀ (1.01 %; CI: 1.00–1.01 %; P = 0.001), NO₂ (1.02 %; CI: 1.00–1.03 %; P = 0.001), NO (1.02 %; CI: 1.00–1.04 %; P = 0.016), NO_x (1.01 %; CI: 1.00–1.01 %; P = 0.002), CO (1.05 %; CI: 1.00–1.11 %; P < 0.0001), with exposure levels on the event day compared to the previous 5 days. Except for O₃, patients without comorbidities like coronary artery disease, heart failure, chronic kidney disease, and thyroid disease were more susceptible to air pollution.

Conclusions

High concentrations of ambient air pollutants with short-term exposure are linked to an increased number of emergency room visits for acute AF attacks.

虽然空气污染物与心肺死亡有关，但其对心律失常的影响尚不清楚。本研究探讨空气污染对台湾急症心房颤动（AF）入院的短期影响。方法本研究使用台湾全民健康保险研究数据库，包括16778374名20岁及以上的参与者，他们在2008年至2017年的10年随访期间居住在同一地区。每小时空气污染物暴露数据来自台湾环境保护署数据库。提取急诊科以ICD-9编码427.31 （AF）为首发诊断的患者记录。在暴露于PM2.5、PM10、二氧化氮（NO2）、氮氧化物（NO）、氮氧化物（NOX）、二氧化硫（SO2）、一氧化碳（CO）和臭氧（O3）等污染物的情况下，比较了房颤的急诊就诊情况。结果在我们的研究队列中，16778,374例患者中，129,595例（0.77%）因房颤发作入院急诊。与前5天的暴露水平相比，AF就诊与PM2.5 （1.01%, CI: 1.00 - 1.02%, P = 0.003）、PM10 （1.01%, CI: 1.00 - 1.01%, P = 0.001）、NO2 （1.02%, CI: 1.00 - 1.03%, P = 0.001）、NO （1.02%, CI: 1.00 - 1.04%, P = 0.016）、NOx （1.01%, CI: 1.00 - 1.04%, P = 0.002）、CO （1.05%, CI: 1.00 - 1.11%, P < 0.0001）存在显著相关性。除O3外，无冠状动脉疾病、心力衰竭、慢性肾脏疾病和甲状腺疾病等合并症的患者更容易受到空气污染的影响。结论短期暴露于高浓度环境空气污染物与急性房颤急诊次数增加有关。

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引用次数: 0

Care pathway in patients after myocardial infarction in Denmark − healthcare and drug utilization 丹麦心肌梗死患者的护理途径——保健和药物利用

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-09-24 DOI: 10.1016/j.ijcha.2025.101809

Marius Mølsted Flege , Theresa Kleinschmidt , Susanne Hansen , Kristoffer Jarlov Jensen , Henrik Kjærulf Jensen , Morten Krogh Christiansen , Charlotte Ottar Merland , Janne Petersen

Background

Following myocardial infarction (MI), patients are recommended to lower their low-density lipid cholesterol (LDL-C) levels and undergo cardiac rehabilitation to prevent recurrent events. Although lowering LDL-C is vital post-MI, many patients fail reaching sufficient levels, resulting in recurrent cardiovascular events. The aim of the study was therefore to investigate the follow-up and the utilisation of lipid lowering therapy one year after MI.

Methods

This register-based nationwide Danish observational study included all hospitalized patients with an incident MI from 2018 to 2021, discharged alive. Patients were followed for one year after discharge with respect to LDL-C measurements, contacts with different healthcare actors, and lipid lowering therapy.

Results

A total of 24,977 patients were included. During follow-up, the incidence of having an LDL-C measured once and twice were 87 % and 67 %, respectively. The incidence of patients visiting a cardiology department, general practitioner with an LDL-C measurement, and having an acute hospital contact were 66 %, 70 %, and 48 %. Statin therapy was redeemed by most patients at least once (87 %) or twice (82 %), while ezetimibe (16 %) and other drugs were prescribed less frequently. Younger, higher educated, less comorbid males with LDL-C ≥ 1.4 mmol/L at hospitalization were more likely to be followed-up with LDL-C measurement or visit to a cardiology department post-MI.

Conclusion

These findings show that a large proportion of patients are not receiving lipid lowering therapy or are not monitored according to guidelines one year after an MI. This suggests a further need for monitoring MI patients with LDL-C levels and healthcare visits.

背景：心肌梗死（MI）后，建议患者降低低密度脂质胆固醇（LDL-C）水平，并进行心脏康复以防止复发。尽管降低心肌梗死后LDL-C至关重要，但许多患者未能达到足够的水平，导致心血管事件复发。因此，该研究的目的是调查心肌梗死一年后的随访和降脂治疗的使用情况。方法：这项基于登记的丹麦全国观察性研究纳入了2018年至2021年所有住院的心肌梗死患者。出院后对患者进行为期一年的LDL-C测量、与不同医护人员的接触以及降脂治疗。结果共纳入24977例患者。在随访期间，检测一次和两次LDL-C的发生率分别为87%和67%。就诊心内科、全科医生进行LDL-C检测和急诊就诊的患者分别为66%、70%和48%。大多数患者至少一次（87%）或两次（82%）使用他汀类药物进行治疗，而依折麦比（16%）和其他药物的使用频率较低。住院时LDL-C≥1.4 mmol/L的年轻、高学历、合并症较少的男性在心肌梗死后更有可能接受LDL-C测量随访或前往心内科就诊。这些发现表明，很大一部分患者在心肌梗死一年后没有接受降脂治疗或没有按照指南进行监测。这表明需要进一步监测心肌梗死患者的LDL-C水平和就诊情况。

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引用次数: 0

Use of the novel virtual myectomy in guiding thoracoscopic myectomy for patients with hypertrophic obstructive cardiomyopathy 应用新型虚拟肌瘤切除术指导胸腔镜下肥厚性梗阻性心肌病患者的肌瘤切除术

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-09-23 DOI: 10.1016/j.ijcha.2025.101795

Peijian Wei , Tong Tan , Shengwen Wang , Jiexu Ma , Guanyu Lu , Haozhong Liu , Hanxiang Xie , Wei Zhu , Jian Zhuang , Jian Liu , Huiming Guo

Background

This study aimed to evaluate the efficacy of a novel virtual myectomy procedure in guiding thoracoscopic trans-mitral myectomy.

Methods and Results

Clinical data from 37 patients who underwent thoracoscopic trans-mitral septal myectomy guided by virtual myectomy between April 2019 and October 2021 were retrospectively analyzed. Enhanced cardiac CT images were imported into Mimics software to perform virtual myectomy. The short-axis two-chamber plane, perpendicular to the interventricular septum (IVS), was marked for each segment from the basal septum to the apex. IVS thickness was continuously measured at each marked segment, and a figurative digital model determined the resection extent. The cohort consisted of 22 women (59.46 %) with a mean age of 53.14 ± 13.62 years. No deaths or permanent pacemaker implantations occurred. Septal thickness decreased significantly from 20.49 ± 3.85 to 11.28 ± 2.53 mm (P < 0.001), resulting in a marked reduction in obstruction (90.84 ± 28.78 to 11.59 ± 11.06 mmHg, P < 0.001). Twelve patients (32.43 %) underwent mitral valve replacement. The virtual resection’s length, width, thickness, and volume showed strong positive correlations with the actual resection (R = 0.76–0.89). The virtual model’s septal thickness was moderately correlated with the actual resection volume (R = 0.51, P < 0.01).

Conclusions

Virtual myectomy effectively guided septal myectomy, with favorable outcomes in selected patients. This approach, combined with preoperative 3D simulation and printing, enables precise planning for complex cases.

背景：本研究旨在评估一种新型虚拟肌瘤切除术在指导胸腔镜经二尖瓣肌瘤切除术中的效果。方法和结果回顾性分析2019年4月至2021年10月37例胸腔镜下经二尖瓣间隔肌切除术引导下虚拟肌切除术患者的临床资料。将增强心脏CT图像导入Mimics软件进行虚拟肌瘤切除术。垂直于室间隔（IVS）的短轴双室平面，标记了从室间隔基部到鼻尖的每段。连续测量每个标记段的IVS厚度，并通过图形化的数字模型确定切除程度。该队列包括22名女性（59.46%），平均年龄为53.14±13.62岁。没有发生死亡或永久性心脏起搏器植入。鼻中隔厚度由20.49±3.85 mm降至11.28±2.53 mm (P < 0.001)，导致阻塞明显减少（90.84±28.78降至11.59±11.06 mmHg, P < 0.001）。12例（32.43%）行二尖瓣置换术。虚拟切除的长度、宽度、厚度和体积与实际切除呈强正相关（R = 0.76-0.89）。虚拟模型的间隔厚度与实际切除体积有中度相关性（R = 0.51, P < 0.01）。结论虚拟肌瘤切除术能有效指导中隔肌瘤切除术，对部分患者疗效良好。这种方法与术前3D模拟和打印相结合，可以对复杂病例进行精确规划。

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引用次数: 0

Short and long-term outcomes of percutaneous coronary intervention in patients with active or prior history of cancer: a systematic review and meta-analysis 有活跃或既往癌症病史的患者经皮冠状动脉介入治疗的短期和长期结果：一项系统回顾和荟萃分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-09-22 DOI: 10.1016/j.ijcha.2025.101806

Nikolaos Vythoulkas-Biotis , David-Dimitris Chlorogiannis , Theoni Theodoropoulou , Ioannis Gialamas , Evangelos Oikonomou , Konstantinos Kalogeras , Helena Michalopoulou , Gerasimos Siasos , Manolis Vavuranakis

Background

Percutaneous coronary intervention (PCI) in patients with active or prior history of cancer presents a challenge due to the increased rates of cardiovascular complications. Therefore, we aimed to evaluate the mortality rates, in addition to early and long-term adverse cardiovascular outcomes in this high-risk population.

Methods

A systematic literature search was conducted across PubMed, Cochrane, and Scopus databases to identify eligible studies comparing clinical outcomes between patients with active or prior history of cancer and patients without cancer. Our primary outcomes were all-cause mortality and cardiovascular mortality at different time points. Secondary outcomes included bleeding, stroke, recurrent myocardial infarction (MI), and heart failure events between the two groups.

Results

Overall, 18 studies with a total of 8 million patients were included. Active or prior history of cancer was associated with increased in-hospital all-cause mortality (RR: 1.43; 95 % CI: 1.03–1.99; p = 0.03), 1-year all-cause mortality (RR: 2.35; 95 % CI: 1.75–3.16; p < 0.001), as well as, increased 1-year cardiovascular mortality (RR: 1.35; 95 % CI: 1.15–1.59; p < 0.001) compared to patients without a history of cancer. Patients with active or prior history of cancer have higher rates of in-hospital (RR: 1.77; 95 % CI: 1.75–1.79; p < 0.001), 1-year (RR: 1.63; 95 %CI: 1.26–2.11; p < 0.001), and long-term bleeding events (RR: 2.08; 95 % CI: 1.30–3.35; p < 0.003) compared to patients without cancer. No significant differences were recorded regarding recurrent MI between the two groups.

Conclusions

Active or prior history of cancer was associated with a negative impact on early and long-term clinical outcomes in patients undergoing PCI. These findings underline the importance of individualized and multidisciplinary approaches when treating this high-risk population.

背景：由于心血管并发症发生率的增加，经皮冠状动脉介入治疗（PCI）在有活跃或既往癌症病史的患者中的应用面临挑战。因此，我们的目的是评估死亡率，以及这一高危人群的早期和长期不良心血管结局。方法对PubMed、Cochrane和Scopus数据库进行系统的文献检索，以确定有活跃或既往癌症病史的患者与无癌症患者的临床结果进行比较。我们的主要结局是不同时间点的全因死亡率和心血管死亡率。次要结局包括两组之间的出血、卒中、复发性心肌梗死（MI）和心力衰竭事件。结果共纳入18项研究，共纳入800万例患者。与没有癌症病史的患者相比，活跃或既往癌症病史与住院全因死亡率（RR: 1.43; 95% CI: 1.03-1.99; p = 0.03）、1年全因死亡率（RR: 2.35; 95% CI: 1.75-3.16; p < 0.001）以及1年心血管死亡率（RR: 1.35; 95% CI: 1.15-1.59; p < 0.001）增加相关。与无癌症患者相比，有活跃或既往癌症病史的患者住院（RR: 1.77; 95% CI: 1.75-1.79; p < 0.001）、1年（RR: 1.63; 95% CI: 1.26-2.11; p < 0.001）和长期出血事件（RR: 2.08; 95% CI: 1.30-3.35; p < 0.003）的发生率更高。两组在心肌梗死复发方面无显著差异。结论：积极或既往癌症病史对PCI患者的早期和长期临床结果有负面影响。这些发现强调了个体化和多学科方法在治疗高危人群时的重要性。

{"title":"Short and long-term outcomes of percutaneous coronary intervention in patients with active or prior history of cancer: a systematic review and meta-analysis","authors":"Nikolaos Vythoulkas-Biotis , David-Dimitris Chlorogiannis , Theoni Theodoropoulou , Ioannis Gialamas , Evangelos Oikonomou , Konstantinos Kalogeras , Helena Michalopoulou , Gerasimos Siasos , Manolis Vavuranakis","doi":"10.1016/j.ijcha.2025.101806","DOIUrl":"10.1016/j.ijcha.2025.101806","url":null,"abstract":"<div><h3>Background</h3><div>Percutaneous coronary intervention (PCI) in patients with active or prior history of cancer presents a challenge due to the increased rates of cardiovascular complications. Therefore, we aimed to evaluate the mortality rates, in addition to early and long-term adverse cardiovascular outcomes in this high-risk population.</div></div><div><h3>Methods</h3><div>A systematic literature search was conducted across PubMed, Cochrane, and Scopus databases to identify eligible studies comparing clinical outcomes between patients with active or prior history of cancer and patients without cancer. Our primary outcomes were all-cause mortality and cardiovascular mortality at different time points. Secondary outcomes included bleeding, stroke, recurrent myocardial infarction (MI), and heart failure events between the two groups.</div></div><div><h3>Results</h3><div>Overall, 18 studies with a total of 8 million patients were included. Active or prior history of cancer was associated with increased in-hospital all-cause mortality (RR: 1.43; 95 % CI: 1.03–1.99; p = 0.03), 1-year all-cause mortality (RR: 2.35; 95 % CI: 1.75–3.16; p < 0.001), as well as, increased 1-year cardiovascular mortality (RR: 1.35; 95 % CI: 1.15–1.59; p < 0.001) compared to patients without a history of cancer. Patients with active or prior history of cancer have higher rates of in-hospital (RR: 1.77; 95 % CI: 1.75–1.79; p < 0.001), 1-year (RR: 1.63; 95 %CI: 1.26–2.11; p < 0.001), and long-term bleeding events (RR: 2.08; 95 % CI: 1.30–3.35; p < 0.003) compared to patients without cancer. No significant differences were recorded regarding recurrent MI between the two groups.</div></div><div><h3>Conclusions</h3><div>Active or prior history of cancer was associated with a negative impact on early and long-term clinical outcomes in patients undergoing PCI. These findings underline the importance of individualized and multidisciplinary approaches when treating this high-risk population.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101806"},"PeriodicalIF":2.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Mental stress is associated with coronary endothelial dysfunction in women with chest pain and non-obstructive coronary artery disease 精神压力与胸痛和非阻塞性冠状动脉疾病女性冠状动脉内皮功能障碍相关

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-09-22 DOI: 10.1016/j.ijcha.2025.101802

Jaskanwal Deep S Sara , Nazanin Rajai , Scott Breitinger , Betsy Medina-Inojosa , Lilach O Lerman , Amir Lerman

Objective

We evaluate the association between chronic mental stress (MS) and coronary endothelial function in patients with chest pain and nonobstructive coronary artery disease (CAD) separately in males and females.

Methods

Patients with nonobstructive CAD (stenosis <40 %) at coronary angiography underwent an invasive assessment for coronary endothelial dysfunction (CED). Macrovascular CED was defined as a percentage change in coronary artery diameter to acetylcholine (%ΔCADAch) ≤ −10 % and microvascular CED was defined as a percentage change in coronary blood flow to acetylcholine (%ΔCBFAch) ≤−50 %. Patients completed a questionnaire within 2 years of the index procedure that included questions regarding chronic MS. The frequency of macrovascular, microvascular and any type of CED was compared across groups. Logistic regression analyses were performed to assess the association between MS and CED.

Results

Between January 2017 and December 2022, 211 patients (mean (sd) age 54.4 (13.6) yrs, 71.0 % female) were included. One hundred forty-two (67.3 %) patients had any type of CED. In females with significant MS there was a higher proportion of individuals with any type of CED compared to without CED (43 (42.6 %) vs. 12 (24.5 %), p = 0.0362). In a multivariable analysis MS was associated with any type of CED in females: OR (95 % CI) 2.70 (1.24–6.25); p = 0.0156.

Conclusion

Chronic MS is associated with CED in females with chest pain and nonobstructive CAD. Chronic MS may underly the mechanism for chest pain in these patients and may play a contributory to cardiovascular disease through its association with endothelial dysfunction.

目的探讨胸痛和非阻塞性冠状动脉疾病（CAD）患者慢性精神应激（MS）与冠状动脉内皮功能的关系。方法非阻塞性CAD（狭窄<； 40%）患者在冠状动脉造影时接受冠状动脉内皮功能障碍（CED）的侵入性评估。大血管CED定义为冠状动脉直径对乙酰胆碱的百分比变化（%ΔCADAch）≤- 10%，微血管CED定义为冠状动脉血流量对乙酰胆碱的百分比变化（%ΔCBFAch）≤- 50%。患者在指标手术后2年内完成一份问卷，其中包括关于慢性ms的问题，比较各组大血管、微血管和任何类型CED的频率。采用Logistic回归分析来评估多发性硬化症与CED之间的关系。结果2017年1月至2022年12月，纳入211例患者（平均（sd）年龄54.4（13.6）岁，女性71.0%）。142例（67.3%）患者有任何类型的CED。在有明显多发性硬化症的女性中，有任何类型的CED的个体比例高于没有CED的个体（43人（42.6%）比12人（24.5%），p = 0.0362）。在多变量分析中，MS与女性任何类型的CED相关：OR (95% CI) 2.70 (1.24-6.25)；p = 0.0156。结论女性胸痛合并非阻塞性CAD患者慢性MS与CED相关。慢性多发性硬化症可能是这些患者胸痛的潜在机制，并可能通过与内皮功能障碍相关而导致心血管疾病。

{"title":"Mental stress is associated with coronary endothelial dysfunction in women with chest pain and non-obstructive coronary artery disease","authors":"Jaskanwal Deep S Sara , Nazanin Rajai , Scott Breitinger , Betsy Medina-Inojosa , Lilach O Lerman , Amir Lerman","doi":"10.1016/j.ijcha.2025.101802","DOIUrl":"10.1016/j.ijcha.2025.101802","url":null,"abstract":"<div><h3>Objective</h3><div>We evaluate the association between chronic mental stress (MS) and coronary endothelial function in patients with chest pain and nonobstructive coronary artery disease (CAD) separately in males and females.</div></div><div><h3>Methods</h3><div>Patients with nonobstructive CAD (stenosis <40 %) at coronary angiography underwent an invasive assessment for coronary endothelial dysfunction (CED). Macrovascular CED was defined as a percentage change in coronary artery diameterto acetylcholine (%ΔCADAch) ≤ −10 % and microvascular CED was defined as a percentage change in coronary blood flowto acetylcholine (%ΔCBFAch) ≤−50 %. Patients completed a questionnaire within 2 years of the index procedure that included questions regarding chronic MS. The frequency of macrovascular, microvascular and any type of CED was compared across groups. Logistic regression analyses were performed to assess the association between MS and CED.</div></div><div><h3>Results</h3><div>Between January 2017 and December 2022, 211 patients (mean (sd) age 54.4 (13.6) yrs, 71.0 % female) were included. One hundred forty-two (67.3 %)patients had any type of CED. In females with significant MS there was a higher proportion of individuals with any type of CED compared to without CED (43 (42.6 %) vs. 12 (24.5 %), p = 0.0362). In a multivariable analysisMS was associated with any type of CED in females: OR (95 % CI) 2.70 (1.24–6.25); p = 0.0156.</div></div><div><h3>Conclusion</h3><div>Chronic MS is associated with CED in females with chest pain and nonobstructive CAD. Chronic MS mayunderly the mechanism for chest pain in these patientsandmay play a contributorytocardiovascular disease through its association withendothelial dysfunction.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101802"},"PeriodicalIF":2.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Atorvastatin pretreatment, ST-segment resolution and long-term prognosis for ST-segment elevation myocardial infarction with primary percutaneous coronary intervention 经皮冠状动脉介入治疗后st段抬高型心肌梗死的阿托伐他汀预处理、st段消退及远期预后

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-09-19 DOI: 10.1016/j.ijcha.2025.101808

Chao Wu , Pei Gao , Tiange Chen , Haiyan Xu , Xiang Li , Yan Wang , Honglei Zhao , Zhifang Wang , Guotong Xie , Yuejin Yang , Xiaojin Gao , Jingang Yang

Background

The benefit of statin pretreatment before primary percutaneous coronary intervention (PCI) on myocardial reperfusion and prognosis in ST-segment elevation myocardial infarction (STEMI) remains unclear. In this study, we evaluated whether atorvastatin pretreatment could improve ST-segment resolution (STR) and long-term clinical outcomes in this setting.

Methods

From the China Acute Myocardial Infarction Registry, we conducted propensity score matching to compare STR and 2-year major adverse cardiovascular events (MACE, all-cause death, reinfarction, and stroke) in 2426 STEMI patients undergoing primary PCI (1213 patients per group).

Results

Within the pretreatment group, 75, 726, 60, and 691 patients received 20 mg, 40 mg, 60 mg or 80 mg atorvastatin respectively. In the matched cohort of 2426 patients with available STR data (1213 pretreated), STR < 50 % occurred in 258 (21 %) patients in the control group versus 159 (13 %) in the pretreatment group (adjusted hazard ratio [HR]: 0.53; 95 % CI: 0.41–0.70). Multivariable analysis showed that atorvastatin pretreatment was significantly associated with lower 2-year MACE rates (6.9 % vs 8.7 %; adjusted HR: 0.68; 95 % CI: 0.48–0.97), which were consistent across multiple subgroups.

Conclusion

A single dose of atorvastatin pretreatment before primary PCI significantly improves myocardial reperfusion parameters and may be associated with long-term clinical benefits, supporting further validation in randomized trials.

背景：st段抬高型心肌梗死（STEMI）经皮冠状动脉介入治疗（PCI）前他汀类药物预处理对心肌再灌注和预后的益处尚不清楚。在这项研究中，我们评估了阿托伐他汀预处理是否可以改善st段分辨率（STR）和这种情况下的长期临床结果。方法来自中国急性心肌梗死登记，我们对2426例接受初级PCI治疗的STEMI患者（每组1213例）进行倾向评分匹配，比较STR和2年主要不良心血管事件（MACE、全因死亡、再梗死和卒中）。结果预处理组中，分别有75例、726例、60例和691例患者接受了20 mg、40 mg、60 mg或80 mg的阿托伐他汀治疗。在可获得STR数据的2426例患者（1213例预处理）的匹配队列中，对照组258例（21%）患者发生了50%的STR，而预处理组159例（13%）患者发生了50%的STR（校正风险比[HR]: 0.53; 95% CI: 0.41-0.70）。多变量分析显示，阿托伐他汀预处理与较低的2年MACE发生率显著相关（6.9% vs 8.7%；调整HR: 0.68; 95% CI: 0.48-0.97），这在多个亚组中是一致的。结论首次PCI术前单剂量阿托伐他汀预处理可显著改善心肌再灌注参数，可能与长期临床获益相关，支持在随机试验中进一步验证。

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引用次数: 0

Increased dose of adenosine and the relationship between the resting full-cycle ratio and fractional flow reserve 腺苷剂量增加及静息全周期比与血流储备的关系

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-09-19 DOI: 10.1016/j.ijcha.2025.101803

Christian A. Christensen , Jens Trøan , Kirstine N. Hansen , Manijeh Noori , Anders Junker , Karsten Veien , Martin K. Christensen , Julia Ellert-Gregersen , Kristian Wachtell , Henrik S. Hansen , Jens F. Lassen , Diyako Qanie , Mikkel Hougaard , Lisette O. Jensen

Background

Intermediate coronary artery stenosis can be evaluated with fractional flow reserve (FFR) and resting full-cycle ratio (RFR) to determine if the stenosis is functionally significant. However, RFR and FFR have shown discordance in around 20% of examinations. One explanation could be that maximal hyperemia was not achieved during adenosine infusion. The aim was to investigate if increased doses of adenosine would reduce FFR further, and if the agreement between RFR and FFR would improve.

Method

Two hundred patients underwent physiological assessment of an intermediate stenosis with RFR and FFR at 140 µg/kg/min (FFR₁₄₀) and 200 µg/kg/min (FFR₂₀₀) of adenosine infusion. The microcirculation function was assessed using the index of microvascular resistance (IMR).

Results

Median RFR was 0.89 (interquartile range [IQR] 0.85–0.93). Median FFR decreased significantly during increased adenosine doses: FFR₁₄₀ = 0.85 (IQR 0.77–0.90) versus FFR₂₀₀ = 0.82 (IQR 0.75–0.87), p < 0.001. Reduction in FFR during increased adenosine doses was higher in patients with IMR ≥ 24 (FFR₁₄₀ 0.85 [IQR 0.78–0.92] versus FFR₂₀₀ 0.82 [IQR 0.75–0.86], p < 0.001) compared to patients with IMR < 24 (FFR₁₄₀ 0.83 [IQR 0.77–0.89] versus FFR₂₀₀ 0.81 [IQR 0.75–0.87], p < 0.001) with an absolute difference of −0.03 (−0.05, −0.01) versus −0.01 (−0.02, 0.0), p < 0.001. Area under the curve (AUC) of RFR compared to FFR₁₄₀ was 0.88 (95 % confidence interval [CI] 0.84–0.93), and for FFR_200, AUC was 0.88 (CI: 0.84–0.93).

Conclusion

Increased doses of adenosine significantly reduced FFR values, whereas the correlation agreement between RFR and FFR was not improved.

背景：中度冠状动脉狭窄可以通过血流储备分数（FFR）和静息全周期比（RFR）来评估，以确定狭窄是否具有功能显著性。然而，RFR和FFR在约20%的检查中显示不一致。一种解释可能是在腺苷输注期间没有达到最大充血。目的是研究增加剂量的腺苷是否会进一步降低FFR，以及RFR和FFR之间的一致性是否会改善。方法200例中度狭窄患者分别以140µg/kg/min （FFR140）和200µg/kg/min （FFR200）腺苷输注RFR和FFR进行生理评估。采用微血管阻力指数（IMR）评价微循环功能。结果中位RFR为0.89（四分位间距[IQR] 0.85 ~ 0.93）。中位FFR在腺苷剂量增加时显著降低：FFR140 = 0.85 (IQR 0.77-0.90) vs FFR200 = 0.82 (IQR 0.75-0.87), p < 0.001。与IMR≥24的患者（FFR140 0.85 [IQR 0.78-0.92] vs FFR200 0.82 [IQR 0.75-0.86], p < 0.001）相比，增加腺苷剂量时，IMR≥24的患者（FFR140 0.83 [IQR 0.77-0.89] vs FFR200 0.81 [IQR 0.75-0.87], p < 0.001）的FFR降低幅度更高，绝对差异为- 0.03 (- 0.05,- 0.01)vs - 0.01 (- 0.02, 0.0), p < 0.001。与FFR140相比，RFR的曲线下面积（AUC）为0.88(95%可信区间[CI] 0.84-0.93)， FFR200的AUC为0.88 （CI: 0.84-0.93）。结论增加腺苷剂量可显著降低FFR值，但RFR与FFR的相关性没有提高。

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引用次数: 0

Prediction of spontaneous echo contrast following mitral valve transcatheter edge-to-edge repair 二尖瓣经导管边缘对边缘修复后自发性回声对比的预测

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-09-15 DOI: 10.1016/j.ijcha.2025.101801

Makoto Takeuchi , Hiroto Utsunomiya , Kiyotaka Tohgi , Ayano Hamada , Yohei Hyodo , Akane Tsuchiya , Atsuo Mogami , Hajime Takemoto , Kanako Izumi , Kosuke Takahari , Yusuke Ueda , Kiho Itakura , Hiroki Ikenaga , Yukiko Nakano

Background

Although no studies predict thrombotic events after mitral valve transcatheter edge-to-edge repair (MV-TEER), 34% of patients experience worsening spontaneous echocardiographic contrast (SEC) following MV-TEER. We hypothesized that predicting the SEC occurrence or rapid progression after MV-TEER and identifying associated cases would be valuable.

Methods

This retrospective study included 176 consecutive patients who underwent MV-TEER at Hiroshima University Hospital. SEC worsening was assessed using intraoperative transesophageal echocardiography pre- and post-procedure.

Results

The study analyzed 168 patients undergoing MV-TEER (median age 80, 56 % male). Severe mitral regurgitation (MR), secondary MR, and atrial fibrillation were present in 67.5 %, 70.2 %, and 57.7 % (36.9 % paroxysmal) of patients, respectively. Overall, 149 patients (88 %) and 19 (12 %) had SEC grade ≤ 2 and SEC grade ≥ 3, respectively, considerably worsening post-MV-TEER in 30 %. Severe SEC or sludge (11 %) correlated with higher rates of non-paroxysmal atrial fibrillation (AF), cardiomyopathy, increased right atrial area index (RAAI), elevated atrial pressures, and reduced cardiac index. Multivariate analysis identified non-paroxysmal AF, RAAI, and preoperative SEC grade ≥ 3 as key predictors of severe SEC or sludge. Rapid SEC worsening (15 cases) was associated with non-paroxysmal AF, reduced left atrial strain, larger RAAI, and lower cardiac index. A predictive scoring model incorporating RAAI, left atrial strain, and cardiac index showed good discrimination (area under the curve: 0.79), aiding risk assessment for post-MV-TEER SEC progression.

Conclusions

Patients with non-paroxysmal AF, right atrial enlargement, reduced left atrial reservoir strain, or low cardiac index are at risk of rapid SEC worsening after MV-TEER, regardless of initial SEC grades.

虽然没有研究预测二尖瓣经导管边缘到边缘修复（MV-TEER）后的血栓形成事件，但34%的患者在MV-TEER后自发性超声心动图对比（SEC）恶化。我们假设预测MV-TEER后SEC的发生或快速进展以及识别相关病例将是有价值的。方法回顾性研究包括176例在广岛大学医院接受MV-TEER治疗的患者。术中术前和术后经食管超声心动图评估SEC恶化情况。结果本研究分析了168例MV-TEER患者（中位年龄80岁，56%为男性）。严重二尖瓣反流（MR）、继发性MR和房颤分别出现在67.5%、70.2%和57.7%（36.9%为阵发性）的患者中。总体而言，149名患者（88%）和19名患者（12%）的SEC等级分别为≤2级和≥3级，30%的患者在mv - teer后显著恶化。严重的SEC或淤血（11%）与非阵发性心房颤动（AF）、心肌病、右心房面积指数（RAAI）升高、心房压力升高和心脏指数降低的发生率较高相关。多变量分析发现，非阵发性房颤、RAAI和术前SEC分级≥3是严重SEC或污泥的关键预测因素。SEC快速恶化（15例）与非阵发性房颤、左心房应变减小、RAAI增大和心脏指数降低相关。结合RAAI、左心房应变和心脏指数的预测评分模型具有良好的判别性（曲线下面积：0.79），有助于mv - teer后SEC进展的风险评估。结论非阵发性房颤、右房增大、左房储层应变减小或心脏指数低的患者在MV-TEER后存在SEC快速恶化的风险，与初始SEC等级无关。

{"title":"Prediction of spontaneous echo contrast following mitral valve transcatheter edge-to-edge repair","authors":"Makoto Takeuchi , Hiroto Utsunomiya , Kiyotaka Tohgi , Ayano Hamada , Yohei Hyodo , Akane Tsuchiya , Atsuo Mogami , Hajime Takemoto , Kanako Izumi , Kosuke Takahari , Yusuke Ueda , Kiho Itakura , Hiroki Ikenaga , Yukiko Nakano","doi":"10.1016/j.ijcha.2025.101801","DOIUrl":"10.1016/j.ijcha.2025.101801","url":null,"abstract":"<div><h3>Background</h3><div>Although no studies predict thrombotic events after mitral valve transcatheter edge-to-edge repair (MV-TEER), 34% of patients experience worsening spontaneous echocardiographic contrast (SEC) following MV-TEER. We hypothesized that predicting the SEC occurrence or rapid progression after MV-TEER and identifying associated cases would be valuable.</div></div><div><h3>Methods</h3><div>This retrospective study included 176 consecutive patients who underwent MV-TEER at Hiroshima University Hospital. SEC worsening was assessed using intraoperative transesophageal echocardiography pre- and post-procedure.</div></div><div><h3>Results</h3><div>The study analyzed 168 patients undergoing MV-TEER (median age 80, 56 % male). Severe mitral regurgitation (MR), secondary MR, and atrial fibrillation were present in 67.5 %, 70.2 %, and 57.7 % (36.9 % paroxysmal) of patients, respectively. Overall, 149 patients (88 %) and 19 (12 %) had SEC grade ≤ 2 and SEC grade ≥ 3, respectively, considerably worsening post-MV-TEER in 30 %. Severe SEC or sludge (11 %) correlated with higher rates of non-paroxysmal atrial fibrillation (AF), cardiomyopathy, increased right atrial area index (RAAI), elevated atrial pressures, and reduced cardiac index. Multivariate analysis identified non-paroxysmal AF, RAAI, and preoperative SEC grade ≥ 3 as key predictors of severe SEC or sludge. Rapid SEC worsening (15 cases) was associated with non-paroxysmal AF, reduced left atrial strain, larger RAAI, and lower cardiac index. A predictive scoring model incorporating RAAI, left atrial strain, and cardiac index showed good discrimination (area under the curve: 0.79), aiding risk assessment for post-MV-TEER SEC progression.</div></div><div><h3>Conclusions</h3><div>Patients with non-paroxysmal AF, right atrial enlargement, reduced left atrial reservoir strain, or low cardiac index are at risk of rapid SEC worsening after MV-TEER, regardless of initial SEC grades.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101801"},"PeriodicalIF":2.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Transcatheter tricuspid valve intervention versus optimal medical therapy alone for severe tricuspid regurgitation: an updated meta-analysis with reconstructed time-to-event data 经导管三尖瓣干预与最佳药物治疗单独治疗严重三尖瓣反流：重建事件时间数据的最新荟萃分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-09-13 DOI: 10.1016/j.ijcha.2025.101794

Ahmed Ibrahim , Laila Shalabi , Sofian Zreigh , Shrouk Ramadan , Ahmed Samir , Mohamed Adel Elsawy , Mohamed Mahmoud Fathy , Belal Mohamed Hamed , Hossam Elbenawi , Mustafa Turkmani , Ahmed Y. Azzam , Hani Mahmoud-Elsayed , Islam Y. Elgendy

Background

Severe tricuspid regurgitation (TR) is strongly associated with high mortality and morbidity. This meta-analysis aims to compare the outcomes of transcatheter tricuspid valve intervention (TTVI) versus optimal medical treatment (OMT) alone among patients with severe TR.

Methods

Electronic databases were systematically searched to identify randomized controlled trials (RCTs) and propensity score-matched observational studies comparing TTVI with OMT. The primary outcome was all-cause mortality. Summary estimates were calculated using a random-effects model.

Results

Five studies (3 RCTs, 2 observational; n = 1988 patients) were included. TTVI was associated with a nonsignificant trend toward a lower incidence of all-cause mortality (risk ratio [RR]: 0.70, 95 % confidence interval [CI] 0.48–1.03; P = 0.071), primarily driven by observational studies. TTVI demonstrated significant benefits in terms of TR severity reduction (RR: 7.82, 95 % CI 5.60–10.93; P < 0.0001), enhanced health status as measured by the Kansas City Cardiomyopathy Questionnaire (mean difference: +14.46 points, 95 % CI 11.55–17.38; p < 0.0001), and reduced heart failure (HF) hospitalization rates (RR: 0.73, 95 % CI 0.56–0.96; P = 0.025). However, TTVI was associated with an increased risk of major bleeding (RR: 3.21, 95 % CI 1.61–6.39; P = 0.0009).

Conclusion

Among patients with severe TR, TTVI was not statistically associated with a lower incidence of all-cause mortality but was associated with a reduced risk of HF hospitalization, significant reduction in TR severity, and improved quality of life. Future large RCTs with extended follow-up are needed to confirm these findings and identify the subset of patients who benefit the most.

Systematic review protocol: CRD420251002402 (PROSPERO)

背景：严重三尖瓣反流（TR）与高死亡率和发病率密切相关。本荟萃分析旨在比较经导管三尖瓣介入治疗（TTVI）与单纯最佳药物治疗（OMT）在严重tr患者中的疗效。方法系统检索电子数据库，以确定比较TTVI与OMT的随机对照试验（rct）和倾向评分匹配的观察性研究。主要结局为全因死亡率。使用随机效应模型计算总估计值。结果共纳入5项研究（3项随机对照试验，2项观察性研究，n = 1988例）。TTVI与全因死亡率降低的无显著趋势相关（风险比[RR]: 0.70, 95%可信区间[CI] 0.48-1.03; P = 0.071），主要由观察性研究驱动。TTVI在TR严重程度降低（RR: 7.82, 95% CI 5.60-10.93; P < 0.0001）、堪萨斯城心肌病问卷测量的健康状况改善（平均差异：+14.46点，95% CI 11.55-17.38; P < 0.0001）和降低心力衰竭（HF）住院率方面显示出显著的益处（RR: 0.73, 95% CI 0.56-0.96; P = 0.025）。然而，TTVI与大出血风险增加相关（RR: 3.21, 95% CI 1.61-6.39; P = 0.0009）。结论在严重TR患者中，TTVI与全因死亡率的降低无统计学相关性，但与HF住院风险降低、TR严重程度显著降低和生活质量改善相关。未来需要大规模的随机对照试验来证实这些发现，并确定受益最大的患者亚群。系统评价方案：CRD420251002402 （PROSPERO）

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引用次数: 0

Prognostic impact of systemic immune-inflammation index (SII) on infarct size and clinical outcomes in patients with ST-segment elevation myocardial infarction 全身免疫炎症指数（SII）对st段抬高型心肌梗死患者梗死面积和临床结局的预后影响

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-09-13 DOI: 10.1016/j.ijcha.2025.101798

Ya-li Zhu , Lai Wei , Xu Wang , Yong Zhou , Jun Pu

Background

Systemic immune-inflammation index (SII), calculated as platelet count × neutrophil count/lymphocyte count, is a novel and easily accessible inflammatory marker. Its prognostic value in predicting infarct size and major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) remains to be fully explored.

Methods

We analyzed 421 patients who underwent primary percutaneous coronary intervention (PCI) within 12 h of symptom onset, enrolled in a prospective multicenter registry (NCT03768453).All patients received immediate admission blood tests for SII calculation (platelet × neutrophil/lymphocyte counts) and completed standardized CMR imaging within 10 days post-PCI.Receiver operating characteristic (ROC) analysis identified the optimal SII cut-off value (914) to predict large infarct size (≥20 % of left ventricular mass). Patients were stratified into high (≥914) and low (<914) SII groups. The relationships between SII, infarct size, and MACE were analyzed using multivariate logistic and Cox regression models.

Results

Patients with high SII had significantly larger infarct size (median 29.0 % vs. 22.3 %, p < 0.001). SII ≥ 914 was independently associated with large infarct size (OR 1.889, 95 %CI: 1.100–3.242, p = 0.021) and higher incidence of MACE (HR 1.874, 95 % CI: 1.255–2.796, p = 0.002).

Conclusions

Elevated SII (≥914) independently associates with larger infarct size and increased MACE risk post-PCI, suggesting potential utility in risk stratification.

系统免疫炎症指数（SII）是一种新的、容易获得的炎症标志物，由血小板计数×中性粒细胞计数/淋巴细胞计数计算而成。其预测st段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）后梗死面积和主要不良心血管事件（MACE）的预后价值仍有待充分探讨。方法：我们分析了421例在症状出现12小时内接受了原发性经皮冠状动脉介入治疗（PCI）的患者，这些患者被纳入前瞻性多中心登记（NCT03768453）。所有患者在pci术后10天内立即接受血液检查进行SII计算（血小板×中性粒细胞/淋巴细胞计数），并完成标准化CMR成像。受试者工作特征（ROC）分析确定了预测大面积梗死（≥左心室质量的20%）的最佳SII临界值（914）。将患者分为高（≥914）和低（<914） SII组。采用多变量logistic和Cox回归模型分析SII、梗死面积和MACE之间的关系。结果SII高的患者梗死面积明显增大（中位数分别为29.0%和22.3%,p < 0.001）。SII≥914与较大的梗死面积（OR 1.889, 95% CI: 1.100-3.242, p = 0.021）和较高的MACE发生率（HR 1.874, 95% CI: 1.255-2.796, p = 0.002）独立相关。结论SII升高（≥914）与pci后梗死面积增大和MACE风险增加独立相关，提示在风险分层中有潜在的应用价值。

{"title":"Prognostic impact of systemic immune-inflammation index (SII) on infarct size and clinical outcomes in patients with ST-segment elevation myocardial infarction","authors":"Ya-li Zhu , Lai Wei , Xu Wang , Yong Zhou , Jun Pu","doi":"10.1016/j.ijcha.2025.101798","DOIUrl":"10.1016/j.ijcha.2025.101798","url":null,"abstract":"<div><h3>Background</h3><div>Systemic immune-inflammation index (SII), calculated as platelet count × neutrophil count/lymphocyte count, is a novel and easily accessible inflammatory marker. Its prognostic value in predicting infarct size and major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) remains to be fully explored.</div></div><div><h3>Methods</h3><div>We analyzed 421 patients who underwent primary percutaneous coronary intervention (PCI) within 12 h of symptom onset, enrolled in a prospective multicenter registry (NCT03768453).All patients received immediate admission blood tests for SII calculation (platelet × neutrophil/lymphocyte counts) and completed standardized CMR imaging within 10 days post-PCI.Receiver operating characteristic (ROC) analysis identified the optimal SII cut-off value (914) to predict large infarct size (≥20 % of left ventricular mass). Patients were stratified into high (≥914) and low (<914) SII groups. The relationships between SII, infarct size, and MACE were analyzed using multivariate logistic and Cox regression models.</div></div><div><h3>Results</h3><div>Patients with high SII had significantly larger infarct size (median 29.0 % vs. 22.3 %, p < 0.001). SII ≥ 914 was independently associated with large infarct size (OR 1.889, 95 %CI: 1.100–3.242, p = 0.021) and higher incidence of MACE (HR 1.874, 95 % CI: 1.255–2.796, p = 0.002).</div></div><div><h3>Conclusions</h3><div>Elevated SII (≥914) independently associates with larger infarct size and increased MACE risk post-PCI, suggesting potential utility in risk stratification.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101798"},"PeriodicalIF":2.5,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0