Texas Heart Institute Journal最新文献

Background: The impact of coronary artery aneurysms (CAAs) caused by Kawasaki disease (KD) on long-term health-related quality of life (HRQOL) in children has not been well documented.

Methods: This study investigated long-term HRQOL in a large sample of children diagnosed with KD-related CAAs. A case-control, retrospective study included 66 patients with KD-related CAAs. A total of 98 hospitalized patients were matched as controls based on age and sex: 49 patients were allocated to a group with pneumonia and 49 patients were allocated to a group with arterio-arterial fistula. Both child-reported and parent-proxy-reported Pediatric Quality of Life Inventory surveys were collected.

Results: The median (IQR) follow-up period was 5.64 (3.81-7.47) years (range, 1.03-10.67 years). The mean (SD) age at diagnosis was 3.73 (1.93) years. At baseline, children and parents as their proxies reported similar HRQOL scores for KD-related CAAs and arterio-arterial fistula that were considerably lower than for pneumonia, respectively. At long-term follow-up, children in the small and medium-sized aneurysms group reported a mean (SD) score of 81.61 (19.50), which was comparable to the arterio-arterial fistula group (83.32 [18.24]), 9.51 points lower than that of the pneumonia group (P = .014), and 9.70 points higher than that of the giant aneurysms group (P = .012). Parents also reported a comparable mean (SD) score of 81.03 (12.57) vs 83.30 (15.17) in the small and medium-sized aneurysms group and arterio-arterial fistula group, both of which had statistically significantly lower scores than the pneumonia group (P = .010) and higher scores than the giant aneurysms group (P = .009).

Conclusion: Despite improvement in HRQOL scores, children with documented KD-related CAAs without complete recovery often encountered issues that disrupted their well-being during long-term follow-up. Routine outpatient HRQOL screening could be instituted to help eliminate the risk of long-term disability following initial clinical improvement.

Background: Although the prognostic value of the CHA₂DS₂-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65-74 years, and female sex) scoring system in patients with stroke has been explored in several studies, a research gap exists in its application, especially in patients without atrial fibrillation (AF).

Methods: This study investigated the association between CHA₂DS₂-VASc score and prognosis at 1 year in patients with acute ischemic stroke (AIS) who do not have AF. A total of 993 patients with AIS but without AF were recruited between January 2019 and December 2022. Patients were categorized into high-risk (CHA₂DS₂-VASc score, >2; n = 424), moderate-risk (CHA₂DS₂-VASc score, 2; n = 218), and low-risk (CHA₂DS₂-VASc score, 0-1; n = 351) groups. The primary outcome was major adverse cardiac events (MACE) at 1 year after index AIS. Multivariate Cox regression analyses evaluated the prognostic value of CHA₂DS₂-VASc scores after controlling for potential confounding factors. A sensitivity analysis was performed based on 3 CHA₂DS₂-VASc groups generated using propensity score matching.

Results: The rate of MACE during 12-month follow-up was statistically significantly higher (P < .01) in patients with a CHA₂DS₂-VASc score greater than 2 (34.7%) than in patients with a score of 2 (23.9%) or of 0 or 1 (14.8%). Multivariate Cox regression models indicated that, compared with a CHA₂DS₂-VASc score of 0 or 1, the hazard ratio (HR) of MACE occurrence was 3.22 (95% CI, 1.93-5.37; P < .01) for a CHA₂DS₂-VASc score greater than 2 and 1.92 (95% CI, 1.24-2.98; P < .01) for a CHA₂DS₂-VASc score of 2. When included in the Cox regression model as a continuous variable, the CHA₂DS₂-VASc score remained strongly associated with higher risks of MACE (HR, 1.19 [95% CI, 1.11-1.26]; P < .01), all-cause mortality (HR, 1.14 [95% CI, 1.05-1.23]; P < .01), and recurrent stroke (HR, 1.15 [95% CI, 1.06-1.256]; P < .01). Sensitivity analyses based on populations generated by propensity score matching yielded similar results.

Conclusion: The CHA₂DS₂-VASc score effectively predicts MACE in patients with AIS but without AF, providing more accurate risk stratification.

Myocardial bridging is a frequent anomaly of the heart in humans and other animals. A myocardial bridge is typically characterized by the systolic narrowing seen with traditional catheter angiography, but this abnormality is not by itself a sign of ischemia or the need for intervention. In particular, transient spontaneous angina must be corroborated by reproducible narrowing during acetylcholine testing; this narrowing occurs during resting conditions and is responsive to nitroglycerin administration. Ischemia in myocardial bridging can result from acquired arterial wall disease (coronary artery atherosclerotic disease) or from instances of coronary spasm. Clinical evaluation should seek to identify baseline features such as myocardial bridge thickness (by using computerized axial tomography or intravascular ultrasonography) and the severity of systolic compression or reproducible spasticity (by administering acetylcholine). Nuclear myocardial scintigraphy is usually negative in patients with isolated myocardial bridging. Spastic coronary hyperactivity must be treated initially with antispasmodic medications, such as calcium channel blockers and nitrates, rather than by percutaneous stent placement or bypass surgery. Only exceptionally prolonged and critically severe spasm can induce intraluminal clotting and acute myocardial infarction. Recognizing the exceptionality and variability of ischemic presentations related to myocardial bridging is essential, as is establishing appropriate investigational methods for each of these facets of the condition.

At the Texas Heart Institute's 2024 Cardiometabolic Syndrome Conference, held on August 23, 2024, experts from diverse academic fields spoke about novel initiatives for addressing the worsening projections for cardiometabolic syndrome. Four major areas in which innovation is ongoing were highlighted: technology, policy, population health, and lifestyle and behavioral modification. This article presents a brief contextualization, summary, and analysis of the novel initiatives being implemented in each of these 4 areas to address cardiometabolic syndrome. Despite alarming projections, cardiometabolic syndrome presents a unique opportunity for innovators to drive change through collaborative, multidisciplinary efforts.

Background: Cardiogenic stroke is associated with substantial morbidity and mortality, necessitating a better understanding of its clinical characteristics for improved patient outcomes. This study aimed to identify clinical characteristics influencing short-term functional prognosis in patients with cardiogenic stroke.

Methods: The study prospectively enrolled 212 patients with cardiogenic stroke, collecting their clinical data and laboratory results. The modified Rankin Scale score at 90 days was used to define functional prognosis, with patients having a good prognosis (modified Rankin Scale ≤2; n = 164) or poor prognosis (modified Rankin Scale ≥3; n = 48).

Results: The poor prognosis group had higher rates of total anterior circulation infarcts (12.5% vs 0.0%; P < .001) and posterior circulation infarction (50.0% vs 38.4%; P < .001) compared with the good prognosis group. Lesion characteristics differed significantly, with the poor prognosis group exhibiting more large-area lesions (39.6% vs 18.9%; P < .001) and multiple confluent lesions (56.3% vs 24.4%; P < .001). Admission-based National Institute of Health Stroke Scale scores were higher in the poor prognosis group (median [IQR], 12 [8-18] vs 5 [4-7]; P <.001), correlating with worse outcomes. The admission National Institute of Health Stroke Scale score predicted patients' 90-day prognosis with good accuracy (area under the curve, 0.937 [95% CI, 0.895-0.965]; P < .001), with a threshold of 7 yielding 85.42% sensitivity and 85.37% specificity.

Conclusion: Higher admission National Institute of Health Stroke Scale scores were significantly associated with poor functional prognosis at 90 days, highlighting the importance of early National Institute of Health Stroke Scale-based assessment for improved outcomes.

Background: Cardiovascular disease (CVD) is associated with high mortality in the United States, but the burden of CVD mortality is unevenly distributed between demographic and geographic subgroups, with poor characterization of state-specific trends. In this study, the disparities in CVD-related mortality trends in Texas and the United States from 1999 to 2019 were assessed.

Methods: Trends in CVD-related mortality were evaluated through analysis of the Multiple Causes of Death Files from the National Center for Health Statistics. Crude and age-adjusted mortality rates (AAMRs) per 100,000 population with associated annual percentage changes were determined. Joinpoint regression was used to assess trends in the CVD-related mortality rates.

Results: Between 1999 and 2019, 29,455,193 CVD-related deaths were reported in the United States, of which 1,937,166 occurred in Texas. After an initial decline in the overall AAMR in Texas (annual percentage change, -2.5 [95% CI, -2.8 to -2.1]), a steady level was maintained from 2009 to 2019 (annual percentage change, 0.2 [95% CI, -0.5 to 0.2]). In the United States, after initial decline, AAMR plateaued from 2011 to 2019. Overall, CVD-related AAMR was slightly higher in Texas than in the overall United States (AAMR, 674.1 [95% CI, 673.2-675.1] vs 654 [95% CI, 653.8-654.3]). Men, non-Hispanic Black people, and people 85 years of age and older had the highest AAMRs in Texas and nationwide. Nonmetropolitan areas, both nationally and in Texas, consistently had higher mortality rates. The AAMRs also varied significantly by county within Texas.

Conclusion: Despite an initial period of decline, CVD-related mortality rates have plateaued in Texas and the United States. Higher AAMRs were observed in Texas than in the overall United States. Prevalent disparities also exist based on demographic and geographic subgroups.

Background: Elevated lipoprotein(a) (Lp[a]) is a risk factor for first atherosclerotic thrombosis events, but the role of elevated Lp(a) in secondary prevention is controversial. This study aimed to retrospectively investigate the influence of elevated Lp(a) levels on the prognosis of patients with coronary artery disease.

Methods: The team collected and compared clinical information of patients hospitalized during percutaneous coronary intervention (PCI). This study used a multivariate logistic regression model to evaluate the relationships between Lp(a) levels, cardiovascular risk factors, and the prognosis of coronary artery disease in patients undergoing PCI.

Results: There were no statistically significant differences between patients grouped according to Lp(a) level in terms of sex; age; body mass index and obesity; hyperuricemia; smoking; cardiac insufficiency; acute myocardial infarction; multivessel lesion; in-stent restenosis; secondary PCI; apolipoprotein AI level; incidence of high total cholesterol or high low-density lipoprotein cholesterol; or family history of hypertension, diabetes, or coronary artery disease. The average Lp(a) concentration did not statistically significantly decrease after 1 year of statin treatment after PCI. One year after patients began statins, there were no significant differences between Lp(a) groups in the incidence of high triglycerides (P = .13), high total cholesterol (P = .52), or high low-density lipoprotein cholesterol (P = .051). Multivariate logistic regression analysis indicated that diabetes (P = .02) was associated with in-stent restenosis, whereas diabetes (P = .02) and multivessel lesions (P < .001) were associated with secondary PCI in patients who underwent coronary angiography 1 year after PCI. Compared with normal Lp(a) levels, high Lp(a) levels did not significantly increase the incidence of in-stent restenosis or secondary PCI in patients who underwent coronary angiography 1 year after PCI.

Conclusion: Sustained high concentrations of Lp(a) did not significantly increase the incidence of in-stent restenosis or secondary PCI in patients who underwent coronary angiography 1 year after PCI.