Postepy W Kardiologii Interwencyjnej最新文献

Introduction: The Fibrosis-4 (FIB-4) index, a non-invasive marker of liver fibrosis originally developed for non-alcoholic fatty liver disease (NAFLD), has gained attention for its prognostic value in cardiovascular disease.

Aim: Given the shared metabolic risk between NAFLD and acute coronary syndrome (ACS), this study aimed to evaluate the association between FIB-4 and major adverse cardiovascular events (MACE) in patients with ACS, in comparison with conventional risk scores.

Material and methods: This is an observational cohort study included 941 patients hospitalized with ACS between 2017 and 2021. Patients were classified into three FIB-4 categories: low, < 1.45; intermediate, 1.45-3.25; and high, ≥ 3.25. Clinical, laboratory, angiographic, and echocardiographic data were collected. MACE incidence was evaluated over a median follow-up of 67.5 months. Cox regression and receiver operating characteristic (ROC) analyses were performed.

Results: MACE occurred in 37.9% of patients in the high FIB-4 group, compared to 28.7% and 29.2% in the low and intermediate groups, respectively (p = 0.046). FIB-4 was an independent predictor of MACE (hazard ratio [HR]: 1.547; 95% CI: 1.169-2.046; p = 0.002). ROC analysis demonstrated superior prognostic accuracy for FIB-4 (area under the ROC curve: 0.693) over SYNTAX (0.609) and GRACE (0.552) scores. A Kaplan-Meier analysis showed significantly lower survival in the high FIB-4 group (p = 0.007).

Conclusions: The FIB-4 index is a robust, accessible predictor of adverse cardiovascular outcomes in ACS and may enhance conventional risk stratification strategies by integrating systemic metabolic burden into cardiovascular risk assessment.

Introduction: Fractional flow reserve (FFR) remains the gold standard for functional evaluation in coronary artery disease (CAD). However, non-hyperemic indices, such as diastolic pressure ratio (dPR) and resting full-cycle ratio (RFR), are increasingly utilized in clinical practice. Data on the safety and long-term outcomes of deferred revascularization based on these indices remain limited.

Aim: This study aimed to evaluate the safety of deferred revascularization in patients with CAD using dPR and RFR indices.

Material and methods: Between January and June 2022, all consecutive patients undergoing functional coronary evaluations at a large tertiary hospital were screened. Primary endpoints included major adverse cardiovascular events (MACE), a composite of all-cause mortality, myocardial infarction (MI), and target vessel revascularization (TVR), along with individual endpoints at 1-year follow-up.

Results: Of 321 patients evaluated, 290 met the eligibility criteria, and 204 underwent deferred revascularization based on non-hyperemic assessments. The cohort had a mean age of 68.2 years (SD ±8.9), with 76.8% male. Chronic coronary syndrome (57.2%), unstable angina (13.8%), and heart failure (9.3%) were the primary indications for coronary angiography. Among 230 lesions assessed with dPR and 243 with RFR, positive findings were observed in 17.4% and 13.2%, respectively (p = 0.15). At 1-year follow-up, MACE occurred in 7.8%, all-cause mortality was 4.9%, MI was 0.5%, and TVR was 2.5%.

Conclusions: Deferred revascularization guided by dPR and RFR appears safe, with outcomes comparable to FFR-guided decisions in the literature. Larger randomized trials are needed to confirm these findings.

Introduction: Out-of-hospital cardiac arrest (OHCA) is a major global cause of mortality, with survival heavily dependent on early intervention. Bystander cardiopulmonary resuscitation (CPR) improves survival rates but remains underutilized in many regions, including Saudi Arabia. Understanding its impact on OHCA survival is crucial for optimizing emergency response efforts.

Aim: This study evaluated the effect of bystander CPR on OHCA survival across Saudi Arabia's 13 regions and identified regional disparities.

Material and methods: A retrospective observational study analyzed Saudi Red Crescent Authority (SRCA) OHCA data from January 1 to June 30, 2024. Key variables included bystander CPR, patient demographics, initial cardiac rhythm, response time, and return of spontaneous circulation (ROSC). Multivariable logistic regression was adjusted for confounders.

Results: Bystander CPR was performed in 12.0% of OHCA cases. ROSC occurred in 12.6%, with higher survival among those receiving bystander CPR (17.6%) versus those who did not (12.0%) (p < 0.001). However, after adjusting for confounders such as witnessed status, mechanical CPR use, and response time, bystander CPR was not independently linked to increased survival. Regional disparities were evident, with Riyadh reporting the highest bystander CPR rate (26.4%), while several regions had rates below 5%.

Conclusions: While bystander CPR improved ROSC rates, its independent effect on survival was not significant. These findings underscore the need for expanded CPR training, improved EMS response times, and targeted interventions to enhance OHCA survival in Saudi Arabia.

Introduction: Comorbidities in aortic stenosis (AS) significantly impact treatment outcomes by influencing intervention timing, choice, and prognosis. Diseases affecting cardiac hemodynamics independently of AS progression may distort echocardiographic interpretation, risking misclassification of AS severity. Understanding how comorbidities alter key echocardiographic parameters may facilitate more precise evaluation.

Aim: To assess the impact of common cardiovascular comorbidities on echocardiographic evaluation of AS.

Material and methods: Medical records of 234 hospitalized patients with moderate/severe AS were retrospectively analyzed. Exclusion criteria included acute myocardial infarction, prior valvular surgery, and congenital heart defects. All patients underwent standard echocardiographic assessment during hospitalization.

Results: Among the 234 patients (median age 76, 47.4% female), 85.0% had severe AS. The most prevalent comorbidities were hypertension (82.5%), chronic kidney disease (CKD, 45.3%), and type 2 diabetes (T2DM, 39.7%). Atrial fibrillation (AF) occurred in 33.8%, predominantly paroxysmal (49.4%). AF was associated with lower aortic valve mean pressure gradient (AVGmean, p = 0.001), peak velocity (Vmax, p < 0.001), and stroke volume (SV, p = 0.01), and higher left atrial (LA) area (p < 0.001). T2DM was associated with lower left ventricular ejection fraction (LVEF, p = 0.02), higher LA area (p = 0.02), and higher left ventricular mass (p = 0.01). Hypertension correlated with lower AVGmean (p = 0.04). CKD correlated with lower LVEF, AVGmean, SV, and cardiac output (p ≤ 0.02), but higher LA area and E/E' (p ≤ 0.01). Previous myocardial infarction was associated with lower LVEF (p = 0.01), aortic valve area (p = 0.002), SV (p = 0.004), and cardiac output (p < 0.001), but higher E/E' (p = 0.01).

Conclusions: Comorbidities significantly affect echocardiographic parameters in AS, potentially leading to miscategorization of severity. The observed differences highlight a need for more comprehensive evaluation in multimorbid patients.

Introduction: Congenital heart disease (CHD) is the most common malformation from birth. The severity of the different forms of CHD varies extensively from superficial mild lesions with follow-up for decades without any treatment to complex cyanotic malformations requiring urgent surgical intervention. One of the most common severe forms of CHD is tetralogy of Fallot (TOF), characterized by a misalignment of the canal septum leading to a deviation of the aorta to the right. microRNAs (miRs) are crucial in cardiac development, giving rise to possible phenotypes in CHD.

Aim: We aimed to evaluate the expression of miRs in 23 children with TOF and 45 controls and correlate them with the clinical characteristics of both the children and the mothers.

Material and methods: We analyzed the miRNA expression of miR-21-5p, miR-155-5p, miR-221-3p, miR-26a-5p, and miR-144-3p by RT-qPCR.

Results: In this study, we found that miR-221-5p, miR-21-5p, and miR-144-3p exhibited a significant difference in expression compared to controls. Through bioinformatics analysis, we found that the target genes of analyzed mIRs are members of the AKT1, SMAD, TNF-α, and FOX families. All have in common that they are associated with different cellular pathways that lead to cell cycle changes, cell growth, and apoptosis, mainly in hypoxic conditions.

Conclusions: The expression levels of miRs in pediatric patients may contribute to the development of TOF. Additionally, the high expression of miR-221-5p, miR-21-5p, and miR-144-3p in children with TOF is associated with genes associated with many cellular pathways involved in TOF development.