Postepy W Kardiologii Interwencyjnej最新文献

Introduction: The debate surrounding the use of high-intensity interval training (HIIT) in cardiac rehabilitation (CR) for patients who have survived myocardial infarction (MI) is ongoing due to concerns regarding safety and long-term efficacy.

Aim: This review presents an overview of the safety, effectiveness, and clinical applicability of HIIT compared to other training methods used in CR after MI.

Methods: This rapid systematic review included randomized controlled trials published until January 20, 2025, in PubMed and Web of Science. Eligible studies used a HIIT protocol, involved adults (≥ 18 years) with a history of MI who participated in a HIIT or other (control) training program, and reported physiological and psychological outcomes. Results: Sixteen studies with 597 participants (n HIIT = 307; n comparison groups = 290) met the inclusion criteria. In most of the included studies HIIT interventions were associated with better improvements in quality of life, cardiorespiratory fitness, endothelial function, echocardiographic parameters, and serum biomarker levels compared to moderate-intensity exercises. However, early post-MI application was associated with fewer beneficial outcomes.

Conclusions: HIIT may be an efficient and time-saving approach for CR, particularly in highly motivated and stable cardiovascular patients. HIIT protocols must be tailored by clinicians and progressively intensified based on tolerance and recovery. Future research should focus on optimizing HIIT protocols and determining their long-term safety and compliance.

Introduction: Despite the growing use of venoarterial extracorporeal membrane oxygenation (VA-ECMO), there are still no clearly defined criteria for VA-ECMO initiation in postcardiotomy (PC) patients.

Aim: To identify the pre-ECMO risk factors associated with increased hospital mortality, paying special attention to the patients' age.

Material and methods: Retrospective review of consecutive adult patients supported with PC ECMO for a 16-year period in a tertiary care center. The primary outcome was all-cause mortality. Logistic regression was performed to identify mortality predictors. To determine the optimal age cut-off that most accurately distinguishes between higher and lower probabilities of mortality, the Youden index was used.

Results: A total of 214 patients were enrolled in the final analysis and 55 (25.7%) survived until hospital discharge. Age was a significant mortality predictor with ROC-AUC of 0.596 (0.508-0.685), p = 0.033. Multivariable logistic regression showed that age over 60 years (OR = 2.119 (95% CI: 1.055, 4.255), p = 0.035), male gender (OR of 0.415, indicating a protective effect) (95% CI: 0.198, 0.869), p = 0.020), pre-ECMO vasoactive inotropic score (VIS) (OR = 1.015 (95% CI: 1.002, 1.027), p = 0.019), and mechanical ventilation duration before ECMO (OR = 1.053 (95% CI: 1.014, 1.092), p = 0.007) remained as independent prognostic factors.

Conclusions: Our study confirms that advanced age is a prognostic marker of mortality in PC ECMO patients and doubles the mortality risk above 60 years. However, age must be considered alongside other mortality predictors. These findings can significantly contribute to the decision-making process.

Introoduction: Hypertension is a common cardiovascular disease, which can lead to severe outcomes without sufficient treatment. Lifestyle modification and exercise have been recommended in the management of hypertension.

Aim: In this meta-analysis, we aimed to determine to what extent resistance training can alter blood pressure and identify factors modulating the potential benefits of resistance training.

Methods: We systematically searched PubMed, the Cochrane Library, Scopus, and Web of Science from inception to December 18, 2024, to identify randomized controlled trials comparing the effect of resistance exercise with control intervention on systolic and diastolic blood pressure. A random-effects model (DerSimonian-Laird) was employed to pool data.

Results: Fourteen randomized controlled trials with 676 patients with hypertension were included in this meta-analysis. We found that compared to the control intervention, resistance training significantly decreased both systolic blood pressure (weighted mean difference (WMD) -8.61 mm Hg, 95% confidence interval (CI) (-13.95, -3.27), I ² = 98.74%) and diastolic blood pressure (WMD = -4.57 mm Hg, 95% CI (-7.26, -1.89), I ² = 97.37%). In subgroup analysis, the beneficial effects of resistance training remained statistically significant in all subgroups of age, gender, length of training, and body mass index (BMI). In addition, the beneficial effects of resistance training on blood pressure were much greater in men, those aged more than 60 years, those with BMI > 28 kg/m², and those undergoing more than 10 weeks of exercise.

Conclusions: These findings support the beneficial effects of resistance training for the management of hypertension, particularly in a selected subgroup of patients.

Introduction: Empagliflozin was shown to improve the clinical outcomes of cardiovascular diseases; however, its effects on cardiac structure and cardiac remodeling in patients with heart failure remain controversial to some extent.

Aim: We conducted this meta-analysis to compare the effect of empagliflozin with placebo on cardiac structure and function among patients with heart failure.

Methods: PubMed, Scopus, Web of Science, and the Cochrane Library were systematically searched from inception to December 20, 2024, to identify randomized controlled trials comparing the effects of empagliflozin with placebo on cardiac structure and function in patients with heart failure. A random-effects model (DerSimonian-Laird) was employed to pool data.

Results: Four studies with 234 individuals in the empagliflozin group and 231 individuals in the placebo group were included. Compared to placebo, empagliflozin 10 (mg/day) significantly increased left ventricular ejection fraction (LVEF) (WMD 2.96%, 95% CI (0.84, 5.09), I ² = 85.28%), decreased left ventricular (LV) end-diastolic volume (WMD -17.05 ml, 95% CI (-23.68, -10.42), I ² = 13.88%), LV end-diastolic volume index (WMD -7.59 ml/m², 95% CI (-10.08, -5.10), I ² = 0.00%), LV end-systolic volume (WMD -15.59 ml, 95% CI (-25.89, -5.28), I ² = 74.69%), LV end-systolic volume index (WMD -6.68 ml/m², 95% CI (-7.95, -5.41), I ² = 0.00%), and left atrial volume index (WMD -2.16 ml/m², 95% CI (-4.21, -0.10), I ² = 0.00%), but did not significantly change LV mass (WMD -11.66 g, 95% CI (-30.54, 7.22), I ² = 90.02%) and LV mass index (WMD -4.01 g/m², 95% CI (-10.94, 2.92), I ² = 64.29%).

Conclusions: Empagliflozin can significantly improve myocardial function and prevent myocardial remodeling in patients with heart failure.