Journal of Geriatric Cardiology最新文献

Implantable cardioverter defibrillators (ICDs) represent an established therapeutic strategy for the prevention of sudden cardiac death and reduction of mortality in high-risk patients, while ICDs with cardiac resynchronization therapy defibrillators improve morbidity, quality of life, and mortality in eligible patients with heart failure who are on optimal medical therapy. However, these devices may adversely affect the patients' psychological status after the delivery of shock therapies or even because of the fear of impending therapy. On the other hand, the potential of effective treatment of malignant arrhythmias may provide a 'safety' sensation in most treated patients without significant impairment in the quality of life during periods of clinical stability. During the past few years, an increasing number of reports have investigated psychological distress, including depression and anxiety status in ICD/cardiac resynchronization therapy defibrillator recipients. However, heterogeneous results have been reported while data on the variation of these psychological indexes over time in implanted patients are quite limited. Several intrinsic and extrinsic factors affect the psychological status of these patients while variations of these disturbances in specific populations are evident. Factors that seem to be associated with a greater risk for depression and anxiety in this setting include female gender, younger age, and device shock therapies. Moreover, depression and anxiety may have an adverse impact on patients' clinical outcomes exacerbating heart failure and increasing the arrhythmic risk. In this brief review article, we provide a concise and critical overview of the current literature on this topic, and we also discuss unresolved and conflicting issues delineating future perspectives.

Background: The association between uric acid-albumin ratio (UAR) with different diseases has been evaluated before. However, the association between UAR with spontaneous reperfusion (SR) in patients with ST-segment elevation myocardial infarction (STEMI) has not been explored.

Methods: STEMI patients admitted to our department and underwent primary coronary angiography between 1^st November 2018 and 31^st December 2020 were retrospectively enrolled. The patients were divided into the SR group and the non-SR group according to the index coronary angiography results. The association between UAR and SR was evaluated by uni-variable and multi-variable logistic analysis. Receiver operating characteristic curve analysis was used to determine the optimum cut-off level of UAR in predicting SR.

Results: Three hundred and fifty-seven patients were finally enrolled in our study, 55 patients were divided into the SR group and 302 patients were divided into the non-SR group. In uni-variable analysis, patients with SR were older (P = 0.032), with higher red blood cell distribution width (P < 0.001) and red blood cell distribution width-to-platelet ratio (P < 0.001), higher level of C-reactive protein (P = 0.046), higher level of uric acid (P < 0.001) compared with patients without SR. Patients with SR had a lower level of platelets (P = 0.008), lower level of on-admission B-type natriuretic peptide (P < 0.001). As for the level of UAR, STEMI patients with SR had significantly higher levels of UAR compared with STEMI patients without SR [11.1 (8.9-13.4) vs. 8.3 (6.6-10.0), P < 0.001]. Further multi-variable logistic analysis reveals that UAR was the independent risk factor of SR in different models after adjusting different variables. Receiver operating characteristic analysis showed that UAR had good predictive value in SR (AUC = 0.75, 95% CI: 0.702-0.794, P < 0.01).

Conclusions: Our study shows that UAR is an independent risk factor for predicting SR in STEMI patients.

Background: Early control of low-density lipoprotein cholesterol (LDL-C) is crucial for reducing the progress of cardiovascular disease. However, its additional role to the risk of primary osteoporosis in men with coronary heart disease was inconclusive. Our study aims to determine the association of LDL-C and its trajectories for osteoporosis risk in the middle-aged and aged men of China.

Methods: The retrospective cohort study of 1546 men aged 69.74 ± 11.30 years conducted in Beijing, China from 2015 to 2022. And the incidence of primary osteoporosis was annually recorded. LDL-C trajectories were further identified by latent class growth model using repeated measurements of LDL-C. The association of baseline LDL-C for osteoporosis was estimated using hazard ratio (HR) with 95% CI in Cox proportional hazard model, while mean level and trajectories of LDL-C for osteoporosis were evaluated using odds ratio (OR) with 95% CI in logistic regression model.

Results: During the median 6.2-year follow-up period, 70 men developed primary osteoporosis. The higher level of baseline LDL-C (HR = 1.539, 95% CI: 1.012-2.342) and mean LDL-C (OR = 2.190, 95% CI: 1.443-3.324) were associated with higher risk of osteoporosis in men with coronary heart disease after adjusted for covariates. Compared with those in the LDL-C trajectory of low-stable decrease, participants with medium-fluctuant trajectory, whose longitudinal LDL-C started with a medium LDL-C level and appeared an increase and then decrease, were negatively associated with osteoporosis risk (OR = 2.451, 95% CI: 1.152-5.216). And participants with initially high LDL-C level and then a rapid decrease demonstrated a tendency towards reduced risk (OR = 0.718, 95% CI: 0.212-2.437).

Conclusions: Elevated LDL-C level and its long-term fluctuation may increase the risk of primary osteoporosis in men. Early controlling a stable level of LDL-C is also essential for bone health.

Objectives: To examine 5-year trends and variations in dual antiplatelet therapy (DAPT) prescription among multiethnic Malaysian patients aged 60 years and older.

Methods: Using the Malaysian National Cardiovascular Disease-Acute Coronary Syndrome (NCVD-ACS) registry, DAPT 5-year temporal trends prescribing patterns at discharge were examined. Multivariate logistic regression was used to calculate the adjusted odds ratio (aOR) of DAPT prescription. The 1-year all-cause mortality by Cox proportional hazard regression model (adjusted hazard ratio, aHR) using inverse proportional weighting covariates adjustment was performed to assess DAPT prognostic impacts.

Results: Data of patients aged 60 years and older were extracted from 2013 to 2017 (n = 3718, mean age: 68 ± 6.74 years, men: 72%, and Malay ethnicity: 43%). The majority of patients were diagnosed with non-ST-segment elevation acute coronary syndrome (63%), predisposed hypertension (76%) and were overweight (74%), while only 35% of patients underwent percutaneous coronary intervention. Over the five years, there was a significant increasing trend in DAPT prescriptions (P < 0.001), with the aspirin-clopidogrel combination being the most common. Aspirin-ticagrelor prescriptions have also increased over the years. Variations in DAPT prescriptions were observed based on patient characteristics. Patients who underwent percutaneous coronary intervention were more likely to be prescribed DAPT in general (aOR = 2.53, 95% CI: 1.95-3.28, P < 0.001) and aspirin-ticagrelor specifically (aOR = 7.76, 95% CI: 5.65-10.68, P < 0.001). Patients with chronic lung disease (aOR = 0.62, 95% CI: 0.42-0.92, P = 0.02) and a history of angina within two weeks (aOR = 0.69, 95% CI: 0.56-0.85, P < 0.001) were approximately 30% less likely to be prescribed DAPT. Approximately 15% of 1-year all-cause mortality were reported. Older patients prescribed DAPT showed significantly higher survival rates than those who were not (aHR < 1.0, P < 0.001). Aspirin-ticagrelor was associated with higher survival rates than aspirin-clopidogrel (aHR = 0.21, 95% CI: 0.11-0.40, P < 0.001).

Conclusions: Despite the optimal prescription rate and variation of DAPT in the older Malaysian population, there is room for investigation and improvement in the prescription of newer DAPT combinations that have been suggested to improve patient survival.

Background: Atrial fibrillation (AF) is a common cardiac arrhythmia in the elderly. This study aimed to evaluate urban-rural disparities in its prevalence and management in elderly Chinese.

Methods: Consecutive participants aged ≥ 65 years attending outpatient clinics were enrolled for AF screening using handheld single-lead electrocardiogram (ECG) from April 2017 to December 2022. Each ECG rhythm strip was reviewed from the research team. AF or uninterpretable single-lead ECGs were referred for 12-lead ECG. Primary study outcome comparison was between rural and urban areas for the prevalence of AF. The Student's t-test was used to compare mean values of clinical characteristics between rural and urban participants, while the Pearson's chi-square test was used to compare between-group proportions. Multivariate stepwise logistic regression analysis was performed to estimate the association between AF and various patient characteristics.

Results: The 29,166 study participants included 13,253 men (45.4%) and had a mean age of 72.2 years. The 7073 rural participants differed significantly (P ≤ 0.02) from the 22,093 urban participants in several major characteristics, such as older age, greater body mass index, and so on. The overall prevalence of AF was 4.6% (n = 1347). AF was more prevalent in 7073 rural participants than 22,093 urban participants (5.6% vs. 4.3%, P < 0.01), before and after adjustment for age, body mass index, blood pressure, pulse rate, cigarette smoking, alcohol consumption and prior medical history. Multivariate logistic regression analysis identified overweight/obesity (OR = 1.35, 95% CI: 1.17-1.54) in urban areas and cigarette smoking (OR = 1.62, 95% CI: 1.20-2.17) and alcohol consumption (OR = 1.42, 95% CI: 1.04-1.93) in rural areas as specific risk factors for prevalent AF. In patients with known AF in urban areas (n = 781) and rural areas (n = 338), 60.6% and 45.9%, respectively, received AF treatment (P < 0.01), and only 22.4% and 17.2%, respectively, received anticoagulation therapy (P = 0.05).

Conclusions: In China, there are urban-rural disparities in AF in the elderly, with a higher prevalence and worse management in rural areas than urban areas. Our study findings provide insight for health policymakers to consider urban-rural disparity in the prevention and treatment of AF.

Myocardial infarction without angiographic moderate to severe stenosis (> 50%) and any other related diagnosis on clinical presentation is defined as myocardial infarction with nonobstructive coronary arteries (MINOCA). Common causes of MINOCA working diagnosis includes plaque disruption, spontaneous coronary artery dissection, coronary artery spasm, coronary thromboembolism, Takotsubo cardiomyopathy, and myocarditis. Clinical history, assay of myocardial enzymes, electrocardiogram, echocardiography, coronary angiography, and left ventriculography facilitate the initial diagnosis of MINOCA and reveal the underlying causes, while cardiovascular magnetic resonance and optical coherence tomography (OCT) are used to confirm the diagnosis. Although cardiovascular magnetic resonance is the gold standard noninvasive diagnostic tool for MINOCA, its ability to diagnose the cause and mechanism underlying this condition in the coronary arteries is limited because of its image resolution. Observational studies have demonstrated that OCT can be used to determine the underlying cause of MINOCA by investigating the characteristics of the culprit lesions and to predict the prognosis of the patients. In this article, we review the current diagnostic approach for MINOCA focusing on each imaging tool. Furthermore, we reevaluate the role of OCT in the clinical management of MINOCA. Identifying the cause of MINOCA through OCT might help select optimal and effective drug treatments and improve prognosis.