Journal of Geriatric Cardiology最新文献

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.

Background: Stress cardiomyopathy (SCM) currently has a high incidence in older adults, and the theories regarding its causes include "catecholamine myocardial toxicity" and "sympathetic hyperactivation". However, the role of the central nervous system in the pathogenesis of SCM remains unknown. We investigated the role of microglia activation in the paraventricular hypothalamic nucleus (PVN) in the development of SCM.

Methods: An SCM model was created using male Sprague-Dawley (SD) rats, immobilized for 6 h every day for a week. Electrocardiogram, cardiac electrophysiology, and echocardiography examinations were performed to verify the changes in cardiac structure and function in rats with SCM. RNA sequencing was used to explore the changes in the hypothalamus during SCM. In addition, brain and heart tissues were collected to detect microglial activation and sympathetic activity.

Results: The main findings were as follows: (1) immobilization stress successfully induced SCM in SD rats; (2) microglia were significantly activated in the hypothalamus, as evidenced by cytosol thickening, increases in the number of microglial branches, and microglia enriched in the PVN; (3) in SCM, the microglia in the PVN exhibited increased central and peripheral cardiac sympathetic activity and increased the expression of neuroinflammatory factors; and (4) it is possible that inhibiting microglial activation could suppress the sympathetic activity of the central nervous system and heart and increase cardiac electrical stability in SCM rats.

Conclusions: SCM was induced in SD rats by immobilization stress, acting through the activation of the hypothalamic microglia. The activated microglia were specifically enriched in the PVN, increasing the activity of the central and peripheral sympathetic nervous systems by regulating the expression of neuro-inflammatory factors, mediating dysfunction of the left ventricle, and increasing the susceptibility to ventricular arrhythmias.

Background: Perioperative adverse cardiac events (PACEs) in elderly patients with hip fractures are associated with perioperative mortality. We investigated the relationship of PACE with post-discharge mortality and further explored whether it differs between patients with and without cardiovascular disease (CVD).

Methods: We retrospectively analyzed data from patients aged ≥ 65 years who underwent fragility hip fracture surgery from September 2016 to December 2021. PACE was defined as a composite of congestive heart failure, cardiogenic shock, myocardial injury after non-cardiac surgery, arrhythmic event, ischemic stroke, or acute pulmonary thromboembolism during hospitalization or within the 30-day postoperative period. Patients with 30-day mortality were excluded. The primary endpoint was all-cause mortality after hospital discharge.

Results: Of the 446 patients (133 patients in the CVD group and 313 patients in the non-CVD group), 14.8% experienced PACE, and overall mortality during a median of 15.9 months (interquartile range: 6.6-27.0 months) was 20.9% [CVD (26.3%) vs. non-CVD (18.5%), P = 0.064]. Patients with PACE demonstrated a significantly worse survival rate than those without PACE in both groups (all log-rank P < 0.05). After adjustment for confounders, PACE was an independent predictor of mortality in the overall population [hazard ratio (HR) = 3.01, 95% CI: 1.69-5.35, P < 0.001]. Its prognostic impact was significant in patients without CVD (HR = 2.69, 95% CI: 1.35-5.38, P = 0.005) but not in those with CVD (HR = 1.20, 95% CI: 0.41-3.50, P = 0.735).

Conclusions: PACE was associated with increased post-discharge mortality after fragility hip fracture, especially in elderly patients without CVD.

Background: Epicardial adipose tissue (EAT) radiomics derived from cardiac computed tomography (CT) images may provide insights into EAT characteristics, which can further predict regression of left ventricular mass index (LVMI) after transcatheter aortic valve replacement (TAVR). This study aimed to develop and validate a radiomics nomogram based on pre-procedural EAT CT to predict inadequate LVMI regression following TAVR.

Methods: Inadequate LVMI regression was defined as ΔLVMI% < 15% at one-year post TAVR. Radiomics features from pre-procedural CT images were selected mainly by least absolute shrinkage and selection operator algorithm. The patients were randomly divided into the training and validation cohorts to establish and evaluate three feature classifier models based on the selected features, using which the Radiomics scores (Radscores) were then calculated. A radiomics nomogram was constructed using independent risk factors and further assessed using area under the curve, calibration curve, and decision curve analysis.

Results: A total of 144 consecutive TAVR patients (42 patients with inadequate and 102 patients with adequate LVMI regression) were randomly assigned to the training and validation cohorts (116 patients and 28 patients, respectively). A total of 1130 radiomics features from each patient yielded 6 features for the Radscore construction after selection, with logistic regression and support vector machine models favored. Subsequently, a nomogram based solely on the Radscore was constructed, with an area under the curve of 0.743 in the validation cohort, along with favorable decision curve analysis and calibration curves.

Conclusions: The developed radiomics nomogram, serving as a non-invasive tool, achieved satisfactory preoperative prediction of inadequate LVMI regression in TAVR patients, thereby facilitating clinical management.

Acetazolamide is the commonly prescribed oral and intravenous carbonic anhydrase inhibitor; over the years, its use in clinical practice has decreased in favor of more recent drugs. However, it is a rather handy drug, which can be useful in several clinical settings when managing critically ill patients. The objective of this review is the evaluation of the most recent evidence on the use of acetazolamide in emergency medicine and critical care medicine. Furthermore, the safety profile of this drug has been evaluated. This is a narrative review on the use of acetazolamide in the main contexts in which this drug can be useful in emergency situations for patients with potential critical issues. For the timeline 1999-2024, a search was conducted on the main scientific platforms; resources of greatest relevance for the use of acetazolamide in critical care and emergency medicine were selected. The most common emergency situations in which a critically ill patient could benefit from acetazolamide therapy are acute heart failure, acute mountain sickness, post hypercapnic metabolic alkalosis, idiopathic intracranial hypertension and acute angle-closure glaucoma. In a few cases, however, randomized controlled clinical trials have been conducted. There are also other less solid indications based mostly on experience or retrospective data. Acetazolamide seems to be an overall safe drug; serious side effects are rare and can be avoided by carefully selecting the patients to be treated. Acetazolamide represents a precious resource for emergency physicians and intensivists; critical patients with different conditions can in fact benefit from it; furthermore, acetazolamide is a safe drug if administered to correctly selected patients.

Objective: To evaluate the benefits of surgical repair acute type A aortic dissection (ATAAD) on survival of octogenarians.

Methods: Patients who underwent surgery for acute ATAAD from the multicenter European Registry of Type A Aortic Dissection (ERTAAD) were the subjects of the present analysis.

Results: 326 (8.4%) patients were aged ≥ 80 years. Among 280 propensity score matched pairs, in-hospital mortality was 30.0% in patients aged ≥ 80 years and 20.0% in younger patients (P = 0.006), while 10-year mortality were 93.2% and 48.0%, respectively (P < 0.001). The hazard of mortality was higher among octogenarians up to two years after surgery, but it became comparable to that of younger patients up to 5 years. Among patients who survived 3 months after surgery, 10-year relative survival was 0.77 in patients aged < 80 years, and 0.46 in patients aged ≥ 80 years. Relative survival of octogenarians decreased markedly 5 years after surgery. Age ≥ 85 years, glomerular filtration rate, preoperative invasive ventilation, preoperative mesenteric mal-perfusion and aortic root replacement were independent predictors of in-hospital mortality among octogenarians (AUC = 0.792; E:O ratio = 0.991; CITL = 0.016; slope = 1.096). An additive score was developed. A risk score ≤ 1 was observed in 68.4% of patients, and their in-hospital mortality was 20.9%.

Conclusions: Provided a thoughtful patient selection, surgery may provide a survival benefit in patients aged ≥ 80 years with ATAAD that, when compared to younger patients and the general population, may last up to 5 years after the procedure. These findings have significant epidemiologic and clinical relevance because of the increasing longevity of the population of the Western countries.

Objective: To examine the association of handgrip strength with aortic stenosis incidence among adults aged 60 years and older.

Methods: We conducted a cohort study using the UK Biobank data to assess the relationship between handgrip strength and incident aortic stenosis in individuals aged 60 years and older. Handgrip strength was measured using a Jamar J00105 hydraulic hand dynamometer. Adjusted Cox proportional hazards regression models were conducted to assess the association between handgrip strength and incident aortic stenosis.

Results: We included 157,097 UK Biobank participants (78,151 women and 78,946 men) in our study, with mean age of 64 ± 2.9 years. During a median follow-up of 8.1 (7.4-8.8) years, 1543 (1.0%) participants developed incident aortic stenosis. Compared with those with the lowest handgrip strength (tertile 1), the adjusted hazard ratios (95% confidence interval) of incident aortic stenosis in the middle (tertile 2) and the highest (tertile 3) were 0.86 (0.77-0.97) and 0.76 (0.67-0.87), respectively.

Conclusions: Higher handgrip strength was associated with lower risk of developing aortic stenosis in older adults. Future studies warrant preventive strategies for older adults with lower handgrip strength.