Journal of Geriatric Cardiology最新文献

Objective: To determine whether frailty is a risk factor for hospitalization and mortality in older adults enrolled in the "Chronic Heart Failure Program" at a hospital in Lima, Peru, between 2018-2021.

Methods: This was an ambispective cohort study. A total of 85 older adults participating in the Chronic Heart Failure Program at Guillermo Almenara National Hospital were included. Each had an initial frailty assessment, forming two cohorts: frail and non-frail older adults. Medical records were reviewed, and patients were followed for one year to track events of interest (hospitalization and mortality). Overall survival and risk factors for hospitalization and death were determined.

Results: During follow-up, 15.3% of the older adults died, and frailty was identified in 58.8% of the patients. Overall survival using the Kaplan-Meier method was 96.5% at 3 months after entering the Chronic Heart Failure Program; 92.9% at 6 months; and 85.9% at one year. Multivariate analysis using Poisson regression found that frailty was not a risk factor for hospitalization (aRR = 0.92; 95% CI: 0.42-2.03). Survival analysis using the Cox proportional hazards model showed that frailty was also not a risk factor for mortality after one year of follow-up (aHR = 1.32; 95% CI: 0.27-6.53).

Conclusions: Our research does not confirm frailty as a risk factor for hospitalization or mortality in older adults enrolled in the "Chronic Heart Failure Program" after one year of follow-up.

Background: There is still limited data on predictive value of coronary computed tomography angiography (CCTA)-derived fractional flow reserve (CT-FFR) for long term outcomes. We examined the long-term prognostic value of CT-FFR combined with CCTA-defined atherosclerotic extent in diabetic patients with coronary artery disease (CAD).

Methods: A retrospective pooled analysis of individual patient data was performed. Deep-learning-based vessel-specific CT-FFR was calculated. All patients enrolled were followed-up for at least 5 years. Predictive abilities for major adverse cardiac events (MACE) were compared among three models (model 1, constructed using clinical variables; model 2, model 1+CCTA-derived atherosclerotic extent (Leiden risk score); and model 3, model 2+CT-FFR.

Results: A total of 480 diabetic patients [median age, 61 (55-66) years; 52.9% men] were included. During a median follow-up time of 2197 (2126-2355) days, 55 patients (11.5%) experienced MACE. In multivariate-adjusted Cox models, Leiden risk score (HR: 1.06; 95% CI: 1.01-1.11; P = 0.013) and CT-FFR ≤ 0.80 (HR: 6.54; 95% CI: 3.18-13.45; P < 0.001) were the independent predictors. The discriminant ability was higher in model 2 than in model 1 (C-index, 0.75 vs. 0.63; P < 0.001) and was further promoted by adding CT-FFR to model 3 (C-index, 0.81 vs. 0.75; P = 0.002). Net reclassification improvement (NRI) was 0.19 (P = 0.009) for model 2 beyond model 1. Of note, adding CT-FFR to model 3 also exhibited significantly improved reclassification compared with model 2 (NRI = 0.14; P = 0.011).

Conclusion: In diabetic patients with CAD, CT-FFR provides robust and incremental prognostic information for predicting long-term outcomes. The combined model exhibits improved prediction abilities, which is beneficial for risk stratification.

Significant progress has been recently made in studying artemisinin and its derivatives for treating cardiovascular diseases, making this area a prominent research focus. Artemisinin, discovered with great acclaim, was initially and widely adopted in antimalarial treatments. As scientific research steadily progressed, its latent potential role in the cardiovascular system gradually captured the attention of the global scientific community. Artemisinin and its derivatives can reportedly play a protective role in the cardiovascular system through various mechanisms, including anti-inflammatory, anti-angiogenic, antioxidant, and anti-fibrotic effects, as well as the regulation of blood lipids and blood pressure. In particular, they have shown promising therapeutic effects in models of cardiovascular diseases such as atherosclerosis, myocardial ischaemia, and cardiac hypertrophy. In addition, artemisinin and its derivatives can improve cardiovascular function and prevent cardiovascular injury by regulating signalling pathways closely related to cardiovascular disease, such as AMPK and NF-kB. Although numerous ex vivo and in vivo experiments have verified the potential role of artemisinin in treating cardiovascular diseases, systematic studies to comprehensively elucidate its specific mechanism of action remain scarce. Further exploration of the precise roles of artemisinin and its derivatives in cardiovascular disease therapy, along with their potential clinical applications, could offer valuable insights for future research and treatment strategies.

Background: In patients with coronary artery disease, age is of known significance in predicting outcomes. Data on clinical outcomes in patients ≥ 85 years undergoing percutaneous coronary intervention (PCI) remain scarce. The study aim was to determine clinical characteristics, risk of adverse cardiovascular events, and mortality in patients aged ≥ 85 years compared to those aged < 85 undergoing PCI.

Methods: In this retrospective study, data were obtained from the nationwide Netherlands Heart Registration on patients undergoing PCI between January 1^st, 2017 and January 1^st, 2021. The primary endpoint was all-cause mortality at long-term follow-up.

Results: A total of 155,683 patients underwent PCI, of which 100,209 (64.4%) acute coronary syndrome cases. Compared to patients aged < 85 years, patients aged ≥ 85 were more often female and showed a higher number of cardiovascular comorbidities, including impaired left ventricle ejection fraction and reduced kidney function. Mortality at short-term and long-term follow-up were significantly higher in those aged ≥ 85 (P < 0.001). Patients aged ≥ 85 were more likely to have a myocardial infarction within 30 days following the index intervention (0.9% vs. 0.7%; P = 0.024), though they less often underwent revascularization at long-term follow-up compared to patients aged < 85 (P < 0.001).

Conclusions: The elderly (≥ 85 years) patient requiring PCI carries an extensive cardiovascular risk profile, translating in significant risk of recurrent cardiovascular events and increased mortality rate. Clinicians should carefully weigh perceived risks and potential benefits in the individual patient, considering the patients' age, cardiovascular risk profile, and associated risk of morbidity and mortality.

Background: As the global population ages, the number of elderly patients with acute coronary syndrome (ACS) rises. However, prognostic assessment tools for elderly patients with ACS remain lacking, particularly in the Chinese population. This study aimed to develop and validate a nomogram to predict 2-year major adverse cardiovascular and cerebrovascular events (MACCE) in elderly Chinese patients with ACS.

Methods: A retrospective analysis was conducted using two independent cohorts of ACS patients aged ≥ 65 years who underwent percutaneous coronary intervention: the derivation cohort (n = 1674) and the validation cohort (n = 2333). Candidate predictors were selected using multivariable Cox proportional hazards regression and the Akaike information criterion. A final nomogram incorporating ten variables was constructed. Model performance was evaluated in terms of discrimination [concordance index (C-index) and area under the receiver operating characteristic curve (AUC)] and calibration (calibration plots).

Results: The 2-year incidence of MACCE was 12.5% (n = 210) in the derivation cohort and 15.6% (n = 364) in the validation cohort. The nomogram demonstrated good discrimination, with C-index values of 0.727 and 0.661 and AUCs of 0.723 and 0.699 in the derivation cohort and the validation cohort, respectively; significantly outperforming the GRACE risk score (P < 0.001). Calibration plots showed good agreement between the predicted and observed outcomes. Patients classified as the high-risk group by the nomogram had a significantly higher MACCE incidence compared to that of the low-risk group (log-rank P < 0.001).

Conclusions: This newly developed nomogram provides a reliable tool for individualized prediction of the 2-year MACCE risk in elderly Chinese patients with ACS who underwent percutaneous coronary intervention. It outperformed the GRACE score in both discrimmination and calibration and may help improve clinical decision-making and personalized risk stratification in this vulnerable population.

Background: Heart failure with preserved ejection fraction (HFpEF) following acute myocardial infarction (AMI) carries substantial morbidity and mortality, yet reliable prognostic markers beyond conventional cardiovascular factors remain limited. Frailty, reflecting diminished physiological reserve, has emerged as a potential determinant of adverse outcomes in this high-risk population. Therefore, the aim of this study was to address a critical knowledge gap and to provide evidence that may guide frailty-adapted management strategies to improve prognosis and quality of life in this high-risk population.

Methods: We conducted a multicenter retrospective cohort study including 4507 patients with HFpEF discharged after AMI across 82 hospitals in China (from January 2010 to March 2024). Frailty was assessed using the Hospital Frailty Risk Score (HFRS), with HFRS < 5 defined as non-frail and HFRS ≥ 5 as frail. Multivariable Cox proportional hazards models, adjusted for demographics, comorbidities, left ventricular ejection fraction, and therapies, were applied to evaluate associations between frailty and clinical outcomes. The primary endpoints were all-cause death and major adverse cardiovascular events (MACE), which defined as the composite of cardiovascular death and heart failure rehospitalization. Secondary endpoints included net adverse clinical events (NACE), which defined as the composite of all-cause death, stroke, recurrent myocardial infarction, revascularization, and major bleeding, as well as the individual components of MACE.

Results: Frailty was independently associated with a higher risk of all-cause death [adjusted hazard ratio (aHR) = 1.52, 95% CI: 1.31-2.03, P = 0.005] and NACE (aHR = 1.20, 95% CI: 1.02-1.41, P = 0.026). At one year, frail patients had higher unadjusted rates of all-cause death (9.0% vs. 2.9%) and NACE (19.8% vs. 13.7%) compared with non-frail patients. For cardiovascular death, the association did not reach statistical significance (aHR = 1.42, 95% CI: 0.99-2.03, P = 0.053). No significant associations were found for MACE (aHR = 1.05, 95% CI: 0.86-1.28, P = 0.636) or heart failure rehospitalization (aHR = 0.94, 95% CI: 0.75-1.19, P = 0.616).

Conclusions: Frailty, as measured by the HFRS, is an independent predictor of one-year mortality and composite adverse events in post-AMI HFpEF patients. These findings support the use of HFRS at discharge to identify high-risk population who may benefit from closer follow-up, optimization of medical therapy, and targeted frailty-focused interventions.

Background: Understanding the type and extent of coronary artery involvement in patients with acute type A aortic dissection (ATAAD) is vital for surgical planning. The Neri classification has been proposed as a guide for surgical strategies, however, its prognostic impact on postoperative mortality rates remains understudied in large-scale cohorts.

Methods: We reviewed 600 ATAAD patients who underwent surgery and coronary computed tomography angiography from 2016 to 2020 at Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Patients were classified based on the Neri classification system: no coronary artery involvement, type A (ostial involvement), type B (dissection in coronary body), and type C (circumferential detachment or complete avulsion). The primary endpoint was 30-day mortality.

Results: Overall, 28.3% of the patients had coronary artery involvement, with Neri type A, Neri type B, and Neri type C accounting for 13.3%, 11.2%, and 3.8%, respectively. The right coronary artery was more frequently involved (25.3%) than the left coronary artery (8.0%). In the unadjusted analysis, patients with coronary artery involvement exhibited a numerically higher 30-day mortality compared to those without (5.3% vs. 2.3%) (OR = 2.35, 95% CI: 0.94-5.88, P = 0.07), though this difference did not reach statistical significance. However, multivariable adjustment revealed significant association (adjusted OR = 3.71, 95% CI: 1.05-13.13, P = 0.04). Interestingly, after additional adjustment for coronary artery bypass grafting, the impact of coronary artery involvement on 30-day mortality no longer remained statistically significant (adjusted OR = 3.13, 95% CI: 0.85-11.58, P = 0.09). The 1-year mortality was higher in those with coronary artery involvement, but this significant association disappeared after adjusting for potential confounding variables. Furthermore, no significant difference in 30-day and 1-year mortality were observed among patients with different Neri classifications.

Conclusions: In patients with ATAAD who undergo surgery, the presence of coronary artery involvement is significantly associated with an increased risk of 30-day mortality. Proactive coronary artery bypass grafting may potentially mitigate the adverse impact of coronary artery involvement on 30-day mortality.