Journal of Geriatric Cardiology最新文献

Background: Left main coronary bifurcation lesions account for 50% of left main coronary artery disease cases. Although a drug-coated balloon (DCB) has the advantages of immediate release of the drug to the arterial wall and no remaining struts, there is no conclusive evidence to support DCB use.

Methods & results: We conducted a systematic review in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. Eighteen retrospective studies and two prospective studies in which left main bifurcation lesions were treated with DCBs were included in our qualitative analysis. The studies were divided into two groups according to the type of DCB used: DCB only and DCB + stent. At the midterm follow-up, the use of DCBs had noninferior or even superior angiographic and clinical outcomes in treating left main bifurcation lesions compared with the use of drug-eluting stents or conventional balloons, whether for de novo or in-stent restenosis lesions. Additionally, side branch late lumen enlargement was observed in several of the included studies, which indicates that DCBs may have the advantage of side branch protection.

Conclusions: According to our descriptive analysis, the DCB technique has a favorable safety and efficacy profiles for the treatment of left main bifurcation lesions. However, additional studies, especially randomized controlled trials, are needed to establish standards for the DCB technique.

Objectives: Autologous blood outgrowth endothelial cells (BOECs) have been proposed to induce therapeutic angiogenesis for treating cardiovascular diseases (CVDs). The aim of the present study was to investigate the proliferative potential and angiogenic characteristics of BOECs among middle-aged and older adults, the population particularly susceptible to CVDs.

Methods: BOECs were isolated from 48 peripheral blood samples of subjects aged 56 ± 4 years. The cells were then distinguished based on their proliferative abilities, and their phenotype, tube formation capacity, and migratory activity were compared using immunofluorescence staining, flow cytometry, tube formation assay, and wound healing assay, respectively. Correlations between demographic, clinical, and dietary parameters with the number of BOECs were also assessed.

Results: A total of 132 BOEC colonies with different proliferative potentials were obtained, including colonies lost proliferative ability before passage 3 (named LPA), stopped proliferating during passage 3-8 (HPA (3-8)), and proliferated after passage 8 (HPA (> 8)). LPA cells appeared later and displayed abnormal morphology, while HPA (3-8) cells exhibited alterations in von Willebrand factor morphology and lower KDR expression. HPA (> 8) cells obtained higher branching intervals and individual cell migration velocity compared with those of HPA (3-8) cells. Correlation analysis showed that the number of both LPA and HPA colonies were positively associated with several CVD risk factors. Additionally, the number of LPA colonies was positively associated with servings of meats and alternatives, fruits, fruits and vegetables, as well as the protein intake.

Conclusions: Our findings provide evidence that the middle-aged and older populations possess BOECs with different proliferative and angiogenic potentials, exhibiting distinctions in cell morphology, appearance dates, VWF morphology, and KDR expression. Strikingly, a higher number of BOECs is likely associated with an increased risk of CVDs, while the number of BOECs with low proliferative ability may be regulated by diet.

The Annual Report on Cardiovascular Health and Diseases in China (2022) intricate landscape of cardiovascular health in China. In connection with the previous section, this 12^th section of the report offers a comprehensive analysis of rehabilitation of cardiovascular diseases. In recent years, China's cardiac rehabilitation has developed vigorously, and its clinical benefits have been proven by more and more evidences. More cardiac rehabilitation centers are built and standards are constantly being promoted. Despite the rapid development and progress, there are still major shortcomings in the current situation, such as lack of awareness among patients and families about the significance and importance of cardiac rehabilitation, and under participation in cardiac rehabilitation; the development of cardiac rehabilitation is uneven, with the majority concentrated in tertiary hospitals in economically developed areas; lack of high-level evidence-based evidences, quality control and safety standards need to be improved; the medical payment system is not thorough; lack of a systematic training and admission system, hindering the development of cardiac rehabilitation in China. Therefore, continuous efforts are needed to strengthen the construction of cardiac rehabilitation centers, which should sink from tertiary hospitals to secondary and primary medical service centers; encourage clinical research on cardiac rehabilitation; introduce consensus on quality control and safety standards; explore more on phase III cardiac rehabilitation; increase investment in integrating high-tech, artificial intelligence, etc. With the unique advantages of traditional Chinese medicine, exploring a Chinese characteristic cardiac rehabilitation model that is in line with China's national conditions. Evidence-based medicine has confirmed that rehabilitation is the most effective method to reduce the disability rate of stroke, and it is also an indispensable key sector in the organized management model of stroke. Rehabilitation should span the entire process of stroke treatment. Perfecting the rehabilitation medical management system, steadily improving the rehabilitation medical service capacity, expanding diversified service methods, and emphasizing early and whole-range rehabilitation treatment have important clinical value and social significance for stroke rehabilitation.

Objective: To assess the prognostic impact of a routine invasive strategy according to the frailty burden in patients with non-ST-segment elevation myocardial infarction (NSTEMI) from the MOSCA-FRAIL clinical trial.

Methods: The MOSCA-FRAIL trial randomized 167 frail patients, defined by a Clinical Frailty Scale (CFS) ≥ 4, with NSTEMI to an invasive or conservative strategy. The primary endpoint was the number of days alive and out of hospital (DAOH) one year after discharge. For this subanalysis, we compared the impact of an invasive strategy on the outcomes between vulnerable (CFS = 4, n = 43) and frail (CFS > 4, n = 124) patients.

Results: Compared to vulnerable patients, frail patients presented lower values of DAOH (289.8 vs. 320.6, P = 0.146), more readmissions (1.03 vs. 0.58, P = 0.046) and higher number of days spent at the hospital during the first year (10.8 vs. 3.8, P = 0.014). The causes of readmission were mostly non-cardiac (56%). Among vulnerable patients, DAOH were similar regardless of strategy (invasive vs. conservative: 325.7 vs. 314.7, P = 0.684). Among frailest patients, the invasive group tended to have less DAOH (267.7 vs. 311.1, P = 0.117). Indeed, patients with CFS > 4, invasively managed lived 29 days less than their conservative counterparts. In contrast, there were no differences in the subgroup with CFS = 4.

Conclusions: Adult patients with frailty and NSTEMI showed different prognosis according to the degree of frailty. A routine invasive strategy does not improve outcomes and might be harmful to the frailest patients.

Background: It has been reported that the mitochondrial respiratory dysfunction (MRD) is important mechanisms affecting the heart failure (HF) pathogenesis. We sought to evaluate the potential role of MRD of peripheral blood mononuclear cells (PBMC) in HF severity prediction in patients with cardioverter-defibrillator implantation indications.

Methods: In this single-center study patients with HF of New York Heart Association (NYHA) I-III functional class (FC) and cardioverter-defibrillator implantation indications underwent transthoracic echocardiography (TTE) and MRD assessment using PBMC. Mitochondrial respiration rate (MRR) indicators (pyruvate + malate + adenosine diphosphate; succinate + adenosine diphosphate; pyruvate + malate - adenosine diphosphate [V_4.1]; succinate - adenosine diphosphate) were calculated. Correlations between HF NYHA FC, TTE and MRR indicators were evaluated. Based on our data, we developed a risk model regarding HF severity.

Results: Of 53 (100.0%) HF patients, 33 (62.3%) had mild exercise intolerance (1^st group) and 20 (37.7%) had moderate-to-severe exercise intolerance (2^nd group). Patients with mild exercise intolerance were likely to have a higher V_4.1 (P < 0.001) values. V_4.1 was independently associated with moderate-to-severe exercise intolerance in univariate and multivariate logistic regression (OR = 0.932, 95% CI: 0.891-0.975, P < 0.001).

Conclusions: The severity of HF is associated with PBMC mitochondrial respiratory dysfunction in patients with cardioverter-defibrillator implantation indications. Our HF severity risk model including V_4.1 parameters is able to distinguish patients with mild and moderate-to-severe exercise intolerance. Further investigations of their predictive significance are warranted.

Background: Motoric cognitive risk (MCR) syndrome as a pre-dementia syndrome often co-occurring with chronic health conditions. This study aims to investigate the prevalence of MCR and its association with cardiometabolic and panvascular multimorbidity among older people living in rural China.

Methods: This population-based study included 1450 participants who were aged ≥ 60 years (66.2% women) and who undertook the second wave examination of the Confucius Hometown Aging Project in Shandong, China when information to define MCR was collected. Data were collected through in-person interviews, clinical examinations, and laboratory tests. Cardiometabolic and panvascular multimorbidity were defined following the international criteria. MCR was defined as subjective cognitive complaints and slow gait speed in individuals free of dementia and functional disability. Multivariable logistic regression models were used to examine the associations of MCR with multimorbidity.

Results: MCR was present in 6.3% of all participants, and the prevalence increased with advancing age. Cerebrovascular disease, ischemic heart disease, heart failure, and increased serum cystatin C were associated with increased likelihoods of MCR (multivariable-adjusted odds ratio range: 1.90-3.02, P < 0.05 for all). Furthermore, there was a dose-response relationship between the number of cardiometabolic diseases and panvascular diseases and the likelihood of MCR. The multivariable-adjusted odds ratio (95% CI) of MCR associated with cardiometabolic and panvascular multimorbidity were 2.47 (1.43-4.26) and 3.85 (2.29-6.47), respectively.

Conclusions: Older adults with cardiometabolic and panvascular multimorbidity are at a higher likelihood of MCR. These findings may have implications for identifying older adults at pre-dementia state as targets for early preventive interventions to delay dementia onset.

Background: Acute coronary syndrome (ACS) presents with a variable prognosis, posing significant public health challenges. This study investigated the potential link between cerebral small vessel disease (CSVD) burden and outcomes in patients with ACS.

Methods: In this retrospective cohort study, ACS patients admitted to Beijing Friendship Hospital, Capital Medical University, Beijing, China from January 2020 to October 2021, were analyzed. CSVD burden was assessed using magnetic resonance imaging markers, including white matter lesions, lacunar infarcts, cerebral microbleeds, and enlarged perivascular spaces. The correlation between CSVD burden and clinical outcomes, including major adverse cardiovascular and cerebrovascular events, myocardial infarction (MI), target vessel revascularization, stroke, and mortality was examined over a one-year follow-up.

Results: Out of 248 patients, 216 patients were categorized into the low score group (LSG-CSVD) and 32 patients were categorized into the high score group (HSG-CSVD). Patients in the HSG-CSVD group exhibited significantly worse prognosis, with an elevated risk of major adverse cardiovascular and cerebrovascular events, MI, and target vessel revascularization. After adjusting for age, sex, hypertension, troponin T, and estimated glomerular filtration rate, a significantly higher risk of MI was observed in the HSG-CSVD group (HR = 4.51, 95% CI: 1.53-13.26, P = 0.006). Subgroup analysis by age and sex consistently demonstrated increased adverse outcomes in the HSG-CSVD.

Conclusions: The study highlights a direct association between increased CSVD burden and poorer ACS outcomes, particularly in MI risk. These findings underscore the importance of considering CSVD burden as a crucial prognostic factor in ACS management, facilitating risk stratification and guiding personalized treatment strategies.