Hellenic Journal of Cardiology最新文献

The updated guideline empowers physicians to tailor treatment plans more effectively to individual patient characteristics, preferences, and responses. With a more flexible and individualized approach to angina management, seems that the traditional stepwise approach may not be optimal for all patients. In addition there is a significant shift in the diagnostic approach of chronic coronary syndromes (CCS). In this review, we will mainly refer to key points and queries concerning the current ESC recommendations regarding the diagnostic approach and treatment of patients with stable angina, recommending practical directions to physicians managing patients with CCS.

Pulmonary arterial hypertension (PAH) is a life-threatening condition characterized by excessive proliferation of pulmonary artery vessels. Despite significant advancements in treatment strategies over recent years, mortality rates remain high. The current treatment strategy focuses on risk assessment both at the time of diagnosis and during follow-up. It involves the initial use of combination therapies targeting PAH, which regulate vascular tone through three main pathways: the endothelin pathway, the nitric oxide/cyclic guanosine monophosphate pathway, and the prostacyclin pathway. Sotatercept, a fusion protein that binds to ligands of the transforming growth factor-β superfamily, rebalances the pro- and antiproliferative signalling of activin receptor type II A/B, thus targeting a unique pathogenic pathway and promoting antiproliferative effects on the pulmonary vasculature. Recently, it received approval from the European Medicines Agency for PAH patients classified as WHO functional class II or III. Proceedings from the latest World Symposium on Pulmonary Hypertension stress the importance of adding sotatercept to the treatment regimen for the majority of patients during follow-up. In anticipation of upcoming scientific guidelines and with the hope of improved outcomes for PAH patients, an expert opinion for the treatment of Greek patients has been developed, focusing on the integration of this novel agent into the therapeutic algorithm.

Background: The impact of renal function on revascularization outcomes in acute myocardial infarction (AMI) with multivessel disease (MVD) remains unclear. This study compared long-term outcomes of complete (CR) and incomplete revascularization (IR) in patients with estimated glomerular filtration rate (eGFR) ≥ 60 or < 60 mL/min/1.73 m².

Methods: Using data from the Korea Acute Myocardial Infarction Registry-National Institute of Health, 5,962 patients (mean age: 65.4 ± 12.1 years; 4,389 men) categorized by renal function: group I (eGFR ≥ 60, n = 4,689) and group II (eGFR < 60, n = 1,273). Each group was subdivided into CR (IA, IIA) and IR (IB, IIB). The primary endpoint was the incidence of MACE, a composite of all-cause death, MI, and repeat revascularization (RR), assessed over a 3-year follow-up.

Results: MACE was more frequent in group II than group I (41.5% vs. 19.4%, p < 0.001). In group I, CR reduced MACE compared to IR (16.7% vs. 22.6%, p < 0.001). However, no significant difference was found between CR and IR in group II (p = 0.118). Key predictors of MACE included advanced age, diabetes, prior myocardial infarction, STEMI, and incomplete revascularization.

Conclusion: CR improved outcomes in patients with eGFR ≥ 60, whereas no difference was observed between CR and IR in those with eGFR < 60. IR may therefore be a viable option for patients with reduced renal function.

It is estimated that the number of patients with a cardiac implantable electronic device (CIED) in Greece exceeds 120,000, and this population is expected to further rise by 5% annually. The importance of adequate monitoring and follow-up management of these devices is well-recognized. However, the increasing complexity and growing number of CIEDs makes their management a demanding medical service. Traditionally, interrogation and programming of CIEDS is performed through the use of a portable programmer by qualified personnel, requiring patient physical presence. During the last decade, remote monitoring (RM) of CIEDs tends to become more and more popular given the advantages and improved outcomes in many groups of patients. Currently, RM represents the standard of care for CIEDs follow-up, and it is recommended by major cardiology societies worldwide, including the European Society of Cardiology. The objective of this statement is to summarize current management of patients with CIED in Greece and the available evidence about clinical efficacy and safety of RM of CIEDs, present the most recent guideline recommendations, and finally, to propose actions to move towards widespread adoption of RM of CIEDs in Greece.

Objective: This study aimed to investigate the association of the DANish CoMorbidity Index for Acute Myocardial Infarction (DANCAMI) score with 30-day unplanned readmission rates and causes in patients with acute coronary syndrome (ACS).

Methods: Using the US National Readmission Database, all index hospitalisations with a principal diagnosis of ACS between October 2015 and December 2019 were stratified by their DANCAMI score using International Classification of Diseases-10th edition codes. Thirty-day unplanned readmission rates and causes were analysed, including the assessment of factors associated with readmission. Multivariable regression analyses were reported as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI).

Results: Of 2,066,328 ACS admissions, 173,304 (8.4%) had a DANCAMI score of 0, 602,640 (29.2%) had a DANCAMI score of 1-3, 327,046 (15.8%) had a DANCAMI score of 4-5, and 963,338 (46.6%) had a DANCAMI score ≥6. 189,240 (9.2%) had an unplanned readmission within 30 days. Patients with a higher DANCAMI score were more likely to be older and have an index presentation of non-ST-elevation ACS. A DANCAMI score ≥6 (aOR 1.30 95% CI 1.27-1.34), age (aOR 1.01 95% CI 1.01-1.01), female sex (aOR 1.09 95% CI 1.08-1.10), index ST-elevation ACS (aOR 1.03 95% CI 1.01-1.04), and atrial fibrillation (aOR 1.35 95% CI 1.33-1.37) were independently associated with readmission (all p < 0.001). Higher scores were associated with an increasing likelihood of readmission for non-cardiovascular causes.

Conclusion: Increased DANCAMI score was associated with higher readmissions in patients with ACS. The DANCAMI score could be a valuable tool to assess risk.

The transradial artery has been established as the default access site for most coronary catheterization procedures with fewer access-related and bleeding complications, rapid hemostasis, early ambulation of the patient, and reduction in all-cause mortality compared with transfemoral access. However, radial artery occlusion (RAO) remains the most frequent complication of coronary catheterization procedures performed via transradial artery access. The purpose of our review was to conduct detailed literature research and summarize all the available treatment strategies for RAO, given the lack of a standardized treatment protocol in the literature. Pharmacological treatment with low-molecular-weight heparin (LMWH) or other anticoagulants, invasive strategies, and pharmaco-invasive methods available in the literature were included in our review. Data were derived from case series, case reports, clinical trials, and observational studies. Eight studies regarding pharmacological treatment with LMWH or any other anticoagulant and seven studies of invasive treatment were included in our review. There were only two randomized studies: one with LMWH (tinzaparin) and one with apixaban. Furthermore, taking into consideration data derived from the above-mentioned studies, a treatment algorithm for RAO was proposed. RAO remains the most frequent complication of coronary procedures with transradial access. Application of preventive strategies and comprehensive knowledge of the risk factors remain the key factors for the reduction of the incidence of this clinical entity. Therapeutic options include anticoagulation regimens and interventional techniques through the distal radial artery. Large, randomized, multicenter studies should be conducted to evaluate the efficacy of the available treatment methods and define a standardized treatment protocol for RAO.

Objective: Surgical aortic valve replacement has been the mainstay of treatment against severe aortic insufficiency despite the high incidence of prosthesis-related complications and better long-term outcomes following aortic valve repair. Annuloplasty and leaflet reconstruction are the integral parts of the procedure. Safety and efficacy of HAART internal annuloplasty ring are hereby investigated through mid-term outcomes of a single referral center.

Methods: Forty-three consecutive patients with either trileaflet or bicuspid aortic insufficiency along with ascending aorta and/or aortic root enlargement were included. Annular stabilization via the internal ring implantation was attempted, whereas leaflet repair was performed whenever required.

Results: Maximum follow-up was 6.3 years, whereas the mean was 2.7 years. Mean age was 54.2 years. At least moderate aortic insufficiency was noted in 69.8% (30/43) of patients, whereas 93% (40/43) of them had an ascending aorta or aortic root over 45 mm. Overall mortality was 2.3% (1/43). No more than mild aortic insufficiency was detected early postoperatively. At the last follow-up, there were 2 cases of ring-related adverse events who were reoperated for aortic valve replacement (4.7%). Mid-term outcomes revealed no more than mild aortic insufficiency, while aortic diameter was less than 50 mm in the vast majority of the patients. New York Heart Association class was also significantly lower compared to preoperatively, although moderate aortic stenosis was present in 16% of our cohort.

Conclusion: Geometric ring annuloplasty is an easily reproducible valve-sparing approach. Midterm results, revealing 2.3% mortality and 95.3% freedom from reoperation, are promising, but long-term outcomes are yet to be discovered.

Under diverse contributing factors in different scientific micro-environments, the number of authors who publish extreme numbers of full articles in a single year has increased. Cardiology is the subfield that has the largest share of authors with extreme publishing behavior than any other subfield in science (outside physics). Between 2000 and 2022, 137 authors in the subfield of Cardiovascular System (CVS, Science-Metrix classification) have published over 60 full articles in at least one calendar year and are also highly cited. The majority (70/137) are from Europe. All 7 countries with the highest prevalence of CVS extreme publishing authors per million population are European countries. Issues of massive authorship of papers by administrative leaders are discussed, including the arguments in favor of sustaining this practice and a refutation of these arguments. Other major contributors to the phenomenon are publications from clinical trials and epidemiological studies and massive authorship of highly cited guidelines. Micro-environments are instrumental in creating extreme publishing behavior in both developed and less developed countries. Listing of contributions does not solve the problem since contributions are also gamed; metrics that probe gaming are nevertheless available. Eventually, authorship carries both credit and accountability. The number of publications is a metric that can be heavily gamed. Emphasis should be given to what makes a major impact on science and human lives.

Background: Sacubitril/valsartan, an angiotensin receptor neprilysin inhibitor (ARNI), shows promising result in treating resistant hypertension (RH) but lacks comprehensive evaluation. We performed a systematic review to assess and compare the efficacy of ARNI in managing RH.

Methods: We conducted a systematic search on multiple databases such as Cochrane, ProQuest, PubMed, and Google Scholar. Studies comparing the effects of ARNI on blood pressure in adult RH patients were included in the review. Data extraction and synthesis followed PRISMA guidelines, and the risk of bias was assessed using Cochrane tools. The primary outcome is to determine the effect of ARNI on blood pressure in RH patients, and the secondary outcome was to assess the safety of ARNI in RH patients.

Results: Four studies involving 915 RH patients were included in the systematic review. The sacubitril/valsartan dose used ranged between 100 and 400 mg/day. All studies reported a statistically significant reduction in blood pressure, with 24-h blood pressure reduction ranging from 15.8/6.5 to 16.6/9.3 mmHg and office systolic blood pressure reduction ranging from 24.7 to 10.3 mmHg. Additionally, two studies reported improvements in cardiac remodeling and left ventricular function associated with sacubitril/valsartan. The most common adverse events were hypotension and elevated serum potassium levels, though these were minimal and did not require discontinuation of ARNI therapy.

Conclusion: Sacubitril/valsartan is a promising alternative to ARB or ACEi in managing RH, offering superior blood pressure reductions and potential benefits in reversing cardiac remodeling, while maintaining a favorable safety profile with minimal risk of serious adverse events.