Hellenic Journal of Cardiology最新文献

Background: Anatomic considerations of transcatheter aortic valve implantation (TAVI) have an important role for the procedure planning, but sex-specific data are lacking.

Methods: All eligible cases undergoing evaluation for TAVI procedure in the period from November 2019 to July 2023 at the University Hospital of Split were included. Cardiac computed tomography was analysed to derive the measures of left ventricular outflow tract (LVOT), aortic root, ascending aorta, and ilio-femoral arteries. Sex-based comparison was conducted using the descriptive statistics.

Results: There were 140 female patients (43.8%) and 180 male patients (56.2%). Female patients had smaller dimensions of aortic annulus (area 391.9 vs. 491.5 mm2, p<0.001), LVOT (area 373.3 vs. 481.8 mm2, p<0.001) and ascending aorta (maximal diameter 32.7 vs. 34.5 mm, p<0.001), as well as ilio-femoral arteries bilaterally (p<0.001). There was no significant difference in the proportion of ilio-femoral unfeasibility for transfemoral TAVI procedure, as measured by diameter of ilio-femoral arteries <5.0 mm (9.0% in males vs. 6.1% in females, p=0.441) and <5.5 mm (24.7% in males vs. 16.7% in females, p=0.156). Female patients were more likely to receive the smallest valve across different valve platforms (p<0.001). There were sex-specific differences in the availability of conventional valve sizes across different platforms (p<0.001). Female patients had significantly higher periprocedural mortality (7.9% vs. 1.7%, p=0.030), while there were no differences in other clinical outcomes, and no association of periprocedural mortality with anatomic measures.

Conclusions: Female patients showed smaller absolute dimensions of LVOT, aortic root and ilio-femoral arteries compared to male patients. There were no differences in the prevalence of ilio-femoral unfeasibility for transfemoral TAVI procedure, but there were sex-specific differences in the availability of conventional valve sizes across different platforms. Female patients exhibited higher periprocedural mortality with no difference in other clinical outcomes.

Objective: Thoracic Aortic Aneurysm (TAA) represents an aortic pathology that is caused by the deranged integrity of the three layers of the aortic wall, and is related to severe morbidity and mortality. Consequently, it is crucial to identify the biomarkers implicated in the pathogenesis and biology of TAA. The aim of the current computational study was to assess the differential gene expression profile of the gap junction proteins (GJPs) in patients with TAA in order to identify novel potential biomarkers for the diagnosis and treatment of this disease.

Methods: We implemented bioinformatics methodology to construct the gene network of the GJPs family, evaluate their expression in pathologic aortic tissue excised from patients with TAA and compare it with healthy controls. We also investigated the related biological functions and miRNA families.

Results: We extracted raw data related to the transcriptomic profile of selected genes from a microarray dataset, incorporating 43 TAA and 43 healthy control samples. A total of 17 GJPs were evaluated. Eight GJPs (47%) were downregulated in TAA (GJA3, GJA9, GJA10, GJB1 GJC2, GJD2, GJD3, GJD4). We also demonstrated the important correlations among the differentially expressed genes (DEGs). Four GJPs (GJA3, GJA9, GJC2, GJD3) were associated with fair discrimination and calibration traits in predicting TAA presentation. Finally, we performed gene set enrichment analysis (GSEA) and identified the major biological functions and miRNA families (hsa-miR-5001-3p, hsa-miR-942-5p, hsa-miR-7113-3p, hsa-miR-6867-3p, and hsa-miR-4685-3p) associated with the DEGs.

Conclusions: These outcomes support the important role of certain gap junction proteins in the pathogenesis of TAA.

Objective: To investigate the modifying role of obesity in the association between abnormal glucose metabolism and atrial fibrillation (AF) risk in older individuals.

Methods: From April 2007 to November 2011, 11,663 participants aged ≥60 years were enrolled in the Shandong area. Glucose metabolic status was determined using fasting plasma glucose and hemoglobin A1c levels, and obesity was determined using body mass index (BMI), waist-to-hip ratio (WHR), and visceral fat area (VFA). Obesity-associated metabolic activities were assessed using the adiponectin-to-leptin ratio (ALR), galectin-3, and triglyceride-glucose index (TyG). New-onset AF was diagnosed by ICD-10.

Results: During an average of 11.1 years of follow-up, 1343 participants developed AF. AF risks were higher in those with prediabetes, uncontrolled diabetes, and well-controlled diabetes than with normoglycemia. The hazard ratios were decreased by 14.79%, 40.29%, and 25.23% in those with prediabetes; 31.44%, 53.56%, and 41.90% in those with uncontrolled diabetes; and 21.16%, 42.38%, and 27.59% in those with well-controlled diabetes after adjusting for BMI, WHR, and VFA, respectively. The population-attributable risk percentages of general obesity, central obesity, and high VFA for new-onset AF were 10.43%, 34.78%, and 31.30%, respectively. ALR, galectin-3, and TyG significantly mediated the association of BMI, WHR, and VFA with AF risk (all P_adj. < 0.001).

Conclusion: Obesity mediates the association between abnormal glucose metabolism and AF risk in older individuals. WHR is a more effective modifier than BMI and VFA for moderating the association. ALR, TyG, and galectin-3 mediate the moderating effect of obesity on the association between abnormal glucose metabolism and AF risk.

Objective: To assess whether the Life's Essential 8 (LE8) score mediates the association of socioeconomic status (SES) with atrial fibrillation (AF) and heart failure (HF).

Methods: A total of 236,754 participants from the UK Biobank were included. SES was determined based on household income, education attainment, and employment status using latent class analysis. Cox regression was utilized to explore the association of SES with AF and HF after adjusting for age, sex, ethnicity, and alcohol status. Counterfactual mediation analysis was employed to calculate the mediation proportion of the LE8 score. Stratified analysis was conducted based on age and sex.

Results: With a median of 13.61 years of follow-up, 14,635 cases of AF and 6878 cases of HF were documented. The HR (95% CI) of the total effect of SES on AF was 1.43 (1.36, 1.48). The indirect effect mediated by the LE8 score was 1.14 (1.13, 1.15), with the mediation proportion being 40.84 (36.97, 47.01)%. The total effect of SES on HF was 2.44 (2.26, 2.59). The indirect effect was 1.28 (1.25, 1.29), with the mediation proportion being 36.77 (34.59, 39.06)%. The mediation proportion was greater for AF in age < 60 years compared to age ≥ 60 years, and it was also higher in males than females for both AF and HF.

Conclusion: Approximately one-third of the socioeconomic inequalities in AF and HF could be explained by the LE8 score. These findings highlighted the importance of integrating cardiovascular health promotion into public health policies aimed at mitigating socioeconomic health inequalities.

Objective: Dilated cardiomyopathy (DCM) is a leading cause of heart failure (HF) characterized by left ventricular dilatation and systolic dysfunction not explained by abnormal loading conditions. Despite its prevalence, DCM's epidemiology and prognosis remain poorly studied in our country.

Methods: A retrospective observational study encompassed patients discharged from all Spanish public hospitals between 2016 and 2021 diagnosed with DCM. Data were extracted from the Minimum Basic Data Set. The study focused on hospital admissions, comorbidities, in-hospital mortality, and readmission rates for circulatory system diseases at 30 and 365 days.

Results: Among 27,402 index episodes, DCM was the primary diagnosis in 12.4%, predominantly affecting men (72.5%). In-hospital mortality was 8.7%, with significant predictors including cardiogenic shock (OR: 12.4, 95% CI: 9.6-15.9), advanced or metastatic cancer (OR: 4.3, 95% CI: 3.8-5.0), renal failure (OR: 2.4, 95% CI: 2.2-2.7), and chronic liver disease (OR: 2.4, 95% CI: 2.1-2.8). Readmission rates were 7.9% at 30 days and 25.5% at 365 days, predominantly due to HF. Multivariate analysis identified age (IRR: 1.02, 95% CI: 1.01-1.02), female sex (IRR: 0.87, 95% CI: 0.79-0.96), severe hematological diseases (IRR: 2.12, 95% CI: 1.45-3.10), and metastatic cancer (IRR: 1.65, 95% CI: 1.31-2.07) as predictors of 30-day readmissions. At 365 days, predictors included age (IRR: 1.02, 95% CI: 1.01-1.02), female sex (IRR: 0.80, 95% CI: 0.74-0.86), severe hematological diseases (IRR: 2.43, 95% CI: 1.66-3.56), and renal failure (IRR: 1.42, 95% CI: 1.31-1.55).

Conclusion: This study highlights the substantial hospitalization burden and mortality risk among DCM patients, emphasizing the necessity for advanced management strategies and specialized cardiac care.

Objective: Patients with advanced light chain cardiac amyloidosis (AL-CA) have a poor prognosis. We aimed to (1) assess the prognostic significance of all cardiac chamber longitudinal strains and (2) to further determine whether the combination of longitudinal strains with the Mayo staging system could provide additional prognostic value.

Methods: Patients classified as Mayo 2012 stage III and IV were included in our study. We documented major adverse cardiac events (MACEs), including hospitalization for heart failure and all-cause mortality. Right ventricular free wall strain (RV-FWS), left ventricular global longitudinal strain (LV-GLS), left atrial longitudinal peak strain (LAPS), and right atrial longitudinal peak strain (RAPS) were assessed using echocardiography.

Results: This research enrolled 140 advanced AL-CA patients, with 49.3% at Mayo 2012 stage IV. During follow-up, 84 patients developed MACEs. LV-GLS, RV-FWS, LAPS, and RAPS were independent risk factors for advanced AL-CA patients. Kaplan-Meier curves revealed that cutoff values of all heart-chamber longitudinal strains had significant additional prognostic values for the Mayo 2012 stage. According to multivariate Cox regression, Age, gender, Mayo 2012, LAPS, RAPS, RV-FWS, and LV-GLS were included in the predictive model. The AUCs of the Model were 0.887, 0.907, and 0.883 for 1-, 3-, and 5-year MACEs, respectively. The model was internally validated using 200 bootstrapped resamples, yielding a corrected C-index of 0.810. A nomogram was developed and dynamically accessed via the following link: https://lxhadvancedalliexiantu.shinyapps.io/ALCA/.

Conclusion: In patients with advanced AL-CA, it is essential to thoroughly evaluate all cardiac chamber longitudinal strains, particularly focusing on LV-GLS, RV-FWS, LAPS, and RAPS.

Background: Epicardial stenosis and coronary microvascular dysfunction (CMD) may coexist in patients with chronic coronary syndrome (CCS). Microvascular resistance reserve (MRR) has been demonstrated to be a valid cross-modality metric using continuous saline infusion thermodilution and intracoronary Doppler flow velocity methods. This study aimed to investigate the prevalence and diagnostic concordance of CMD defined by MRR using two methods-stress transthoracic Doppler echocardiography (S-TDE) and the invasive bolus thermodilution method (B-Thermo)-in patients with functionally significant epicardial stenosis.

Methods: We retrospectively investigated 204 left anterior descending artery (LAD) territories in CCS. All patients underwent physiological assessment using a pressure-temperature wire and S-TDE before elective fractional flow reserve (FFR)-guided percutaneous coronary intervention. The concordance rate was evaluated using κ values.

Results: In the final analysis, the median age was 72 years, and 72.5% of patients were male. The median FFR value was 0.69. MRR_S-TDE and MRR_B-Thermo were similar (3.41 vs. 3.48, P=0.877), whereas only a weak, albeit significant relationship was observed between these two metrics (r=0.167, P=0.017). CMD was diagnosed in 20.6% and 32.8% of patients using S-TDE and B-Thermo, respectively, when a cutoff MRR value of 2.7 was applied. The concordance rate of CMD diagnosis between the two methods was low (κ=0.079).

Conclusions: MRR_S-TDE and MRR_B-Thermo showed a very weak correlation in the LAD territory with functionally significant stenosis in patients with CCS. The prevalence of CMD diagnosed using MRR_S-TDE and MRR_B-Thermo was not comparable, and the diagnostic concordance of CMD using these two methods was very low.