Hellenic Journal of Cardiology最新文献_第3页

Revealing key research gaps in contemporary randomized controlled trials on cardiopulmonary resuscitation: a scoping review 揭示当代心肺复苏随机对照试验的关键研究空白：一项范围综述。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2025-11-01 DOI: 10.1016/j.hjc.2025.05.003

Eleni Giannopoulou , George Latsios , Damianos Tsilivarakis , Elias Sanidas , Konstantinos Toutouzas , Konstantinos Tsioufis , Stavroula Kosmopoulou

Cardiac arrest is a global health problem. Evidence from the literature highlights significant gaps in research related to cardiopulmonary resuscitation. The aim was to conduct a scoping review of the randomized controlled trials involving adults who experienced non-traumatic cardiac arrest, published between January 1, 2015 and December 31, 2024, focusing on therapeutic interventions during cardiac arrest or within 24 h of return of spontaneous circulation (ROSC). MEDLINE and DOAJ databases were used to identify primary articles. Data on demographic characteristics, cardiac arrest location, initial heart rhythm, type of intervention, and primary research objectives were extracted. A total of 78 studies with 80,600 participants (70.4% men, 29.6% women; mean age 64.6 years) were included. Fifty-six trials (71.8%) studied out-of-hospital cardiac arrest, 9 (11.5%) studied in-hospital cardiac arrest, and 10 (12.8%) studied both types. Few studies included patients with exclusively shockable (9 studies, 11.5%) or non-shockable (2 studies, 2.6%) initial cardiac arrest rhythm. Interventions before ROSC were investigated in 51.3% of studies (40 trials). The common primary research objectives were patient survival (24 articles, 30.8%), neurological function (20 articles, 25.6%), biomarker evaluation (16 articles, 20.5%), and ROSC rates (14 articles, 17.9%). Only 5 studies (6.4%) investigated long-term effects beyond 6 months. This scoping review showed that gaps exist in the research of cardiopulmonary resuscitation. They mainly concern age and gender representation and research on in-hospital cardiac arrest, initial arrest cardiac rhythms, and long-term prognosis. Future studies should be designed accordingly.

心脏骤停是一个全球性的健康问题。来自文献的证据突出了与心肺复苏相关的研究中的重大差距。目的是对2015年1月1日至2024年12月31日期间发表的涉及成人非创伤性心脏骤停患者的随机对照试验进行范围审查，重点关注心脏骤停期间或24小时内自发循环恢复（ROSC）的治疗干预。使用MEDLINE和DOAJ数据库来识别主要文章。提取了人口统计学特征、心脏骤停部位、初始心律、干预类型和主要研究目标等数据。共有78项研究，80,600名参与者(男性70.4%，女性29.6%；平均年龄64.6岁)。56项（71.8%）研究院外心脏骤停，9项（11.5%）研究院内心脏骤停，10项（12.8%）研究两种类型。很少有研究纳入了完全休克性（9项研究，11.5%）或非休克性（2项研究，2.6%）初始心脏骤停节律的患者。51.3%的研究（40项试验）调查了ROSC之前的干预措施。常见的主要研究目标是：患者生存（24篇，30.8%）、神经功能（20篇，25.6%）、生物标志物评价（16篇，20.5%）和ROSC率（14篇，17.9%）。只有5项研究（6.4%）调查了超过6个月的长期影响。这一范围综述表明，心肺复苏的研究存在空白。它们主要涉及年龄和性别代表性以及院内心脏骤停、初始骤停心律和长期预后的研究。未来的研究应据此设计。

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引用次数: 0

Revisiting treatment of pulmonary arterial hypertension in the current era: a Greek scientific document 在当今时代重新审视肺动脉高压的治疗：希腊科学文件。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2025-11-01 DOI: 10.1016/j.hjc.2025.02.004

Eftychia Demerouti , Frantzeska Frantzeskaki , Tonia Adamidi , Anastasia Anthi , Effrosyni Filiou , Panagiotis Karyofyllis , Athanasios Manginas , Ioanna Mitrouska , Stylianos E. Orfanos , Georgia Pitsiou , Iraklis Tsangaris , George Giannakoulas

Pulmonary arterial hypertension (PAH) is a life-threatening condition characterised by the 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. These therapies regulate vascular tone through 3 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 anti-proliferative signalling of activin receptor type II (A/B), thus targeting a unique pathogenic pathway and promoting anti-proliferative effects on the pulmonary vasculature. Recently, it received approval from the European Medicines Agency for patients with PAH classified as World Health Organisation 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, including those at high risk. In anticipation of upcoming scientific guidelines and with the hope of improved outcomes for patients with PAH, an expert opinion for the treatment of Greek patients has been developed, focusing on the integration of this novel agent into the therapeutic algorithm.

肺动脉高压（PAH）是一种以肺动脉血管过度增生为特征的危及生命的疾病。尽管近年来治疗策略取得了重大进展，但死亡率仍然很高。目前的治疗策略侧重于诊断时和随访期间的风险评估。它涉及最初使用针对PAH的联合治疗，PAH通过三个主要途径调节血管张力：内皮素途径、一氧化氮/环鸟苷单磷酸途径和前列环素途径。sotaterept是一种结合转化生长因子-β超家族配体的融合蛋白，可重新平衡激活素受体II型a /B的促增殖和抗增殖信号，从而靶向独特的致病途径并促进肺血管的抗增殖作用。最近，它获得了欧洲药品管理局的批准，将多环芳烃患者归类为世卫组织功能II或III类。最新的世界肺动脉高压研讨会的会议记录强调了在随访期间对大多数患者的治疗方案中加入索他塞普的重要性。鉴于即将出台的科学指南，并希望改善PAH患者的预后，专家已经就希腊患者的治疗提出了意见，重点是将这种新型药物整合到治疗算法中。

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引用次数: 0

Incremental value of high-risk CMR attributes to predict adverse remodeling after ST-segment elevation myocardial infarction across LVEF categories 高风险 CMR 属性在预测 ST 段抬高心肌梗死后不同 LVEF 类别的不良重塑方面的增量价值。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2025-11-01 DOI: 10.1016/j.hjc.2024.06.003

Qian Guo , Xiao Wang , Ruifeng Guo , Yingying Guo , Yan Yan , Wei Gong , Wen Zheng , Hui Wang , Lei Xu , Bin Que , Shaoping Nie

Background

A couple of cardiac magnetic resonance (CMR) attributes strongly predict adverse remodeling after ST-segment elevation myocardial infarction (STEMI); however, the value of incorporating high-risk CMR attributes, particularly, in patients with non-reduced ejection fraction, remains undetermined. This study sought to evaluate the independent and incremental predictive value of a multiparametric CMR approach for adverse remodeling after STEMI across left ventricular ejection fraction (LVEF) categories.

Methods

A total of 157 patients with STEMI undergoing primary percutaneous coronary intervention were prospectively enrolled. Adverse remodeling was defined as ≥20% enlargement in left ventricular end-diastolic volume from index admission to 3 months of follow-up.

Results

Adverse remodeling occurred in 23.6% of patients. After adjustment for clinical risk factors, a stroke volume index <29.6 mL/m², a global longitudinal strain >−7.5%, an infarct size >39.2%, a microvascular obstruction >4.9%, and a myocardial salvage index <36.4 were independently associated with adverse remodeling. The incidence of adverse remodeling increased with the increasing number of high-risk CMR attributes, regardless of LVEF (LVEF ≤ 40%: P = 0.026; 40% < LVEF < 50%: P = 0.001; LVEF ≥ 50%: P < 0.001). The presence of ≥4 high-risk attributes was an independent predictor of LV adverse remodeling (70.0% vs. 16.8%, adjusted OR 9.68, 95 CI% 3.25–28.87, P < 0.001). Furthermore, the number of high-risk CMR attributes had an incremental predictive value over reduced LVEF and baseline clinical risk factors (AUC: 0.81 vs. 0.68; P = 0.002).

Conclusions

High-risk CMR attributes showed a significant association with adverse remodeling after STEMI across LVEF categories. This imaging-based model provided incremental value for adverse remodeling over traditional clinical factors and LVEF.

背景：一些心脏磁共振（CMR）属性可有力预测ST段抬高型心肌梗死后的不良重构，但纳入高风险CMR属性的价值，尤其是在射血分数未降低的患者中的价值仍未确定。本研究旨在评估多参数 CMR 方法对 STEMI 后不同左心室射血分数（LVEF）类别的不良重塑的独立预测价值和增量预测价值：前瞻性地纳入了157名接受经皮冠状动脉介入治疗的STEMI患者。从入院到随访3个月期间，左心室舒张末期容积扩大≥20%即为不良重塑：结果：23.6%的患者发生了不良重塑。在对临床风险因素进行调整后，卒中容积指数为2，整体纵向应变>-7.5%，梗死面积>39.2%，微血管阻塞>4.9%，心肌挽救指数为结论：高风险 CMR 属性与 STEMI 后 LVEF 类别的不良重塑有显著关联。与传统的临床因素和 LVEF 相比，这一基于成像的模型为不良重塑提供了增量价值。

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引用次数: 0

Estimated pulse wave velocity predicts mortality in patients with heart failure with preserved ejection fraction 估计脉搏波速度可预测射血分数保留型心力衰竭患者的死亡率

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2025-11-01 DOI: 10.1016/j.hjc.2024.05.013

Ruicong Xue , Jiancheng Zhang , Zhe Zhen , Weihao Liang , Yi Li , Lili Zhang , Yugang Dong , Bin Dong , Chen Liu

Objective

Estimated pulse wave velocity (ePWV), a newly established arterial stiffness (AS) parameter, predicts the development of cardiovascular disease (CVD) and death in the general population or in patients with CVD risk factors. However, whether ePWV is associated with adverse outcomes in heart failure with preserved ejection fraction (HFpEF) patients remains unknown. Our study aimed to evaluate the prognostic value of ePWV on clinical outcomes in HFpEF.

Methods and Results

We analyzed HFpEF participants from the Americas in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial with available baseline data (n = 1764). Cox proportional hazard model was used to explore the prognostic value of ePWV on long-term clinical outcomes (all-cause mortality, cardiovascular mortality, all-cause hospitalization, and heart failure hospitalization). Each ePWV increase by 1 m/s increased the risk for all-cause death by 16% (HR:1.16; 95% CI:1.10–1.23; P < 0.001) and CVD mortality by 13% (HR:1.13; 95% CI:1.04–1.21; P = 0.002) after adjusting for confounders. Patients were then grouped into 4 quartiles of ePWV. Our study indicated that the highest ePWV quartile (ePWV ≥ 12.806 m/s) was associated with increased risk of all-cause mortality (HR: 1.96; 95% CI: 1.43–2.69; P < 0.001) and CVD mortality (HR: 1.72; 95% CI: 1.16–2.56; P = 0.008) after adjusting for potential confounders.

Conclusion

These results suggested ePWV is independently associated with increased all-cause mortality and CVD mortality in HFpEF patients, indicating ePWV is an appropriate predictor of prognosis in patients with HFpEF.

目的估计脉搏波速度（ePWV）是一个新建立的动脉硬度（AS）参数，可预测普通人群或有心血管疾病危险因素的患者心血管疾病（CVD）的发展和死亡。然而，ePWV是否与保留射血分数（HFpEF）心力衰竭患者的不良结局相关仍不清楚。本研究旨在评估ePWV对HFpEF临床预后的预测价值。方法和结果我们分析了来自美洲的HFpEF参与者，在醛固酮拮抗剂（TOPCAT）治疗保留心功能心力衰竭的试验中，有可用的基线数据（n = 1764）。采用Cox比例风险模型探讨ePWV对长期临床结局（全因死亡率、心血管死亡率、全因住院率和心力衰竭住院率）的预后价值。调整混杂因素后，ePWV每增加1 m/s，全因死亡风险增加16% (HR:1.16; 95% CI: 1.10-1.23; P < 0.001)，心血管疾病死亡率增加13% （HR:1.13; 95% CI: 1.04-1.21; P = 0.002）。然后将患者分为4个ePWV四分位数。我们的研究表明，在调整潜在混杂因素后，最高ePWV四分位数（ePWV≥12.806 m/s）与全因死亡率（HR: 1.96; 95% CI: 1.43-2.69; P < 0.001）和心血管疾病死亡率（HR: 1.72; 95% CI: 1.16-2.56; P = 0.008）的风险增加相关。结论ePWV与HFpEF患者全因死亡率和CVD死亡率升高独立相关，提示ePWV可作为HFpEF患者预后的预测指标。

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引用次数: 0

Intra-hospital variation of gut microbiota product, trimethylamine N-oxide (TMAO), predicts future major adverse cardiovascular events after myocardial infarction 肠道微生物群产物三甲胺 N-氧化物（TMAO）的院内变化可预测心肌梗死后未来的主要不良心血管事件。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2025-11-01 DOI: 10.1016/j.hjc.2024.05.007

Aneta Aleksova , Alessandra Lucia Fluca , Mariano Stornaiuolo , Giulia Barbati , Alessandro Pierri , Donna R. Zwas , Daniela Santon , Stefano D’Errico , Maria Marketou , Gianfranco Sinagra , Yosefa Avraham , Ettore Novellino , Milijana Janjusevic

Objective

Trimethylamine N-oxide (TMAO) has been associated with atherosclerosis and poor outcome. We evaluated the prognostic impact of intra-hospital TMAO variation on patient outcome.

Methods and Results

Blood samples from 149 patients with acute myocardial infarction (AMI) were taken on admission and discharge. Plasma TMAO was determined by HPLC-MS. The endpoint was a composite three-point MACE (major adverse cardiovascular events), including all-cause mortality, re-infarction, or heart failure (HF) development. Median TMAO concentration on admission was significantly higher than on discharge (respectively, 7.81 [3.47–19.98] vs 3.45 [2.3–4.78] μM, p < 0.001). After estimating the 3.45 μM TMAO cut-off with the analysis of the continuous hazard ratio, we divided our cohort into two groups. The first group included 75 (50.3%) patients whose TMAO levels remained below or decreased under cut-off (low-low/high-low; LL/HL), while the second group included 74 (49.7%) patients whose TMAO levels remained high or increased above the cut-off during hospitalisation (high-high/low-high; HH/LH). During the median 30-month follow-up, 21.5% of patients experienced the composite endpoint. At Kaplan-Meier analysis, a trend of increasing MACE risk was observed in patients in the HH/LH group (p = 0.05). At multivariable Cox analysis, patients from the HH/LH group had more than two times higher risk of MACE during the follow-up than the LL/HL group (HR = 2.15 [95% CI, 1.03–4.5], p = 0.04). Other independent predictors of MACE were older age and worse left ventricular systolic function.

Conclusion

In patients with AMI, permanently high or increasing TMAO levels during hospitalisation are associated with a higher risk of MACE during long-term follow-up.

背景和目的：三甲胺N-氧化物（TMAO）与动脉粥样硬化和不良预后有关。我们评估了院内 TMAO 变化对患者预后的影响：我们采集了 149 名急性心肌梗死（AMI）患者入院和出院时的血样。血浆中的 TMAO 采用 HPLC-MS 法测定。终点是综合三点MACE（主要不良心血管事件），包括全因死亡率、再梗死或心力衰竭（HF）发展。入院时的 TMAO 中位浓度明显高于出院时（分别为 7.81 [3.47 - 19.98] vs 3.45 [2.3 - 4.78] μM，p结论：在急性心肌梗死患者中，住院期间 TMAO 水平长期居高不下或不断升高与长期随访期间 MACE 风险较高有关。

{"title":"Intra-hospital variation of gut microbiota product, trimethylamine N-oxide (TMAO), predicts future major adverse cardiovascular events after myocardial infarction","authors":"Aneta Aleksova , Alessandra Lucia Fluca , Mariano Stornaiuolo , Giulia Barbati , Alessandro Pierri , Donna R. Zwas , Daniela Santon , Stefano D’Errico , Maria Marketou , Gianfranco Sinagra , Yosefa Avraham , Ettore Novellino , Milijana Janjusevic","doi":"10.1016/j.hjc.2024.05.007","DOIUrl":"10.1016/j.hjc.2024.05.007","url":null,"abstract":"<div><h3>Objective</h3><div>Trimethylamine N-oxide (TMAO) has been associated with atherosclerosis and poor outcome. We evaluated the prognostic impact of intra-hospital TMAO variation on patient outcome.</div></div><div><h3>Methods and Results</h3><div>Blood samples from 149 patients with acute myocardial infarction (AMI) were taken on admission and discharge. Plasma TMAO was determined by HPLC-MS. The endpoint was a composite three-point MACE (major adverse cardiovascular events), including all-cause mortality, re-infarction, or heart failure (HF) development. Median TMAO concentration on admission was significantly higher than on discharge (respectively, 7.81 [3.47–19.98] vs 3.45 [2.3–4.78] μM, p < 0.001). After estimating the 3.45 μM TMAO cut-off with the analysis of the continuous hazard ratio, we divided our cohort into two groups. The first group included 75 (50.3%) patients whose TMAO levels remained below or decreased under cut-off (low-low/high-low; LL/HL), while the second group included 74 (49.7%) patients whose TMAO levels remained high or increased above the cut-off during hospitalisation (high-high/low-high; HH/LH). During the median 30-month follow-up, 21.5% of patients experienced the composite endpoint. At Kaplan-Meier analysis, a trend of increasing MACE risk was observed in patients in the HH/LH group (p = 0.05). At multivariable Cox analysis, patients from the HH/LH group had more than two times higher risk of MACE during the follow-up than the LL/HL group (HR = 2.15 [95% CI, 1.03–4.5], p = 0.04). Other independent predictors of MACE were older age and worse left ventricular systolic function.</div></div><div><h3>Conclusion</h3><div>In patients with AMI, permanently high or increasing TMAO levels during hospitalisation are associated with a higher risk of MACE during long-term follow-up.</div></div>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":"86 ","pages":"Pages 4-16"},"PeriodicalIF":3.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140904695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Left ventricular morphology and geometry in élite athletes characterised by extreme anthropometry 以极端人体测量为特征的精英运动员的左心室形态和几何形状。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2025-11-01 DOI: 10.1016/j.hjc.2024.06.007

Eleonora Moccia , Harshil Dhutia , Aneil Malhotra , Efstathios Papatheodorou , Elijah Behr , Rajan Sharma , Michael Papadakis , Sanjay Sharma , Gherardo Finocchiaro

Objective

The aim of the study was to explore the individual impact of BMI and height on LV size and geometry in a cohort of healthy athletes.

Methods

From a total cohort of 1857 healthy élite athletes (21 ± 5 years, males 70%) investigated with ECG and echocardiogram, we considered three groups: Group 1 n = 50: BMI ≥ 30 and height < 1.90 m; Group 2 n = 87: height ≥ 1.95 m and BMI < 30; control Group 3 n = 243: height < 1.90 m and BMI = 20–29.

Results

BSA was ≤2.3 m² in 52% of athletes in group 1 and 47% of athletes in group 2. Athletes in group 1 and in group 2 showed an enlarged LV end-diastolic diameter (LVEDD) (57 ± 6 vs 57 ± 4 vs 53 ± 4 mm in Group 3); 50% of athletes in group 1 and 38% of athletes in group 2 exhibited a LVEDD > 57 mm (p = 0.23). LV wall thickness was higher in group 1 (11 ± 1 vs 10 ± 2 mm in Group 2, p = 0.001). Concentric hypertrophy or concentric remodelling was found in 20% of athletes in group 1 vs 7% of athletes in group 2 (p = 0.04). Athletes of group 1 with BSA ≤ 2.3 m² showed lower LVEDD (53 ± 5 vs 60 ± 5 mm, p < 0.001), similar LV wall thickness (10 ± 1 vs 11 ± 1 mm, p = 0.128) and higher prevalence of concentric hypertrophy or concentric remodelling (31% vs 8%, p = 0.04) compared to those with BSA > 2.3 m².

Conclusion

Athletes with high BMI have similar LV dimensions but greater wall thickness and higher prevalence of concentric remodelling compared to very tall athletes. Athletes with high BMI and large BSA have the widest LV dimensions.

研究目的本研究旨在探讨体重指数和身高对健康运动员队列中左心室大小和几何形状的个体影响：我们对 1857 名健康精英运动员（21 ± 5 岁，男性占 70%）进行了心电图和超声心动图检查，并将其分为三组：第 1 组 n = 50：体重指数≥ 30，身高结果：第 1 组 52% 的运动员和第 2 组 47% 的运动员的 BSA 均小于 2.3 平方米。第 1 组和第 2 组运动员的左心室舒张末期直径（LVEDD）增大（第 1 组为 57 ± 6 mm vs 第 2 组为 57 ± 4 mm vs 第 3 组为 53 ± 4 mm）；第 1 组 50%的运动员和第 2 组 38%的运动员的左心室舒张末期直径大于 57 mm（P = 0.23）。第 1 组的左心室壁厚度更高（11 ± 1 mm，第 2 组为 10 ± 2 mm，p = 0.001）。第 1 组 20% 的运动员与第 2 组 7% 的运动员相比存在同心性肥厚或同心性重塑（p = 0.04）。BSA≤2.3 m2的第1组运动员的LVEDD较低（53 ± 5 vs 60 ± 5 mm，p 2.3 m2）：高体重指数运动员的左心室尺寸与非常高的运动员相似，但左心室壁厚度更大，同心重塑的发生率更高。高体重指数和大体重指数运动员的左心室尺寸最宽。

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引用次数: 0

Multimodality imaging for the diagnosis of giant cavernous hemangioma of the right ventricle 诊断右心室巨大海绵状血管瘤的多模式成像。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2025-11-01 DOI: 10.1016/j.hjc.2024.10.003

Leizhi Ku , Youping Chen , Yuhang Wang , Zheng Liu , Xiaojing Ma

引用次数: 0

Efficacy of drug-coated balloons versus drug-eluting stents in bifurcated lesions: a systematic review and meta-analysis 药物包被球囊与药物洗脱支架治疗分叉性病变的疗效：系统综述和荟萃分析。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2025-11-01 DOI: 10.1016/j.hjc.2025.03.009

Lefteris Teperikidis , Georgios Zormpas , Paschalis Karakasis , Dimitrios Patoulias , Aristi Boulmpou , Dimitrios E. Kouzoukas , Bernardo Cortese , Giuseppe Biondi-Zoccai , Christodoulos Papadopoulos

引用次数: 0

To implement or to innovate? Which is the noble action for the future in heart failure 实施还是创新？这是对未来心力衰竭的崇高行动。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2025-11-01 DOI: 10.1016/j.hjc.2025.11.003

Charalambos Vlachopoulos , Alexandros Briasoulis

引用次数: 0

Association of beat-to-beat P-wave analysis index to the extent of left atrial low-voltage areas in patients with paroxysmal atrial fibrillation 阵发性心房颤动患者逐次搏动 P 波分析指数与左心房低电压区范围的关系。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2025-11-01 DOI: 10.1016/j.hjc.2024.05.011

Antigoni Sakellaropoulou , Georgios Giannopoulos , Dimitrios Tachmatzidis , Konstantinos P. Letsas , Antonios Antoniadis , Dimitrios Asvestas , Dimitrios Filos , Panagiotis Mililis , Michael Efremidis , Ioanna Chouvarda , Vassilios P. Vassilikos

Background

Left atrial (LA) fibrosis has been shown to be associated with atrial fibrillation (AF) recurrence. Beat-to-beat (B2B) index is a non-invasive classifier, based on B2B P-wave morphological and wavelet analysis, shown to be associated with AF incidence and recurrence. In this study, we tested the hypothesis that the B2B index is associated with the extent of LA low-voltage areas (LVAs) on electroanatomical mapping.

Methods

Patients with paroxysmal AF scheduled for pulmonary vein isolation, without evident structural remodeling, were included. Pre-ablation electroanatomical voltage maps were used to calculate the surface of LVAs (<0.5 mV). B2B index was compared between patients with small versus large LVAs.

Results

35 patients were included (87% male, median age 62). The median surface area of LVAs was 7.7 (4.4–15.8) cm² corresponding to 5.6 (3.3–12.1) % of LA endocardial surface. B2B index was 0.57 (0.52–0.59) in patients with small LVAs (below the median) compared to 0.65 (0.56–0.77) in those with large LVAs (above the median) (p = 0.009). In the receiver operator characteristic curve analysis for predicting large LVAs, the c-statistic was 0.75 (p = 0.006) for B2B index and 0.81 for the multivariable model including B2B index (multivariable p = 0.04) and P-wave duration.

Conclusion

In patients with paroxysmal AF without overt atrial myopathy, B2B P-wave analysis appears to be a useful non-invasive correlate of low-voltage areas—and thus fibrosis—in the LA. This finding establishes a pathophysiological basis for B2B index and its potential usefulness in the selection process of patients who are likely to benefit most from further invasive treatment.

背景：左心房（LA）纤维化已被证明与房颤（AF）复发有关。逐搏（B2B）指数是一种无创分类器，基于 B2B P 波形态学和小波分析，显示与房颤发生率和复发率相关。在本研究中，我们测试了 B2B 指数与电解剖图上 LA 低电压区（LVA）范围相关的假设：方法：纳入计划进行肺静脉隔离且无明显结构重塑的阵发性房颤患者。采用消融前电解剖电压图来计算 LVA 的表面（结果：35 名患者（87% 为男性）被纳入研究：共纳入 35 名患者（87% 为男性，中位年龄为 62 岁）。LVA 的中位表面积为 7.7 (4.4-15.8) 平方厘米，相当于 LA 心内膜表面的 5.6 (3.3-12.1) %。小 LVA（低于中位值）患者的 B2B 指数为 0.57（0.52-0.59），而大 LVA（高于中位值）患者的 B2B 指数为 0.65（0.56-0.77）（P=0.009）。在预测大LVA的接收器操作特征曲线分析中，B2B指数的c统计量为0.75（p=0.006），包括B2B指数（多变量p=0.04）和P波持续时间在内的多变量模型的c统计量为0.81：对于没有明显心房肌病的阵发性房颤患者，B2B P 波分析似乎是 LA 低电压区--也就是纤维化--的一个有用的无创相关指标。这一发现为 B2B 指数奠定了病理生理学基础，并有助于筛选出可能从进一步有创治疗中获益最多的患者。

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引用次数: 0