Hellenic Journal of Cardiology最新文献

The rapid evolution of highly adaptable and reusable artificial intelligence models facilitates the implementation of digital twinning and has the potential to redefine cardiovascular risk prevention. Digital twinning combines vast amounts of data from diverse sources to construct virtual models of an individual. Emerging artificial intelligence models, called generalist AI, enable the processing of different types of data, including data from electronic health records, laboratory results, medical texts, imaging, genomics, or graphs. Among their unprecedented capabilities are an easy adaptation of a model to previously unseen medical tasks and the ability to reason and explain output using precise medical language derived from scientific literature, medical guidelines, or knowledge graphs. The proposed combination of a digital twinning approach with generalist AI is a path to accelerate the implementation of precision medicine and enhance early recognition and prevention of cardiovascular disease. This proposed strategy may extend to other domains to advance predictive, preventive, and precision medicine and also boost health research discoveries.

Objective: We aimed to examine biventricular remodeling and function after Ebstein anomaly (EbA) surgical correction using echocardiographic techniques, particularly, the relations between the biventricular changes and the EbA types.

Methods: From April 2015 to August 2022, 110 patients with EbA were included in this retrospective study based on the Carpentier classification. Echocardiography assessments during the preoperative, early, and mid-term postoperative periods were performed.

Results: The 54 patients with types A and B EbA were included in group 1, whereas the 56 patients with types C and D were in group 2. Seventy-eight patients underwent surgical correction of EbA. The median age at operation was 8.8 years. During the mid-term follow-up, only 9.1% of the patients had moderate or severe tricuspid regurgitation. Right ventricular (RV) systolic function worsened in group 2 at discharge (fractional area change: 27.6 ± 11.2 vs. 35.4 ± 11.5 [baseline], P < 0.05; global longitudinal strain: -10.8 ± 4.4 vs. -17.9 ± 4.7 [baseline], P = 0.0001). RV function slowly recovered at a mean of 12 months of follow-up. Regarding left ventricular (LV) and RV systolic function, no statistical difference was found between before and after surgery in group 1.

Conclusion: A high success rate of surgical correction of EbA, with an encouraging durability of the valve, was noted. Biventricular systolic function was maintained fairly in most patients with types A and B postoperatively. A late increase in RV systolic function after an initial reduction and unchanged LV systolic function were observed in the patients with types C and D postoperatively.

Objective: Previous studies have shown that remnant cholesterol (RC) is associated with cardiovascular disease (CVD). The study aimed to identify the association of RC and the discordance between RC and lipoprotein cholesterol (LDL-C) with CVD.

Methods: Data were obtained from the Kailuan study. RC was calculated as the non-high-density lipoprotein cholesterol minus LDL-C. Discordant RC and LDL-C were defined by percentile difference and clinical cut-off points. Cox proportional hazard models were used to explore the association of RC and the discordance between RC and LDL-C with CVD.

Results: A total of 96,769 participants were included, with a median age of 51.61 years and 79.56% were male. There was a significant association between RC levels and the risk of CVD, with an HR of 1.10 (95% CI, 1.08-1.13) in the continuous analysis. The group with a discordantly high RC had a significant increase in CVD, MI, and stroke risk, with HRs of 1.18 (95% CI, 1.10-1.26), 1.23 (1.06-1.43), and 1.15 (1.07-1.24), respectively. Compared with the group with low LDL-C and low RC, the group with low LDL-C and high RC had significantly higher incidences of CVD (HR, 1.33 [95% CI, 1.26-1.40]), MI (HR, 1.59 [95% CI, 1.41-1.80]), and stroke (HR, 1.28 [95% CI, 1.20-1.35]).

Conclusions: Elevated levels of RC and discordantly high RC with LDL-C were associated with the risk of CVD, MI, and stroke. These findings demonstrate the clinical significance of identifying residual risk related to RC.

Objective: The COVID-19 pandemic had an adverse impact on several cardiovascular risk factors. This study investigated the prevalence, awareness and treatment of hypertension in Greece before and after the pandemic. Data were collected in the context of the May Measurement Month (MMM) global survey initiated by the International Society of Hypertension.

Methods: Adult volunteers (age ≥ 18 years) were recruited through opportunistic screening in public areas across cities in Greece in 2019 and 2022. Medical history and triplicate sitting blood pressure (BP) measurements were taken using validated automated upper-arm cuff devices. The data were uploaded to the international MMM cloud platform. Hypertension was defined as systolic BP ≥ 140 mm Hg and/or diastolic ≥90 mm Hg and/or self-reported use of drugs for hypertension. The same threshold was used to define uncontrolled BP in treated individuals.

Results: Data from 12,080 adults were collected (5,727/6,353 in MMM 2019/2022; men 46/49%, p < 0.01; mean age 52.7 ± 16.6/54.8 ± 16.2, p < 0.001; smokers, 24.7/30.5, p < 0.001; diabetics 12/11.5%, p = NS; cardiovascular disease 5/5.8%, p = NS). The prevalence of hypertension was 41.6/42.6% (MMM 2019/2022, p = NS), with 21.3/27.5% of individuals with hypertension being unaware of their condition (p < 0.001), 5.6/2.4% aware untreated (p < 0.001), 24.8/22.1% treated uncontrolled (p < 0.05), and 48.3/47.8% treated controlled (p = NS).

Conclusion: In Greece, the COVID-19 pandemic did not appear to affect the prevalence and control of hypertension; however, the rate of undiagnosed hypertension was higher after the pandemic. National strategies need to be implemented for the early detection and optimal management of hypertension in the general population in Greece.

Objective: Transcatheter edge-to-edge repair (TEER) is a prominent therapeutic option for mitral regurgitation (MR) patients. However, it lacks objective parameters to assess procedural efficacy. This study aims to investigate pulmonary venous (PV) flow as a surrogate for valvular hemodynamics and its associations to clinical outcomes.

Methods: Consecutive MR patients who underwent TEER in our center from January 2020 to October 2021 were retrospectively investigated. PV flow parameters were measured before and after TEER, including velocity (cm/s), velocity time integral (VTI) (cm), and systolic/diastolic ratios. Primary outcomes were 1, 6, and 12 months heart failure hospitalizations (HFH) and 1 year all-cause mortality.

Results: The cohort consisted of 80 patients. The mean age was 74.76 ± 10.13 years, 26 with primary and 54 with secondary MR. Systolic wave parameters improved significantly after TEER: mean peak velocity increased from 9.94 ± 31.95 to 35.74 ± 15.03 cm/s, and VTI from 3.62 ± 5.99 to 8.33 ± 4.72 cm. Furthermore, systolic to diastolic VTI and peak-velocities ratios showed significant improvement of 0.39 ± 0.63 to 0.81 ± 0.47 and 0.23 ± 0.66 to 0.91 ± 0.43, respectively. Using multivariable analysis, higher post-procedural S_VTI was associated with less HFH: 1-month (OR = 0.72, CI [0.52,0.98]), 6-months (OR = 0.8, CI [0.66,0.97]), 1-year (OR = 0.85, CI [0.73,0.99]), as well as reduced 1-year mortality (OR = 0.64 95% CI [0.45,0.91]). Furthermore, compared to patients with SVTI ≥ 3, patients with SVTI < 3 had a higher risk for HFH at: 1-month (OR = 16.59, CI [1.48,186.02]), 6-months (OR = 12.2, CI [1.69,88.07]), and 1-year (OR = 8.61, CI [1.27,58.27]), as well as elevated 1-year mortality (OR = 8.07, 95% CI [1.04,62.28]).

Conclusion: PV flow was significantly improved following TEER, and several hemodynamic parameters were associated with HFH and mortality. These results may offer a basis for establishing future procedural goals to ensure better clinical outcomes.

Objective: Lifestyle interventions are recommended as the first-line treatment to control metabolic syndrome components and improve cardiometabolic risk factors. However, studies directly comparing the cardiometabolic effects of the Dietary Approaches to Stop Hypertension (DASH) vs. the Mediterranean diet (MedDiet) accompanied by salt restriction are currently lacking. Thus, with the present secondary analyses of a randomized trial, we aimed to assess the cardiometabolic effects of a 3-month intensive dietary intervention implementing salt restriction alone or on top of the DASH and MedDiet compared to no/minimal intervention in never drug-treated adults with high normal blood pressure (BP) or grade 1 hypertension.

Methods: We randomly assigned individuals to the control group (CG, n = 60), salt restriction group (SRG, n = 60), DASH diet with salt restriction group (DDG, n = 60), or MedDiet with salt restriction group (MDG, n = 60).

Results: According to the intention-to-treat analysis, the DDG and the MDG had lower odds ratio (OR) (95% CI) of metabolic syndrome [0.29 (0.12, 0.72), and 0.15 (0.06, 0.41), respectively] compared to the CG. Moreover, the MDG had lower odds of metabolic syndrome compared to the SRG and lower odds of elevated BP levels than the DDG and the SRG. Moreover, total and LDL-cholesterol, fasting glucose, HbA1c, and systolic/diastolic BP were reduced in all three intervention groups compared to the CG.

Conclusion: On a background of salt restriction, the MedDiet was superior in BP reduction, but the DASH and MedDiet reduced the prevalence of metabolic syndrome to the same extent.

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.