Archives of Cardiovascular Diseases最新文献

Background: The role of sodium-glucose cotransporter-2 inhibitors in patients with acute myocardial infarction remains elusive.

Aim: To evaluate the effect of early application of a sodium-glucose cotransporter-2 inhibitor on ventricular remodelling and prognosis in patients with anterior wall acute myocardial infarction.

Methods: In this prospective study, 102 patients diagnosed with anterior wall acute myocardial infarction were enrolled and divided into intervention and control groups according to the use of dapagliflozin within 24hours after admission. Demographic and clinical data, including age, sex, associated co-morbidities, number of lesions, length of hospital stay, N-terminal prohormone of brain natriuretic peptide, left ventricular ejection fraction, left ventricular end-systolic and end-diastolic diameters and drug-related adverse reactions, were collected and analysed between the two groups. All patients were followed up 1, 3 and 6 months after discharge.

Results: At 6 months, left ventricular ejection fraction was higher (55.98±7.17% vs. 52.71±7.78%; P=0.03) and N-terminal prohormone of brain natriuretic peptide was lower (141.52±83.18 vs. 203.69±152.13pg/mL; P=0.01) in the intervention group versus the control group. Left ventricular end-systolic diameter (35.68±4.32 vs. 38.00±5.01mm; P=0.01) and left ventricular end-diastolic diameter (50.48±4.90 vs. 52.67±4.91mm; P=0.03) were smaller in the intervention group versus the control group. Event-free survival rates were better in the intervention group than in the control group (90% vs. 74.5%; P=0.03). The cumulative incidence of drug-related adverse reactions was similar in the two groups (14% vs. 4.0%; P=0.15).

Conclusions: Use of dapagliflozin within 24hours after admission can improve cardiac function, inhibit ventricular remodelling, improve clinical prognosis and have high safety in patients with anterior wall acute myocardial infarction during 6-month follow-up.

Background: Most patients with Fontan circulation struggle to increase cardiac output during exercise, affecting aerobic capacity and quality of life.

Aim: We sought to identify factors in the preFontan period and in management that influence their exercise cardiac performance.

Methods: We retrospectively collected anatomical, clinical and pre- and postFontan invasive haemodynamic data, including ventricular filling pressure in 57 consecutive Fontan patients who underwent cardiopulmonary exercise testing. Exercise cardiac performance was assessed by peak cardiac index measurement using a thoracic bioelectrical impedance device.

Results: The median age at Fontan procedure was 6.3 (interquartile range 2.8) years, and 43 patients had concomitant fenestration. Age at cardiopulmonary exercise testing was 14.7 (interquartile range 5.4) years. In multivariable models, peak cardiac index was influenced by cyanosis duration (B=-0.272; P<0.0001) and by the Norwood procedure (-1.977; P=0.002). Peak indexed stroke volume was influenced by cyanosis duration (B=-1.109; P=0.0002), whereas peak heart rate was influenced by preFontan peripheral oxygen saturation (B=0.602; P=0.009). Cyanosis duration≤6.9 years predicted a peak indexed stroke volume≥45mL/m² (area under the curve=0.747; P=0.001). Furthermore, peak indexed stroke volume and peak heart rate were correlated with postFontan ventricular filling pressure: r_p=-0.539 (P=0.012) and r_p=-0.552 (P=0.010), respectively. PostFontan ventricular filling pressure was correlated with bidirectional cavopulmonary shunt duration (r_s=0.498; P=0.023).

Conclusions: Cyanosis duration and low preFontan peripheral oxygen saturation affect exercise cardiac performance after Fontan, partly through ventricular dysfunction. Early Fontan procedure and limited postFontan cyanosis could promote better long-term exercise cardiac performance.

Cellular senescence, identified as a state of permanent cell cycle arrest, has become central to understanding aging and disease. Initially seen as a cellular aging mechanism, it is now recognized for its roles in development, tissu repair and tumour suppression. However, the accumulation of senescent cells with age contributes to chronic diseases such as diabetes, atherosclerosis and neurodegeneration. Recent efforts have focused on "senotherapeutics", including senolytics, which aim to eliminate senescent cells to mitigate age-related decline. Despite significant advances, senescence research faces critical challenges because of inconsistent detection methods. Common markers, such as p16INK4a and senescence-associated β-galactosidase, vary across tissues and contexts, complicating cross-study comparisons and clinical applications. A standardized multifaceted approach to senescence detection is essential, and should incorporate complementary methods, clear thresholds for senescence classification and considerations for cell type-specific variations. Such standardization would enhance reproducibility, streamline research and facilitate clinical translation, advancing therapeutic applications in aging and disease management.

Background: Patient characteristics, technology and clinical practice surrounding primary prevention implantable cardioverter defibrillators have evolved continuously over time.

Aim: To explore the temporal changes in patient characteristics, pharmacological therapy and device types among implantable cardioverter defibrillator recipients implanted for the primary prevention of sudden cardiac death over the last two decades in France.

Methods: Characteristics of participants and type of device from the retrospective DAI-PP Pilot Study (2002-2012) were compared with those from the ongoing prospective DAI-PP Consortium (2018 onwards).

Results: This study included 9588 participants overall (DAI-PP Pilot Study, n=5539; DAI-PP Consortium, n=4049). Compared with the DAI-PP Pilot Study, the DAI-PP Consortium subjects were older at implantation (62.5 vs 65.2 years; P=0.001) and had a higher proportion of women (15.1% vs 20.6%; P<0.001), a similar proportion of ischaemic heart disease (60.2% vs 60.2%; P=0.98), a higher left ventricular ejection fraction (27±7% vs 30±8%; P<0.001) and more patients with narrow QRS complexes (30.5% vs 46.0%; P<0.001). The proportion of patients treated with heart failure drugs increased significantly (70.1% vs 83.1%; P<0.001), whereas the use of amiodarone became much less frequent (22.7% vs 14.7%; P<0.001). Finally, the proportions of cardiac resynchronization therapy defibrillators (53.8% vs 46.4%; P<0.001) and dual-chamber defibrillators (23.3% vs 17.3%; P<0.001) decreased, whereas subcutaneous implantable cardioverter defibrillators now account for a sizeable proportion of implants (14.6%).

Conclusions: Over a 20-year period, the primary prevention implantable cardioverter defibrillator population has evolved significantly, with an older age and a higher proportion of women. The type of device has changed, with fewer cardiac resynchronization therapy defibrillators and more subcutaneous implantable cardioverter defibrillators.

Background: Infective endocarditis is a rare but severe complication that may arise following transcatheter aortic valve implantation. Recent advances in microbiological epidemiology have highlighted staphylococci and enterococci as the primary pathogens involved.

Aim: To investigate the prevalence of these bacteria in patients' cutaneous flora before and after transcatheter aortic valve implantation procedures, and to assess the implications for antibiotic prophylaxis recommendations.

Methods: A single-centre prospective epidemiological study was conducted, enrolling patients admitted consecutively for transcatheter aortic valve implantation procedures between June 2021 and February 2022. Cutaneous samples were obtained from each patient at the puncture site of the transcatheter aortic valve implantation procedure, before and after skin detersion, and from operator hands after skin detersion.

Results: One hundred patients were included, with a mean age of 82±6.1years, a male-to-female ratio of 0.48 and a mean body mass index of 29±4.4kg/m². Before skin detersion, cutaneous samples were positive in 58 patients; among them were coagulase-negative staphylococci (n=48, 82%, 95% confidence interval 71-91%), enterococci (n=12, 21%, 95% confidence interval: 11-33%), Staphylococcus aureus (n=2, 3%, 95% confidence interval 0-12%) and Enterobacteriaceae (n=4, 7%, 95% confidence interval: 2-17%).

Conclusions: Enterococci are frequently present in patients' cutaneous flora at the puncture site before skin detersion, suggesting a potential source for infective endocarditis after transcatheter aortic valve implantation. These findings support considering amoxicillin-clavulanate as antibiotic prophylaxis before transcatheter aortic valve implantation procedures to mitigate the risk of infective endocarditis associated with enterococcal colonization.