Archives of Cardiovascular Diseases最新文献

Background: Women of reproductive age are an important group to consider in the global burden of rheumatic heart disease (RHD).

Aim: We aimed to systematically analyse the burden of RHD among women of reproductive age from 1990 to 2021.

Methods: We used Global Burden of Disease (GBD) 2021 to comprehensively analyse the global burden of RHD among women of reproductive age, including incidence, prevalence, mortality and disability-adjusted life years (DALY) and examined the relationship between the burden of disease and different regions, sociodemographic index (SDI) and age.

Results: The incidence and prevalence rates of RHD in women of reproductive age increased globally from 1990 to 2021. The incidence rate (per 100,000 population) increased from 60.37 (95% UI: 44.12-82.42) in 1990 to 64.06 (95% UI: 46.24-86.76) in 2021 and the prevalence rate increased from 951.74 (95% UI: 723.08-1197.48) to 1110.17 (95% UI: 843.45-1402.27). When countries were grouped by SDI, incidence rate and prevalence rate negatively correlated with SDI. Low SDI regions had the highest burden. In 2021, women of reproductive age 15-19years had the most incident cases, and the number of deaths and DALY connected positively with age.

Conclusions: The increasing incidence of RHD among women of reproductive age represents an important global health concern, particularly in low-SDI regions where the disease burden remains highest. The early onset of RHD highlights the need for preventive efforts targeting younger women. Prevention and management strategies should be adapted to disease patterns and health-system capacity, with an emphasis on early detection and effective secondary prevention in high-burden settings.

Background: Assessing right ventricular (RV) function in children is challenging, particularly in RV overload, where conventional echocardiographic indices do not account for afterload.

Aims: This prospective single-centre study evaluated the feasibility and utility of RV myocardial work (MW), which integrates strain and afterload, in children with different RV loading conditions.

Methods: The study included children with volume overload (pre-tricuspid shunts) or pressure overload (precapillary pulmonary hypertension) and healthy controls. All underwent two- and three-dimensional echocardiography to assess RV volumes and strain, and derive RV MW from the pressure-strain relationship.

Results: RV MW indices (median [minimum-maximum; interquartile range]) were higher in pressure overload (n=17) versus volume overload (n=18) versus controls (n=17): RV global work index (740 [479-1624; 311] vs 445 [368-676; 92] vs 361 [242-485; 108] mmHg%; all P<0.05); RV global constructive work (854 [708-2208; 588] vs 564 [467-754; 103] vs 468 [281-594; 122] mmHg%; all P<0.05) and RV global wasted work (69 [19-282; 147] vs 29 [9-54; 13] vs 20 [5-44; 15] mmHg%; P<0.05 for pressure overload vs volume overload and controls). Global work efficiency did not differ significantly between groups. Tricuspid annular plane systolic excursion divided by systolic pulmonary artery pressure showed strong inverse correlations with RV global work index (ρ=-0.83; P<0.0001) and RV global constructive work (ρ=-0.88; P<0.0001), a moderate correlation with global wasted work (ρ=-0.57; P<0.0001) and a weak, non-significant correlation with global work efficiency (ρ=0.26; P=0.0578).

Conclusion: RV MW assessment is feasible in children and reveals functional alterations not detected by conventional indices, particularly in the context of pressure overload, highlighting its potential as an advanced tool for evaluating RV function in paediatric RV overload.

Background: Heart transplantation following donation after controlled circulatory death (DCD) is not authorized in France, hence a feasibility study was mandatory.

Aims: To conduct a preclinical study to validate the feasibility of DCD heart procurement. We further sought to investigate the metabolic signature of DCD hearts during normothermic ex-situ perfusion (NESP).

Methods: The study design was approved by the Agence de la biomedecine (PFS20-004, La Plaine Saint-Denis, France). Five patients were considered for DCD heart procurement. Femoral vessels were canulated to ensure abdominal normothermic regional perfusion (A-NRP). Direct procurement followed by 4hours of NESP was performed. Donors' demographics and duration of functional warm ischaemic time (fWIT) were collected. Lactate levels were assessed every 30minutes during NESP. Plasma and left ventricular biopsies were collected every 30 and 60minutes, respectively, for untargeted metabolomic analyses using liquid chromatography coupled to high-resolution mass spectrometry.

Results: Mean±standard deviation donor age was 40±11 years and fWIT for the hearts was 26±10min. DCD lungs and kidneys were transplanted except in one case each (impaired ex vivo lung perfusion and premature arrest of A-NRP, respectively). DCD livers were all transplanted when allocated. All hearts were successfully perfused for 4hours. Lactate decreased during NESP for all hearts with a mean±standard deviation initial lactate at 5.42±0.98mmol/L and a final concentration at 3.02±0.86mmol/L (P=0.003). In plasma samples, there were notable changes for 166 metabolites. Most of them either initially increased and stabilized (64/166; 38.6%, e.g. carnitines) or continuously increased (67/166; 40.4%, e.g. purines, medium-chain fatty acids and amino acids). In biopsy samples, there were notable changes for 103 metabolites. Most of them initially decreased and stabilized, such as carnitines and nucleotides.

Conclusion: DCD heart procurement is feasible in France. Lactate trends were consistent with suitability of these hearts for transplantation. The metabolomic signature was characterized by nucleotide catabolism along with consumption of carnitines.

Background: Transthyretin amyloidosis can lead to transthyretin amyloid cardiomyopathy (ATTR-CM) and heart failure.

Aims: To describe the prevalence of cardiac and extracardiac diseases in patients with ATTR-CM and examine mortality predictors, including diuretic dosage, using the French National Health Database.

Methods: Patients with ATTR-CM and their medical characteristics were identified from the French database from 2011 to 2019. Diuretic doses were categorized into four classes (furosemide dose: level 1<20mg; level 2 20 to <60mg; level 3 60 to<120mg; level 4 ≥120mg). Predictive factors for mortality were examined.

Results: Of 7804 patients with ATTR-CM, 33.0% were on level 1 diuretics, 25.8% on level 2, 15.8% on level 3 and 25.3% on level 4 at diagnosis. Leading extracardiac conditions included kidney disease (37.0%), diabetes (29.5%), neurologic disorders (17.9%), gastrointestinal disorders (15.7%) and musculoskeletal conditions (11.8%). Median (95% confidence interval [CI]) survival was 3.1 (3.0-3.3) years. Multivariable analysis identified age at diagnosis (hazard ratio [HR] 1.482, 95% CI 1.400-1.558), male sex (HR 1.258, 95% CI 1.125-1.406), diuretic dose (HR 1.380, 95% CI 1.315-1.449), heart failure (HR 1.251, 95% CI 1.090-1.437), arrhythmia/conduction disorder (HR 1.143, 95% CI 1.001-1.306), kidney disease (HR 1.224, 95% CI 1.104-1.358), gastrointestinal disorder (HR 1.143, 95% CI 1.000-1.307) and diabetes (HR 1.192, 95% CI 1.071-1.326) as significantly associated with mortality.

Conclusion: Patients with ATTR-CM face a significant burden of associated diseases requiring comprehensive management alongside their ATTR-CM treatment. Beyond addressing these comorbidities, diuretic dosage emerges as a pivotal prognostic indicator.