Global Heart最新文献

Background: Rheumatic heart disease (RHD) remains one of the leading causes of mitral valve (MV) disease in developing countries. Despite the availability of percutaneous and surgical interventions, long-term outcomes remain unclear. This study aims to identify determinants of outcomes following percutaneous or surgical intervention in patients with rheumatic MV disease, addressing critical gaps in treatment selection.

Methods: A retrospective, intention-to-treat study was conducted on patients with symptomatic rheumatic MV disease, primarily characterized by mitral stenosis, who underwent either percutaneous mitral valvuloplasty (PMV) or MV replacement (MVR). Demographic, clinical, and echocardiographic variables were collected. The long-term outcome was defined as a composite of death, repeat PMV, need for cardiac surgery, and stroke.

Results: A total of 246 patients were enrolled (mean age 43.8 ± 13 years, 80% women, with 45% in New York Heart Association [NYHA] class III/IV). Of these, 90 patients (37%) underwent MVR, while 156 patients (63%) underwent PMV, with similar clinical characteristics at baseline. During a mean follow-up of 2.8 years, ranging from 1 day to 7.8 years, 45 patients (18%) reached the composite outcome, including 11 deaths (4%). Long-term outcomes were comparable between PMV and MVR (P = 0.231). Independent predictors of composite outcomes included baseline NYHA class III/IV (adjusted hazard ratio [HR] 2.10, 95% confidence interval [CI] 1.10-4.11, P = 0.023) and older age (HR 1.03, 95% CI 1.01-1.06, p = 0.020). Predictors of all-cause mortality following either PMV or MVR were older age (HR 1.08, 95% CI 1.03-1.14, P = 0.002) and lower left ventricular ejection fraction (HR 0.93, 95% CI 0.88-0.99, P = 0.021).

Conclusions: This study identified older age and higher NYHA functional class as significant predictors of composite outcomes in patients with rheumatic MV disease requiring intervention. Left ventricular systolic dysfunction was independently associated with increased mortality following both percutaneous and surgical intervention. Long-term outcomes were comparable between patients undergoing PMV and MVR, reinforcing PMV as an effective alternative to surgery in appropriately selected patients.

Objective: This study aims to analyse the burden of ischemic heart disease (IHD) in China and other G20 countries from 1990-2021 and predict the burden for the next decade.

Methods: Using data from the Global Burden of Disease (GBD) 2021 study, we evaluated the age-standardised rates (ASRs) of incidence, prevalence, mortality and disability-adjusted life years (DALYs) by estimated annual percentage change (EAPC). The Bayesian age-period-cohort (BAPC) model was used to forecast the incidence, mortality and DALY rates of IHD in China from 2021-2040.

Results: The ASRs of incidence, mortality and DALYs of IHD in China increased with EAPCs of 0.66 (95% CI: 0.50, 0.82), 0.97 (95% CI: 0.63, 1.31) and 0.51 (95% CI: 0.24, 0.78), respectively. Compared with other G20 countries, China was ranked 14th for the ASR of incidence in 1990 and then rose to 7th in 2021. The ASR of prevalence for IHD in China jumped from 8th in 1990 to 5th in 2021, and both the ASR of mortality and DALYs for IHD in China ranked 7th in 2021. The top five risk factors affecting mortality in China in 2021 were high systolic blood pressure, dietary risk, air pollution, high LDL cholesterol and tobacco. Over the next 20 years, the ASR of incidence, mortality and DALYs for IHD will increase continuously in males.

Conclusion: The burden of IHD is expected to increase steadily in China, highlighting the urgency for early monitoring and preventative strategies, particularly focusing on the elderly and male populations.

Background: Increasing exposure to climatic features is strongly linked to various adverse health outcomes and mortality. While the link between these features and cardiovascular outcomes is well established, most studies are from high-income countries.

Objectives: This review synthesizes evidence as well as research gaps on the relationship between climate indicators, household/ambient air pollution, and all-cause cardiovascular disease (CVD) morbidity and mortality in low- and middle-income countries (LMICs).

Methods: Seven electronic databases were searched up to June 15, 2024. Articles were included if they focused on LMICs, addressed all-cause CVD morbidity and/or mortality, and studied climate or environmental exposures. Studies were selected using ASReview LAB, extracted and analyzed with random effect meta-analysis performed if sufficient articles were identified.

Results & conclusion: Out of 7,306 articles, 58 met the inclusion criteria: 26 on morbidity, 29 on mortality, and 3 on both. Exposures included PM₁₀, PM_2.5, NO₂, SO₂, BC, O₃, CO, solid fuel usage, and temperature variation. Short-term exposure to PM_2.5 was significantly associated with CVD morbidity (RR per 10 µg/m³ increase:1.006, 95% CI 1.003-1.009) and mortality (RR:1.007, 95% CI 1.002-1.012). Short-term exposure to NO₂ and O₃ also increased CVD mortality risk. Long-term exposure to PM_2.5 elevated CVD morbidity (RR per 10 µg/m³ increase:1.131, 95% CI 1.057-1.210) and mortality (RR:1.092, 95% CI 1.030-1.159). High and low temperatures and long-term solid fuel use were linked to CVD deaths. The bulk of studies were from mainland China (72%), which may not accurately reflect the situation in other LMICs. Sub-Saharan Africa was particularly lacking, representing a major research gap.

Background: Rheumatic heart disease is a post-infectious sequelae of acute rheumatic fever resulting from an abnormal immune response to streptococcal pharyngitis that triggers valvular damage. It is the most commonly acquired heart disease in children, particularly in developing countries.

Objective: This study aimed to describe rheumatic valvulopathy among schoolchildren and adolescents in Yaoundé, Cameroon.

Methods: A cross-sectional echocardiography study was conducted from December 2022 to May 2023 among students aged 5 to 19 in primary and secondary schools in Yaoundé, Cameroon. All students with informed parental consent and who agreed to participate in the study were included. The data collected were entered and analysed using SPSS statistics software version 23.0. The association between the qualitative variables was verified using Odd-Ratio with a 95% confidence interval and a significance level of 5%.

Results: Of the 1020 children recruited, 133 (13.03%) had rheumatic heart disease with a mean age of 11.69 ± 4.09 years. The sex ratio (M/F) was 0.56. Most of the participants lived in urban slums (60.9%). Cardiac murmurs were detected in 23 (17.3%) participants during auscultation, with the majority (78.3%) being located at the mitral focus. The definitive form of rheumatic heart disease was observed in 69 (51.9%) children. Mitral involvement was observed in all participants. Mitral valve abnormalities were primarily characterized by mitral insufficiency in 124 (93.2%) participants, valvular thickening (74.4%), and restriction of movement (42.9%). Age between 10 and 14 years [OR = 2.36; CI = (1.11-5.01)] and residence in urban slums [OR = 2.14; CI = (1.05-4.36)] were significantly associated with an increase in the occurrence of definitive rheumatic valve disease.

Conclusion: Rheumatic heart disease is common among schoolchildren in this setting. It systematically affects the mitral valve. The clinical presentation is usually silent at first.

Background: The incidence of non-rheumatic valvular heart diseases (NRVHD) has shown an increasing trend. However, most studies have overlooked the impact of gender on the disease. Female patients, as a specific subgroup, have rarely been discussed independently. It is essential to conduct separate epidemiological studies to understand the latest epidemiological data for female NRVHD patients and to raise awareness among researchers and clinicians.

Methods: Data from the Global Burden of Disease (GBD) 2021 database were retrieved to obtain epidemiological data on female NRVHD from both global and regional perspectives, covering 204 countries and territories. Joinpoint regression, age-period-cohort analysis, decomposition, and predictive analyses were employed to further examine the epidemiological data.

Results: The incidence of female NRVHD patients has shown a continuous upward trend and is expected to persist in the future, particularly in regions with high and high-middle Socio-Demographic Index (SDI). However, in low and lower-middle SDI regions, patients experience relatively higher Disability-Adjusted Life Years (DALYs) and Years Lived with Disability (YLDs), with a greater number of heart failure cases attributed to NRVHD. Decomposition analysis indicates that the increase in the incidence of NRVHD and its subtypes is primarily driven by population growth and aging.

Conclusions: With economic development and population aging, female NRVHD remains a significant healthcare burden for countries worldwide. Low- and middle-SDI regions should implement tertiary prevention strategies to address the impending shift in the spectrum of valvular heart diseases. Further clinical research should focus on female patients as a distinct subgroup of NRVHD, exploring the unique aspects of the disease in this population.

Heart failure with preserved ejection fraction (HFpEF) is an ongoing challenge for healthcare systems. Major limitations that hinder adequate control of the disease, including an incomplete understanding of its pathophysiology, limited therapy options, and the absence of sufficient information on the management of comorbidities. Diagnosis and management of HFpEF in Egypt lack standardization as they are complicated with multiple comorbidities and limited by the lack of resources and data on epidemiology and patient characteristics. Diagnostic procedures for HFpEF should be implemented through guideline-specified scoring systems, due to the heterogeneity of clinical presentations and the absence of a golden standard for confirming HFpEF. In Egypt, the H₂FPEF scoring system is more commonly used for establishing HFpEF diagnosis. All HFpEF patients should be treated through multidrug regimens tailored for their state, symptoms, and comorbidities, with sodium-glucose cotransporter-2 (SGLT2) inhibitors as the mainstay of treatment together with either one or a combination of loop diuretic and aldosterone antagonists. This paper provides an integrated review of epidemiology, means of diagnosis, current and novel pharmacological therapy options for HFpEF patients in the light of the recent advances in treatment of HFpEF, discussing means of healthcare delivery and unmet needs, and proposing recommendations for clinical practice and pathways for future research.

Background: The World Health Organization recommends fixed-dose combination (FDC) pills for treating hypertension. Antihypertensive FDC pills often contain a renin-angiotensin inhibitor (RASI) or diuretic. Thus, screening and monitoring for dyskalemia (hypokalemia or hyperkalemia) before and after starting these classes of medications are recommended, a significant barrier for implementation in resource-limited settings. However, the need for blood tests may be overemphasized if the prevalence of dyskalemia in patients with hypertension is uncommon and the incidence of dyskalemia is rare after initiation of FDC.

Methods: We conducted a community-based blood pressure (BP) screening program in Dhaka, Bangladesh, and determined the prevalence of dyskalemia, as defined by K < 3.0 or K > 5.5 mmol/L, in untreated adults with SBP ≥140 mmHg and/or DBP ≥90 mmHg. Among those with a baseline serum K of ≥3.0 or ≤5.0 mmol/L and creatinine clearance ≥30 ml/min, we determined the incidence of dyskalemia 2 months after initiation of a daily FDC of telmisartan 40 mg and amlodipine 5 mg. Secondary outcomes were BP change, medication adherence, and symptoms.

Results: In 2022-2023, we recruited 1,073 adults with SBP ≥140 mmHg and/or DBP ≥90 mmHg. The mean age was 54 years, with 71% men and mean baseline BP 157/94 (SD 12/9.3) mmHg. The prevalence of hypokalemia and hyperkalemia was 1.6% and 0.2%, respectively. FDC was initiated in 1,017 eligible patients, and 864 completed the 2-month follow-up visit. Incident hypokalemia occurred in 1.5% of patients, but there was no case of incident hyperkalemia. The mean change in serum potassium after initiating FDC was -0.05 (0.53) mmol/L. At follow-up, 92% had BP <140/90 mmHg with a mean SBP change of -29.8 mmHg. 1% self-reported mild symptoms (e.g., leg swelling), and there was one death of undetermined cause.

Conclusions: Given low prevalence and incidence of hyperkalemia and evident reduction in BP, our study suggests initiating FDC with telmisartan and amlodipine may be a practical and safe option for newly diagnosed hypertension, especially in resource-constrained settings where blood tests cannot be easily obtained.

Background: The changing epidemiological landscape, marked by the increasing prominence of Non-Communicable Chronic Diseases (NCDs), underscores the need for studies that identify and analyze these conditions and their associated risk factors. This secondary analysis aims to describe the association between socioeconomic and educational characteristics and the prevalence of self-reported NCDs among participants in the PURE-Ecuador cohort in urban and rural populations of the Metropolitan District of Quito (MDQ), Ecuador.

Methods: This secondary analysis is part of the Prospective Urban Rural Epidemiological (PURE) study. Data were collected from February to December 2018, including 2028 participants aged 35 to 70 years from different urban and rural areas of the MDQ. Data collection utilized standardized questionnaires administered in face-to-face interviews. Pearson's chi-square tests and multivariate logistic regression were used to assess associations.

Results: The self-reported prevalence of hypertension was 16.2%, rising to 32.7% in individuals over 60 years old. The prevalence of diabetes mellitus was 6.7%, coronary heart disease 1.3%, stroke 1.6%, heart failure 1.3%, COPD 0.4%, asthma 1.3%, and cancer 1.9%. Multimorbidity affected 5.9% of participants, with the highest rates in obese and older individuals (≥60 years). Adherence to medications was high for hypertension and diabetes mellitus but varied substantially between communities.

Conclusions: The secondary analysis revealed significant disparities in the prevalence and management of NCDs in MDQ. The prevalence of self-reported NCDs in Quito, Ecuador, is significantly associated with age and body mass index (BMI). Older individuals, particularly those over 60 years, and obese participants demonstrated higher rates of NCDs and multimorbidity. While socioeconomic factors such as education and income showed some associations with NCD prevalence, these were less pronounced after adjusting for other variables. These findings highlight the importance of age-specific and obesity-focused interventions in addressing the burden of NCDs in this population.