Global Heart最新文献

Heart rate (HR) has been proved to be associated with major adverse cardiovascular events (MACE) in Acute coronary syndrome patients. However, the threshold value and clinical significance of time in target of resting heart rate (TTR-HR) remain insufficiently elucidated. Our study aimed to evaluate the independent association between TTR-HR and cardiovascular outcomes in the follow-up study of ACS. A total of 1455 ACS patients who underwent percutaneous coronary intervention (PCI) and were admitted to 22 hospitals between 2019 and 2022 were enrolled and followed up for 12 months. MACE was defined as a composite of cardiac death, nonfatal recurrent myocardial infarction, ischemic-driven revascularization, and ischemic stroke. The association between TTR-HR and cardiovascular outcomes was assessed using Cox regression model. Compared to patients with TTR-HR 0-50% and >50%-75%, patients with TTR-HR > 75%-100% were older and less alcohol user, less likely to use diuretics and anti-diabetic drugs, these patients had less comorbidities of hyperlipidemia, diabetes, heart failure, and cardiac shock. After 12 months follow up, the incidence of MACE and composite endpoint but not mortality was higher in patients with TTR-HR 0-50% and >50%-75% than those with TTR-HR > 75%-100%. After multivariate adjustment, TTR-HR [hazard ratio = 2.11, 95% CI: 1.19-3.74, p = 0.01] was independently associated with composite endpoint. In summary, our study demonstrates that TTR-HR holds significant prognostic value, with TTR-HR > 75%-100% being independently associated with reduced composite endpoint risk in ACS patients following PCI. These findings emphasize the importance of effective heart rate control in ACS patients following PCI.

Objectives: Significant associations between pregnancy loss and risk of future maternal cardiovascular disease (CVD) have been found in Western countries, but the association in China is still unclear. Therefore, this study aimed to investigate the associations of pregnancy loss, number of pregnancy losses, subtype of pregnancy loss (i.e. induced abortion, miscarriage and stillbirth) and age at the first pregnancy loss with CVD risk in Chinese population.

Methods: We examined data of 7,486 middle-aged women (mean age 58.1 years) from the China Health and Retirement Longitudinal Study. Pregnancy loss and CVD including coronary heart disease (CHD) and stroke were self-reported and documented in surveys.

Results: In the cohort, 1,850 (24.7%) women experienced pregnancy loss. Over 39 years follow-up, 2,055 (27.5%) women developed CVD. After adjusting covariates, pregnancy loss was associated with the risk of CVD (HR 1.73, 95% CI 1.56 to 1.92). Specifically, pregnancy loss due to induced abortion and miscarriage instead of stillbirth increased CVD (HR 2.11, 95% CI 1.82 to 2.44, and 1.47, 95% CI 1.16 to 1.72, respectively). The risk of CVD gradually increased from ≤23 years to 23-25, 26-29 and ≥30 years with HR 1.29, 95% CI 1.24 to 1.34.

Conclusion: Chinese women that have experienced pregnancy loss due to induced abortion and miscarriage had increased risk of CVD. The risk increased with the number of pregnancy losses and older age at the first pregnancy loss.

Background: The global trend of population aging has resulted in more frequent cardiovascular disease among seniors. Primary percutaneous coronary intervention (pPCI) is the standard of care for ST-elevation myocardial infarction (STEMI) without an upper age limit. Nevertheless, the outcomes are variable among studies, and data on pPCI outcomes in the elderly in Africa is scarce. Thus, we attempted to gain better insight into the outcomes of primary PCI in this age group from a single center in upper Egypt.

Objective: To study the patient characteristics and in-hospital outcomes of pPCI in elderly patients presenting with STEMI in a tertiary cardiac center in upper Egypt.

Methods and results: This observational cohort study was based on data from the pPCI registry in a tertiary cardiac center in upper Egypt, which included 3,627 consecutive patients who underwent pPCI between January 2014 and June 2023. The elderly were defined as those aged 70 years or older and represented 15.9% (575 patients) of the entire cohort, of whom 103 (2.8%) were octogenarians. Clinical characteristics, procedural details, and in-hospital outcomes were compared between the age groups. The elderly had a significant trend of being female and hypertensive, and having chronic kidney disease (CKD), worse Killip class, more frequent severe non-culprit vessel lesions, and left main trunk involvement. The in-hospital mortality was significantly higher than that of younger patients (14.1 vs. 4%, p = <0.001), with higher mortality in octogenarians (23.3%). Killip class ≥II was independently associated with increased hospital mortality in all study age groups. Contrast-induced nephropathy and TIMI major bleeding were also significantly higher.

Conclusion: Compared to younger patients, elderly patients undergoing pPCI had a higher prevalence of hypertension and CKD and were more likely to have a worse Killip class. The radial approach was utilized less often in the elderly group. In-hospital complications and mortality, particularly among the octogenarians, were significantly higher than in younger patients.

Background: The albumin-bilirubin (ALBI) score has demonstrated prognostic value in a range for liver and heart diseases. However, its association with all-cause mortality in intensive care unit (ICU) patients with heart failure remains uncertain.

Objective: This study sought to investigate the relationship between the ALBI score and the risk of all-cause mortality in ICU patients with heart failure.

Methods and results: The ICU patients diagnosed with heart failure were selected from the Medical Information Mart for Intensive Care IV database (MIMIC-IV, version 2.2) and stratified into tertiles according to their ALBI scores. The primary outcome of interest was the occurrence of all-cause mortality within 365 days post-discharge. The analysis encompassed a cohort of 4,239 patients, with Kaplan-Meier curves indicating that individuals with higher ALBI levels exhibited an elevated risk of all-cause mortality (log-rank p < 0.001). Multivariate adjusted Cox regression and subgroup analysis demonstrated that individuals in T2 (hazard ratio (HR) 1.09, 95% CI 0.99-1.21) and T3 (HR 1.17, 95% CI 1.02-1.34) had an increased risk of mortality compared to individuals in T1 (p for trend < 0.001), and each incremental tertile in ALBI was linked to a 10% rise in mortality risk, while each individual unit increase in ALBI was associated with a 36% increase in mortality risk. This relationship was consistently observed across most subgroups, except for using or not using inotropes or vasopressors, different ages, different creatinine levels. The restricted cubic spline (RCS) analysis indicated a linear relationship between ALBI levels and the risk of all-cause mortality.

Conclusion: The ALBI scores are independently associated with the risk of all-cause mortality in ICU patients with heart failure, particularly in those not using inotropes or vasopressors, younger patients, and with lower levels of creatinine. ALBI may help identify high-risk patients and optimize risk stratification in this population.

Background: In Acute Coronary Syndrome without ST-segment elevation, the use of high-sensitivity troponins in rapid protocols is considered the gold standard for diagnostic exclusion/confirmation, in conjunction with clinical stratification. The biggest concern regarding the techniques for troponin evaluation is the time required between collection and delivery of the result.

Objective: The objective of the present study is the clinical/laboratory validation of a POCT device for TnI.

Methods: In the first phase of the study, samples from 108 patients with known troponin values High Sensitivity Automated Troponin T (TnT) assay from Roche Diagnostics were analyzed for analytical comparability between hs-cTnI of the Analyzer Atellica® vTLi and hs-cTnT Cobas®. The second phase of the study was performed with samples from 51 patients who reported to the emergency department with chest pain for a clinical prospective evaluation and correlation between the hs-cTnI assays of the Analyzer Atellica® vTLi, hs-cTnT Cobas® and Atellica IM 1300.

Results: There was a correlation between the POCT Atellica® vTLi and hs-cTnT Cobas® in the serum samples of the control group (r = 0.660, p < 0.0001). Besides, there was a correlation between the Atellica® vTLi, serum hs-cTnT Cobas®, plasma hs-cTnT Cobas®, serum Atellica IM and plasma Atellica IM 1300 platforms in the second phase (p < 0.0001 in all cases).

Conclusion: In the present study, the Siemens POCT Atellica® vTLi device showed excellent performance in laboratory validation and correlation with the high-sensitivity TnT assay in different troponin concentration ranges. Given these results, the device can be used in institutions that intend to use a POCT device for 0- and 1-hour chest pain protocols.

Background: Sudden cardiac death (SCD) is a major concern in patients with hypertrophic cardiomyopathy (HCM). The American College of Cardiology/American Heart Association (ACC/AHA) and the European Society of Cardiology (ESC) have different guidelines for SCD risk stratification. Their comparative performance in diverse populations remains uncertain.

Objective: Evaluate the performance of the 2020 ACC/AHA and 2014 ESC guidelines for SCD stratification in a Brazilian cohort with HCM.

Methods: This retrospective cohort study included patients diagnosed with HCM who were followed in a dedicated clinic at a tertiary hospital in Brazil. The primary outcome was SCD, aborted cardiac arrest due to ventricular fibrillation (VF), sustained ventricular tachycardia (SVT), an episode of VF or SVT, or appropriate ICD therapy. Risk prediction models were assessed using the C-index.

Results: A total of 187 patients were included, with a mean follow-up of 8.3 years. The 2020 ACC/AHA guidelines classified 106 (56%) patients as high-risk for SCD, while the 2014 ESC guidelines identified 54 (29%). The primary outcome occurred in 12% of the high-risk group identified by the ACC/AHA guidelines and 13% of the high-risk group identified by the ESC guidelines. Both guidelines showed low discriminatory power for SCD risk in this Brazilian cohort, with AUC values of 0.634 and 0.581 for the ACC/AHA and ESC guidelines, respectively.

Conclusions: The 2020 ACC/AHA and 2014 ESC guidelines have limitations in predicting SCD events and defining ICD indications in Brazilian HCM patients. Further studies are needed to refine risk stratification and optimize SCD prevention in this population.

In low- and middle-income countries where the majority of preventable cardiovascular disease deaths occur, less than 10% of eligible patients receive statins for primary cardiovascular disease prevention. Since 2017, the Global Hearts initiative has implemented simple World Health Organization (WHO) HEARTS hypertension and diabetes treatment protocols. In this editorial, we propose an approach of integrating statin treatment into existing HEARTS hypertension and diabetes protocols as a way of expanding statin coverage in low-and middle-income countries.