Global Heart最新文献

Background: Emerging evidence suggests that spirituality improves patient outcomes, however, this has undergone only limited evaluation in randomized trials. Hypertension is a major cause of cardiovascular morbidity and mortality worldwide.

Objectives: To evaluate whether a spirituality-based intervention, compared to a control group, can reduce blood pressure (BP) and improve endothelial function after 12 weeks in patients with mild or moderate hypertension (HTN).

Methods: Open randomized controlled trial of adults with stage I or II hypertension. Following baseline evaluation, including lifestyle questionnaires, and measurements of office and central blood pressure (BP), home blood pressure monitoring (HBPM) and flow mediated dilation (FMD), patients were randomized to a spirituality-based intervention, which included training for forgiveness, gratitude, optimism, and life purpose delivered by daily WhatsApp communications, or to the control group (CG). Main outcomes were between group difference in change from baseline to 12 weeks in office and central BP, HBPM and FMD, using t-tests, analyses of covariance (ANCOVA) adjusting for baseline differences, and, in addition, missing data imputation as a sensitivity analysis.

Results: Fifty-one patients were randomized to spirituality-based intervention and 49 to control group. Baseline characteristics were well balanced between groups. Spirituality training, compared with control, improved 7.6 mmHg office systolic blood pressure (SBP), 4.1 mmHg central SBP and 4.1 percentage points FMD. Compared to control group, t-test demonstrated statistical significance for office SBP (-7.04 mmHg, p = 0.047) and FMD (7.46 percentage points, p < 0.001), and ANCOVA adjustment for baseline differences showed statistical significance for central SBP (-6.99 mmHg, p = 0.038) and FFMD (7.95 percentage points, p < 0.001) There was no significant effect on HBPM.

Conclusion: A spirituality-based intervention was associated with improved control of office SBP and FMD. These findings will be prospectively evaluated in a nationwide larger and well-powered RCT.

Transposition of great arteries (TGA) is a critical congenital heart disease leading to a fatal outcome if timely management is not provided. Management in low-income countries is challenging. A retrospective analysis was carried out at Sudan Heart Center for infants with TGA who underwent balloon atrial septostomy (BAS) from January 2010 to December 2020. Immediate clinical- and procedure-related outcomes were evaluated. Intermediate-term outcomes were studied using follow-up hospital records as well as direct telephone calls. The study included 75 infants (70% males) with a median age at presentation of 25 and at the time of BAS of 28 days. Pre-BAS median oxygen saturation was 48 (Interquartile Range (IQR) 40-60%). BAS was performed under fluoroscopy and echocardiography guidance with immediate success achieved in 98% of patients. Post-BAS oxygen saturation increased to 87 (IQR 85-90%) with a median improvement of 40% (p = 0.048), which was more significant in those less than 2 weeks of age. Minor complications occurred in 14 patients, and two patients (2.6%) died. Surgery (atrial in 44% and arterial switch operations in 41%) was performed in 39 patients (52%) at a mean age of three months with perioperative mortality of 30%. Infants who underwent surgery had a significantly higher survival rate (69%) compared to those who did not (5.6%) (p < 0.001). Patients with TGA present at a late age with good immediate outcomes of BAS. Access to surgery is limited with a high surgical mortality. Those who survived surgery had good intermediate-term outcomes while most unoperated patients died.

Background: Low-middle income countries harbor the highest burden of cardiovascular diseases globally, but there is an under-representation of these countries in cardiovascular clinical trials. This limits the generalizability of the trial results to these countries. There is a lack of data on insights of cardiologists in these countries regarding conducting and participating in clinical trials. We sought the views of cardiovascular healthcare professionals in Iraq on participation in clinical trials.

Method: Cardiovascular professionals in Iraq were identified and contacted, via special platforms on social media specified for them, to answer a 30-item online survey.

Results: We surveyed n = 255specialists (20% were women); interventional cardiologists constituted 44.7%, followed by cardiology trainees at 31%. Almost 30% reported having been involved in clinical trials, with data collection being the more frequently reported role (21.2%). Prior participation was not significantly associated with respondent gender, academic affiliation, or presence of institutional ethical committee. Of the total, 95.7% thought that clinical trials should be conducted in Iraq, with 58.8% reporting that they would participate if invited. The most common barriers to respondents' participation in trials were lack of electronic health records (52.2% of those surveyed) and time (51.4%), followed by the requirement of additional follow-up visits or investigations (34.1%). The most common motivators were establishing electronic health records (86.27%), education and training of the general population about clinical trials (84.7%), and dedicated training for healthcare providers about clinical trial basics (84.3%).

Conclusion: Our work helps pave the path to implementing a robust clinical trial ecosystem in Iraq. Institutional and financial factors and a lack of dedicated research time are related to the cardiovascular clinical trial lag in Iraq. Future qualitative research can help in getting a deeper understanding of what is needed to create the right infrastructure.

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.