Global Heart最新文献

Background: Heart failure (HF) is a diverse and potentially fatal condition affecting more than 60 million people worldwide. Previous studies have identified a close relationship between leptin levels and HF, and that leptin levels in patients with HF are higher than those in healthy individuals. However, some studies have reported inconsistent results. Therefore, the association between leptin levels and HF remains controversial.

Methods: A literature search was conducted on the Web of Science, Wiley Online Library, Embase, and PubMed databases. The title or abstract search term 'leptin' was used in combination with 'heart failure' and 'HF'. Meta-analysis results were reported as standardized mean differences (SMD) with corresponding 95% confidence intervals (CI).

Results: Eighteen studies comprising 1149 patients with HF and 622 healthy controls were included in the meta-analysis. Leptin levels in patients with HF were significantly higher than those in healthy individuals (SMD, 0.54; 95% CI [0.15, 0.93]).

Conclusions: To our knowledge, this systematic review is the first to evaluate the relationship between leptin and HF. Determining the role of leptin in HF will significantly contribute to its diagnosis and treatment.

Introduction: In 2021, cardiovascular diseases (CVD) caused around 20.5 million deaths worldwide, making them a major health concern.

Methods: Incidence, prevalence, death, years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life years (DALYs) were the burden measures that were assessed. All measures are reported as both all-age numbers and age-standardized rates (ASR) with 95% uncertainty intervals (UI). Decomposition analysis was conducted on CVD incidence.

Results: From 1990 to 2021, all-age CVD prevalence in Iran increased by 182.6% (2.9 to 8.3 million cases), with males consistently showing higher age-standardized prevalence rates (ASPR) than females (11,350 vs. 9,431 per 100,000 in 2021). ASPR remained stable nationally (9,956 to 10,386 per 100,000), peaking in adults ≥80 years. Incident cases rose by 159.6% (0.36 to 0.92 million), driven by population growth (49.5%) and aging (136.2%), while age-standardized incidence rates (ASIR) declined by 28.3% (1,337 to 1,197 per 100,000); with males (1,336) exhibiting higher rates than females (1,060) in 2021. All age deaths doubled (86,527 to 169,582) during this period, but age-standardized death rates (ASDR) decreased substantially by 42.97% (446 to 255 per 100,000). DALYs increased by 53.7% (2.4 to 3.7 million), though age-standardized DALY rates dropped 45.3% (9,096 to 4,977 per 100,000), dominated by ischemic heart disease (2,731 ASR) and stroke (1,229 ASR). High systolic blood pressure, dietary risks, and LDL cholesterol remained the leading contributors to DALYs nationwide.

Conclusion: Iran's rising CVD burden demands prioritizing cardiac care infrastructure in underserved provinces like Golestan, enforcing sodium reduction policies aligned with Iran's existing trans-fat regulations, and integrating sex-specific programs such as tobacco control for males and community hypertension screening for women are critical. Multisectoral collaboration, including urban design promoting physical activity and subsidies for whole grains, must address provincial inequities exacerbated by Iran's aging population and dietary risks.

Background: Heart failure (HF) is a major contributor to cardiovascular morbidity and mortality. Adversely impacting health outcomes in Kenya and other developing countries, data on the direct medical cost of HF hospitalization remain limited.

Methods: This was a prospective study conducted at Moi Teaching and Referral Hospital. Patients with HF were identified by sequential medical chart abstraction. Primary causes were extracted from echocardiogram reports and adjudicated by a cardiologist. Direct medical cost of hospitalization was derived using activity-based and micro-costing methods, adopting payers' system perspective. Drivers of overall cost were explored using linear regression models.

Results: 142 participants were consecutively recruited from September to November 2022. 51.4% were females, and the mean age was 54 (SD 20). The leading primary causes were cor pulmonale (CP), 28.9%; dilated cardiomyopathy (DCM), 26.1%; rheumatic heart disease (RHD), 19.7%; hypertensive heart disease (HHD), 16.9%; ischaemic heart disease (IHD), 6.3%; and pericardial disease (PD), 2.1%. Overall direct cost of HF hospitalization was KES 11,470.94 (SD 8,289.57) [USD 93.49 (67.56)] per patient per day, with the mean length of hospital stay of 10.1 (SD 7.1). RHD incurred the highest costs, KES 15,299.08 (SD 13,196.89) [USD 124.70 (107.56)] per patient per day; IHD, KES 12,966.47 (SD 6656.49) [USD 105.68 (54.25)]; and DCM, KES 12,268.08 (SD 7,816.12) [USD 99.99 (63.71)]. The cost of medications was the leading driver, β = 0.56 (0.55 - 0.56), followed by inpatient fees, β = 0.27 (0.27 - 0.28), and laboratory investigations, β = 0.19 (0.18 - 0.19).

Conclusion: Cor pulmonale, CM, RHD, and HHD were the major causes of HF. The overall direct medical cost of hospitalization was extremely expensive compared with the Kenyan average monthly household income per capita. Widespread comprehensive health insurance coverage is therefore recommended to cushion families against such catastrophic health expenditures besides public health measures aimed at addressing primary causes of HF.

Background: Limited data are available on bicytopenia (BC) in patients with heart failure (HF).

Objectives: This study evaluated the association between BC and prognosis in patients with HF.

Methods: This retrospective cohort study enrolled consecutive hospitalised patients with HF. We compared all-cause and cardiovascular mortality between those with and without BC. BC was defined as the combination of any two conditions among leukopaenia, thrombocytopaenia, and anaemia. Propensity score matching and a Cox proportional hazards model were applied.

Results: Among 935 hospitalised patients, 103 patients had BC. Patients in the BC group were older (80.0 ± 12.0 vs. 73.4 ± 14.7 years; P < 0.0001), including a higher proportion of females (55.3% vs. 41.7%; P = 0.009), had a higher prevalence of atrial fibrillation (51.5% vs 41.1%; P = 0.047), had a lower baseline estimated glomerular filtration rate (50.8 ± 24.1 vs. 56.2 ± 23.9 mL/min/1.73 m²; P = 0.03), and had a higher left ventricular ejection fraction (48.1 ± 16.1 vs. 42.4 ± 15.8%; P = 0.0008). Propensity score matching with a 1:1 ratio produced 63 matched pairs. All-cause mortality was significantly higher in the BC group than in the non-BC group (log-rank P = 0.069 and Wilcoxon P = 0.048); however, cardiovascular mortality and hospitalisation for HF showed no significant differences. In the multivariate Cox proportional hazard model, BC was associated with higher all-cause mortality but not with cardiovascular mortality (hazard ratio, 1.983; 95% confidence interval, 1.008-3.898; P = 0.047).

Conclusion: BC was associated with all-cause mortality but not with cardiovascular mortality in patients with HF. BC is an important risk factor for all-cause mortality in patients with HF.

Objective: Cardiovascular disease (CVD) is the leading cause of death among patients with non-alcoholic fatty liver disease (NAFLD). This study investigates the association between high-sensitivity cardiac troponin (hs-cTn) levels and mortality in adults at risk of NAFLD in a representative U.S. population sample.

Methods: Among participants aged 18 years and older in the 1999-2004 National Health and Nutrition Examination Survey, we measured high-sensitivity troponin T using a single assay (Roche) and high-sensitivity troponin I using three assays (Abbott, Siemens, and Ortho). Myocardial injury was identified by elevated levels of hs-cTn. Mortality outcomes were determined through linkage with the National Death Index database, with follow-up until December 31, 2019. A multivariable Cox proportional hazards model was used to evaluate the associations between myocardial injury and mortality in the NAFLD population. Sensitivity analyses were conducted to assess the robustness of the main findings.

Results: A total of 2581 at risk of NAFLD were included in this observational study, with myocardial injury identified in 7.01%. Over a median follow-up of 16.7 years, 937 all-cause deaths occurred, including 319 cardiovascular disease-related deaths. NAFLD individuals with myocardial injury had worse survival rates at 5, 10, and 15 years compared to those without myocardial injury. After adjusting for baseline characteristics, myocardial injury was associated with an increased risk of all-cause mortality (adjusted Hazard Ratio [aHR] 1.785, 95% CI 1.494-2.134, P < 0.001) and cardiovascular mortality (aHR 2.155, 95% CI 1.606-2.893, P < 0.001).

Conclusion: This large, nationally representative study demonstrates that myocardial injury, defined by elevated hs-cTn levels, is independently associated with increased all-cause and cardiovascular mortality risks in the adult population at risk of NAFLD in the United States. This association persisted after adjusting for various factors and in patients without pre-existing cardiovascular disease. The Siemens hs-cTn I assay demonstrated the strongest association with all-cause mortality. These findings highlight the potential of hs-cTn as a valuable prognostic marker in NAFLD patients, even in those without clinically apparent cardiovascular disease. Routine hs-cTn assessment may aid in risk stratification and guide targeted interventions to reduce mortality risk in this population.

Background: Hypertension is a leading global cause of morbidity and mortality and is increasing in low- and middle-income countries, where unawareness of hypertension is a primary obstacle to management. Community health workers (CHWs) in combination with mobile health (mHealth) tools are increasingly used in LMIC health systems to strengthen primary care infrastructure. In this study, we applied this care model to hypertension in rural Guatemala by comparing the accuracy of CHWs equipped with an mHealth clinical decision support application in diagnosing hypertension to concurrent physician evaluation.

Methods: We performed a prospective diagnostic accuracy study in which adults from rural Guatemalan communities were assessed independently by a CHW aided by a mHealth application and a physician. Assessment included medical history; measurement of blood pressure, height and weight; and determination of hypertension status. CHW-physician agreement on hypertension status and past medical history elements was assessed by Kappa analysis and proportional agreement, with a priori thresholds of Kappa = 0.61 and agreement of 90%. Agreement on patient measurements was evaluated using Bland-Altman and regression analyses.

Results: Of 359 participants enrolled, 47 (13%) were confirmed to have hypertension and another 11 (3%) had possible hypertension. CHW-physician agreement was high for hypertension diagnosis, with Kappa = 0.8 (95% CI = 0.72, 0.88) and overall agreement 92.8% (95% CI = 90.1%, 95.4%). Bland-Altman analysis showed small biases toward lower systolic blood pressure, higher height, and lower BMI measurements by CHWs. Most patient history characteristics showed moderate to almost perfect (Kappa: 0.41-1) agreement between physicians and CHWs.

Conclusions: In this study based in rural Guatemala, CHWs using a mHealth clinical decision support application were found to screen adult patients for hypertension with similar accuracy to a physician. This approach could be adapted to other low-resource settings to reduce the burden of undiagnosed and untreated hypertension.

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.