Acta Cardiologica Sinica最新文献

Background: Myocardial ischemia can cause repolarization heterogeneity, manifesting as variations in QT interval; we hypothesized that repolarization heterogeneity could help identify patients with coronary artery disease (CAD). We tested this hypothesis by measuring repolarization heterogeneity with a newly developed multielectrode electrocardiogram (MECG) system, which uses 28 electrodes to increase the spatial resolution of body surface electrical activity.

Methods and results: Male patients admitted for coronary angiography were enrolled. Eighty-five patients were included in the training dataset, and 42 in the validation dataset. QTc heterogeneity indices including QTc dispersion (QTD) and smoothness index of QTc (SI-QTc) were derived from MECG signals. Sixty and 32 patients in the training and validation datasets, respectively, were found to have significant coronary stenosis. The SI-QTc (12.79 ± 4.29 vs. 9.22 ± 2.40 ms, p = 0.0004) and QTD (92.12 ± 34.31 vs. 67.2 ± 19.11 ms, p = 0.0004) of the patients in the training dataset were significantly higher in the CAD patients. The areas under the curve of SI-QTc and QTD in the training dataset were 0.7437 and 0.7433, respectively, for detecting CAD. With cutoff values of SI-QTc ≥ 9.95 ms and QTc dispersion ≥ 69 ms, the sensitivity and specificity for diagnosing CAD were 71.9% and 80.0%, respectively, in the validation dataset.

Conclusions: Resting MECG is a promising noninvasive tool for CAD diagnosis, with sensitivity and specificity comparable to those of the exercise electrocardiography test.

Background: The efficacy, safety, and clinical outcomes in patients switching to generic rosuvastatin compared to those taking other brand-name atorvastatin are unclear.

Methods: Electronic medical records were retrospectively collected from January 1, 2013 to December 31, 2020 of patients who switched medication because of hospital policy from brand-name to generic rosuvastatin after March 14, 2018. Only patients who had taken the medication for at least 1 year prior to and 1 year after that date were enrolled. The records of patients who consistently used brand-name atorvastatin during the same period were also collected. The efficacy of lipid control, potential adverse effects, clinical outcomes of major cardiovascular events (MACE), and medical expenses were compared between the 2 groups. Propensity score matching (PSM) was conducted to balance potential cofounders.

Results: After 1:1 PSM, 592 patients were enrolled in the rosuvastatin and atorvastatin groups, respectively. No significant differences were observed in total cholesterol level (-4.38 ± 23.0 vs. -3.72 ± 26.95 mg/dL, p = 0.702), low-density lipoprotein (-2.38 ± 19.89 vs. -2.42 ± 23.63 mg/dL, p = 0.976), or glycated hemoglobin (-0.05% ± 0.7% vs. -0.08% ± 0.76%, p = 0.543). No significant difference was noted in cumulative MACE rate (2.70% vs. 3.89%, log-rank p = 0.265) after the switch date, and each person in the generic group had a 16% average reduction in medical expenses.

Conclusions: Switching to generic rosuvastatin led to comparable lipid-lowering efficacy, safety, and clinical outcomes and lower medical expenses compared with consistently using brand-name atorvastatin.

Background: The aim of this study was to investigate the consistency of diastolic hyperemia-free ratio (DFR) and instantaneous wave-free ratio (iFR) before and after lesions in the distal coronary artery.

Methods: The PRIME-DFRiFR Study was a single-center, prospective, observational study that evaluated DFR and iFR at points distal and proximal to lesions in distal coronary vessels after angiography and successful percutaneous coronary intervention (PCI). Target lesions with diameter stenosis of 50% to 70% were selected, and DFR and iFR were evaluated from the vessel distal point, the lesion distal point, the lesion proximal point, and the vessel proximal point, respectively.

Results: Thirty patients (23 males [76.7%]; age 70.6 ± 10.2 years) were enrolled between August 2022 and December 2023, with a total of 37 single intermediate coronary lesions, clinical manifestations of unstable angina, acute coronary syndrome, dilated cardiomyopathy, or syncope. The DFR and iFR values at the vessel distal point, lesion distal point, lesion proximal point, and vessel proximal point were 0.95 ± 0.06 and 0.94 ± 0.05, 0.96 ± 0.05 and 0.95 ± 0.05, 0.99 ± 0.03 and 0.99 ± 0.03, and 1.00 ± 0.01 and 1.00 ± 0.02, respectively. The Pearson correlation coefficients of the four point values were 0.894, 0.834, 0.667 and 0.632, respectively (p < 0.001).

Conclusions: The significant positive correlations indicate that DFR can show relevant pressure changes before and after lesions in a comparable manner to iFR. In this study, the biggest influencing factor for discordance between DFR and iFR was old myocardial infarction. Post-PCI results indicated that DFR wires appeared to maintain relatively good maneuverability with comparable accuracy to iFR wires.

Background: Obesity is a major risk factor for atrial fibrillation (AF). Individuals with obesity can be further classified into metabolically unhealthy obesity (MUO) or healthy obesity (MHO) groups based on the metabolic health subtype. The influence of these phenotypes and overweight status on AF ablation outcomes remains unclear.

Objective: This study aimed to examine the recurrence of paroxysmal AF (PAF) after ablation in patients across distinct obesity phenotypes.

Methods: From January 2019 to November 2023, 599 patients with drug-refractory PAF undergoing a first ablation were retrospectively analyzed. Based on the World Health Organization-defined body mass index thresholds for Asians regarding overweight (23-25 kg/m²) and obesity (> 25 kg/m²), the participants were categorized into normal-weight, metabolically healthy overweight (MHOW), metabolically unhealthy overweight (MUOW), MHO, or MUO groups. Metabolic health required the absence of hypertension, diabetes, and dyslipidemia. Pulmonary vein isolation was achieved using either a force-sensing catheter or cryoablation.

Results: The mean age of the patients was 60.7 ± 11.7 years, and 64.1% were men. Compared with the normal-weight patients, AF recurrence was higher in the MUOW (19.8%), MHO (18.0%), and MUO (14.9%) groups after an average follow-up of 534 days, with respective hazard ratios (HRs) of 3.240 (p = 0.003), 2.973 (p = 0.013), and 2.182 (p = 0.033) after adjusting for chronic kidney disease. MHOW (14.9%; HR 2.593, p = 0.053) showed a non-significant trend toward a higher risk. Complete pulmonary vein isolation was achieved in all patients.

Conclusions: Overweight and obesity, regardless of metabolic status, were associated with a significantly higher risk of AF recurrence after ablation compared to normal-weight, underscoring the importance of weight management in PAF.

[This corrects the article DOI: 10.6515/ACS.202505_41(3).20250224A.].

Background: Various factors associated with cardiopulmonary bypass (CPB) can produce an inflammatory response, resulting in morbidity and mortality. The aim of this study was to investigate how adenosine deaminase (ADA) activity changes after surgery in relation to the emergence of CPB-related complications.

Methods: The study included 78 patients, of whom 30 had complications. Blood samples were collected three times: on admission to the ward (preoperative), on the first postoperative day, and on the fifth postoperative day. The blood samples were analyzed for routine hematological and biochemical variables. In addition, serum ADA activity was evaluated, and normalized ADA [ADA_(Nor)] levels were calculated.

Results: On postoperative day 1, ADA and ADA_(Nor) levels differed between the groups. In multivariate analysis, left atrium diameter (p = 0.015), and ADA_(Nor) (p = 0.001) on postoperative day 1 were significant predictors of CPB-related complications. Receiver operating characteristic curve analysis showed that the area under curve for postoperative first day ADA_(Nor) was 0.767 (95% confidence interval 0.664-0.871). Using a cut-off value of 11.87, postoperative first day ADA_(Nor) predicted postoperative complication emergencies with 63.3% sensitivity and 77.1% specificity.

Conclusions: This study is the first to identify blood ADA_(Nor) activity as an independent risk factor for the development of postoperative CPB-related complications.