Acta Cardiologica Sinica最新文献

The prevalence of cardiovascular disease (CVD) is increasing globally. Hypertension and dyslipidemia are well-established risk factors, and their co-existence significantly increases the risk of CVD. Epidemiological studies consistently report a high prevalence of their co-existence, ranging from 15% to 31%. The combined impact of hypertension and dyslipidemia on the vascular endothelium is more detrimental than their individual effects, potentially accelerating atherosclerosis and increasing the overall risk of CVD. This review highlights the benefits of concurrently treating dyslipidemia and hypertension to prevent CVD, drawing insights from the Anglo-Scandinavian Cardiac Outcomes Trial study and recent clinical studies conducted in Asia. Notably, the single-pill combination of amlodipine and atorvastatin has been shown to enhance adherence while providing a synergistic effect in protecting the vascular endothelium and preventing CVD. By aggressively managing both conditions, healthcare providers can significantly reduce the risk of future cardiovascular events across diverse patient populations and ethnicities.

Background: In advanced heart failure patients, limited exercise capacity often prevents significant increases in core temperature. Due to reduced muscle mass and minimal blood flow in inactive muscles, their limb temperatures tend to be lower. This study investigates whether core-hand temperature difference can serve as a distinguishing criterion between New York Heart Association (NYHA) Class III and IV heart failure.

Methods: This study included 80 patients with NYHA Class IV (median age: 68 years) and 82 with NYHA Class III (median age: 65 years) heart failure with reduced ejection fraction. Core body temperature was measured using an infrared thermometer, while hand temperature was recorded with a forward looking infrared C5 thermal camera after a 15-minute acclimatization at room temperature.

Results: The core-mean hand temperature difference (Tc-Mht) was 8.7 °C ± 1.5 °C in the Class IV group and 7.1 °C ± 1.7 °C in the Class III group (p < 0.001). The difference in hand temperature (highest-lowest) was 3 °C (2-4 °C) in the Class IV group and 1 °C (0-2 °C) in the Class III group (p < 0.001).

Conclusions: A Tc-Mht > 7.7 °C showed 76% sensitivity (95% confidence interval: 66-84%) for detecting NYHA Class IV in thermoneutral environments. Tc-Mht may serve as a prognostic marker in heart failure patients.

Background: The Taiwan Registry of Hypertrophic Cardiomyopathy (THIC) is a multicenter national registry containing the clinical and imaging data of patients with hypertrophic cardiomyopathy (HCM) in Taiwan. The aim of the registry is to systematically evaluate the clinical, genetic and biochemical features, possible natural course, and outcomes of HCM and relevant rare diseases that mimic HCM such as Fabry disease (FD) and transthyretin amyloid cardiomyopathy in Taiwan, and to identify their specific "red-flag" signs, which are especially valuable from the perspective of unique genetic mutations or clinical manifestations in Taiwanese patients. Herein, we present the design and initial baseline data from the registry.

Methods: The THIC is an observational program that aims to collect prospective and/or retrospective data of patients with HCM in Taiwan. The registry plans to recruit 800 individuals with unexplained left ventricular hypertrophy, including 200 with FD, with a follow-up period of at least 12 months, and the project is expected to run for 5 years. Data on baseline characteristics, laboratory and imaging results, deaths, major adverse cardiovascular, cerebrovascular and renal events are collected.

Results: The THIC has been in the enrollment phase since December 2022, and has enrolled 534 patients (age 62.37 ± 13.41 years, male 65.6%) as of March 15, 2025 from 13 centers. At enrollment, 284 of these patients had HCM, 227 had FD, and 23 had ATTR-CM. Family history was found to be an important diagnostic clue; however, common echocardiographic and laboratory data including N-terminal pro-brain natriuretic peptide were not significantly different between the three groups.

Conclusions: The THIC will contain comprehensive clinical and imaging data of patients with HCM, FD and ATTR-CM in Taiwan, and provide an opportunity to extend our knowledge on the clinical presentations and long-term consequences of these disease entities. It will aid in understanding patients with unexplained LVH in the context of the genetic background of Taiwanese patients, and in identifying predictors of LVH and important clinical events.

Objectives: This study aimed to evaluate the prognostic implications and optimal timing for assessing left ventricular ejection fraction (LVEF) trajectory in patients with heart failure (HF) and an LVEF < 50%.

Methods: The Taiwan Society of Cardiology HF Registry 2020 is a prospective, multicenter registry of hospitalized HF patients in Taiwan. This study included patients with an LVEF < 50% during their index HF hospitalization, and at least one follow-up echocardiogram within 2 years. HF with improved EF (HFimpEF) was defined as an absolute increase in LVEF > 10% from baseline. The primary endpoints were all-cause mortality and HF hospitalization at 2 years. Predictors of an improvement in LVEF trajectory were also evaluated.

Results: A total of 1478 patients were enrolled, with 873 in the HFimpEF group and 605 in the non-HFimpEF group. HFimpEF was associated with a lower risk of mortality (hazard ratio: 0.41 [0.27-0.62], p < 0.001) and reduced HF hospitalizations (8.6% vs. 24.4%, p < 0.001) at 2 years follow-up. Subgroup analysis showed that survival benefits diverged at an LVEF improvement > 10%, emerging as early as 6 months and persisting beyond 12 months. Lower baseline LVEF was paradoxically associated with better survival. Neither maximal guideline-directed medical therapy (GDMT) score nor revascularization correlated with LVEF trajectory. However, HFimpEF patients received higher doses of renin-angiotensin system inhibitors and beta-blockers in the first year.

Conclusions: LVEF trajectory at 6 months appears to be a valuable prognostic tool, and higher-dose fundamental HF therapy was more important than achieving a higher overall GDMT score.

Background: The aim of this study was to assess the prognostic significance of the longitudinal tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) ratio as a surrogate marker of right ventricular (RV) to pulmonary arterial (PA) coupling in patients with pulmonary arterial hypertension (PAH).

Methods: A retrospective cohort study was conducted on patients with PAH. The TAPSE/PASP ratio at baseline and at 3 to 6 months of follow-up was evaluated along with other echocardiographic and clinical parameters.

Results: The study included 68 patients with PAH, 75% of whom were female, with a mean age of 46 years and a mean follow-up duration of 64 months. At baseline, non-survivors had higher brain natriuretic peptide levels, shorter 6-minute walk distance (6MWD), and worse hemodynamic profiles compared with survivors. A TAPSE/PASP ratio > 0.22 mm/mmHg at baseline and > 0.23 mm/mmHg at 3 to 6 months of follow-up was associated with improved survival. Compared with baseline, survivors had lower pulmonary vascular resistance, lower PASP, and reduced left ventricular eccentricity indexat follow-up. In addition, better outcomes were observed in patients with World Health Organization functional class (WHO FC) I/II and 6MWD > 390 m compared with those in WHO FC III/IV and 6MWD ≤ 390 m.

Conclusions: The TAPSE/PASP ratio is a noninvasive marker of RV-PA coupling that can provide dynamic prognostic insights in patients with PAH. It may assist in guiding treatment escalation and individualized therapy. Further studies are needed to verify its role and integration into comprehensive PAH risk assessment frameworks.

Background: Myocardial infarction (MI) remains a leading cause of mortality and morbidity worldwide. Cardiac rehabilitation (CR) is an evidence-based intervention that improves cardiovascular outcomes; however, the optimal timing and contents of CR remain unclear.

Objectives: This study aimed to investigate the effects of an early-phase, exercise-based supervised comprehensive CR program on functional exercise capacity, grip strength, fatigue, sleep quality, and health-related quality of life (HRQOL) in patients with MI.

Methods: A randomized controlled trial was conducted involving 32 medically stable MI patients allocated to either an intervention or control group. The intervention group received a two-phase supervised CR program initiated within the first week post-MI, including inpatient and outpatient aerobic, calisthenic, and strengthening exercises for eight weeks. The control group received usual care. Primary and secondary outcomes included the 6-minute walk distance (6MWD), 30-second sit-to-stand test (30-sec STS), grip strength, fatigue (functional assessment of chronic illness therapy [FACIT]-fatigue), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), and HRQOL (12-Item Short-Form Questionnaire and MacNew Heart Disease Health-Related Quality of Life Questionnaire).

Results: Compared to the control group, the intervention group showed significant improvements in 6MWD (mean difference [MD] = 97.3 m, p < 0.001), 30-sec STS (MD = 3.1 repetitions, p = 0.001), grip strength (MD = 5.7 kg, p = 0.04), FACIT-Fatigue score (MD = 8.8 points, p < 0.001), PSQI score (MD = -2.7 points, p < 0.001), and HRQOL subdomains (p < 0.05). No adverse events were reported.

Conclusions: Early-phase supervised CR significantly enhanced physical capacity, fatigue, sleep quality, and HRQOL in this cohort of MI patients. Early initiation of structured CR should be considered in clinical practice to promote faster recovery and improve long-term outcomes following MI.

Background: The Coronavirus disease 2019 (COVID-19) pandemic necessitated rapid advances in treatment, with Paxlovid emerging as an effective oral antiviral. Despite its efficacy in reducing hospitalizations and mortality among high-risk patients, the impact of Paxlovid on cardiovascular outcomes remains unclear, especially given the increased cardiovascular risks associated with COVID-19.

Methods: We conducted a retrospective cohort study using data from the Chang Gung Memorial Hospital System in Taiwan of patients admitted with COVID-19 from January 1, 2022 to December 31, 2022. Propensity score matching was used to create comparable cohorts of patients treated with Paxlovid and those not treated with Paxlovid. The primary outcomes were cardiovascular events and all-cause mortality within a 12-month follow-up period.

Results: The study analyzed 606 patients treated with Paxlovid and 1,809 matched patients who were not. Paxlovid significantly reduced all-cause mortality at 3 months (relative risk [RR] 0.75, p = 0.0216) and 6 months (RR 0.81, p = 0.0492), but this effect was not sustained at 12 months (p = 0.2069). Notably, venous thromboembolism rates were significantly higher in the Paxlovid group at 6 months (RR 4.78, p = 0.0057) and 12 months (RR 2.65, p = 0.0477).

Conclusions: While Paxlovid treatment resulted in significant short-term survival improvements among COVID-19 patients, it was also associated with a higher incidence of venous thromboembolic complications. These findings highlight the need for careful patient selection and monitoring, particularly for those with preexisting cardiovascular conditions.