Acta Cardiologica Sinica最新文献

Geriatric heart disease is a common disease in modern society. Due to the characteristics of advanced age and multiple underlying diseases, elderly patients with heart disease have a variety of types and treatment methods compared to other diseases. We searched the databases of CNKI, PubMed, and Web of Science to search for the causes and treatment methods of traditional Chinese and Western medicine for heart diseases using the terms "geriatric heart disease", "treatment", "ischemic heart disease", "pulmonary heart disease", "hypertensive heart disease", "rheumatic heart disease", "thyroid heart disease", "coronary heart disease", "arrhythmia", and "heart conduction block". The search also included the terms "reasonable emotional therapy", "Baduanjin", "TaiChi", "Wuqinxi", "Qigong", "acupuncture and moxibustion", "moxibustion", "guasha" and so on, auxiliary Chinese medicine therapies for geriatric heart disease. The results showed that traditional Chinese medicine (TCM) has a relatively comprehensive treatment plan for different types of geriatric heart disease. Generally, TCM combined with Western medicine or surgery can effectively improve heart function and treat the disease. Chinese exercise and TCM therapy also play an indispensable role in the auxiliary treatment of geriatric heart disease, effectively improving the living conditions of the elderly.

Background: Sodium-glucose cotransporter-2 (SGLT2) inhibitors have shown renoprotective effects in diabetic patients, however their impact on heart transplant recipients remains controversial due to limited data.

Methods: This retrospective cohort study included heart transplant recipients with diabetes from January 2016 to December 2023. The patients were divided into a treatment group who used SGLT2 inhibitors for at least 1 year, and a control group who had never used SGLT2 inhibitors. We used propensity score matching to balance baseline characteristics between the two groups. The primary outcome was a renal-specific composite, including a sustained decline of ≥ 50% in estimated glomerular filtration rate (eGFR), end-stage kidney disease, or death from renal causes.

Results: After 15-18 months, the SGLT2 inhibitor group showed significant improvements in eGFR compared to the control group. The renal-specific composite outcome occurred less frequently in the SGLT2 inhibitor group compared with the control group (log-rank test, p = 0.0064). The SGLT2 inhibitor group had a lower risk of the renal-specific composite outcome compared to the control group, and this finding was consistent across the study cohort [adjusted hazard ratio (aHR): 0.30; p = 0.0270] and propensity-matched cohort (aHR: 0.26; p = 0.0341).

Conclusions: The long-term use of SGLT2 inhibitors in heart transplant recipients with diabetes mellitus was associated with significant renal function preservation and reduced risk of adverse renal outcomes. These findings support the renoprotective potential of SGLT2 inhibitors in this population, warranting further prospective studies.

Increased low-density lipoprotein cholesterol (LDL-C) is one of the most important risk factors for atherosclerotic cardiovascular disease (ASCVD). However, the attainment rate of recommended LDL-C targets is not optimal with significant scope for improvement in Taiwan. This clinical pathway for cholesterol management was developed based on the Taiwan lipid guidelines and expert opinions from major medical societies in Taiwan. It was designed with the aim of improving the outcomes of people at risk of or with ASCVD who would benefit from lipid control to reduce the risk of new or recurrent cardiac events. The pathway proposes adequate LDL-C targets for people at different risk levels of ASCVD and standardizes lipid management and follow-up in patients receiving lipid lowering therapy. The ultimate purpose is to facilitate the attainment of individual LDL-C targets and ensure that patients are monitored adequately and optimized on the appropriate lipid lowering therapy to reduce the risk of ASCVD.

[This corrects the article DOI: 10.6515/ACS.202501_41(1).20240722C.].

Background: Approximately half of the patients presenting with acute coronary syndrome have multivessel disease. There has been conflicting data regarding the residual coronary artery disease (CAD) burden and its impact on mortality, especially in older people. Therefore, we aimed to assess all-cause mortality and residual CAD burden in older patients with acute coronary syndrome.

Methods: Patients over 75 years of age who presented with acute coronary syndrome and underwent percutaneous coronary intervention were retrospectively included in the study. After the index procedure, residual The Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) scores were calculated and the patients were divided into two groups as residual SYNTAX > 8 and < 8. In-hospital and long-term all-cause mortality were defined as the endpoints of the study.

Results: Overall, 352 patients were included in the study. The mean age was 82.0 ± 4.8 years and 188 (53.4%) patients were female. The median follow-up was 35 (3-57) months. Both in-hospital and long-term mortality were significantly higher in the patients with residual SYNTAX sore > 8 (33.9% vs. 12.0% and 70.1% vs. 48.4% both p < 0.01, respectively). Kaplan-Meier analysis survival curves continued to separate showing increased mortality in the patients with residual SYNTAX score > 8 (p < 0.01). In multivariate Cox regression analysis, high residual CAD burden [residual Syntax score > 8, hazard ratio: 1.83 (1.30-2.56 95% confidence interval), p < 0.01], age, diabetes mellitus, left ventricular ejection fraction and renal insufficiency were associated with long-term all-cause mortality.

Conclusions: Elderly patients with residual SYNTAX score > 8 had higher in-hospital and long-term all-cause mortality rates. Strategies aiming to reduce residual CAD burden by revascularization seem reasonable.

Background: Cardiovascular disease is the leading cause of mortality among hemodialysis patients. Frailty, characterized by diminished physiological reserve, is increasingly recognized as an important risk factor for adverse outcomes in this population.

Objectives: This study aimed to investigate the role of frailty in cardiovascular mortality among patients undergoing maintenance hemodialysis.

Methods: This prospective cohort study enrolled 1,136 hemodialysis patients from 12 centers in Hsinchu, Taiwan. Baseline data on demographics, comorbidities, dialysis-related factors, and laboratory results were collected. Frailty was assessed using modified Fried frailty criteria, and the patients were followed for a median of 1,187 days. Cardiovascular death was the primary outcome, with a particular emphasis on sudden cardiac death. Cox proportional hazards models were used to analyze the data.

Results: Of the 1,136 participants, 34.3% were classified as frail. The frail patients had significantly higher rates of cardiovascular death [25% vs. 12%, hazard ratio (HR) = 2.34, p < 0.001] and sudden cardiac death (16% vs. 6%, HR = 3.12, p < 0.001) compared to the non-frail patients. Multivariate analysis confirmed frailty as an independent predictor of cardiovascular death (HR = 1.62, 95% confidence interval 1.20, 2.19, p = 0.002). The association between frailty and sudden cardiac death was more pronounced than that between frailty and non-sudden cardiac death.

Conclusions: Frailty was a strong predictor of cardiovascular mortality, and particularly sudden cardiac death, in the enrolled hemodialysis patients. These findings underscore the importance of frailty assessments and targeted interventions to reduce cardiovascular risk in this vulnerable group. Further research is needed to elucidate the mechanisms linking frailty with cardiovascular outcomes and to develop effective management strategies.

Background: The obesity paradox refers to lower mortality rates among overweight or obese individuals within certain populations. However, whether this paradox is applicable to patients undergoing percutaneous coronary intervention (PCI) remains unclear.

Methods: A total of 5,427 patients with coronary artery disease (CAD) who underwent successful PCI between 2005 and 2015 were enrolled. The association between body mass index (BMI) and future adverse cardiovascular events post PCI was analyzed. The study endpoints encompassed total cardiovascular (CV) events, including cardiac death, nonfatal myocardial infarction (MI), ischemic stroke, and hospitalization for congestive heart failure (CHF).

Results: Over an average follow-up period of 65.1 ± 32.1 months, 942 patients (17.4%) had CV events, including 200 CV deaths (3.7%), 294 acute MIs (5.4%), 111 ischemic strokes (2.0%), 469 CHF hospitalizations (8.6%), and 1,098 revascularizations (20.2%). A J-shaped relationship between BMI and future adverse events was observed, in which individuals with a BMI of 25.0-29.9 kg/m² had significantly lower risks of total CV events [hazard ratio (HR) = 0.84, 95% confidence interval (CI) = 0.72-0.98], major adverse cardiovascular events (HR = 0.76, 95% CI = 0.63-0.93), acute MI (HR = 0.76, 95% CI = 0.58-1.00), and ischemic stroke (HR = 0.61, 95% CI = 0.39-0.95), compared to those with a BMI of 22.0-24.9 kg/m².

Conclusions: We found a J-shaped relationship between baseline BMI and future adverse events in CAD patients undergoing PCI. Overweight individuals (BMI 25.0-29.9 kg/m²) had the lowest future risk of total CV events compared to those with a normal BMI (22.0-24.9 kg/m²).

Aims: This study aims to verify the feasibility and safety of percutaneous coronary intervention (PCI) after a distal transradial approach (dTRA) with radial artery occlusion (RAO) recanalization.

Methods: Between July 2018 and January 2022, 30 patients underwent PCI following attempted RAO recanalization via dTRA. Among these cases, the target radial arteries could not be recanalized in five patients, necessitating alternative vascular access. The remaining 25 patients with successful RAO recanalization were divided into a standard group (n = 19) and tough group (n = 6), the latter requiring more than 10 minutes and complex techniques and devices for recanalization.

Results: The procedural success rate was 96.7%, with vascular access-site complications occurring in 20% of the cases, including five perforations easily managed with prolonged balloon inflation and one pseudoaneurysm without flow limitation. In the tough group, no significant increase in procedural complications, access-site vascular complications, or total major adverse cardiac and cerebrovascular events was observed. However, Doppler ultrasound one month later for the recanalized radial artery revealed a significantly higher rate of severe stenosis and re-occlusion at 100% compared to 10% in the standard group, as supported by receiver operating characteristic curve analysis.

Conclusions: The feasibility and safety of PCI following RAO recanalization via dTRA were acceptable. We propose a 10-minute threshold to differentiate between standard and tough groups during RAO recanalization. Given the uncertainty of long-term patency in recanalized RAs, the primary goal in tough cases is to ensure the guide catheter reaches the ascending aorta for subsequent PCI.

Background: Atrial fibrillation (AF) increases the risks of stroke and mortality. It remains unclear whether rhythm control reduces the risk of stroke in patients with AF concomitant with hypertrophic cardiomyopathy (HCM).

Methods: We identified AF patients with HCM who were ≥ 18 years old in the Taiwan National Health Insurance Database. Patients using antiarrhythmic medications for ≥ 30 defined daily doses (DDDs) or receiving catheter ablation for AF constituted the rhythm control group. Patients using rate control medications for ≥ 30 DDDs constituted the rate control group. A multivariable Cox regression model was used to evaluate the hazard ratio (HR) for adverse cardiovascular events.

Results: We enrolled a total of 178 patients with both AF and HCM without pre-existing cardiovascular diseases. Among them, 99 were in the rhythm control group and 79 were in the rate control group. After a follow-up period of 6.47 ± 0.98 years, the rhythm control group had a lower risk of stroke than the rate control group (adjusted HR: 0.380, p = 0.031) after adjusting for covariates including use of antithrombotic agents. After excluding patients receiving catheter ablation, the rhythm control group still had a lower risk of stroke than the rate control group (adjusted HR: 0.380, p = 0.037).

Conclusions: In patients with AF and HCM, rhythm control with mainly pharmacological treatment better prevented stroke than rate control in long-term follow-up. The beneficial effect of lowering stroke risk through rhythm control was independent of oral anticoagulant use.