Acta Cardiologica Sinica最新文献

Background: Cardiovascular disease, particularly ST-segment elevation myocardial infarction (STEMI), continues to be a leading cause of death worldwide despite advances in treatment options. Contrast-induced nephropathy (CIN) increases the risk of morbidity and mortality after percutaneous coronary intervention (PCI) in STEMI patients. Blood pressure variability (BPV), defined as fluctuations in blood pressure (BP) over time, has been associated with cardiovascular events, stroke, target organ damage and renal dysfunction independently of BP levels. The relationship between BPV and CIN is unknown.

Methods: This prospective study investigated the relationship between invasively measured short-term BPV and CIN in haemodynamically stable STEMI patients undergoing PCI. In 220 patients, BP was monitored through the femoral sheath for six hours after PCI, and systolic and diastolic standard deviation (SD), average real variability (ARV) and delta parameters were calculated using universal formulae.

Results: The results indicated a significant association between short-term BPV, especially systolic BPV, and the development of CIN (p < 0.01). In particular, systolic SD [odds ratio (OR): 1.055, 95% confidence interval (CI) 1.003-1.110, p = 0.04] and systolic ARV (OR: 1.084, 95% CI 1.011-1.162, p = 0,02) emerged as independent predictors of CIN.

Conclusions: Our study demonstrated that intra-arterially measured short-term BPV was associated with the development of CIN in STEMI patients. Notably, systolic SD and systolic ARV were independent predictors of CIN, which may be of clinical importance for early diagnosis and prevention. These results suggest that BPV may be an indicator of CIN risk, and further large-scale randomised trials are warranted to clarify this relationship.

Aim: To evaluate the feasibility, safety, and effectiveness of the TAI QING^TM single-hub occluder for patent foramen ovale (PFO) in preclinical animal experiments.

Methods: Twelve Labrador retrievers were included to establish an animal model of PFO. Under fluoroscopic guidance, the TAI QING^TM single-hub occluder was implanted in the animals with PFO. Three animals were sacrificed at 1, 3, 9 and 12 months post-implantation, respectively, to evaluate the macroscopic anatomical structure and pathological conditions.

Results: The TAI QING^TM single-hub occluder was successfully implanted in all 12 Labrador retrievers (100%). No implant-related complications were detected during the operation and follow-up. The occluder remained stable in its implant location. At 1 month post-implantation, the surfaces of both discs was covered with a translucent layer. Over time, the surface of the occluder became covered with an opalescent membrane, and the tissue surrounding the occluder gradually thickened. Histological and electronic microscopy analysis revealed the presence of endothelial cells and collagen fiber deposition in the tissue with increasing implantation time. Furthermore, at 12 months post-implantation, successful re-puncture was performed.

Conclusions: The TAI QING^TM single-hub occluder was safe and effective in the animal model. The results support further investigations in large animal models and human clinical trials.

[This corrects the article DOI: 10.6515/ACS.201905_35(3).20181125A.].

Background: The prevalence of patent foramen ovale (PFO) is higher in patients who have experienced a cryptogenic ischemic stroke. Recent trials have demonstrated the efficacy of PFO closure in preventing recurrent cerebrovascular events. This study evaluated the clinical outcomes of percutaneous PFO closure at a tertiary center in Northern Taiwan.

Methods: A total of 21 patients underwent transcatheter PFO closure between 2014 and 2022. Eighteen patients with a history of ischemic stroke or transient ischemic attack were further analyzed to assess their stroke risk, imaging studies, perioperative adverse events, and post-procedure outcomes. The follow-up period spanned from 2014 to 2023.

Results: Of the 18 patients, the proportion of males was higher (79%), and the average age was 48.4 years. Dyslipidemia was the most common comorbidity (50%), and 44.4% of the patients had cerebral vascular stenosis. The most common intra-operative event was premature atrial contractions. Post-procedure adverse events included headache, local hematoma, chest tightness, and bradycardia. During follow-up, three patients (16.7%) had recurrent cerebrovascular events, potentially associated with intracranial arterial stenosis as seen in brain imaging. The average recurrence rate of stroke after PFO closure was 3.5 events per 100 patient-years.

Conclusions: Transcatheter PFO closure could be considered as secondary prevention for patients younger than 60 years with cryptogenic ischemic stroke. The underlying diseases and anatomic features of PFO should be evaluated comprehensively to inform shared decision-making. Post-procedure follow-up includes evaluating cardiac arrhythmia and underlying diseases contributing to cerebrovascular stenosis, as they may be associated with recurrent stroke.

Background: Thyroid storm represents a critical and potentially life-threatening complication of thyrotoxicosis. Despite modern critical care, it has a high mortality rate and often requires admission to the intensive care unit (ICU) and the application of extracorporeal membrane oxygenation (ECMO). This study aimed to investigate the outcomes of thyroid storm patients requiring ECMO in a Taiwanese ICU setting.

Methods: This retrospective study included patients admitted to the ICU at a medical center in Taiwan from 2018-2021 who were diagnosed with thyroid storm and required ECMO. The patients were categorized into survivor and non-survivor groups. The primary outcome evaluated was ICU mortality rate. Univariate logistic regression analysis was conducted to determine associations between study variables and ICU mortality.

Results: Fourteen patients received ECMO, with a median age of 39 years, and 57.1% were male. Key triggers included non-compliance with medications and amiodarone use. The median ECMO support duration and ICU stay were 93.5 hours and 10 days, respectively. Four patients (28.6%) died, of whom three died from unsuccessful ECMO removal. An elevated lactate level on the first day of admission was significantly associated with increased mortality risk (odds ratio = 1.64, 95% confidence interval: 1.02-2.63, p = 0.04).

Conclusions: The survival rate of ICU patients with thyroid storm and treated with ECMO was approximately 70%, highlighting the effectiveness of ECMO and potential benefits in critical cases. Early lactate levels on admission day 1 may serve as a prognostic tool in this specific patient subgroup.

Background: The uric acid-to-high-density lipoprotein cholesterol ratio (UHR) has been associated with both the functional and anatomical significance of coronary lesions. This study aimed to investigate the relationship between UHR and the severity of coronary artery disease (CAD) in patients with non-ST-elevation myocardial infarction (NSTEMI), as evaluated using the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score.

Methods: This retrospective study analyzed data from 606 NSTEMI patients who underwent coronary angiography between April and December 2024. UHR was calculated by dividing serum uric acid by high-density lipoprotein cholesterol. Patients were classified into low (SYNTAX < 23) and intermediate-high severity (SYNTAX ≥ 23) groups and compared in terms of parameters including UHR.

Results: UHR showed a significant positive correlation with SYNTAX score (ρ = 0.417, p < 0.001) and emerged as an independent predictor of intermediate-high severity CAD (odds ratio: 1.069, p < 0.001). Receiver operating characteristic curve analysis yielded an area under the curve of 0.705, with a UHR cut-off of > 20.35 predicting intermediate-high severity with 49.5% sensitivity and 85.4% specificity. Left ventricular ejection fraction also independently predicted CAD severity.

Conclusions: UHR is an easily measurable, cost-effective biomarker for assessing CAD severity in NSTEMI patients. Its integration into clinical practice may improve early risk stratification and management strategies.