Acta Cardiologica Sinica最新文献

Background: Acute limb ischemia (ALI) is a medical emergency necessitating immediate action to avert irreversible tissue harm and limb loss. Rotarex mechanical thrombectomy (RMT) has become an efficient treatment alternative for ALI. However, there is a lack of data on RMT in Taiwan.

Methods: We retrospectively analyzed 61 ALI patients treated with RMT at our hospital between January 2016 and January 2022. We collected baseline characteristics, laboratory and angiographic data. We also examined the outcomes at 30 days, 6 months, and 1 year, including major amputations, minor amputations, all-cause mortality, and major adverse limb events (MALEs).

Results: Among the 61 RMT-treated patients, the average age was 70 ± 14 years. ALI affected the upper extremities in 9 cases and lower extremities in 52 cases. One-year outcomes revealed 2 major amputations (3.3%), 2 minor amputations (3.3%), 6 all-cause deaths (9.8%), and 10 MALEs (16.4%). After multiple logistic regression analysis, hemoglobin drop was significantly associated with 1-year all-cause mortality, and a history of peripheral artery disease (PAD) was significantly associated with MALEs.

Conclusions: Our research is the first investigation into the application of RMT for ALI in Taiwan. The short- and mid-term outcomes after RMT for ALI revealed reductions in amputation, mortality, and MALE rates. In addition, a decline in hemoglobin level was a significant predictor of increased mortality, and a history of PAD was a significant predictor of increased MALEs following RMT.

Background: Data regarding the distribution of left ventricular ejection fraction among patients with newly diagnosed heart failure (HF) and the outcomes of patients with heart failure with preserved ejection fraction (HFpEF) in Taiwan are limited.

Methods: Patients with newly diagnosed HF were identified from a multi-institutional database between 2016 and 2020. Outcomes were compared between patients with HFpEF and heart failure with reduced ejection fraction (HFrEF) after propensity score matching (PSM).

Results: Of 7,736 newly diagnosed HF patients, 4,393 (56.8%) had HFpEF and 1,977 (25.6%) had HFrEF. The HFpEF group was older (71.5 vs. 64.2 years) and more likely to be female (48.9% vs. 31.1%). Comorbidities were more common in the HFpEF patients. Median follow-up was 2.1 years. Prior to PSM, the HFpEF patients had higher all-cause mortality risk [hazard ratio (HR) 1.21, 95% confidence interval (CI) 1.11-1.33] but lower cardiovascular (CV) death risk (HR 0.84, 95% CI 0.72-0.97) compared to those with HFrEF. The HFpEF group had a trend of higher overall hospitalization risk (HR 1.06, 95% CI 0.99-1.14), but lower HF hospitalization risk (HR 0.61, 95% CI 0.55- 0.67). After PSM, all-cause mortality and overall hospitalization were comparable. The HFpEF group had lower rates of CV death (HR 0.82, 95% CI 0.68-1.0) and HF hospitalization (HR 0.60, 95% CI 0.53-0.69) compared to the HFrEF group.

Conclusions: Among patients with newly diagnosed HF, HFpEF is the predominant phenotype, characterized by older age, higher female prevalence, and increased comorbidities. After adjusting for these factors, all-cause death and hospitalization risks became similar between the HFpEF and HFrEF patients. The HFpEF patients had lower risks of CV death and HF hospitalization.

Background: Pre-transcatheter aortic valve replacement (TAVR) nutritional status can potentially affect the length of hospital stay (LoS) after TAVR. The Prognostic Nutritional Index (PNI) is a widely recognised nutritional index. We aimed to determine the effect of PNI on LoS in patients undergoing TAVR.

Methods: The study population (158 patients) was divided into two groups: early discharge (LoS ≤ 3 days) and late discharge (LoS > 3 days). PNI was calculated before TAVR.

Results: In the LoS > 3 days group, the median age, creatinine level, rate of surgical access site closure and rate of major complications were higher, whereas estimated glomerular filtration rate, albumin, haemoglobin, lymphocyte count and PNI were significantly lower. Receiver operating characteristic curve analysis revealed a PNI cutoff of 39 (area under the curve = 0.778, p < 0.001) with 86.8% sensitivity and 55.2% specificity for predicting extended LoS. The 30-day endpoint analysis revealed significantly higher rates of death and hospitalisation with LoS > 3 days and PNI ≤ 39. Multivariate binary logistic regression analysis identified several independent predictors of extended LoS: severe renal insufficiency [odds ratio: 3.951 (95% confidence interval: 1.281-12.191); p = 0.017], surgical access site closure [4.353 (1.701-11.141); p = 0.002), complications [7.448 (1.305-42.518); p = 0.024] and PNI < 39 [5.906 (2.375-14.684); p < 0.005].

Conclusions: Decreased PNI may be associated with LoS > 3 days after TAVR. Nutritional status assessed using PNI may be a useful independent predictor of LoS after TAVR.

Objectives: Cardiac amyloidosis (CA) is a type of systemic amyloidosis. Amyloid-targeting positron emission tomography (PET) has shown potential as an imaging method for CA. However, the optimal imaging protocol and role of ¹⁸F-florbetaben (FBB) PET in the diagnosis and subtyping of CA have yet to be determined.

Methods: Patients with suspected CA who had positive or equivocal results of technetium-99m pyrophosphate (PYP) scintigraphy were enrolled for dynamic and late FBB PET imaging. In addition to visual assessment, a kinetic modeling-based approach including target-to-background ratio (TBR) and myocardial retention fraction (RF) of serial images reconstructed from a 20-min dynamic acquisition, and a late image at 110 min post-injection were performed. We compared FBB PET measures of four typical patients with light chain amyloidosis (AL), wild-type transthyretin amyloidosis (ATTRwt), variant transthyretin amyloidosis (ATTRv), and heart failure, respectively. We also reviewed the literature on the clinical use of amyloid PET in CA.

Results: Myocardial tracer retention was only found in the AL patient on the late images. TBR and RF were highest in the AL patient followed by the ATTRwt patient, and lowest in the ATTRv and non-CA patients.

Conclusions: FBB PET has potential in the detection and non-invasive subtyping of CA, especially in subjects with equivocal PYP findings or monoclonal gammopathy.

Atherosclerotic cardiovascular disease (ASCVD) is one of the leading causes of death worldwide and in Taiwan. It is highly prevalent and has a tremendous impact on global health. Therefore, the Taiwan Society of Cardiology developed these best-evidence preventive guidelines for decision-making in clinical practice involving aspects of primordial prevention including national policies, promotion of health education, primary prevention of clinical risk factors, and management and control of clinical risk factors. These guidelines cover the full spectrum of ASCVD, including chronic coronary syndrome, acute coronary syndrome, cerebrovascular disease, peripheral artery disease, and aortic aneurysm. In order to enhance medical education and health promotion not only for physicians but also for the general public, we propose a slogan (2H2L) for the primary prevention of ASCVD on the basis of the essential role of healthy dietary pattern and lifestyles: "Healthy Diet and Healthy Lifestyles to Help Your Life and Save Your Lives". We also propose an acronym of the modifiable risk factors/enhancers and relevant strategies to facilitate memory: " ABC₂D₂EFG-I'M₂ ACE": Adiposity, Blood pressure, Cholesterol and Cigarette smoking, Diabetes mellitus and Dietary pattern, Exercise, Frailty, Gout/hyperuricemia, Inflammation/infection, Metabolic syndrome and Metabolic dysfunction-associated fatty liver disease, Atmosphere (environment), Chronic kidney disease, and Easy life (sleep well and no stress). Some imaging studies can be risk enhancers. Some risk factors/clinical conditions are deemed to be preventable, and healthy dietary pattern, physical activity, and body weight control remain the cornerstone of the preventive strategy.