Acta Cardiologica Sinica最新文献

[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.

Background: Assessing the risk of sudden cardiac death in hypertrophic cardiomyopathy (HCM) patients is crucial. Cardiac magnetic resonance imaging (CMR) with late gadolinium enhancement (LGE) helps identify fibrosis, a key risk factor for sudden cardiac death. Current American Heart Association guidelines recommend implantable cardioverter-defibrillators for primary prevention in HCM patients with over 15% LGE. However, accurate LGE quantification requires specialized software, which is often unavailable in many centers. Symptom severity is often closely correlated with disease severity. This study investigates the relationship between symptom burden and high fibrosis in HCM patients.

Methods: HCM patients from our cardiomyopathy clinic who underwent CMR between October 2021 and May 2023 were included. Symptom burden was assessed with the Kansas City Cardiomyopathy Questionnaire (KCCQ), with a lower score indicating higher symptom burden. High fibrosis was defined as LGE of 15% or more, evaluated by two radiologists.

Results: Among 195 patients, 57 had high fibrosis. There were no significant differences in demographic data between groups. However, the high fibrosis group had significantly lower KCCQ scores, higher troponin and N-terminal pro B-type natriuretic peptide levels, lower left ventricular ejection fraction (LVEF), and greater wall thickness and LV mass index (LVMI). Logistic regression identified KCCQ score, LVEF derived from CMR, and CMR-LVMI as independent predictors of high fibrosis. A KCCQ score cut-off of 57.9 predicted high fibrosis with 77.1% sensitivity and 33.3% specificity (area under the curve: 0.717).

Conclusions: Lower KCCQ score, reflecting higher symptom burden, was an independent predictor of high fibrosis in the enrolled HCM patients, highlighting its potential utility for fibrosis risk assessment.

Background: Atrial fibrillation (AF) increases the risks of ischemic stroke and systemic embolism, especially in patients with mitral stenosis (MS). Non-vitamin K antagonist oral anticoagulants (NOACs) are effective in preventing AF-related stroke and systemic embolic events. However, patients with AF and concomitant moderate-to-severe MS have been excluded from previous pivotal studies. We aimed to evaluate and compare the efficacy and safety of NOACs with vitamin K antagonists (VKAs) in this patient group.

Methods: This retrospective observational study used data from the Chang Gung Research Database. We enrolled patients with AF and concomitant moderate-to-severe MS between January 2010 and December 2019. Propensity score matching was used to balance covariates between the NOAC and VKA groups. The risks of stroke, systemic embolism, and bleeding events were assessed following treatment.

Results: After PSM, 115 patients with AF and concomitant moderate-to-severe MS were analyzed, of whom 32 were treated with NOACs and 83 with VKAs. There were no significant differences in the composite efficacy outcomes and bleeding risk between the NOAC and VKA groups. However, the all-cause mortality incidence rate was significantly lower in the NOAC group. Cox regression analysis showed that CHA₂DS₂-VASc score, but not mitral valve area, was a significant predictor of the composite efficacy outcomes.

Conclusions: NOACs were as effective as VKAs in preventing stroke and systemic embolic events, with comparable bleeding risks in AF patients with concomitant moderate-to-severe MS. CHA₂DS₂-VASc score was superior to mitral valve area in predicting composite efficacy outcomes.

Background: The primary aim of this study was to explore the effectiveness of aromatherapy in alleviating hospitalization-related anxiety in patients with acute myocardial infarction (AMI).

Methods: A search of PubMed, Ovid Medline, Cochrane Library, CINAHL Database, Taiwan Periodical Literature Index System, and Airiti Library was conducted in October 2023. Following the inclusion and exclusion criteria, randomized controlled trials on aromatherapy in patients with AMI aged 18 years or older were identified. The risk of bias in the retrieved trials was assessed using the revised Cochrane Risk-of-Bias Tool for randomized controlled trials.

Results: A total of 14 trials were identified. Aromatherapy was found to significantly reduce anxiety (Hedges's g = -2.087, 95% confidence interval [CI] = -2.8341 to -1.341, p < 0.001), although heterogeneity was notably high (I2 = 96.7%). The effects of different aromatherapies on anxiety were inconsistent. Geranium (Hedges's g = -6.970, 95% CI= -10.283 to -3.675, p < 0.001), M. Chamomile (Hedges's g = -3.735, 95% CI= -6.881 to -0.590, p = 0.002), and C. Aurantium (Hedges's g = -3.614, 95% CI= -5.885 to -1.343, p < 0.001) were found to significantly reduce anxiety. Aromatherapy was found to have a significant effect in lowering systolic blood pressure in these patients (Hedges's g = -0.903, 95% CI = -1.689 to -0.117, p = 0.024).

Conclusions: Our findings suggest that clinical staff can apply aromatherapy in the care of AMI patients to alleviate anxiety and improve the quality of care.