Acta Cardiologica Sinica最新文献

Background: This study aimed to investigate the relationship between cardiorespiratory fitness (CRF) levels and changes in arterial elasticity parameters immediately following maximal exercise in young elite athletes compared to healthy controls. Understanding how CRF influences arterial elasticity could provide insights into optimizing cardiovascular health through exercise interventions.

Methods: The study population comprised 34 elite athletes and 17 healthy controls with similar demographic characteristics. All participants underwent a baseline echocardiographic assessment, followed by a cardiopulmonary exercise test. Echocardiographic measurements, including aortic elasticity parameters derived from M-mode imaging of the ascending aorta, were repeated at 5, 15, and 60 minutes post-exercise. Aortic stiffness index (ASI) was used as the primary measure of arterial elasticity.

Results: The athletes had significantly higher mean VO₂max compared to the controls (50 vs. 38 ml/kg/min, p < 0.01). At rest, the athletes had lower aortic stiffness (ASI: 4.18 vs. 5.92, p < 0.01), indicating better arterial elasticity. A moderate negative correlation was observed between VO₂max and resting ASI (r = -0.51; p < 0.01), suggesting that higher CRF was associated with greater arterial elasticity. Post-exercise, ASI in the athletes returned to baseline levels by 60 minutes, whereas the controls showed a significant reduction in ASI compared to baseline (-0.02 vs. -0.33; p < 0.01).

Conclusions: These findings underscore the importance of CRF in maintaining arterial elasticity and highlight differences in vascular adaptation to exercise between athletes and healthy individuals. The results suggest that exercise interventions should be tailored to individual fitness levels to optimize cardiovascular benefits and improve arterial health.

Background: Current evidence supports the early initiation of all guideline-directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction (HFrEF), but clinical inertia persists in real-world practice.

Methods: Clinical data of 343 HFrEF patients hospitalized from January 2018 to December 2019 were collected, and they were followed for at least 3 years. We analyzed the benefits of optimizing GDMT at hospital discharge, the reasons for underprescription of GDMT, and factors associated with different outcomes after multivariate adjustments.

Results: Starting at least 3 pillars of GDMT at hospital discharge significantly reduced the risks of all-cause mortality, cardiovascular (CV) death, and heart failure hospitalization (hazard ratio = 0.22, 0.21, 0.28, respectively; all p < 0.001). Renal impairment was the major factor associated with the non-optimization of GDMT, and 78.4% of patients receiving fewer than 3 pillars of GDMT had a baseline chronic kidney disease stage 3-5. However, the prescription of GDMT was not associated with any observable risk of adverse renal outcomes.

Conclusions: This study demonstrated the CV benefits and safety regarding renal outcomes with the early initiation of GDMT in HFrEF patients. Efforts should be made to address the disparity between evidence-based medicine and daily practice.

Background: Cardiac catheterization laboratories (CCLs) contribute significantly to hospital waste and environmental impact. While sustainability efforts in healthcare are growing, comprehensive strategies for waste reduction in CCLs remain limited.

Aims: This study evaluated the effectiveness of a quality improvement initiative in reducing waste output and enhancing recycling practices in a high-volume CCL.

Methods: A one-year study was conducted in a single-center CCL performing approximately 2,800 annual procedures. Interventions included staff education, waste tracking, improved segregation, forming a sustainability team, and regular progress updates. Waste outputs were measured at baseline, one month, three months, and one year post-intervention. Carbon footprint reductions were calculated using emission factors of 340.00 kg/ton of carbon dioxide equivalent (tCO₂e) for incinerated waste and 0.11 kg/tCO₂e for recyclable glass.

Results: Over one year, infectious waste decreased by 35.4% [from 2.38 ± 0.40 to 1.54 ± 0.09 kilogram per procedure (kg/procedure)], and general waste decreased by 26.4% (from 0.83 ± 0.14 to 0.61 ± 0.03 kg/procedure). Recyclable paper increased by 55.5% (from 0.30 ± 0.05 to 0.47 ± 0.03 kg/procedure). The estimated annual carbon footprint reduction was 1,084.2 kg carbon dioxide equivalent.

Conclusions: Sustainability initiatives can significantly reduce waste and carbon emissions in CCLs while promoting recycling. This study provides a practical framework for advancing environmental sustainability in high-volume CCLs.

Aims: This study aims to evaluate the feasibility, efficacy, procedural complications, and long-term outcomes of left ventricular (LV) endocardial pacing lead implantation at the latest activation site of the LV. This procedure is guided by three-dimensional (3D) mapping and performed via transseptal puncture, and targets heart failure (HF) patients who either do not respond to conventional cardiac resynchronization therapy (CRT) or face challenges in lead implantation.

Methods and results: A retrospective analysis of clinical data was performed on 11 patients with dilated cardiomyopathy who were treated with LV endocardial pacing. Compared to conventional CRT, this procedure required longer operation and fluoroscopy times and higher radiation dose. Clinical improvements, as evidenced by at least one New York Heart Association class improvement, were achieved in 63.6% of the patients, with an average decrease in Minnesota Living with Heart Failure Questionnaire score of 33.8 ± 2.2 points (p < 0.05). However, complications and adverse events were noted in 3 patients (27.3%) one month postoperatively, including pocket hematomas in 3 patients (27.3%), a pocket infection in 1 patient (9.1%), and a thromboembolic event in 1 patient (9.1%). In addition, 3 patients (27.3%) had worsening HF after implantation. The estimated mortality rates at 1, 3, and 5 years post-implantation were 9.1%, 18.2%, and 27.3%, respectively.

Conclusions: Implanting the LV endocardial pacing lead at the latest activation site under 3D mapping guidance via transseptal puncture offers a viable alternative for patients eligible for CRT who face challenges with LV epicardial lead implantation due to anatomical issues or CRT non-response. However, this procedure is associated with a relatively high incidence of complications, requires careful patient selection, and may necessitate lifelong anticoagulation after implantation.

Background: Transcatheter aortic valve implantation (TAVI) is a treatment option for severe aortic stenosis; various factors have been associated with mortality after TAVI. The Atherogenic Index of Plasma (AIP) is calculated as the logarithmic ratio of triglycerides to high-density lipoprotein cholesterol (log [TG/HDL-C]), and it has been associated with multiple clinical conditions and might be a predictor of mortality in some populations. This study aimed to investigate the relationship between AIP and mortality at 1 and 5 years following TAVI.

Methods: This study included 448 consecutive patients who underwent TAVI. Based on their AIP values, they were divided into three groups. One- and 5-year mortality rates were analyzed using the Kaplan-Meier method, and factors influencing mortality were identified through Cox regression analysis.

Results: The overall 1-year cardiac mortality rate was 21%, and the 5-year mortality rate was 42%. For the high AIP group, both 1-year (29%; p = 0.02) and 5-year (57%; p = 0.05) mortality rates were significantly higher compared to the other groups. Kaplan-Meier analysis with the log-rank test demonstrated significantly lower event- free survival rates in the high AIP group at 1 year (p = 0.001) and 5 years (p = 0.005). Multivariable Cox regression revealed a 4.447-fold increased risk of mortality in the high AIP group (hazard ratio: 4.447, p = 0.01).

Conclusions: This study found a significant association between AIP and cardiac mortality in patients undergoing TAVI. Higher AIP levels were correlated with increased 1-year and 5-year mortality risks.

Objective: The relationship between accessory renal arteries (ARAs) and hypertension remains controversial. This study aimed to investigate the influence of ARAs on hypertension.

Methods: A retrospective analysis was conducted on 1,113 patients with essential hypertension. The patients were divided into ARA and non-ARA groups based on computed tomography angiography of renal arteries, and propensity score matching (PSM) was applied to balance baseline characteristics between the two groups.

Results: ARAs were present in 67.5% of the patients (751 in the ARA group, 362 in the non-ARA group). After PSM, each group included 362 patients with balanced baseline characteristics. No significant differences were observed between the groups in 24-hour mean blood pressure, echocardiographic measurements (including left atrial diameter, left ventricular end-diastolic diameter, interventricular septal thickness and left ventricular posterior wall thickness), and renal function indicators (including serum creatinine, blood uric acid and urinary microalbumin levels) after PSM. Moreover, among the patients screened after adequate drug washout, there were no differences in the levels of direct renin concentration and plasma aldosterone concentration between the two groups before and after PSM.

Conclusions: ARAs are a common anatomical variation of the renal vasculature and are unlikely to be major contributors to elevated blood pressure or more serious target organ damage in patients with essential hypertension.

Background: Electrocardiography (ECG) plays a pivotal role in diagnosing certain cardiac pathologies. Interpreters receive significant training in this area; however, an electrocardiogram must be performed correctly for accurate interpretation. It should also be recorded and interpreted swiftly. The aim of this study was to assess the level of technical knowledge regarding ECG performance among healthcare professionals.

Methods: The study was conducted between June 2023 and September 2023. A total of 243 participants, including nurses, doctors, and medical and nursing faculty students, were enrolled. The participants were asked 16 questions via a Google survey. The participants were statistically compared based on their professions and workplaces.

Results: The relationships between the descriptive characteristics of the participants and electrocardiography knowledge scores were not statistically significant in terms of age, gender, employment status, or duration of employment (p > 0.05). However, medical faculty students had significantly higher ECG knowledge scores compared to nurses (p < 0.01). Among the nurses, those working in surgical units had significantly lower scores than those working in internal medicine and pediatric units (p < 0.05).

Conclusions: In this study, 16 questions were used to evaluate ECG acquisition knowledge. The ECG knowledge scores of the participants ranged between 0-14 and the mean score was 6.95 ± 3.13, which is quite low for a simple and applicable test. A simple mistake or delay in performing an electrocardiogram can lead to catastrophic consequences. Although nurses are the primary personnel performing ECG, their technical knowledge in performing the procedure was not as proficient as doctors. Some areas of focus may lead to errors. Although research has consistently focused on interpreting ECG, we still do not know how to perform ECG properly. More emphasis should be placed on ECG training, with the potential for regular training throughout the year as needed. These simple and preventable errors can be more easily overcome with artificial intelligence-supported programs.