Acta Cardiologica Sinica最新文献

Atrial fibrillation (AF) is the most common form of cardiac arrhythmia in the elderly population with a high lifetime risk after the age of 45 years, leading to a major impact on the public health from elicited left atrial (LA) thrombogenesis and cardioembolic stroke. Imaging in the AF population plays a crucial role, not only in assessing LA size but also in delineating the underlying cardiac structural and functional features to reach a more specific diagnosis. Contemporary clinical practice guideline recommended anticoagulation therapy based on annual thromboembolic event risk using a validated clinical risk score. However, patients who remain uncertain about the anticoagulation may benefit from considering other risk variables or markers, such as bedside atrial imaging, to help inform the clinical decision. In this regard, imaging in the diagnosis, potential etiology and thromboembolic risks of AF can facilitate decisions about anticoagulation therapy among patients at an intermediate annual risk. Additionally, the implementation of advanced imaging for catheter-based interventions, such as catheter ablation, further provides pivotal anatomical and pathophysiological insights during procedures and assists in monitoring after therapeutic delivery. Our current consensus offers an overview highlighting the evolution, strengths, and advances of these imaging techniques and tools, whether using invasive or non-invasive modalities, and their potential to supplement precision medicine in the context of AF.

According to current scientific consensus, the definitive treatment for cardiac implantable electronic device (CIED)-related infection is complete removal of the device with adjunctive antibiotic therapy. However, this approach carries the risk of major complications and mortality during or after lead extraction. Conservative treatment with continuous, in situ targeted, ultrahigh-concentration antibiotics (CITAs) to treat localized CIED infection has been shown to have a high success rate without major complications in high-risk patients. Herein, we describe the details of CITA treatment and our experience with four patients, three of whom successfully avoided the need for lead extraction. CITAs represent a promising alternative approach to lead extraction in patients with localized CIED infections. However, further prospective studies are necessary to definitively establish its effectiveness and potentially modify current consensus recommendations.

Background: This research sought to assess the role of calprotectin as a biomarker in patients with pulmonary embolism (PE) and to explore its correlation with established biomarkers such as D-dimer, troponin, and pro brain natriuretic peptide (BNP). In addition, we examined the correlation between calprotectin level and right ventricular (RV) function in patients with PE.

Methods: This prospective study was conducted between January 2022 and December 2023 and included 58 patients diagnosed with acute PE and 31 age- and sex-matched controls. Calprotectin level, renal function, hematological parameters, demographic characteristics, and echocardiographic parameters were recorded. For the PE patients, additional data on troponin, D-dimer, high-sensitivity troponin T (hs-troponin T), blood gas analysis, and Pulmonary Embolism Severity Index scores were also collected.

Results: The patients with PE had significantly higher calprotectin, urea, creatinine and leukocyte levels compared to the controls, as well as lower platelet count (p < 0.001). A calprotectin cut-off level of 1.555 mcg/ml could predict PE with 73% sensitivity and 62% specificity in receiver operating characteristic curve analysis. Elevated calprotectin levels were associated with worse RV function, as evidenced by lower tricuspid annular plane systolic excursion and right ventricular systolic myocardial velocity measurements. Correlation analysis revealed that calprotectin levels were inversely related to tricuspid annular plane systolic excursion (r = -0.315, p = 0.016) and RV systolic myocardial velocity (r = -0.290, p = 0.027). While calprotectin was not correlated with D-dimer or hs-troponin T, it had a weak correlation with proBNP (r = 0.271, p = 0.04).

Conclusions: This study emphasizes the potential of calprotectin as a valuable biomarker in PE, providing additional insights into RV dysfunction. Although further research is needed to fully establish its clinical utility, calprotectin, which was weakly correlated with proBNP in this study, could complement existing biomarkers such as proBNP and hs-troponin T in the evaluation and management of PE.

Background: The treatment of ST-elevation myocardial infarction (STEMI) has significantly advanced with the introduction of primary percutaneous coronary intervention (PCI). While primary PCI with drug-eluting stents is widely accepted as the standard treatment, concerns regarding in-stent restenosis and stent thrombosis persist. Drug-coated balloons (DCBs) offer a promising alternative, delivering antiproliferative drugs directly to the vessel walls without leaving any metal behind.

Methods: This clinical registry evaluated the clinical safety and efficacy of the Selution SLR^TM DCB in 36 STEMI patients who underwent primary PCI with Selution SLR^TM DCBs between July 2021 and April 2023 in a tertiary center in Singapore. Immediate angiographic outcomes, procedural details and 12-month clinical outcomes were analyzed.

Results: The mean age of the patients was 56.6 years with male predominance (86.1%). Most patients presented with inferior STEMI (61.1%) and received Selution SLR^TM DCBs primarily in the left circumflex artery (41.7%). No patients required bailout stenting, and most achieved significant luminal gain with < 30% residual stenosis post-PCI. At 12 months, the mortality rate was 11.1%, 5.4% of the patients required target lesion revascularization, and 5.4% had angina.

Conclusions: Our preliminary findings showed that the Selution SLR^TM DCB was safe and effective in primary PCI with low rates of adverse events at 12 months. Further research, including randomized controlled trials, is warranted to corroborate these findings and evaluate long-term outcomes.

Background: To investigate the clinical impact of early sacubitril/valsartan initiation on clinical outcomes and left ventricular reverse remodeling in patients with newly diagnosed heart failure with reduced ejection fraction (HFrEF).

Methods: Patients with newly diagnosed HFrEF and prescriptions for sacubitril/valsartan were identified from a multi-institutional database in Taiwan from 2016 to 2020. The patients were categorized as early users if they initiated sacubitril/valsartan within 6 months of the initial diagnosis, and late users if they initiated sacubitril/valsartan 6 months or more after the diagnosis. Clinical outcomes and changes in left ventricular ejection fraction (LVEF) assessed by echocardiography were compared between the early and late users after inverse probability of treatment weighting (IPTW) adjustment.

Results: Among the 410 enrolled patients, 188 were early users and 222 were late users. The early users were younger and had a lower LVEF, while the late users had higher rates of hypertension, diabetes, dyslipidemia, and chronic kidney disease. After IPTW, the two groups had similar baseline characteristics. There were no significant differences in the incidence rates of all-cause death, cardiovascular death, and heart failure hospitalization before and after IPTW. However, post-IPTW, the early user group had a lower risk of cumulative emergency department visits (hazard ratio: 0.84, 95% confidence interval: 0.71-0.99; p = 0.0353). Both groups demonstrated reverse remodeling, with an increase in LVEF from 28.7% to 45.3% in the early users, and from 28.9% to 40.1% in the late users, which was significantly more prominent in the early users (p < 0.0001).

Conclusions: In patients with newly-diagnosed HFrEF, the early initiation of sacubitril/valsartan was associated with a lower risk of the cumulative number of emergency visits and a greater improvement in LVEF.