Acta Cardiologica Sinica最新文献

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.

Background: The mechanisms underlying coronary artery disease (CAD), which is characterized by atherosclerotic plaque accumulation in the arteries, are still not fully understood. The role of serum fetuin-A level in the development of CAD and its effects on other risk factors are important research topics that have attracted increasing attention. The aim of this study was to evaluate serum fetuin-A level and the effects of nutritional status on serum fetuin-A concentration in CAD patients.

Methods: The study was carried out on 47 male participants (case group) who were newly diagnosed with CAD by conventional coronary angiography and 40 male participants without CAD (control group) aged between 35-75 years. Biochemical parameters, anthropometric measurements and three-day food records of all participants were recorded. In addition, Gensini and SYNTAX scores were calculated using angiography images to determine the extent and severity of CAD.

Results: Serum fetuin-A concentration in the case group was higher than that in the control group (p < 0.001). Waist circumference, hip circumference, waist/height ratio, Gensini and SYNTAX scores and serum fetuin-A levels in the participants in the case group were positively correlated (p < 0.05). In addition, there were negative correlations between serum fetuin-A concentration and dietary polyunsaturated fatty acids, omega-6 fatty acids, vitamin E, vitamin B₁, folate, potassium, and selenium intake in the participants in the case group (p < 0.05).

Conclusions: The results of the study indicate that high serum fetuin-A levels may be a risk factor for the development of CAD, and that nutritional status might affect serum fetuin-A level.

Prostate cancer (PC) is one of the leading causes of cancer-related deaths among men globally, and it frequently coexists with cardiovascular disease (CVD). With increasing cancer survival rates and an aging population, the incidence of CVD among PC patients is also on the rise. The treatments for PC include androgen deprivation therapy, androgen receptor pathway inhibitors, and docetaxel-based chemotherapy, and the cardiovascular complications include hypertension, metabolic syndrome, heart failure and arrhythmias. As it is important to provide personalized treatment planning and close monitoring, cardio-oncology collaboration plays a crucial role in optimizing treatment outcomes, emphasizing cardiovascular risk assessments and tailored treatment plans that balance cancer control and cardiovascular health. In this consensus statement, we review several important issues including the association between CVD and PC, screening for cardiovascular diseases and risk factors, timing and criteria for cardiology referral, cardiovascular risk assessments and management, and multidisciplinary collaboration and patient education. However, challenges remain in screening and preventive measures, and future research should focus on developing robust cardiovascular risk assessment tools, preventive measures, and interdisciplinary approaches to improve patient outcomes and reduce cardiovascular morbidity in patients being treated for PC.