Acta Cardiologica Sinica最新文献

Background: Cardiac implantable electronic device (CIED) infection is a serious complication of CIED therapy and has been associated with increased morbidity, mortality, and healthcare costs. The use of an absorbable antibiotic-eluting envelope (TYRX^TM, Medtronic, Minneapolis, US) has been reported to reduce the risk of CIED infection without increasing the risk of additional complications. To investigate the real-world efficacy in Taiwanese patients, we retrospectively reviewed the outcomes of CIED patients with and without the use of an envelope.

Methods: A total 456 patients underwent CIED procedure from January 2022 to June 2023, including initial implantation, generator replacement, upgrade, or revision. There were 154 patients in the envelope group and 302 patients in the control group, all of whom received our standard infection prophylaxis care. Patient demographics and CIED complications during serial clinical follow-ups were analyzed.

Results: Both groups demonstrated comparable characteristics including age, sex, body mass index, CIED type, and left ventricular ejection fraction. More of the envelope group were receiving dialysis (Envelope vs. Control: 13.6% vs. 7.0%, p = 0.015), anticoagulant therapy (Envelope vs. Control: 35.7% vs. 27.5%, p = 0.048), and had a longer procedure time (Envelope vs. Control: 83.4 ± 40.3 vs. 70.4 ± 31.7 minutes, p = 0.0002). CIED-related infections occurred in none of the envelope patients and 4 of the control patients (0% vs. 1.3%, p = 0.19; Kaplan-Meier estimate 0% vs. 2.02%, hazard ratio: 0.24, 95% confidence interval: 0.03-2.03, p = 0.19). Two patients reported allergic reactions to the envelope.

Conclusions: The envelope group had a higher risk of CIED infections but similar infection rate , compared with the control group. However, the envelope group had a slightly longer procedure time and possibly an increased risk of allergic reaction.

Background: Patients in the coronary care unit (CCU) who undergo percutaneous coronary intervention (PCI) and receive dual antiplatelet treatment (DAPT) are at an increased risk of upper gastrointestinal bleeding (UGIB). The effectiveness of histamine-2 receptor antagonists (H2RAs) or proton pump inhibitors (PPIs) in preventing UGIB in this context remains uncertain.

Methods: This retrospective study enrolled 288 CCU patients undergoing DAPT after PCI, and the incidence of UGIB was assessed at specific timeframes: within 72 hours and beyond 72 hours post catheterization. Factors considered included patient histories, medication regimens (PPIs, H2RAs), and the absence of prophylactic UGIB medication.

Results: Within 72 hours, acute UGIB occurred in 8.3% of the patients, with a history of cerebrovascular accident and higher Killip grade identified as risk factors. Excluding the acute cases, the other patients received PPIs (n = 41), H2RAs (n = 57), or no prophylactic medication (n = 166). Delayed UGIB (> 72 hours) occurred in 4.9% of the patients, with chronic kidney disease and higher Killip grade identified as significant risk factors. UGIB rates in the PPI, H2RA, and non-prophylactic groups showed no significant difference (p = 0.264), and TriMatch analysis revealed consistent rates (7.5%, 7.5%, 5.0%) (p = 0.875).

Conclusions: No significant difference was found in the incidence of UGIB post PCI between the patients who did and did not receive prophylactic anti-ulcer medications. However, prophylactic medication and vigilant monitoring are suggested for high-risk UGIB patients within the critical CCU setting.

Introduction: Superficial femoral artery (SFA) stenosis is a common type of peripheral arterial disease. Percutaneous treatment has similar long amputation rates with open surgery. There are various predictors of worse outcomes in this patient group, such as chronic kidney disease and malnutrition. The NAPLES score (NPS) is simple scoring system which consists of four elements. We aimed to investigate the role of NPS in predicting long-term mortality in patients with SFA stenosis who underwent a percutaneous intervention.

Methods: A total of 567 patients who underwent percutaneous treatment for stenosis of the SFA from January 2012 to December 2020 were enrolled. The primary endpoint was mortality, and the secondary endpoints were in-hospital thrombosis, restenosis, residual stenosis and postintervention complications. The patients were divided into two groups: high NPS (3, 4) and low NPS (0, 1, 2). Each group was evaluated in terms of clinical, laboratory and technical aspects.

Results: The patients with high NPS had a higher rate of mortality (34% vs. 16.3%, p < 0.05), and shorter time to (17.2 ± 14.7 vs. 29.2 ± 19.3 months, p < 0.05). In multivariate analysis, after adjusting for confounding factors, age [hazard ratio (HR): 1.049, 95% confidence interval (CI): 1.025-1.073, p < 0.001], chronic kidney disease (HR: 1.994, 95% CI: 1.347-2.951, p = 0.001), Rutherford class 5-6 (HR: 1.839, 95% CI: 1.195-2.830, p = 0.006), high C-reactive protein values (HR: 1.004, 95% CI: 1.001-1.008, p = 0.022), and estimated higher NPS (HR: 1.748, 95.5 CI: 1.189-2.572, p = 0.005) were shown to be independent risk factors of mortality.

Conclusions: NPS is a simple scoring system that can be used to predict long-term mortality in this group. More strict control of risk factors is required in patients with a high NPS.

Background: Inflammation and malnutrition have negative effects on heart failure. The Naples Prognostic Score (NPS) is a new scoring system that incorporates these two parameters.

Objectives: Our aim was to investigate the relationship between the NPS and long-term mortality in patients with advanced-stage heart failure.

Methods: The study included 148 patients with advanced-stage heart failure. The patients were divided into two groups: those who died, and those who survived. Demographic, clinical, and laboratory characteristics of the groups were compared. The impact of NPS on mortality was examined.

Results: The patients were further classified into three groups according to NPS. The patients with NPS 3 had a higher mortality rate compared to those with NPS 1 and NPS 2 (died vs. survived respectively, NPS 3: 75% vs. 25%, NPS 1: 31.1% vs. 68.9%, NPS 2: 48.9% vs. 51.1%, p < 0.001). In multivariate regression analysis, NPS 3 was found to be an independent predictor [odds ratio: 0.13, 95% confidence interval (CI): 0.051-0.333; p = 0.0001]. Receiver operating characteristic analysis revealed that NPS had a sensitivity of 82% and specificity of 53% for mortality, with an area under curve of 0.699 (95% CI: 0.614-0.784, p = 0.0001). Kaplan-Meier survival analysis demonstrated a higher mortality rate in those with a high NPS (long-rank: 5.29, p = 0.021). In patients with advanced-stage heart failure, NPS may be considered a determinant of long-term mortality.

Conclusions: This study demonstrated an association between NPS and long-term mortality in patients with advanced-stage heart failure. NPS, indicating inflammation and nutritional status, can be utilized as a long-term prognostic indicator in patients with advanced-stage heart failure.

Purpose: Dilated cardiomyopathy (DCM) is considered a severe non-ischemic myocardial disease, and there is currently no effective method for the early detection of DCM. Therefore, we aimed to use machine learning algorithms to discover more accurate factors to guide clinical drug development and precision medicine diagnosis.

Methods: Two datasets containing patients with DCM and healthy controls were downloaded from the Gene Expression Omnibus database. After data preprocessing, differentially expressed genes (DEGs) between the DCM patients and normal samples were identified using the limma package. In addition, to screen for DEGs closely associated with immune inflammation, we collected immune-related genes and defined overlapping genes as differential immune genes (Immune-DEGs). Protein-protein interaction (PPI) network construction and functional enrichment analysis were then functionally validated for the differential immune genes. Subsequently, we further screened the immune-DEGs using the least absolute shrinkage and selection operator (LASSO) technique and support vector machine algorithm (SVM), resulting in the screening of five potential modulators closely associated with DCM. Finally, the diagnostic efficacy of the modifiers was assessed using subject operating characteristic curves based on independent external data, and the intrinsic pathological mechanisms of different differential immune genes were explored by immune infiltration analysis.

Results: A consensus of 184 differential immune genes were identified, and the functional enrichment results of their PPI network modules suggested that inflammation, immune disorders, and viral infections play an essential role in the pathogenesis of DCM. Five signature genes were then further screened using LASSO and SVM algorithms: KLRC4, CCL4, IGHV3-33, ITGAL, and inducible T-cell kinase.

Conclusions: This study constructed a gene set of potential DCM regulators with five immune-related genes, which could provide a new strategy for the diagnosis and treatment of DCM.

Background: Stroke remains a concern in patients with atrial fibrillation despite the efficacy of oral anticoagulants. Left atrial appendage closure has emerged as a treatment option for patients with suboptimal pharmacological therapy.

Objectives: This retrospective multicenter study aimed to evaluate the feasibility, safety, and outcomes of left atrial appendage occlusion procedures for two different indications. Short-term outcomes between two different methods of general anesthesia during the procedures were also compared.

Methods: The study included patients who underwent appendage closure between September 2017 and June 2021. Two indications for the procedures, anticoagulant intolerance, and anticoagulant inadequacy were recorded. One-year outcomes were analyzed between groups. Short-term outcomes were compared between the intravenous general anesthesia with high-flow nasal cannula oxygen therapy and intubated general anesthesia groups.

Results: A total of 75 consecutive patients were enrolled: 19 patients in the anticoagulant inadequacy group and 56 in the anticoagulant intolerance group. Appendage occlusion was effective in reducing stroke risk in atrial fibrillation patients with suboptimal pharmacological therapy. There were no significant differences in outcomes between the two indication groups. Appendage closure under high-flow nasal cannula oxygen therapy was found to be feasible and safe, with comparable results to intubated general anesthesia.

Conclusions: Appendage occlusion is effective and safe for Taiwan National Health Insurance-approved indications, with no difference between indication groups during 1-year of follow-up. Appendage occlusion under high-flow nasal cannula oxygen therapy is feasible and comparable to intubated general anesthesia. Larger randomized studies with longer follow-up are needed to confirm these findings.