Acta cardiologica最新文献

Background: Nocturnal blood pressure dipping is crucial for cardiovascular health, but the effect of exercise on this phenomenon is not well understood. This study aims to investigate how a single session of aerobic exercise impacts nocturnal blood pressure dipping in individuals with hypertension who are on medication.

Methods: Twenty hypertensive adults (67 ± 16 years) participated in a randomised, parallel-group clinical trial. They were randomly assigned to either an exercise or control group. Resting blood pressure was measured after a 20-minute period of comfortable seating in a calm environment. The exercise group performed 40 min of treadmill running/walking at an intensity of 60-70% of their reserve heart rate. The control group remained seated for an equivalent period with reading allowed. Ambulatory blood pressure monitoring was used to measure blood pressure over 24 h. Nocturnal dip was calculated by comparing the mean wakefulness and sleep blood pressure values.

Results: No significant differences were observed between the exercise and control groups in systolic and diastolic blood pressure values at rest, during wakefulness, sleep, or over 24 h. The absolute nocturnal dip also showed no significant differences between the groups for systolic blood pressure (MD = 3.00 [95% CI: -4.77 to 10.77] p = 0.428) or diastolic blood pressure (MD = 4.60 [95% CI: -2.81 to 12.00] p = 0.208). Similarly, the relative nocturnal dip (percentage) did not differ significantly for systolic blood pressure (MD = 0.029 [95% CI: -0.039 to 0.837] p = 0.465) or diastolic blood pressure (MD = 0.047 [95% CI: -0.036 to 0.132] p = 0.250).

Conclusions: A single session of aerobic exercise does not impact the nocturnal dip in systolic and diastolic blood pressure in medication-controlled hypertensive individuals.

This case report discusses the management of a 75-year-old man who developed an unusual type of atypical atrial flutter following a previous pulmonary vein isolation for paroxysmal atrial fibrillation. Despite a second attempt to re-isolate the pulmonary veins and performing cavotricuspid isthmus ablation (which was suspected to be part of the arrythmia circuit), the flutter continued and was converted to sinus rhythm through electrical cardioversion. A few weeks later, the patient's atrial tachycardia relapsed. Initial ablation attempts at the coronary sinus ostium were unsuccessful due to incomplete assessment of the circuit, leading to another transseptal approach. Activation mapping identified a macroreentrant circuit around the site of the first transseptal puncture, which was successfully ablated. This report highlights the risk of macroreentrant atrial tachycardias developing at transseptal puncture sites and the difficulty of diagnosing 'pseudotypical' flutters, which may appear to originate from the cavotricuspid isthmus but are in fact passively activated. The report emphasises that electrophysiologists should be aware of these factors in similar cases, especially with the growing number of left atrial procedures requiring transseptal access.

Objective: Elevated systolic blood pressure and increased pulse pressure are closely associated with renal damage; however, the exact mechanism remains unclear. Therefore, we investigated the effects of increased pulse pressure on tubulointerstitial fibrosis and renal damage in elderly rats with isolated systolic hypertension (ISH). Additionally, the role of renal tubular epithelial-mesenchymal transition (EMT) and its upstream signalling pathways were elucidated.

Methods: Ten-month-old male rats were randomly divided into control and ISH groups, with seven rats in each group administered warfarin and vitamin K1 for 6 weeks. Blood pressure, renal function, mean blood flow in the common iliac artery, and diastolic vessel diameter were assessed, and the rat kidney medulla was collected for histological, genetic, and protein level analysis.

Results: Increased pulse pressure, abnormal renal function, and increased shear stress were detected in rats with ISH. Histology assessments revealed fibrosis in the interstitium of ISH rats. Epithelial marker E-cadherin protein expression was decreased, while the protein expression of interstitial markers α-SMA and Vimentin was increased, and transforming growth factor (TGF)-β1/Smad3 signalling was upregulated in the kidney tissue of ISH rats.

Conclusions: Increased pulse pressure in elderly rats with ISH caused an increase in shear stress. These effects led to the development of EMT and the activation of its upstream TGF-β1/Smad3 signalling pathway, ultimately leading to renal tubular interstitial fibrosis causing renal injury.

Background: Trans-radial coronary angiogram (TR-CAG) has gained popularity due to lower complication rates compared to transfemoral access. Operators can use either conventional catheters, such as Judkins, or single dedicated catheters, such as Tiger-II. This meta-analysis compared the safety and efficacy of Tiger-II versus Judkins catheters in TR-CAG.

Methods: We searched PubMed, Web of Science, Scopus, and Cochrane Library through February 2024 for studies comparing Tiger-II and Judkins catheters in TR-CAG. Fixed- and random-effect models pooled estimates of odds ratios (ORs) and standardised mean differences (SMDs). Primary outcomes included fluoroscopy time and contrast volume. Secondary outcomes included procedural time, radiation exposure, procedural success, radial artery vasospasm, and crossover rate.

Results: Seven studies with 2879 patients (1799 in Tiger-II and 1080 in Judkins) were included. Tiger-II use significantly reduced fluoroscopy time (SMD = -0.50 min, 95% CI [-0.80, -0.19], p < 0.01), procedural time (MD = -2.00 min, 95% CI [-2.35, -1.66], p < 0.01), and contrast volume (MD = -7.48 ml, 95% CI [-12.66, -2.29], p < 0.01). Radial artery spasm incidence was also lower (OR = 0.30, 95% CI [0.12, 0.75], p = 0.01). There were no significant differences in radiation exposure, procedural success, or crossover rate.

Conclusion: Tiger-II catheters offer reduced fluoroscopy time, procedural time, contrast volume, and radial artery spasm rates in TR-CAG.

Background: The implantable cardioverter-defibrillator (ICD) remains the cornerstone in the prevention of sudden cardiac death. Cost-effectiveness depends on survival after implantation. In Belgium there are unexplained major differences in 3-year mortality after ICD implantation. Centre volume and socio-economic differences might affect survival after implantation.

Methods: In total, 9647 patients underwent a first ICD implantation between February 2010 and 2016 in Belgium and were retrospectively compared for demographics, 30-day and 3-year mortality. Chi-squared and Mann-Whitney U tests were used to determine differences across centre volume.

Results: Low-volume centres treated patients with different characteristics and implanted more patients with ischaemic heart disease (50.2 vs 47.9%, p = 0.002), in primary prevention (66.7 vs 62.0%, p < 0.001) and with overall more comorbidities. Kaplan-Meier survival analysis showed a significant higher 3-year mortality in low-volume centres (16.3 vs 11.4%, p < 0.001). After adjudication with a multivariable Cox model, centre volume remained an independent predictor of 3-year mortality (low volume HR 1.300 [95% CI 1.124-1.504]. However similar 30-day mortality (0.6% in low vs 0.5% in high volume centres, p = 0.393) suggests that implantation related determinants alone are insufficient to explain the long-term survival difference. Socio-economic factors like regional average income (wealth) and overall survival (health) also were associated with the survival difference between low- and high-volume centres.

Conclusions: There exist large survival differences after ICD implantation between implanting centres in Belgium that cannot only be explained by a volume-outcome effect. Centres size and characteristics are inhomogeneous and vary according to different socio-economic variables. Some of these variables are also significantly associated with survival and warrant further investigation.