Acta cardiologica最新文献

Background: This study aimed to evaluate the association between peak tricuspid regurgitation velocity (TRV) and 1-year heart failure (HF) readmission in hospitalised patients with HF with preserved ejection fraction (HFpEF) because the impact of peak TRV on the short-term prognosis of these patients has been unclear.

Methods: From January 2020 to December 2021, 513 hospitalised HFpEF patients age ≥ 60 years with 1-year follow-up were included in this study. Peak TRV was classified as normal (≤ 2.8 m/s) and high (> 2.8 m/s) value according to pulmonary hypertension probability.

Results: Approximately 68.23% of HFpEF patients had a high peak TRV value. In the final adjusted Cox regression model, peak TRV was still independently associated with HF readmission (HR: 1.74, 95% CI: 1.19-2.55, p = 0.004). Furthermore, patients with high peak TRV were also associated with an increased risk of HF readmission (HR: 2.30, 95% CI: 1.31-4.04, p = 0.004), compared to those with normal peak TRV. After inverse probability of weighting, the risk of HF readmission in patients with high peak TRV was 2.53 (95% CI: 1.35-4.75, p = 0.004) compared to those with normal peak TRV. Additionally, Subgroup analysis revealed very elderly patients, male, and patients with hypertension had a significantly worse prognosis.

Conclusion: Peak TRV is independently associated with HF readmission in hospitalised HFpEF patients. High peak TRV has a higher risk of HF readmission in patients age ≥ 80 years, male and patients with hypertension, indicating that special attention should be paid to these patients.

Background: Patients with chronic kidney disease (CKD) undergoing maintenance haemodialysis (MHD) develop several abnormalities of left ventricular (LV) structure and function. Speckle-tracking echocardiography permits compressive assessment of LV myocardial deformation. Previous studies involving CKD patients have shown a significant reduction in LV global longitudinal strain (GLS) with strong prognostic implications. However, the other components of LV deformation have not been fully elucidated.

Methods: A total of 90 CKD patients undergoing MHD (mean age 41.3 ± 12.5 years, 80% men) were compared with 45 apparently healthy age- and gender-matched controls.

Results: The CKD patients had a high prevalence (77.8% patients) of LV hypertrophy. They also had a significantly elevated ratio of early diastolic mitral inflow velocity to annular velocity (12.1 ± 4.6 vs. 7.1 ± 1.5, p < .001) indicating a high prevalence of LV diastolic dysfunction. LV ejection fraction (LVEF) was the same between the two groups, but the CKD patients had significantly impaired LVGLS (-17.8 ± 3.9 vs. -20.8 ± 2.6, p < .001), global circumferential strain (-14.0 ± 3.5 vs. -16.1 ± 3.4, p = .001), LV apical rotation (6.6 ± 4.7° vs. 8.8 ± 4.0°, p = .008) and LV twist (12.8 ± 6.1° vs. 15.0 ± 6.0°, p = .037). There was no difference in the global radial strain between the two groups.

Conclusions: The present study shows that CKD patients on MHD have significantly impaired LV longitudinal and circumferential mechanics despite preserved LVEF. The prognostic implications of reduced LVGLS have already been demonstrated previously. Future studies are needed to assess the prognostic implications of abnormal LV circumferential mechanics as well as their reversibility following renal transplant.

Background: Type 2 diabetes mellitus (T2DM) is a primary contributor to coronary artery disease (CAD). Insulin resistance (IR) is a hallmark of T2DM and a significant risk factor for the progression of CAD. The triglyceride-glucose (TyG) index is a new alternative indicator to identify IR. We aimed to explore the association between the TyG index and severity of CAD in patients with T2DM.

Methods: 280 inpatients with T2DM were enrolled from November 2019 to November 2022, classified into the CAD group (n = 175) and non-CAD group (n = 105). The TyG index and SYNTAX score were calculated. According to SYNTAX score, patients were further classified into the mid-CAD group (n = 97) and moderate to severe CAD group (n = 78).

Results: A significant positive correlation between the TyG index and SYNTAX score was found in the CAD group (r = 0.70, p < 0.01). The TyG index predicted the presence of moderate to severe CAD significantly, and the area under the ROC curve was 0.79 (95% CI: 0.71-0.85, p < 0.01). The higher LDL-C and TyG index, the higher risk of developing moderate to severe CAD (OR = 4.40, 95% CI 1.28 - 15.16, p = 0.02; OR = 9.00, 95% CI 3.69 - 21.96, p < 0.01).

Conclusions: There was a significantly positive correlation between the TyG index and SYNTAX score in T2DM patients who developed CAD; the TyG index could predict a mid/high SYNTAX score (≥ 23) and increase the risk of moderate to severe CAD.

Atrial fibrillation is a chronic progressive disease and is the most common arrhythmia in adults. It is a major cause of cardiovascular morbidity and mortality. The EAST-AFNET 4 trial demonstrated that rhythm control in patients with early atrial fibrillation significantly reduces cardiovascular outcomes compared to usual care. The effectiveness of early rhythm control is predominantly mediated by the presence of sinus rhythm and early rhythm control is more effective in patients with multiple comorbidities. Studies such as STOP-AF First, Cryo-FIRST, EARLY-AF and its 3-year follow-up trial demonstrate that first-line catheter ablation is more effective in maintaining sinus rhythm than anti-arrhythmic drug therapy. These findings are leading to a paradigm shift in the electrophysiology community in favour of early rhythm control with catheter ablation when feasible.

Paravalvular leaks (PVL) following mitral valve replacement occur in 7% to 17% of cases, with 1% to 5% being clinically significant. Although surgical repair is often recommended, transcatheter PVL closures have shown positive outcomes with fewer complications. This case report discusses a patient with a severe paravalvular leak after aortic and mitral valve replacement treated via a transapical approach, evaluating outcomes and potential complications.

Pulmonary arterial hypertension (PAH) is a rare disease affecting the small pulmonary vessels, ultimately leading to right ventricular failure and death. Current treatment options target three different pathways (endothelin, nitric oxide/cGMP and prostacyclin pathways). Despite their demonstrated efficacy, these therapies (commonly used in combination) do not cure the disease which is why novel pathways beyond the traditional 'big three' are being developed. Sotatercept is a ligand trap for multiple proteins within the TGF-β superfamily that was recently approved in the US for the treatment of PAH. Unlike currently available therapies, sotatercept has the potential to act as an anti-remodelling agent rather than a vasodilator. The safety and efficacy of subcutaneous (SC) sotatercept have been established in two multicentre, placebo-controlled randomised-controlled trials. The compound has been shown to consistently improve a variety of measurable endpoints, including exercise capacity, haemodynamics, quality of life and delay of clinical worsening. The drug appears to have an acceptable safety profile, although it is associated with an increased risk in developing telangiectasia and biological changes affecting platelet counts and haemoglobin. This study reviews the current evidence on SC sotatercept and provides a Belgian perspective on its place in the future treatment strategy for PAH.