Acta cardiologica最新文献

Background: Severe mitral stenosis (MS) leads to morphological and functional changes in the left atrium (LA) causing dysfunction. Relieving mitral obstruction improves the LA mechanics and structural remodelling. However, this is not taken as a measure of successful Ballon Mitral Valvotomy (BMV) in clinical practice.

Methods: We studied the relationship between LA strain and severe MS and the short-term effect of BMV on LA mechanics in a prospective observational single-centre study.

Results: Peak atrial longitudinal strain (PALS) was impaired in patients (n = 40) with severe MS and improved 24 h following BMV (11.93 ± 3.29% vs 14.96 ± 3.59%, p < 0.001). There was a significant decrease in transmitral gradient (12.0 ± 4 mmHg vs 3.2 ± 1.6 mmHg, p < 0.001) and systolic pulmonary artery pressure (sPAP) (42.0 ± 8 mmHg vs 40.0 ± 4.8 mmHg, p < 0.001) after the procedure. Mitral valve area (1.03 ± 0.27 cm² vs 1.81 ± 0.31 cm², p < 0.001) significantly increased after the procedure. Peak atrial longitudinal strain failed to predict the success of the procedure as (AUC: 0.53; 95% CI, 0.32-0.75, p = 0.791). A cut-off value of 11.42% demonstrated a sensitivity of 64.7% and specificity of 66.7%. (R = 0.33; 95% CI 0.09, 0.6, p = 0.038).

Conclusion: Peak atrial longitudinal strain shows a significant improvement following a successful BMV. This increase in values reflects an improvement in clinical status and function class in follow-up. While PALS offers promise, it has limitations. Therefore, it seems reasonable to consider PALS as a supportive indicator alongside established markers like MV area and pressure gradient for assessing procedural success.

Background: The cardiometabolic index (CMI) combines abdominal obesity and abnormal blood lipid indices, representing a good predictive indicator of risk in cardiovascular diseases (CVDs). However, the association between CMI and myocardial infarction (MI) is not clear.

Objective: The present project was designed to explore the linkage between CMI and MI.

Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 2005-2018 were employed in this project, with CMI as the independent variable and MI as the dependent variable. Weighted logistic regression was applied in the association analysis between CMI and MI. Restricted cubic spline (RCS), subgroup analysis, and interaction tests were employed to elucidate the non-linear relationship and stability of CMI and MI's link. Moreover, to verify the robustness of the results, sensitivity analysis was conducted, with the MI status of subjects taking lipid-lowering drugs as the outcome variable.

Results: A total of 13,923 participants were gathered in this project, with 605 cases of MI, accounting for 3.5%. In the weighted logistic regression model, a positive linkage was observed between CMI and the risk of MI (OR: 1.41, 95% CI: 1.18-1.68, p < 0.001). The RCS curves indicated a linear relationship between CMI and MI (P-non-linear = 0.146). Subgroup analysis manifested that CMI was positively linked with MI risk in males, individuals with BMI > 30kg/m², and alcohol drinkers (p < 0.05). In addition, the interaction results demonstrated that there was no heterogeneity in the association between CMI and MI risk in the subgroups (p > 0.05). The sensitivity analysis showed that after adjusting for all confounding factors in the model, there was still a significant positive correlation (p < 0.01) between CMI and MI in the population taking lipid-lowering drugs.

Conclusion: There is a significant positive linkage of CMI with MI risk, which is particularly significant in males, those with a BMI greater than 30 kg/m², and those who have drinking habits. Even after considering the impact of lipid-lowering drug therapy, the positive correlation between CMI and MI remains robust, supporting CMI as a promising tool for assessing MI risk and guiding clinical prevention. Further research is required to probe into the application of CMI in different populations and its role in the prevention of CVDs.

Objective: We aimed to examine the correlation between the platelet-to-lymphocyte ratio (PLR) and coronary artery lesions (CALs) in individuals diagnosed with Kawasaki disease (KD) and to evaluate its prognostic significance.

Methods: Our study entailed a detailed retrospective examination and analysis of clinical records for patients diagnosed with KD at the First Affiliated Hospital of Anhui Medical University from January 2017 to January 2023. In our methodological approach, we applied various statistical techniques - including univariate analyses, binary logistic regression, and receiver operating characteristic (ROC) curve analysis - to meticulously assess the relationship between the PLR and the incidence of CALs in this patient cohort. Our objective was to elucidate potential predictive markers for CALs development in KD patients, thereby contributing valuable insights into the prognosis and management of this condition.

Results: In the conducted research, a total of 364 patients were analysed, among which 63 individuals (17.3%) exhibited CALs upon admission. Through the application of binary logistic regression analysis, our findings underscored PLR as a statistically significant predictor for the presence of CALs. Furthermore, the ROC curve analysis demonstrated an AUC (area under the curve) value of 0.707 (95%CI 0.641-0.772, p < .001) for the prognostic capacity of PLR concerning CALs.

Conclusions: The outcomes of our investigation indicate that PLR acts as a significant risk indicator for CALs. Such insights pave the way for improved risk stratification and potentially guide therapeutic decision-making in patients with KD.

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.

Introduction: Determining the normal diameter of the abdominal aorta in different populations and its relationship with other demographic factors is crucial for diagnosing and managing abdominal aortic diseases. This study aimed to assess the size of the abdominal aorta in a healthy Iranian population.

Methods: This cross-sectional study included healthy individuals. Various variables including age, sex, height, and weight were measured as part of this study. We performed an echocardiographic evaluation to assess the aortic sections.

Results: The study encompassed 167 participants, predominantly women (67.7%). Notable differences in sizes of the ascending aorta, aortic arch, sinus of Valsalva, and abdominal aorta were observed across the four age groups. Men exhibited greater sizes in multiple aortic sections within the 45-64 age group. Correlation and regression analyses demonstrated significant positive relationships between abdominal aorta size and various aortic dimensions, with a one-millimeter increase in ascending or descending aorta diameter corresponding to a 0.23 and 0.35 mm increase, respectively, in abdominal aorta diameter. The relationship between abdominal aorta size and demographic factors such as gender, age, weight, BSA, and SBP was explored, revealing age as a significant predictor.

Conclusions: We observed significant differences in the sizes of distinct aortic sections across different age groups, underscoring the importance of considering age-related changes when evaluating aortic characteristics. These findings contribute to our understanding of the structural changes that occur in the aorta over time. Echocardiographic screening of the abdominal aorta would enable echocardiologists to diagnose the aneurysmal aorta.

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.