Acta cardiologica最新文献

In modern oncology, despite the efficacy of chemotherapy, there is a risk of cardiotoxicity resulting in heart failure. This necessitates early diagnosis to prevent complications and improve prognosis. The study is aimed at analysing the abilities of speckle-tracking echocardiography as a modern tool in detecting cardiotoxicity in the early stages. This non-invasive method allows evaluating myocardial strain and its contractility. During a thorough analysis and extensive review of the scientific literature, it was found that the speckle-tracking echocardiography technique demonstrates an exceptionally high sensitivity to detecting early signs of cardiotoxicity, significantly outpacing conventional echocardiography methods in this aspect. This advantage makes it an invaluable tool in the early detection of potentially dangerous changes in the myocardium, which is especially important for patients at risk of developing cardiotoxic reactions as a result of chemotherapy. Speckle-tracking echocardiography has a unique ability to identify even the slightest local abnormalities in the structure and function of the myocardium, significantly before any clinical symptoms become apparent, thereby allowing doctors to take preventive measures at the earliest stages. This outstanding diagnostic ability is supported by an extensive body of scientific research and publications that unequivocally confirm the effectiveness of speckle-tracking echocardiography as an advanced tool for the early diagnosis of cardiotoxic changes. Thus, the timely application of this technique can significantly reduce the risks to the cardiac health of patients and contribute to more effective treatment of oncological diseases. Speckle-tracking echocardiography serves as an important tool in the early detection of cardiotoxicity in patients undergoing chemotherapy, allowing clinicians to timely adapt treatment protocols and prevent the development of serious cardiovascular complications, thereby improving the prognosis and quality of life of cancer patients.

Background: TTE is the main modality used to assess RV function, but conventional TTE parameters have limited diagnostic value because they may fail to detect early abnormalities in RV systolic function. Due to its ability to detect subclinical impairment of cardiac function, 2D STE has been widely used to investigate RV function. In this study, we aimed to investigate whether there are sequelae of RV function in recovered COVID-19 patients with pulmonary involvement.

Methods: This is a prospective observational cohort study of 57 healthy volunteers and 54 patients. Participants had no history of chronic illness and no evidence of respiratory or cardiac symptoms. The patients had been hospitalised with COVID-19 with pulmonary involvement but did not require intensive care unit follow-up or non-invasive mechanical ventilation support. TTE was performed. Demographic and clinical characteristics and laboratory test results were collected.

Results: LVEF, TAPSE, St and FAC were significantly lower in the patient group. LV-LS 3-chamber, LV-GLS, RV-FWS, RV-GLS were significantly lower in the patient group.

Conclusions: RV-LS and LV-GLS were shown to decrease in the patient group. Although no obvious pathological values were observed in RV parameters on conventional echocardiography, TAPSE, St and FAC values were lower in the patient group.

İntroduction: The pathophysiology of heart failure with preserved ejection fraction has not been clearly elucidated. Therefore, there is not enough information about the prediction of poor prognosis in these patients. Our aim is to investigate whether the pulmonary artery pulsatile index, derived from right heart catheterisation parameters, is associated with mortality in these patients.

Materials and methods: The study was designed retrospectively. Patients who underwent right heart catheterisation between 2016 and 2023 and were diagnosed with heart failure with preserved ejection fraction were included in the study. The patients were divided into 2 groups. Dead patients were included in the first group, and surviving patients were included in the second group. Basic characteristics, right heart catheterisation results, pre-catheter blood and echocardiography parameters, and pulmonary artery pulsatile index were compared between both groups.

Results: Pulmonary artery pulsatile index, mean pulmonary artery pressure, and body mass index were found to be independent predictors of mortality in heart failure patients with preserved ejection fraction. A PAPi value of <2.84 was found to have 76.2% sensitivity and 77% specificity in predicting mortality in heart failure patients with preserved ejection fraction.

Conclusion: This study shows how important the pulmonary artery pulsatile index is in predicting mortality in heart failure patients with preserved ejection fraction. Since low levels of pulmonary artery pulsatile index at the time of diagnosis may predict poor prognosis, importance should be given to follow-up and treatment in these patients. Routine use of this index may contribute to reducing mortality and morbidity in patients.

Background: In Ecuador, there are few data about the clinical behaviour of heart failure (HF). This study aims to analyse the clinical characteristics, treatment and prognosis according to the current classification based on left ventricular ejection fraction (EF).

Methods: A retrospective observational study was carried out in patients with chronic HF from the 'Los Ceibos' registry during the period January 2017-December 2022. Patients were classified into HF with preserved EF (HFpEF) [EF ≥ 50%], HF with mildly reduced EF (HFmrEF) [EF:41-49%], and HF with reduced (HFrEF) [EF ≤ 40%]. The patients were followed up for a mean time of 2.28 (IQR 1.25-3.49) years.

Results: A total of 711 patients were included, 333 (46.8%) with HFrEF, 109 patients (15.3%) with HFmrEF and 269 patients (37.8%) with HFpEF. The average age was 69.8 ± 13.1 years, 31.4% were women. The main comorbidity was arterial hypertension (92.7%). Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were used in 74.5%, beta-blockers in 82.3%, and mineralocorticoid receptor antagonists in 51.3%. 58.3% of patients with HFrEF received three drugs of the so-called foundational quadruple therapy. A lower all-cause (24.5%) and cardiovascular mortality rate (11,2%) was observed in the HFpEF group compared to HFmrEF (47.4% and 25,7%) and HFrEF (45.3% and 25,8%), p < 0.001.

Conclusions: In the 'Los Ceibos' registry, a higher prevalence of HFrEF was observed. The main comorbidity was HTN. Half of the patients with HFrEF received three drugs of the foundational therapy. At four years of follow-up, lower all-cause and cardiovascular mortality rate was observed in the HFpEF group.

Introduction: Heart failure (HF) is one of the leading causes of morbidity and mortality worldwide. This study aimed to assess the impact of sex on sociodemographic, clinical, and laboratory parameters in patients with HF who were included in the Colombian Heart Failure Registry (RECOLFACA).

Methods: This was a cross-sectional analytical research. All 2528 patients included in RECOLFACA were analysed. The Mann-Whitney U test was used to compare median values as well as first and third quartiles (Q1-Q3). The age-related trend of NT-proBNP levels for both men and women groups was statistically evaluated.

Results: The study included 2528 patients with HF (1072 women and 1456 men). The echocardiographic evidence showed that men presented reduced left ventricular ejection fraction (LVEF) (79.63 vs. 69.75%, respectively; p < 0.001) more often than women, which had a significantly higher proportion of preserved LVEF (20.46 vs.11.24%, respectively; p < 0.001). Women displayed a higher value of systolic blood pressure (p < 0.001) and heart rate (p = 0.014) compared to men. Haemoglobin, creatinine, and sodium levels were significantly higher in men. Men had a considerably lower glomerular filtration rate value, with the median reaching a G3a value for chronic renal failure. According to age, the levels of NT-proBNP in each sex increased equivalently with age.

Conclusion: Sex differences presented in this study are comparable to those discovered in other nations. However, certain variations show that these sex differences may differ by geographical area, which should encourage further investigations to describe them.

Background: Sarcopenia is a progressive age-related skeletal muscle disease associated with adverse outcomes in those with cardiovascular disease. In this study, the prevalence of sarcopenia and its effect on clinical outcomes in heart failure with mildly reduced ejection fraction (HFmrEF) patients were examined.

Methods: A total of 722 patients from three centres who applied to the outpatient clinic with the diagnosis of HFmrEF between 01 January 2020 and 01 June 2021 were included in the study retrospectively. Sarcopenia was diagnosed with a screening test using age, grip srength and calf circumference. At least two-year follow-up results were reviewed from the date the patients were included in the study.

Results: Of the 722 HFmrEF patients, 169 (23.4%) were sarcopenic. During the follow-up of sarcopenic patients, a higher rate of hospitalisation and two-year mortality was detected compared to the non-sarcopenic group (49.7% vs 33.3%, p < .001 and 23.7% vs 13.2%, p = .001, respectively). Additionally, atrial fibrillation (AF), chronic obstructive pulmonary disease (COPD), chronic renal failure (CRF) and smoking were detected at higher rates in sarcopenic patients. In subgroup analysis, AF was found to be significantly higher in overweight/obese sarcopenia patients compared to other groups. According to Receiver operating characteristic (ROC) analysis, the sarcopenia score cut-off of 73.61 predicted mortality with 65% sensitivity and 63% specificity, and the cut-off level of 71.10 predicted hospitalisation with 68% sensitivity and 69% specificity.

Conclusion: In HFmrEF patients, sarcopenia is associated with adverse events and is an important prognostic marker.

Background: In 2015, more than 11 million patients treated for arterial hypertension in France. According to several studies in the general population, about 50% of hypertensive subjects are treated and about 20% are treated and controlled. There is very few data in general medicine. Our work has studied how hypertension control may have differed in general medicine.

Methods: A cross-sectional observational study was carried out in a rural health centre (Domfront, Normandy, France) on subjects aged 40 to 65 years in 2018. A subject was considered to be hypertensive if his blood pressure (taken in the office in routine care) was greater than 140/90 or if it was treated with antihypertensive drugs.

Outcomes: Of 1,925 subjects, there were 54.3% women, aged 54.6 ± 7.1 years. The mean blood pressure was 127 ± 13/76 ± 8 mmHg, 60.6% (682/1,127) were overweight and 5.0% (96/1,925) were diabetic. 646 (33.6%) were hypertensive and 410 hypertensive (63.5%) were treated. 39.0% (252/646) were treated and controlled.

Discussion: In general medicine, blood pressure control seems to be better than in the general population, whereas the general practitioner is often the first contact with the healthcare system. Poor blood pressure control in the general population can be explained by the lack of general medicine consultation for untreated hypertensive subjects. A systematic annual consultation in general practice could be proposed for this specific population.