Acta cardiologica最新文献

Background: Heterozygous familial hypercholesterolaemia (HeFH) confers a high risk of cardiovascular disease (CVD) due to elevated levels of LDL-cholesterol (LDL-C). The aim of this study is to assess the influence of clinical and genetic factors on coronary artery calcium (CAC) score in patients with HeFH.

Methods: CAC score were obtained for 129 genetically confirmed HeFH patients from NAGENCOL project, who had no CVD. Association of CAC with clinical and genetic variables as well as with the SAFEHEART-risk equation (SAFEHEART-RE) was evaluated.

Results: 65 patients had CAC = 0 (50.4%), 24 had CAC score between 1 and 99 (18.6%), and 40 had a score of ≥100 (31%). Individuals with a CAC score ≥100 were older (56.5 years vs. 39 years for those with a CAC score of 0, p < 0.001). They also had a higher prevalence of classical risk factors and history of CAD in the family. In addition, this group had higher maximum LDL-C levels (308.8 mg/dL vs. 262.5 mg/dL, p < 0.001), higher age at genetic diagnosis (45 years vs. 31.3, p < 0.001) and at the beginning of Treatment (34.5 years vs. 26.6, p = 0.002). Consequently, the cumulative LDL-C throughout their life was higher (13745.3 mg/dL vs. 8693.2 mg/dL, p < 0.001). There was a correlation between the results of the SAFEHEART-RE and CAC score.

Conclusions: Early diagnosis and early initiation of appropriate treatment are essential for reducing the accumulated cholesterol burden in patients with HeFH. Given the heterogeneity in CVD in patients with HeFH, tools such as the SAFEHEART-RE and CAC score may be useful for better risk stratification.

Background: It is well known that soluble suppression of tumorigenicity 2 (sST2) predicts heart failure outcomes. Little attention has been paid to its use in atrial fibrillation (AF). We investigated whether sST2 is involved in AF formation and recurrence after catheter ablation.

Methods: A systematic review and meta-analysis study was completed. Until the end of November 2023, the potential articles from Cochrane, OpenMD, PubMed, and ScienceDirect were collected. The assessment of study quality was conducted using the Newcastle-Ottawa scale (NOS). All relevant data from eligible studies were extracted. A random effect model was used for the pooled analysis.

Results: A total of 14582 participants from 19 studies were involved in this study. The sST2 level was greater in individuals with AF than those with sinus rhythm (standardised mean difference [SMD] = 0.45; 95% confidence interval [CI] = 0.29 to 0.61; p < 0.01). Elevated sST2 levels were correlated with an increased likelihood of developing AF (hazard ratio [HR] = 1.07; 95% CI = 1.00 to 1.14; p = 0.04). A higher sST2 level was found in individuals with recurrent AF (SMD = 0.78; 95% CI = 0.32 to 1.23; p < 0.01). An elevated level of sST2 was related to a greater recurrent AF risk (HR = 1.17; 95% CI = 1.04 to 1.32; p = 0.01).

Conclusions: The circulating biomarker sST2 has an essential role in AF development. Moreover, sT2 is a significant predictor for recurrent AF after a successful catheter ablation procedure.

Background: The predictive role of right ventricular dysfunction (RVD) in patients with functional mitral regurgitation (FMR) undergoing transcatheter edge-to-edge repair (TEER), as well as RV remodelling following the procedure, remains uncertain. We evaluated the prognostic impact of pre-procedural three-dimensional (3D) right ventricular ejection fraction (RVEF) in patients with FMR. Additionally, we assessed the RV reverse remodelling (RVRR) based on 3D volumes and ejection fraction six months after the procedure.

Methods: Data from 74 patients treated with TEER for FMR were prospectively collected. Pre-procedural RVD, defined as 3D RVEF ≤45%, was observed in 47 patients (63.5%). Patients were divided into three groups according to pre-procedural 3D-RVEF: no RVD (No-RVD, RVEF >45%, n = 27), mild-to-moderate RVD (MRVD, RVEF 31-45%, n = 36), and severe RVD (SRVD, RVEF ≤30%, n = 11).

Results: Patients with SRVD demonstrated a significant higher rate of all-cause mortality compared with the other two groups (p = 0.04) and RVEF ≤ 30% was associated with all-cause death, independently of left ventricular ejection fraction (LVEF) and left atrial volume index (LAVi) (HR: 3.72, 95% CI 1.12-12.30, p = 0.03). At 6-month follow-up, only patients with pre-procedural MRVD showed a significant reduction in 3D RV volumes and an improvement in RVEF compared to baseline (p < 0.05).

Conclusions: RVD was common among patients undergoing mitral TEER for FMR. Those with pre-procedural SRVD had worse mid-term survival compared to patients with MRVD and No-RVD. The group with MRVD was the only one to demonstrate an RVRR six months after the procedure.

Background: An increasing number of medical conditions are recognised as causative factors in dilated cardiomyopathy (DCM). Investigating aetiology in DCM is variable in extent among cardiologists and often not performed. We assessed the usefulness of a pre-specified blood panel in identifying an underlying cause in a population of DCM patients.

Methods: Non-ischaemic DCM patients were identified from sequential new patients with heart failure-reduced ejection fraction (HFrEF) at a regional HF clinic over a 2 year period. Each patient underwent clinical assessment and a blood panel related to causes of DCM. The likely aetiology was documented after initial assessment, and reclassified where relevant when the blood panel results were reviewed.

Results: 55 non-ischaemic DCM patients (mean age 63.4 [9.2]yr, 54.5% male) were identified from 259 HFrEF patients. Mean LVEF was 31.3 (4.3)%. After clinical assessment 29 (52.7%) were classified as idiopathic. The commonest specific aetiologies were toxin-mediated (n = 8, 14.5%), genetic (n = 7, 12.7%) and inflammatory (n = 6, 10.9%). Review of blood panels resulted in reclassification in 3 (5.4%) and detection of unrelated medical conditions in 2 (3.6%).

Conclusions: Despite thorough clinical assessment, DCM remains idiopathic in at least half of cases. Adding an extensive blood panel identifies a specific aetiology in a small proportion of cases.

Introduction: Heart failure (HF) is often accompanied by muscle wasting and elevated C-reactive protein (CRP). This study aimed to examine the association between CRP and appendicular lean soft tissue index (ALSTI) in patients with HF, focusing on potential sex differences.

Methods: Using data from the National Health and Nutrition Examination Survey (NHANES), 73 HF patients (36 males, 37 females) aged ≥18 years were analysed. ALSTI was calculated using lean soft tissue adjusted for height squared (kg/m²), and CRP was measured via latex-enhanced nephelometry; higher CRP defined as the top 50^th percentile of the cohort. Linear regression models were employed to assess the association between CRP and ALSTI.

Results: Higher CRP was not associated with ALSTI in unadjusted models (p = 0.39), but fully adjusted models revealed a significant negative association (b = -0.41 kg/m², 95% CI -0.79 to -0.02, p = 0.04). Sex-stratified analyses showed a link in males (b = -0.69 kg/m², 95% CI -1.23 to -0.16, p = 0.01), but not females (p = 0.47). In patients ≥50 years, similar findings were shown (males → b = -0.70 kg/m², 95%CI -1.33 - -0.08, p = 0.03; females → b = 0.69 kg/m², 95%CI -1.59 - 2.96, p = 0.51). Elevated CRP demonstrated significantly negative female-male associations with ALSTI for both 18-59- and 50-59-year-olds (p < 0.01).

Conclusions: CRP is associated with ALSTI in males with HF, highlighting the need for sex-specific investigations through longitudinal and experimental studies.