Acta cardiologica最新文献

Objective: The relationship between vascular endothelial function and bone mineral density (BMD) in T2DM patients with metabolic dysfunction associated fatty liver (MAFLD) is still unclear. This study aims to analyse the correlation between vascular endothelial function and BMD or fracture risk in T2DM patients with MAFLD.

Methods: A total of 872 T2DM patients aged ≥50 years were enrolled and divided into two groups according to the diagnostic criteria of MAFLD: MAFLD (+) and MAFLD (-). Flow-mediated dilation (FMD) was measured by high-resolution ultrasound to reflect vascular endothelial function. BMD was measured by dual-energy X-ray bone densitometry, and FRAX scores were calculated for 10-year hip fracture risk (HF¹) and major osteoporotic fracture risk (MOF).

Results: After multivariate adjustment, there was no significant correlation between FMD and BMD in MAFLD (-) group (p > 0.05). In MAFLD (+) and FMD < 4% group, FMD was positively correlated with WB, LS, and FN BMD, while FMD was negatively correlated with fracture risk and osteoporotic fracture history, and this correlation was only observed in female patients. However, FMD was not correlated with BMD and fracture risk and osteoporotic fracture history in 4%≤FMD ≤ 7% and FMD > 7% groups.

Conclusions: The association of FMD with BMD in T2DM patients with MAFLD varies according to FMD level. The decrease of FMD is associated with reduced BMD and increased fracture risk in female patients with FMD < 4% group. FMD may be an influential factor for the occurrence and development of osteoporosis, and has some clinical value in early diagnosis of osteoporosis in T2DM patients with MAFLD.

Background: It's difficult to detect the severity of coronary artery disease in the patients who have stable angina pectoris. Echocardiography is a well-validated non-invasive diagnostic tool for detecting myocardial ischaemia, but judging wall motion abnormalities is subjective. Conventional echocardiography can assess radial mechanics only, so it cannot assess the sensitive longitudinal mechanics. 2-Dimensional strain echocardiography is a recent tool that has the ability to solve these drawbacks.

Aim of study: To detect the accuracy of 2D-STE in prediction of significant coronary artery stenosis in the patients with stable angina pectoris.

Methods: This study included 70 patients who have stable angina pectoris. Conventional and 2D speckle tracking echocardiography were done to all patients then compared with the coronary angiography results. Patients were classified into three groups according to their coronary arteries affection; patients with normal Coronaries, non-obstructed lesion and patients with significant lesion.

Results: Our study results show that the mean GLS was (-18.67 ± 0.93) in normal cases, and it was (-15.82 ± 1.11) in non-obstructed lesions but GLS was (-13.19 ± 1.7) in patients with significant CAD. And the best cut-off point of GLS was reported as (-17.35%) with a sensitivity of 97.6% and specificity of 93.3%. Also we found that SLS results in significant lesions of LAD, LCX, RCA territory was (-16.3%, -15.95%, -17.45%) with sensitivity and specificity (87.8%, 93.3%), (70.7%, 93.3%), (82.9%, 93.3%) respectively.

Conclusion: Global longitudinal strain has a good diagnostic significance over visual evaluation during conventional echocardiogram in predicting significant stenosis of the coronary arteries in patients with stable coronary artery disease. Segmental Longitudinal strain is also a sensitive tool to detect the affected Coronary Territory.

Background: Blood pressure (BP) control in haemodialysis (HD) patients is essential. Peri-dialytic BP levels do not accurately diagnose hypertension or predict the cardiovascular (CV) mortality.

Methods: In this study, we recruited 43 adult patients who had been on chronic HD for ≥3 months. Seven-day home BP monitoring (HBPM) (values of Day1 discarded) and 44-h interdialytic ambulatory BP monitoring (iABPM) were performed. Pre- and post-dialysis BP levels were measured during the 6 dialysis sessions prior to iABPM. A 6-year follow-up was carried out to assess all-cause and CV mortality.

Results: In patients considered as normotensive in pre-dialysis (n = 17), masked hypertension was found in 24% and 29% on the basis of iABPM and HBPM, respectively. Conversely, among hypertensive patients in pre-dialysis (n = 26), 'white-coat' hypertension was noted in 23% either by iABPM or HBPM. After a 6-year follow-up, 25 patients were deceased including 6 patients from CV causes. Day-time systolic BP measured by iABPM was associated with all-cause mortality in an adjusted model for age and gender (p = 0.045).

Conclusion: In chronic HD patients, 44-h iABPM and 6-day HBPM show a reliable concordance and help to re-classify ∼25% of cases miscategorised based on pre-dialysis measurements. Day-time systolic BP levels using iABPM were significantly associated with 6-year all-cause mortality.

Background: In patients with acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI), female patients have a worse short-term prognosis than male patients has been consistently concluded in many studies. However, the impact of sex differences on long-term prognosis remains uncertain. Additionally, women are underrepresented in clinical trials exploring optimal antithrombotic strategies in patients with atrial fibrillation (AF) and ACS or PCI. To bridge this gap, this study aimed to investigate sex differences in clinical characteristics, treatment, and long-term clinical outcomes in patients with AF and ACS or PCI.

Patients and methods: This study included a total of 1237 patients with AF and ACS and 539 patients with AF and stable coronary artery disease (SCAD) who underwent PCI at the Fuwai Hospital of the Chinese Academy of Medical Sciences from January 2017 to December 2019. Patients were followed up until the end of 2021 to observe the occurrence of major adverse cardiovascular events (MACE). The relationship between sex and MACE was evaluated using Cox regression models and Kaplan-Meier's survival curves.

Results: In patients with AF and ACS, multivariable COX regression analysis revealed that female patients were independently associated with a higher risk of MACE (HR = 1.45, 95% CI 1.11-1.89, p = .006). However, in AF patients with SCAD who underwent PCI, the analysis showed that female patients were not independently associated with MACE risk (HR = 1.12, 95% CI 0.62-2.03, p = .717).

Conclusions: In patients with AF and ACS, females have a significantly higher risk of long-term MACE compared to males. However, among patients with AF and SCAD who underwent PCI, there was no significant difference in long-term MACE risk between males and females.

Objective: To provide valuable insight into the prevention and treatment of coronary heart disease, this study aimed to explore the association between psychosocial elements and endothelial dysfunction in diagnosed patients.

Methods: Using a cross-sectional study design, we selected patients with coronary heart disease who visited the cardiology department of our hospital from January to December 2021. According to coronary angiography results, patients were divided into the coronary stenosis group (≥50%) and the normal coronary group (<50%), with 100 cases in each group. We assessed the levels of psychosocial factors using the Type A Behaviour Pattern Scale (TABP), Self-Rating Anxiety Scale (SAS), Social Support Rating Scale (SSRS), and Self-Rating Depression Scale (SDS). Endothelial synthesis of nitric oxide (NOx) and endothelium-dependent (EDF) and endothelium-independent (NEDF) vasodilation functions were measured and compared using enzyme-linked immunosorbent assay (ELISA) and colour Doppler ultrasonography, respectively.

Results: Patients in the coronary stenosis group had significantly higher scores in Type A behaviour, anxiety, and depression and significantly lower scores in social support compared with the normal coronary group (t = 3.21, 4.15, 3.87; p < 0.05; t = -2.96; p < 0.05). EDF, NEDF, and NOx levels were significantly lower in the coronary stenosis group than in the normal coronary group (t = -4.32, -3.76, -4.67; p < 0.05). Psychosocial factors were negatively correlated with endothelial function indices (r = -0.31 to -0.48; p < 0.05). Multiple linear regression analysis revealed that Type A behavioural anxiety, depression, and social support were independent risk factors influencing endothelial dysfunction (β = -0.23, -0.26, -0.21, -0.19; p < 0.05).

Conclusion: A close relationship was observed between psychosocial factors and endothelial dysfunction in patients with coronary heart disease. Assessment and intervention of psychosocial factors in these patients should be strengthened to improve endothelial function and reduce the risk of cardiovascular events.

Objective: The present study sought to compare the reliability and radiation dose of coronary artery calcium (CAC) scoring using low tube current (16 mAs), low kilo-voltage peak (100 kVp) and advanced modelled iterative reconstruction (ADMIRE 5) with the standard protocol (80 mAs, 120 kVp, ADMIRE 3).

Material and methods: A prospective single centre study including 200 consecutive patients with suspected coronary artery disease referred for CT coronary angiography was conducted. All 200 patients underwent CAC scoring using the low current-low kVp protocol as well as standard protocol and were subdivided into a derivation and validation cohorts.

Results: Correlation between CAC scores obtained using low current-low kVp protocol and standard protocol in derivation cohort was excellent (r = 0.99; p < 0.001). A linear regression model was used to derive a formula for predicting CAC that enabled conversion of CAC(low current-low kVp) to CAC(corrected) [CAC(corrected) = 1.067 × CAC(low current-low kVp)]. The formula was applied in validation cohort where CAC (corrected) showed excellent agreement with CAC(standard) (intraclass correlation coefficient, 0.9970; 95%CI, 0.9956-0.9980). Excellent agreement for risk classification (weighted kappa, 0.94379; 95%CI, 0.89629-0.99130) was observed between CAC(corrected) and CAC(standard) scores. The low current-low kVp protocol demonstrated an 88.87% reduction in radiation dose (0.0679 ± 0.01032 mSv vs. 0.610 ± 0.2403 mSv; p < 0.0001).

Conclusion: The low current-low kVp protocol for CAC scoring has comparable reliability to the standard technique with significant radiation dose reduction. This extremely low-dose protocol may prove useful as an alternative to standard CAC scoring, particularly for screening in the low-to-intermediate risk population.

Background: Atrial fibrillation (AF) is the commonest supraventricular arrhythmia in adults. Timely AF diagnosis seems to ameliorate patients prognosis.

Purpose: To investigate the association between peak left atrial longitudinal strain (PALS) and new onset AF in the general population.

Objectives: We searched major electronic databases for articles assessing the relationship between PALS and incident AF.

Results: Eight studies (11,145 patients) were analysed. Lower levels of PALS were significantly associated with higher risk of incident AF (HR: 0.95; 95%CI: 0.92-0.97, I²: 83%). According to the diagnostic accuracy meta-analysis, PALS <33.4% presents 64% (95%CI: 46-79%) sensitivity and 69% (95%CI: 63-75%) specificity.

Conclusions: In a relatively healthy population, lower levels of PALS were significantly associated with incident AF. The overall diagnostic accuracy was moderate. Lower levels of PALS seem to justify an opportunistic - rather than a systematic-screening approach. These findings could allow more efficient utilisation of healthcare resources.