Acta cardiologica最新文献

Background: Transthyretin amyloid cardiomyopathy (ATTR-CM) patients continue to experience worsening heart failure despite therapy with disease modifying therapies (tafamidis, patisiran, etc.). Given the proven benefits of SGLT2 inhibitors in heart failure, their efficacy in ATTR-CM patients remains unexplored.

Methods: A systematic search of PubMed, Google Scholar, Web of Science, and Cochrane Central Library was conducted from inception to April 2025 for studies evaluating the efficacy of SGLT2 inhibitors in ATTR-CM patients receiving disease-modifying therapy. A random-effects meta-analysis model was used, and all-cause mortality was analysed as the primary outcome.

Results: Seven observational studies comprising 7283 patients with transthyretin amyloidosis (ATTR) cardiomyopathy were included. SGLT2 inhibitors were associated with lower risk of all-cause mortality (RR: 0.51 [0.45, 0.57] 95% CI, p < 0.00001; I² = 10%), cardiovascular mortality (RR: 0.30 [0.16, 0.55] 95% CI; p = 0.0001; I² = 25%) and MACE (RR: 0.69 [0.59, 0.81] 95% CI; p < 0.00001; I² = 10%) as compared to patients receiving no SGLT2 inhibitor. Additionally, the use of SGLT2 inhibitors was associated with significantly improved glomerular filtration rates (MD: 3.11 [0.52, 5.71] 95% CI, p = 0.02; I² = 54%) as compared to patients receiving no SGLT2 inhibitor. SGLT2 inhibitor therapy did not have a significant effect on the risk of hospitalisations due to heart failure.

Conclusions: SGLT2 inhibitors, when used alongside disease-modifying agents, appear to improve survival and renal outcomes in patients with ATTR-CM. However, these findings are derived from observational studies with their inherent biases and must be interpreted with caution. High-quality randomised controlled trials are needed to confirm these associations and better define their clinical role in ATTR-CM.

Background: This study investigated whether functional characteristics and barriers to cardiac rehabilitation (CR), assessed through the Cardiac Rehabilitation Barriers Scale (CRBS), predict 30-day hospital readmission following discharge for acute coronary syndrome (ACS).

Methods: Single-center, observational longitudinal study conducted at a cardiology hospital.At hospital discharge, participants underwent assessments of respiratory muscle strength (maximum inspiratory [MIP] and expiratory pressures [MEP]), handgrip strength (HGS-D), and functional capacity (6-minute walk distance [6MWD]). At 30 days post-discharge, patients completed the CRBS, encompassing four domains (perceived needs/healthcare factors, logistical factors, work/time conflicts, and comorbidities/functional status) and were evaluated for hospital readmission.

Results: A total of 320 patients (63.8% men, mean age 63.5 ± 11.3 years, median GRACE score 109 [range 63-173]) were included. After adjustment for confounders (age, sex, BMI, GRACE score, length of stay, and time since discharge), shorter 6MWD (OR = 0.981, 95%CI 0.968-0.994, p = 0.005), lower MEP (OR = 0.891, 95%CI 0.841-0.945, p < 0.001), and higher CRBS comorbidities/functional status scores (OR = 1.429, 95%CI 1.241-1.645, p < 0.001) were associated with increased odds of hospital readmission. Additionally, 6MWD was inversely associated with the CRBS sum score (β = -0.020, 95%CI -0.034 to -0.006, p = 0.005).

Conclusion: Functional impairments and perceived barriers to cardiac rehabilitation are significant predictors of 30-day hospital readmission in ACS patients. Early identification of at-risk individuals may enhance post-discharge care strategies and reduce readmission rates.

Background and aims: Sodium-glucose transporter 2 inhibitors have recently shown promise as a therapy to reduce mortality and hospitalisation for heart failure (HF) in patients with and without type 2 diabetes mellitus. The aim of this prospective study was to determine the results of a multiparametric evaluation after the addition of dapagliflozin to standard therapy in patients with heart failure with reduced ejection fraction (HFrEF).

Methods: From February to November 2022, 45 patients with chronic HF who regularly visited our HF outpatient clinic were selected for this study. Exclusion criteria were severe chronic renal insufficiency (GFR < 25 ml/min), type 1 diabetes, hypertrophic or restrictive cardiomyopathy, active myocarditis, constrictive pericarditis. The included patients took dapagliflozin once daily in addition to sacubitril/valsartan and other HF drugs. The following parameters were recorded before the start of therapy and at the 3-month follow-up: NYHA functional class, characteristics of the cardiopulmonary exercise test (CPET), parameters of the six-minute walk test (6MWT), quality of life (QoL) using the Kansas City Cardiomyopathy Questionnaire (KCCQ), echocardiographic evaluation.

Results: At 3-month follow-up, a significant increase in peak Vo2 (from 17.5 to 18.2, p < 0.001) and a significant decrease in VE/VCO2 (35.2 to 33.1, p = 0.011) were observed. In addition, Vo2/work gradient and pulse O2 increased significantly. Furthermore, a significant improvement in 6MWT, quality of life and left ventricular dimensions and systolic function was observed.

Conclusion: This prospective, multiparametric study showed that the additional administration of dapaglifozin to sacubitril/valsartan and other HF drugs is effective after three months.

Cardiovascular disease (CVD), comprising heart and blood vessel disorders, persists as the foremost contributor to global morbidity and mortality. In modern times, the intricate composition of gut microbiota has garnered significant focus, particularly for its varying impact on diverse ailments. Gut dysbiosis, or harmful alterations in the makeup of the gut microbiota, has been related to the development and progression of a variety of disorders, including cardiovascular disease (CVD). Imbalances in the host-microbial interaction hamper homeostatic processes that govern health and can activate various pathways that contribute to the advancement of CVD risk factors, including conditions like atherosclerosis, hypertension, and heart failure. Discovering the link between gut microbiota and CVD development can lead to the development of innovative microbiome-based preventive and therapeutic approaches. To enable effective and highly precise preventative and therapeutic strategies for CVD, an interdisciplinary approach is needed to shed light on gut bacterial-mediated mechanisms (e.g., using advanced nanomedicine technologies and incorporating other factors such as age, sex, medical conditions, co-morbidity, food habits, physical activity, etc.). This comprehensive review delves into the pivotal role of gut microbiota in maintaining cardiovascular well-beings.

This study explores microRNAs (miRNAs) as biomarkers for hypertrophic cardiomyopathy (HCM), an inherited cardiac disease with clinical diversity and sudden death risk. Using bioinformatics and machine learning (ML), Gene Expression Omnibus (GEO) datasets were analysed to identify miRNA signatures for early detection, risk assessment, and personalised treatment of HCM. Differential expression analysis of three GEO datasets identified 155 differentially expressed genes (DEGs) and 5 differentially expressed miRNAs (DE-miRNAs). Functional annotation and pathway analysis revealed their roles in inflammatory responses, extracellular matrix organisation, and cellular stress responses. Notably, upregulated (COL21A1, PROM1) and downregulated (FOS, BTG2, ELL2, PDK4, SERPINE1, SRGN, TIPARP) genes were detected as potential DE-miRNA targets. Validation highlighted importance of ELL2 and PDK4 in HCM pathology. Support Vector Machine (SVM) and Random Forest (RF) models demonstrated high predictive accuracy for HCM using DE-miRNAs, suggesting new paths for early diagnosis and personalised therapy.

Background: Patients with atrial fibrillation/flutter (AF/AFL) face higher risks of death, heart failure, and thromboembolic events, with major attributable risk factors.

Objective: This study examined epidemiological data and trends on six major risk factors contributing to the AF/AFL burden from the 2021 Global Burden of Disease (GBD) study.

Methods: AF/AFL risk-attributable deaths, disability-adjusted life years (DALYs), and age-standardised mortality (ASMR) and DALY (ASDRs) rates from 1990 to 2021 were extracted from the GBD database. Future trends were predicted using the ARIMA model, and annual percentage changes assessed major risk factors and regional disease burden differences, with subgroup analyses by socio-demographic index (SDI) regions and countries. Statistical analysis was performed using R software version 4.3.1, and a two-sided p < 0.05 was considered statistically significant.

Results: Environmental, behavioural, and metabolic risk factors significantly influenced the AF/AFL burden from 1990 to 2021, with ASMRs and ASDRs showing clear spatial and temporal patterns.

Forecasted trends: Deaths and DALYs attributable to these risk factors are projected to continue rising over the next 30 years, with body mass index (BMI) driving the largest increase in AF/AFL burden, while environmental and behavioural influences are expected to plateau.

Spatial variation: Regional disparities remain, with high-SDI areas experiencing burden stabilisation through improved risk factor control, whereas low-SDI regions - particularly those undergoing rapid urbanisation with higher lead exposure and alcohol use - face increasing burdens, especially from metabolic risks.

Conclusion: AF/AFL burden will continue to rise, primarily driven by metabolic risks such as high BMI, with regional disparities highlighting the need for targeted preventive strategies.

Background: Acute coronary syndrome (ACS) patients with multiple cardiovascular risk factors face particularly high recurrence rates. The differential impact of cardiac rehabilitation across ACS subtypes in high-risk patients remains understudied.

Methods: This prospective, randomised, single-center study evaluated cardiac rehabilitation effects on adherence across ACS subtypes in high-risk patients. 260 patients with baseline smoking, BMI ≥25 kg/m², and physical inactivity were randomised 1:1 to cardiac rehabilitation or control groups. Patients were stratified by ACS type: STEMI, NSTEMI, and unstable angina pectoris (UAP). Primary outcomes included adherence to medical treatment, dietary recommendations, physical activity guidelines, smoking cessation, and weight management at one-year follow-up.

Results: Among 260 patients (130 rehabilitation, 130 control), NSTEMI was most common (45.4%), followed by STEMI (32.7%) and UAP (21.9%). Cardiac rehabilitation significantly improved adherence across all ACS subtypes. Overall adherence rates in rehabilitation vs. control groups were: medical treatment (89.2% vs. 71.5%, p < 0.001), dietary recommendations (82.3% vs. 58.5%, p < 0.001), physical activity (85.4% vs. 42.3%, p < 0.001), smoking cessation (76.9% vs. 43.1%, p < 0.001), and weight management (73.1% vs. 51.5%, p < 0.001). STEMI patients excelled in smoking cessation (84.7% vs. 38.6%), NSTEMI in physical activity (88.1% vs. 40.7%), and UAP in medical adherence (92.9% vs. 75.0%). All-cause rehospitalization rates were significantly lower in the rehabilitation group (12.3% vs. 23.1%, p = 0.023), as were cardiovascular-related rehospitalizations (7.7% vs. 18.5%, p = 0.012).

Conclusion: Structured cardiac rehabilitation significantly enhances adherence to all secondary prevention measures across STEMI, NSTEMI, and UAP subtypes in high-risk patients, with subtype-specific patterns of improvement.