Acta cardiologica最新文献

Artificial intelligence (AI) is rapidly revolutionising cardiovascular medicine, offering significant potential to enhance patient outcomes, streamline clinical workflows, and optimise healthcare resource utilisation. However, integrating AI effectively into routine cardiology practice requires overcoming substantial technical, ethical, regulatory, and economic challenges. This position paper provides Belgian cardiologists, healthcare policymakers, and clinical leaders with a clear, pragmatic roadmap for implementing predictive, generative, and agentic AI technologies. We highlight successful real-world examples, outline precise criteria for clinical validation, propose practical reimbursement strategies, and detail steps to address ethical and regulatory obligations, emphasising AI as augmented rather than artificial intelligence. Our goal is to facilitate the safe, effective, and ethical adoption of AI technologies to augment Belgian cardiology practice.

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.

This editorial highlights key advances featured in the current issue of Acta Cardiologica, reflecting the shift toward more precise, personalized, and evidencebased cardiovascular care. Contributions span artificial intelligence, bedside clinical assessment, biomarker-driven risk stratification, lifestyle determinants, advanced imaging, and interventional cardiology. Together, they illustrate how emerging technologies can be effectively integrated with rigorous clinical judgment, while maintaining a pragmatic focus on real-world applicability. The collected studies emphasize the importance of human oversight, simple yet powerful diagnostic tools, and individualized risk assessment to optimize patient outcomes in contemporary cardiology practice.

Objective: This study aimed to explore the relationship between daily sitting time and the risk of heart attack and cardiovascular mortality, as well as the mediating effect of serum osmolality.

Methods: Data were collected from the 2007-2020 National Health and Nutrition Examination Survey, including sitting time and heart attack history from questionnaires, serum osmolality from lab tests, and death causes from follow-ups. Logistic regression and subgroup analyses were used to examine the relationships, while restricted cubic spline (RCS) was employed to analyze the mediating effect.

Results: Among 10,597 participants, heart attack and cardiovascular mortality increased with daily sitting time. The highest hazard ratio for cardiovascular mortality was observed in the group with the longest sitting time (G4). RCS analysis revealed that serum osmolality significantly mediated the risk of heart attack due to prolonged sitting. After a median follow-up of 6-7 years, the risk of heart attack death increased with sitting time, especially when serum osmolality was ≥277 mmol/kg. Subgroup analyses indicated that sitting time was significantly associated with heart attack risk, influenced by race, sex, education, poverty income ratio, smoking, drinking, and BMI.

Conclusions: Daily sitting time was significantly associated with the risk of heart attack and cardiovascular mortality; participants sitting ≥8 hours had a higher incidence than those sitting <4 hours. Serum osmolality plays a key mediating role in the impact of sitting time on heart attack development.

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.

Background: Implantable cardioverter-defibrillators (ICDs) are lifesaving devices that prevent sudden cardiac death in patients at risk of life-threatening arrhythmias. However, if ICDs are not deactivated in the terminal phase of life, they may deliver shocks that can pose a problem during end-of-life care. While guidelines recommend initiating discussions on ICD deactivation early, in practice these conversations often take place too late or not at all.

Methods: A scoping review aimed at three key groups (patients, relatives, and healthcare professionals) was performed based on a search of PubMed and Embase conducted on June 9, 2024, focusing on studies examining attitudes towards ICD deactivation. Studies were selected based on their relevance to the perspectives of patients, relatives, and healthcare professionals.

Results: 32 articles were included: 16 focused on patients, 10 on professionals, 3 on relatives, and 3 on combinations of study groups. Findings revealed significant knowledge gaps. Many patients and relatives were unaware that ICD deactivation was an option. Healthcare professionals felt they lacked confidence in initiating discussions, citing time constraints and discomfort. A preference for shared decision-making was identified, although preferences varied. There was no consensus on the optimal timing for these discussions. All groups reported ethical and legal concerns about ICD deactivation.

Conclusion: This review emphasises the need for individualised ICD deactivation discussions. Enhancing communication, education, and training for healthcare professionals is essential. Timely, ongoing conversations about ICD deactivation should be integrated into routine care, ensuring decisions align with patient values, especially in the final stages of life.