Acta cardiologica最新文献

Importance: Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening form of heart failure affecting women during late pregnancy or early postpartum. Its impact on maternal, delivery, and neonatal outcomes remains understudied, highlighting the need for comprehensive research.

Objective: To determine the effects of PPCM during pregnancy on maternal, delivery, and neonatal outcomes using a large, contemporary nationwide database.

Design: Retrospective analysis of a population-based cohort using the Healthcare Cost and Utilisation Project Nationwide Inpatient Sample (HCUP-NIS) database from 2004 to 2014.

Setting: Hospital inpatient stays across 48 states and the District of Columbia in the United States.

Participants: 9,096,788 pregnant women who delivered or had a maternal death, including 2127 diagnosed with PPCM.

Exposures: Diagnosis of peripartum cardiomyopathy during or after pregnancy, identified using ICD-9 diagnosis code 674.5x.

Main outcomes and measures: Women with PPCM had significantly higher rates of pregnancy-induced hypertension, preeclampsia, eclampsia, caesarean delivery, postpartum haemorrhage, and maternal death compared to those without PPCM. Delivery outcomes showed increased rates of preterm delivery, chorioamnionitis, and wound complications among PPCM patients. Neonatal outcomes revealed higher incidences of intrauterine foetal death and congenital anomalies in offspring of women with PPCM. Demographic and clinical characteristics associated with PPCM included advanced maternal age, African American race, obesity, chronic hypertension, previous caesarean section, smoking during pregnancy, and pregestational diabetes.

Background: There is limited evidence regarding the effect of physical activity interventions on exercise tolerance, left ventricular (LV) filling pressure, and quality of life (QoL) in patients with heart failure with preserved ejection fraction (HFpEF). This study assessed the acceptability, feasibility, and physiological outcome of a novel, personalised, home-based physical activity intervention in HFpEF.

Methods: This was a prospective, feasibility randomised study. Forty HFpEF patients, clinically stable were randomised 2:1 ratio to an intervention group (60±6 years, n=25, 12 male) which involved increasing daily physical activity by 2000 steps from baseline (Active-at-Home-HF) or to standard care control group (60±7 years, n=15, four male) for 12 weeks. Before and after 12 weeks, patients underwent supervised exercise stress test on treadmill, and assessment of exercise stress echocardiography, QoL (Minnesota Living with Heart Failure questionnaire) and N-terminal prohormone of brain natriuretic peptide (NTproBNP) were also assessed before and after intervention. All patients were monitored weekly via telephone and pedometers.

Results: In the intervention group, patients achieved target step count after three weeks (from 4457±653 to 6592±546 steps per day, p<0.001), and maintained throughout the duration of the study. Exercise duration increased significantly in intervention (350±122 vs 463±135 s) but not in control group (399±126 vs 358±88 s, p = 0.007 group × time interaction) at follow-up. Left ventricular filling pressure (E/E') improved in intervention group (12.43±3.6 vs 9.72±1.86) but was not significantly different compared to controls (12.86±3.17 vs 12.44±2.23) (group × time interaction, p=0.08). The left atrial (LA) reservoir strain significantly improved in intervention group (25.5±4.4 vs 23.3±4.5%) and not in non-intervention group (21.8±4.4 vs 21.9±4.8%) (p=0.015). There was no change in NTproBNP, LV ejection fraction, LV longitudinal strain, stroke volume, cardiac output, cardiac power output and right ventricular systolic function in the intervention or control group (p>0.05). There were no adverse events.

Conclusions: In this study of HFpEF patients, a 12-week personalised home-based physical activity intervention is feasible, acceptable, safe, improves LA function, exercise duration and QoL and may improve LV filling pressures.

Background: This study aimed to evaluate the accuracy and readability of ChatGPT-4 responses related to cardiac rehabilitation (CR) for patients with heart failure (HF), with the objective of assessing its potential as a patient education tool.

Methods: The study involved 16 open-ended questions related to CR, developed by two specialists (one cardiologist and one physical medicine and rehabilitation specialist). These questions were submitted to ChatGPT-4, and its responses were evaluated for accuracy and readability. Accuracy was assessed using a 6-point Likert scale, while readability was analysed using the Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Coleman-Liau Index (CLI), and Gunning Fog Index (GFI). Inter-evaluator reliability was assessed by the intraclass correlation coefficient (ICC).

Results: The mean accuracy score of ChatGPT-4 responses was high (5.25 ± 0.77 and 5.38 ± 0.62 for two raters), with 81.25% of responses rated 5 or above. The readability analysis revealed a median FRE of 59.5, indicating moderate readability, with FKGL at 7.1 and CLI at 11.2. The ICC between the two evaluators was 0.854, indicating good agreement.

Conclusion: ChatGPT-4 provided accurate and reliable information on CR for HF patients. Although the readability was slightly above the ideal level, its overall performance suggests potential as a supportive tool in patient education. Further improvements in language simplicity are needed to optimise its usability.

Background and aims: Loop diuretic maintenance therapy has been associated with worse clinical outcomes in heart failure (HF) patients. Despite this, recent HF trials report high prescription rates. Optimal guideline-directed medical therapy (GDMT) may reduce need for loop diuretics and improve long-term outcomes. This study evaluated loop diuretic and GDMT prescription patterns in a HF clinic of a Belgian tertiary hospital cohort and compared findings to recent HF trials.

Methods: This prospective registry included consecutive HF patients with a left ventricular ejection fraction (LVEF) ≤50% from the HF outpatient clinic starting from 23 November 2023 to 22 May 2024 up to the inclusion of 1000 patients. Data on baseline characteristics, medications, echocardiography and laboratory were extracted from electronical health records.

Results: Among the included patients, 543 (54.3%) had HF with reduced ejection fraction. Median age was 72 (63-80) years, with a median LVEF of 45% (35-45). Most were male (72.6%), with serum creatinine of 1.15 (0.93-1.45) mg/dL and eGFR of 60 (43-77) mL/min/1.73 m². Hypertension (56%), atrial fibrillation (47%), and coronary revascularisation (53%) were common comorbidities. GDMT prescription rates were high, with 68.7% on triple or quadruple therapy, while only 27% received loop diuretics. Baseline characteristics and GDMT prescription rates were comparable to recent registries and trials, but loop diuretic prescriptions were significantly lower in the current cohort.

Conclusions: This study highlights progress in HF management but emphasises the need for a patient-centred approach in a HF clinic which enables optimisation of care, allows addressing comorbidities, and reduction in loop diuretic dependence.

Background: Cardiac arrest (CA) is common but deadly. Prior hospitalisation represents a missed opportunity for prevention and identification of high-risk groups before CA. This study aims to determine the extent of and underlying reasons for hospitalisations during the 30-day period preceding an admission with CA.

Methods: We conducted a retrospective cohort study using the United States National Readmission Database (NRD) during 2018-2020. We evaluated hospitalisations with a diagnosis of CA and admissions in the 30-day period before hospitalisation with CA. Multiple logistic regressions were used to identify factors associated with prior hospitalisation and mortality on admission with CA.

Results: Among 1,637,240 hospital episodes with CA, 255,500 (15.6%) had an admission to hospital in the 30-day period prior to hospitalisation with a diagnosis with CA. The categories for causes of previous admissions were disorders of the circulatory system (27%), infectious and parasite disease (13%), and disorders of the respiratory system (12%). The most common diagnoses were sepsis, hypertensive heart and renal disease, acute myocardial infarction, and respiratory failure. Cancer (OR 2.09 95%CI 2.04-2.15, p < 0.001), chronic kidney disease (OR 1.45 95%CI 1.42-1.48, p < 0.001), and chronic lung disease (OR 1.25 95%CI 1.22-1.27, p < 0.001) were the most significant factors associated with prior admission. Previous hospital admission was associated with increased odds of mortality (OR 1.58 95%CI 1.55-1.62, p < 0.001).

Conclusions: Hospitalisations within the 30-day period preceding an admission with CA are common and occur in about 1 out 6 patients. The most common primary diagnoses for prior hospitalisation were sepsis, renal and cardiovascular disease.

Identification of a cardiomyopathy phenotype should prompt a systematic search for the underlying aetiology, which may be genetic or acquired and can be associated with extracardiac manifestations. Fabry Disease (FD) is an inherited metabolic disorder causing left ventricular hypertrophy along with multiples other cardiac symptoms. Due to its X-linked transmission, FD was long thought to only affect men, although women are also involved but with a different spectrum of presentations, with less important symptoms that tend to appear later or with atypical phenotype.