Acta cardiologica最新文献

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.

Artificial intelligence (AI) is transforming the medical landscape, offering unprecedented advancements in diagnostic precision, treatment planning, and decision-making across various specialties. However, its adoption also raises complex questions, particularly when AI-generated recommendations conflict with human expertise. This article explores through an institutional survey the challenges faced by physicians when introducing a unique AI application for the interpretation of the ECG across several medical specialties.

Background: This study aimed to evaluate the predictive value of the triglyceride-glucose (TyG) index in combination with inflammatory markers-systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and high-sensitivity C-reactive protein (hsCRP)-for the severity of coronary artery disease (CAD) and the incidence of major adverse cardiovascular events (MACEs) following percutaneous coronary intervention (PCI).

Methods: A retrospective cohort study was conducted with 759 acute coronary syndrome (ACS) patients who underwent PCI from September 2022 to December 2023. The primary outcome was the occurrence of MACEs within one year, defined as a composite of all-cause death, myocardial infarction, stroke, and angina. TyG index was calculated at admission, and multivariable regression models were used to explore the associations between TyG, inflammatory markers, and coronary lesion severity. Cox proportional hazards models evaluated the predictive ability for MACEs.

Results: Compared with non-MACEs patients, the MACEs group had significantly elevated hsCRP, NLR, and SII levels, and a higher TyG index (8.8 vs. 8.9, p = 0.007). The interaction between TyG and hsCRP remained an independent predictor of MACEs (HR = 1.014, p < 0.001). ROC analysis showed the highest predictive accuracy for MACEs with the TyG-hsCRP combination (AUC = 0.708).

Conclusion: The TyG index-inflammation composite is an independent and effective predictor of post-PCI MACEs and may aid in refining current cardiovascular risk prediction models.