Acta cardiologica最新文献

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.

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.

Background: The Minimalist Approach (MA) in Transcatheter Aortic Valve Implantation (TAVI) aims to enhance procedural efficiency while maintaining safety and efficacy. Despite its potential advantages, adoption varies across Europe due to institutional protocols, operator experience, and training availability. This study explores healthcare professionals' perspectives on the MA across European centres.

Methods: A multicentre, cross-sectional survey was conducted among healthcare professionals involved in TAVI across 27 European countries. The questionnaire assessed anaesthesia preferences, use of invasive monitoring, post-procedural management, and formal training in the MA.

Results: A total of 119 respondents participated, primarily interventional cardiologists (42.9%) and nurses (33.6%). Formal training in the MA was reported by 41.2% of respondents. Local anaesthesia was the preferred strategy (74.8% strongly agreed, 20.2% agreed). The use of central venous (16%) and urinary catheters (19.3%) was limited among respondents favouring the MA. Early mobilisation (63.9%) and short hospitalisation (58%) were widely supported. Adoption of the MA varied by profession, but all subgroups supported early mobilisation and short hospitalisation.

Conclusions: The MA in TAVI is widely accepted across Europe, particularly regarding anaesthesia and early mobilisation. However, structured training programs remain limited, highlighting the need for standardised education and institutional protocols to ensure broader adoption and optimise patient outcomes.

Background: Cardiac output (CO) is the product of the heart rate (HR) and the stroke volume (SV).over time. It is a direct marker of myocardial function. In healthy subjects, the myocard normally responds well and CO improves after exercise training. However, the effect of exercise on CO in patients with heart failure with preserved ejection fraction (HFpEF) is less clear. Therefore, this study aimed to systematically summarise the current evidence on the effects of an exercise intervention on CO in subjects with HFpEF.

Material and methods: A literature search in Medline, Embase, CENTRAL, and SportDiscus was performed. Included were all RCTs that compared the effect of exercise training on CO in patients with HFpEF and were published before 11 April 2024. Risk of bias assessment was performed by using Cochrane's RoB 2 tool. The review was reported according to preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines.

Results: We identified 750 abstracts that were screened for eligibility. A total of 11 selected full texts were analysed. One study fulfilled our inclusion criteria. No significant difference in the change of CO between the intervention and control groups at rest or during maximal exercise after the intervention was detected.

Discussion: The identification of only one RCT hallmarks the sparse evidence on alterations of CO prior to post an exercise intervention in subjects with HFpEF. This might be because other markers such as V̇O₂max are much easier to measure.

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: Mitral valve prolapse (MVP) is a common valvular heart disease with potential for progression to mitral regurgitation (MR) and arrhythmias. While extensively studied in adults, its evolution from childhood remains underexplored. This study aimed to evaluate morphological changes in MVP from paediatric to adult age and their association with MR progression using transthoracic echocardiography (TTE).

Methods: This retrospective single-centre study included 53 patients with confirmed MVP diagnosed in childhood and followed up into adulthood (mean follow-up 9 ± 5 years). Each patient had at least two TTEs, and echocardiographic parameters were assessed and indexed for body surface area and height. The presence and progression of mitral annulus disjunction (MAD) were also analysed.

Results: At baseline, the mean age was 8.13 ± 3.25 years; at final follow-up, 18.45 ± 6 years. MAD was present in 60% of patients at both TTEs, while 13% developed MAD over time. Indexed MVP morphological parameters, including leaflet length, annular diameter, and MAD distance, remained stable from childhood to adulthood. However, the severity of MR increased over time and was associated with changes in multiple mitral valve parameters, rather than a single feature. No significant arrhythmic events or implantable cardioverter defibrillator (ICD) implantations were recorded.

Conclusions: MVP-related structural changes remain morphometrically stable when indexed for growth, yet MR severity can worsen due to a combination of morphological alterations. MAD can be identified in paediatric patients and may develop over time. These findings support the view that MVP may encompass different phenotypes and potentially represent a form of cardiomyopathy.

Background/introduction: Long-term data on hemodynamic performance and valve durability are essential to guide bioprosthetic valve selection and to safely expand transcatheter aortic valve implantation (TAVI) to lower-risk patients with severe aortic stenosis (AS).

Purpose: This study aimed to assess the hemodynamic valve performance in a large cohort of patients undergoing TAVI with balloon-expandable (BEV) or self-expandable valves (SEV) and identify possible predictors of bioprosthetic valve degeneration (BVD).

Methods: All patients undergoing TAVI for native AS in a single centre between March 2008 and September 2023 underwent sequential echocardiographic follow-up at 30 days, 6 months and yearly thereafter. BVD was categorised as moderate or severe according to the Valve Academic Research Consortium 3 criteria.

Results: 784 patients (82 ± 7 years, 53.1% male, median EuroSCORE II 6.0% (3.6;10.7)) were treated with BEV (n = 584; 74.5%) or SEV (n = 200; 25.5%). Patients treated with BEV had a significantly higher 30-day mean transprosthetic gradient (TPG) (10.8 (95% CI 10.4-11.2) vs 6.8 mmHg (95% CI 6.3-7.4), p < 0.0001), but fewer more-than-mild aortic regurgitation as compared with SEV. Moderate/severe BVD were observed in 29 and 8 patients respectively, corresponding with a 6-year cumulative incidence of 7.3% (95% CI 5.0-10.1%). BVD was significantly associated with all-cause mortality for moderate (HR 2.2, 95% CI 1.3-4.0, p = 0.0051) and severe BVD (HR 4.5, 95% CI 1.4-14.1, p = 0.0105). Both a mean post-implantation TPG > 9 mmHg (HR 2.2; 95% CI 1.0-5.0, p = 0.0456) and implantation of the 20 mm SAPIEN BEV (n = 4) (HR 6.8; 95% CI 1.5-30.3, p = 0.0114) were associated with an increased incidence of BVD.

Conclusion: BVD is a rare complication in elderly intermediate-to-high risk patients undergoing TAVI. However, BVD is associated with increased mortality.

Background: Hypertension is a clinical condition that presents an enormous prevalence worldwide. Despite there being gold-standard treatments, several people frequently present sequelae and die. Transcranial direct current stimulation (tDCS) emerges as a cheap, easy-to-use, and portable intervention to modulate the central nervous system and control cardiovascular parameters.

Objective: To evaluate the tDCS effects on the hemodynamic and autonomic parameters of hypertensive people.

Methods: This systematic review included clinical trials published in databases that used tDCS as an intervention, isolated or associated, in hypertensive people to modulate the hemodynamic and autonomic parameters. We calculated the effect sizes, performed a meta-analysis, and evaluated the risk of bias in the studies. Three different researchers performed all the steps presented in the methods section.

Results: Four studies suited the eligibility criteria of this review. Some studies showed that tDCS isolated after one session generated improvements in hemodynamic and autonomic parameters. Despite in meta-analysis, no statistical differences were detected between the groups, there was a tendency to reduce systolic (MD: -0.72 (CI: -1.54; 0.11; p = 0.06) and diastolic blood pressure (MD: -1.23; CI: -3.45; 0.99; p < 0.01), and root mean square of successive differences (MD: 0.73; CI: -0.30; 1.76; p < 0.01). There was no statistical difference after ten tDCS sessions. All the studies presented a low risk of bias.

Conclusion: After one session, isolated tDCS might be able to modulate hypertensive people's hemodynamic and autonomic parameters. The anodic stimulation over the primary motor cortex shows signs of being the best target to generate a response.