Acta cardiologica最新文献

Background: Heterozygous familial hypercholesterolaemia (HeFH) confers a high risk of cardiovascular disease (CVD) due to elevated levels of LDL-cholesterol (LDL-C). The aim of this study is to assess the influence of clinical and genetic factors on coronary artery calcium (CAC) score in patients with HeFH.

Methods: CAC score were obtained for 129 genetically confirmed HeFH patients from NAGENCOL project, who had no CVD. Association of CAC with clinical and genetic variables as well as with the SAFEHEART-risk equation (SAFEHEART-RE) was evaluated.

Results: 65 patients had CAC = 0 (50.4%), 24 had CAC score between 1 and 99 (18.6%), and 40 had a score of ≥100 (31%). Individuals with a CAC score ≥100 were older (56.5 years vs. 39 years for those with a CAC score of 0, p < 0.001). They also had a higher prevalence of classical risk factors and history of CAD in the family. In addition, this group had higher maximum LDL-C levels (308.8 mg/dL vs. 262.5 mg/dL, p < 0.001), higher age at genetic diagnosis (45 years vs. 31.3, p < 0.001) and at the beginning of Treatment (34.5 years vs. 26.6, p = 0.002). Consequently, the cumulative LDL-C throughout their life was higher (13745.3 mg/dL vs. 8693.2 mg/dL, p < 0.001). There was a correlation between the results of the SAFEHEART-RE and CAC score.

Conclusions: Early diagnosis and early initiation of appropriate treatment are essential for reducing the accumulated cholesterol burden in patients with HeFH. Given the heterogeneity in CVD in patients with HeFH, tools such as the SAFEHEART-RE and CAC score may be useful for better risk stratification.

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.

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.

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.

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.