Acta cardiologica最新文献

Background: Since its introduction in clinical practice, patient selection and procedural technique for transcatheter aortic valve implantation (TAVI) have continued to evolve.

Methods: We investigated temporal trends in patient profiles, procedural, 30-day and 1-year clinical outcomes in all consecutive patients undergoing TAVI at our centre from March 2008 to February 2024 (n = 1000). Patients were stratified into eight consecutive 2-year calendar cohorts. Outcomes were reported according to VARC-III criteria.

Results: Median age was 82 y (53% male). Over the consecutive cohorts, we observed significant decreases in STS score (8.1 ± 3.1 to 4.4 ± 2.6%) and EuroSCORE II (10.2 ± 8.0 to 6.4 ± 7.0; p < 0.001 for both). In-hospital death rates decreased significantly (9.4% to 1.3%; p = 0.030). The incidence of major vascular complications, life-threatening bleeding, and cardiac tamponade decreased significantly over time (p < 0.05 for all). Enhanced learning and a shift to a minimalist approach resulted in reduced need for intensive care (from 4 [3-5] to 0 days) and shorter hospital stay (from 13 [8-19] to 2 [2-4] days) (p < 0.001 for both). Overall 30-day survival was 96.4%, with significant improvement across cohorts (93.4% to 98.7%), while 1-year survival was 88.1% with a similar gradual increase (81.3% to 90.2%). Composite VARC-III endpoints demonstrated high technical success and significant improvements in device success and early safety across the eight 2-year cohorts.

Conclusions: Over 15 years we observed a shift from very high-risk towards predominantly intermediate- to high-risk patients, together with substantial procedural simplification and a marked reduction in in-hospital complications and length of stay. These improvements translated into a significant increase in 30-day and 1-year survival.

Background/aims: Identifying clinical risk factors of failed electrical cardioversion (ECV) for persistent or long-standing persistent atrial fibrillation (AF) can guide selection of rhythm control.

Methods: A total of 1058 patients who underwent ECV for persistent or long-standing persistent AF at multiple centres were retrospectively reviewed. Patients were divided into three groups: group 1 maintained sinus rhythm (SR) for >1 year, group 2 maintained SR ≤1 year after ECV, and group 3 had failed ECV. SR maintenance was assessed via regular electrocardiography follow-ups or Holter.

Results: Group 1, 2 and 3 comprised 315 (30%), 654 (62%), and 89 (8%) patients, respectively. The mean patient age was 61 ± 10 years, with males accounting for 78% (824). Group 3 showed longer AF duration, female dominance, high proportion of patients with history of coronary artery disease (CAD) and heart failure (HF), and increased left atrium (LA) diameter, LA volume index (LAVI), cardiac size, and cardiothoracic ratio. Univariate analysis revealed that AF duration (≥50 months), female sex, history of CAD and HF, increased LA diameter (≥ 45 mm) and LAVI (≥ 45 mL/m²), and no antiarrhythmics were risk factors of failed ECV for persistent or long-standing persistent AF. Among them, AF duration (≥50 months), history of HF, and increased LAVI showed clinical significance in the multivariate analysis.

Conclusions: Longer AF duration, history of HF, and increased LAVI were strongly associated with failed ECV in patients with persistent or long-standing persistent AF.

Background: It is well known that soluble suppression of tumorigenicity 2 (sST2) predicts heart failure outcomes. Little attention has been paid to its use in atrial fibrillation (AF). We investigated whether sST2 is involved in AF formation and recurrence after catheter ablation.

Methods: A systematic review and meta-analysis study was completed. Until the end of November 2023, the potential articles from Cochrane, OpenMD, PubMed, and ScienceDirect were collected. The assessment of study quality was conducted using the Newcastle-Ottawa scale (NOS). All relevant data from eligible studies were extracted. A random effect model was used for the pooled analysis.

Results: A total of 14582 participants from 19 studies were involved in this study. The sST2 level was greater in individuals with AF than those with sinus rhythm (standardised mean difference [SMD] = 0.45; 95% confidence interval [CI] = 0.29 to 0.61; p < 0.01). Elevated sST2 levels were correlated with an increased likelihood of developing AF (hazard ratio [HR] = 1.07; 95% CI = 1.00 to 1.14; p = 0.04). A higher sST2 level was found in individuals with recurrent AF (SMD = 0.78; 95% CI = 0.32 to 1.23; p < 0.01). An elevated level of sST2 was related to a greater recurrent AF risk (HR = 1.17; 95% CI = 1.04 to 1.32; p = 0.01).

Conclusions: The circulating biomarker sST2 has an essential role in AF development. Moreover, sT2 is a significant predictor for recurrent AF after a successful catheter ablation procedure.

Background: Transthyretin amyloid cardiomyopathy (ATTR-CM) patients continue to experience worsening heart failure despite therapy with disease modifying therapies (tafamidis, patisiran, etc.). Given the proven benefits of SGLT2 inhibitors in heart failure, their efficacy in ATTR-CM patients remains unexplored.

Methods: A systematic search of PubMed, Google Scholar, Web of Science, and Cochrane Central Library was conducted from inception to April 2025 for studies evaluating the efficacy of SGLT2 inhibitors in ATTR-CM patients receiving disease-modifying therapy. A random-effects meta-analysis model was used, and all-cause mortality was analysed as the primary outcome.

Results: Seven observational studies comprising 7283 patients with transthyretin amyloidosis (ATTR) cardiomyopathy were included. SGLT2 inhibitors were associated with lower risk of all-cause mortality (RR: 0.51 [0.45, 0.57] 95% CI, p < 0.00001; I² = 10%), cardiovascular mortality (RR: 0.30 [0.16, 0.55] 95% CI; p = 0.0001; I² = 25%) and MACE (RR: 0.69 [0.59, 0.81] 95% CI; p < 0.00001; I² = 10%) as compared to patients receiving no SGLT2 inhibitor. Additionally, the use of SGLT2 inhibitors was associated with significantly improved glomerular filtration rates (MD: 3.11 [0.52, 5.71] 95% CI, p = 0.02; I² = 54%) as compared to patients receiving no SGLT2 inhibitor. SGLT2 inhibitor therapy did not have a significant effect on the risk of hospitalisations due to heart failure.

Conclusions: SGLT2 inhibitors, when used alongside disease-modifying agents, appear to improve survival and renal outcomes in patients with ATTR-CM. However, these findings are derived from observational studies with their inherent biases and must be interpreted with caution. High-quality randomised controlled trials are needed to confirm these associations and better define their clinical role in ATTR-CM.

Background: This study investigated whether functional characteristics and barriers to cardiac rehabilitation (CR), assessed through the Cardiac Rehabilitation Barriers Scale (CRBS), predict 30-day hospital readmission following discharge for acute coronary syndrome (ACS).

Methods: Single-center, observational longitudinal study conducted at a cardiology hospital.At hospital discharge, participants underwent assessments of respiratory muscle strength (maximum inspiratory [MIP] and expiratory pressures [MEP]), handgrip strength (HGS-D), and functional capacity (6-minute walk distance [6MWD]). At 30 days post-discharge, patients completed the CRBS, encompassing four domains (perceived needs/healthcare factors, logistical factors, work/time conflicts, and comorbidities/functional status) and were evaluated for hospital readmission.

Results: A total of 320 patients (63.8% men, mean age 63.5 ± 11.3 years, median GRACE score 109 [range 63-173]) were included. After adjustment for confounders (age, sex, BMI, GRACE score, length of stay, and time since discharge), shorter 6MWD (OR = 0.981, 95%CI 0.968-0.994, p = 0.005), lower MEP (OR = 0.891, 95%CI 0.841-0.945, p < 0.001), and higher CRBS comorbidities/functional status scores (OR = 1.429, 95%CI 1.241-1.645, p < 0.001) were associated with increased odds of hospital readmission. Additionally, 6MWD was inversely associated with the CRBS sum score (β = -0.020, 95%CI -0.034 to -0.006, p = 0.005).

Conclusion: Functional impairments and perceived barriers to cardiac rehabilitation are significant predictors of 30-day hospital readmission in ACS patients. Early identification of at-risk individuals may enhance post-discharge care strategies and reduce readmission rates.