Acta cardiologica最新文献

Background and aims: Sodium-glucose transporter 2 inhibitors have recently shown promise as a therapy to reduce mortality and hospitalisation for heart failure (HF) in patients with and without type 2 diabetes mellitus. The aim of this prospective study was to determine the results of a multiparametric evaluation after the addition of dapagliflozin to standard therapy in patients with heart failure with reduced ejection fraction (HFrEF).

Methods: From February to November 2022, 45 patients with chronic HF who regularly visited our HF outpatient clinic were selected for this study. Exclusion criteria were severe chronic renal insufficiency (GFR < 25 ml/min), type 1 diabetes, hypertrophic or restrictive cardiomyopathy, active myocarditis, constrictive pericarditis. The included patients took dapagliflozin once daily in addition to sacubitril/valsartan and other HF drugs. The following parameters were recorded before the start of therapy and at the 3-month follow-up: NYHA functional class, characteristics of the cardiopulmonary exercise test (CPET), parameters of the six-minute walk test (6MWT), quality of life (QoL) using the Kansas City Cardiomyopathy Questionnaire (KCCQ), echocardiographic evaluation.

Results: At 3-month follow-up, a significant increase in peak Vo2 (from 17.5 to 18.2, p < 0.001) and a significant decrease in VE/VCO2 (35.2 to 33.1, p = 0.011) were observed. In addition, Vo2/work gradient and pulse O2 increased significantly. Furthermore, a significant improvement in 6MWT, quality of life and left ventricular dimensions and systolic function was observed.

Conclusion: This prospective, multiparametric study showed that the additional administration of dapaglifozin to sacubitril/valsartan and other HF drugs is effective after three months.

Cardiovascular disease (CVD), comprising heart and blood vessel disorders, persists as the foremost contributor to global morbidity and mortality. In modern times, the intricate composition of gut microbiota has garnered significant focus, particularly for its varying impact on diverse ailments. Gut dysbiosis, or harmful alterations in the makeup of the gut microbiota, has been related to the development and progression of a variety of disorders, including cardiovascular disease (CVD). Imbalances in the host-microbial interaction hamper homeostatic processes that govern health and can activate various pathways that contribute to the advancement of CVD risk factors, including conditions like atherosclerosis, hypertension, and heart failure. Discovering the link between gut microbiota and CVD development can lead to the development of innovative microbiome-based preventive and therapeutic approaches. To enable effective and highly precise preventative and therapeutic strategies for CVD, an interdisciplinary approach is needed to shed light on gut bacterial-mediated mechanisms (e.g., using advanced nanomedicine technologies and incorporating other factors such as age, sex, medical conditions, co-morbidity, food habits, physical activity, etc.). This comprehensive review delves into the pivotal role of gut microbiota in maintaining cardiovascular well-beings.

This study explores microRNAs (miRNAs) as biomarkers for hypertrophic cardiomyopathy (HCM), an inherited cardiac disease with clinical diversity and sudden death risk. Using bioinformatics and machine learning (ML), Gene Expression Omnibus (GEO) datasets were analysed to identify miRNA signatures for early detection, risk assessment, and personalised treatment of HCM. Differential expression analysis of three GEO datasets identified 155 differentially expressed genes (DEGs) and 5 differentially expressed miRNAs (DE-miRNAs). Functional annotation and pathway analysis revealed their roles in inflammatory responses, extracellular matrix organisation, and cellular stress responses. Notably, upregulated (COL21A1, PROM1) and downregulated (FOS, BTG2, ELL2, PDK4, SERPINE1, SRGN, TIPARP) genes were detected as potential DE-miRNA targets. Validation highlighted importance of ELL2 and PDK4 in HCM pathology. Support Vector Machine (SVM) and Random Forest (RF) models demonstrated high predictive accuracy for HCM using DE-miRNAs, suggesting new paths for early diagnosis and personalised therapy.

Background: Patients with atrial fibrillation/flutter (AF/AFL) face higher risks of death, heart failure, and thromboembolic events, with major attributable risk factors.

Objective: This study examined epidemiological data and trends on six major risk factors contributing to the AF/AFL burden from the 2021 Global Burden of Disease (GBD) study.

Methods: AF/AFL risk-attributable deaths, disability-adjusted life years (DALYs), and age-standardised mortality (ASMR) and DALY (ASDRs) rates from 1990 to 2021 were extracted from the GBD database. Future trends were predicted using the ARIMA model, and annual percentage changes assessed major risk factors and regional disease burden differences, with subgroup analyses by socio-demographic index (SDI) regions and countries. Statistical analysis was performed using R software version 4.3.1, and a two-sided p < 0.05 was considered statistically significant.

Results: Environmental, behavioural, and metabolic risk factors significantly influenced the AF/AFL burden from 1990 to 2021, with ASMRs and ASDRs showing clear spatial and temporal patterns.

Forecasted trends: Deaths and DALYs attributable to these risk factors are projected to continue rising over the next 30 years, with body mass index (BMI) driving the largest increase in AF/AFL burden, while environmental and behavioural influences are expected to plateau.

Spatial variation: Regional disparities remain, with high-SDI areas experiencing burden stabilisation through improved risk factor control, whereas low-SDI regions - particularly those undergoing rapid urbanisation with higher lead exposure and alcohol use - face increasing burdens, especially from metabolic risks.

Conclusion: AF/AFL burden will continue to rise, primarily driven by metabolic risks such as high BMI, with regional disparities highlighting the need for targeted preventive strategies.

Background: Acute coronary syndrome (ACS) patients with multiple cardiovascular risk factors face particularly high recurrence rates. The differential impact of cardiac rehabilitation across ACS subtypes in high-risk patients remains understudied.

Methods: This prospective, randomised, single-center study evaluated cardiac rehabilitation effects on adherence across ACS subtypes in high-risk patients. 260 patients with baseline smoking, BMI ≥25 kg/m², and physical inactivity were randomised 1:1 to cardiac rehabilitation or control groups. Patients were stratified by ACS type: STEMI, NSTEMI, and unstable angina pectoris (UAP). Primary outcomes included adherence to medical treatment, dietary recommendations, physical activity guidelines, smoking cessation, and weight management at one-year follow-up.

Results: Among 260 patients (130 rehabilitation, 130 control), NSTEMI was most common (45.4%), followed by STEMI (32.7%) and UAP (21.9%). Cardiac rehabilitation significantly improved adherence across all ACS subtypes. Overall adherence rates in rehabilitation vs. control groups were: medical treatment (89.2% vs. 71.5%, p < 0.001), dietary recommendations (82.3% vs. 58.5%, p < 0.001), physical activity (85.4% vs. 42.3%, p < 0.001), smoking cessation (76.9% vs. 43.1%, p < 0.001), and weight management (73.1% vs. 51.5%, p < 0.001). STEMI patients excelled in smoking cessation (84.7% vs. 38.6%), NSTEMI in physical activity (88.1% vs. 40.7%), and UAP in medical adherence (92.9% vs. 75.0%). All-cause rehospitalization rates were significantly lower in the rehabilitation group (12.3% vs. 23.1%, p = 0.023), as were cardiovascular-related rehospitalizations (7.7% vs. 18.5%, p = 0.012).

Conclusion: Structured cardiac rehabilitation significantly enhances adherence to all secondary prevention measures across STEMI, NSTEMI, and UAP subtypes in high-risk patients, with subtype-specific patterns of improvement.

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.