Acta cardiologica最新文献

Background: Cardiac arrest (CA) is common but deadly. Prior hospitalisation represents a missed opportunity for prevention and identification of high-risk groups before CA. This study aims to determine the extent of and underlying reasons for hospitalisations during the 30-day period preceding an admission with CA.

Methods: We conducted a retrospective cohort study using the United States National Readmission Database (NRD) during 2018-2020. We evaluated hospitalisations with a diagnosis of CA and admissions in the 30-day period before hospitalisation with CA. Multiple logistic regressions were used to identify factors associated with prior hospitalisation and mortality on admission with CA.

Results: Among 1,637,240 hospital episodes with CA, 255,500 (15.6%) had an admission to hospital in the 30-day period prior to hospitalisation with a diagnosis with CA. The categories for causes of previous admissions were disorders of the circulatory system (27%), infectious and parasite disease (13%), and disorders of the respiratory system (12%). The most common diagnoses were sepsis, hypertensive heart and renal disease, acute myocardial infarction, and respiratory failure. Cancer (OR 2.09 95%CI 2.04-2.15, p < 0.001), chronic kidney disease (OR 1.45 95%CI 1.42-1.48, p < 0.001), and chronic lung disease (OR 1.25 95%CI 1.22-1.27, p < 0.001) were the most significant factors associated with prior admission. Previous hospital admission was associated with increased odds of mortality (OR 1.58 95%CI 1.55-1.62, p < 0.001).

Conclusions: Hospitalisations within the 30-day period preceding an admission with CA are common and occur in about 1 out 6 patients. The most common primary diagnoses for prior hospitalisation were sepsis, renal and cardiovascular disease.

Identification of a cardiomyopathy phenotype should prompt a systematic search for the underlying aetiology, which may be genetic or acquired and can be associated with extracardiac manifestations. Fabry Disease (FD) is an inherited metabolic disorder causing left ventricular hypertrophy along with multiples other cardiac symptoms. Due to its X-linked transmission, FD was long thought to only affect men, although women are also involved but with a different spectrum of presentations, with less important symptoms that tend to appear later or with atypical phenotype.

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: 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.