Acta cardiologica最新文献

Background: Blood pressure (BP) control in haemodialysis (HD) patients is essential. Peri-dialytic BP levels do not accurately diagnose hypertension or predict the cardiovascular (CV) mortality.

Methods: In this study, we recruited 43 adult patients who had been on chronic HD for ≥3 months. Seven-day home BP monitoring (HBPM) (values of Day1 discarded) and 44-h interdialytic ambulatory BP monitoring (iABPM) were performed. Pre- and post-dialysis BP levels were measured during the 6 dialysis sessions prior to iABPM. A 6-year follow-up was carried out to assess all-cause and CV mortality.

Results: In patients considered as normotensive in pre-dialysis (n = 17), masked hypertension was found in 24% and 29% on the basis of iABPM and HBPM, respectively. Conversely, among hypertensive patients in pre-dialysis (n = 26), 'white-coat' hypertension was noted in 23% either by iABPM or HBPM. After a 6-year follow-up, 25 patients were deceased including 6 patients from CV causes. Day-time systolic BP measured by iABPM was associated with all-cause mortality in an adjusted model for age and gender (p = 0.045).

Conclusion: In chronic HD patients, 44-h iABPM and 6-day HBPM show a reliable concordance and help to re-classify ∼25% of cases miscategorised based on pre-dialysis measurements. Day-time systolic BP levels using iABPM were significantly associated with 6-year all-cause mortality.

Cor Triatriatum Dexter (CTD) is a rare congenital heart malformation, with an estimated incidence of 0.025%, characterised by a membrane dividing the right atrium (RA) into two chambers. A variant, incomplete CTD (CTDi), occurs when the right membrane extends partially into the interatrial septum without fully dividing the RA. CTDi can be associated with interatrial septal defects, found in 5% of patients with atrial septal defects or a patent foramen ovale (PFO). The study reports three adult patients (46-53 years old) with CTDi and a PFO, all presenting cryptogenic stroke and referred for PFO closure. Two cases underwent percutaneous closure with guidance from fluoroscopy and 2D/3D transesophageal echocardiography (TEE), and the last one utilised intracardiac echocardiography (ICE) for device placement. In patients referred for PFO closure, CTDi is common and can complicate visualisation, prolong procedure times, and reduce success rates. Difficulties in device deployment and the risk of residual shunt or embolisation have been reported. The authors highlight that using oversizing techniques, traction manoeuvres during device deployment, and preoperative planning with advanced imaging (such as ICE or 3D TEE) are crucial for successful percutaneous closure in cases with CTDi and PFO.

Background: Atrial fibrillation (AF) is the commonest supraventricular arrhythmia in adults. Timely AF diagnosis seems to ameliorate patients prognosis.

Purpose: To investigate the association between peak left atrial longitudinal strain (PALS) and new onset AF in the general population.

Objectives: We searched major electronic databases for articles assessing the relationship between PALS and incident AF.

Results: Eight studies (11,145 patients) were analysed. Lower levels of PALS were significantly associated with higher risk of incident AF (HR: 0.95; 95%CI: 0.92-0.97, I²: 83%). According to the diagnostic accuracy meta-analysis, PALS <33.4% presents 64% (95%CI: 46-79%) sensitivity and 69% (95%CI: 63-75%) specificity.

Conclusions: In a relatively healthy population, lower levels of PALS were significantly associated with incident AF. The overall diagnostic accuracy was moderate. Lower levels of PALS seem to justify an opportunistic - rather than a systematic-screening approach. These findings could allow more efficient utilisation of healthcare resources.

Atrial fibrillation is a chronic progressive disease and is the most common arrhythmia in adults. It is a major cause of cardiovascular morbidity and mortality. The EAST-AFNET 4 trial demonstrated that rhythm control in patients with early atrial fibrillation significantly reduces cardiovascular outcomes compared to usual care. The effectiveness of early rhythm control is predominantly mediated by the presence of sinus rhythm and early rhythm control is more effective in patients with multiple comorbidities. Studies such as STOP-AF First, Cryo-FIRST, EARLY-AF and its 3-year follow-up trial demonstrate that first-line catheter ablation is more effective in maintaining sinus rhythm than anti-arrhythmic drug therapy. These findings are leading to a paradigm shift in the electrophysiology community in favour of early rhythm control with catheter ablation when feasible.