Acta cardiologica最新文献

Background: Mediastinal cysts are common mediastinal lesions in which diagnostic and therapeutic choices are not always unambiguously presented. Usually, these cysts are asymptomatic and detected by coincidence. The question remains whether, if symptoms are present, the cyst is responsible and whether it should be treated. Unfortunately, there is a lack of standardised guidelines concerning diagnostic, therapeutic management and follow-up.

Case summary: In this case series we reported five patients with mediastinal cysts. All patients received a thoracic CT during the initial diagnostic assessment. Four out of five patients were symptomatic and were surgically treated during a uniportal video-assisted thoracoscopy. One patient was asymptomatic and receives a biennial follow-up. Most often, histopathological examination confirmed the already presumed type of non-neoplastic mediastinal cyst based on anatomical location and tissue characteristics (one thymic cyst, one bronchogenic cyst and two pericardial cysts). Except for one patient, all surgically treated patients experienced improvement in symptoms.

Conclusion: Regarding diagnosis and treatment of this entity, a systematic approach in accordance with the most recent literature is important. The diagnosis can only be confirmed on histopathological examination, but several imaging techniques, with contrast-enhanced CT as the first-choice technique, could guide the differential diagnosis. In large, symptomatic cysts or present potential malignant features, surgical removal is indicated. This case series encourages further substantial research concerning the selection and timing of therapy.

Background and aims: Overweight and obesity have been found to exhibit a statistically significant increase in corrected QT interval (QTc), a major contributing factor to sudden death. However, the influence of widely used weight loss strategies including diet, exercise, anti-obesity drugs, and bariatric surgery on QTc remains inconsistent. Therefore, the present systematic review and meta-analysis aim to quantitatively analyse and evaluate the effect of weight loss on QTc in obese patients after diet control with exercise intervention and anti-obesity drugs, as well as bariatric surgery.

Methods: Twenty randomised controlled trials (RCT) and observational studies were included in the meta-analysis on the effects of weight loss on QTc. The fixed-effects model was employed in the RCTs, and the random-effects model was employed due to the presence of statistical heterogeneity among observational studies. Subgroup analysis was conducted to understand the differences in distinct weight loss methods and follow-up time.

Results: Overall, the QTc of people with obesity after weight loss was shorter than that before (mean difference (MD) = 21.97 ms, 95% confidence interval (CI) = 12.42, 31.52, p < .0001). Subgroup analysis restricted to seven included studies whose intervention was diet control with exercise showed a decrease of QTc with statistical significance (MD = 9.35 ms, 95%CI = 2.56, 37.54, p = .007). In the remaining 11 studies, bariatric surgery was the weight loss method. The results also showed a shortening of QTc after surgery, and the difference was statistically significant (MD = 29.04 ms, 95%CI = -16.46, 41.62, p < .00001). A statistically significant difference in QTc shortening at 6 months compared to pre-operation values was further observed (MD = -31.01 ms, 95%CI = -2.89, -59.12, p = .03). The shortening of QTc at 12 months of follow-up was also significantly different from that before surgery (MD = 36.47 ms, 95%CI = 14.17, 58.78, p < .00001). Moreover, the differences became more pronounced as the follow-up time extended.

Conclusions: We demonstrate that weight loss links to a shortened QTc, without considering the means of weight loss. Bariatric surgery has been found to result in a greater reduction in QTc.

Background: This study aimed to evaluate the association between peak tricuspid regurgitation velocity (TRV) and 1-year heart failure (HF) readmission in hospitalised patients with HF with preserved ejection fraction (HFpEF) because the impact of peak TRV on the short-term prognosis of these patients has been unclear.

Methods: From January 2020 to December 2021, 513 hospitalised HFpEF patients age ≥ 60 years with 1-year follow-up were included in this study. Peak TRV was classified as normal (≤ 2.8 m/s) and high (> 2.8 m/s) value according to pulmonary hypertension probability.

Results: Approximately 68.23% of HFpEF patients had a high peak TRV value. In the final adjusted Cox regression model, peak TRV was still independently associated with HF readmission (HR: 1.74, 95% CI: 1.19-2.55, p = 0.004). Furthermore, patients with high peak TRV were also associated with an increased risk of HF readmission (HR: 2.30, 95% CI: 1.31-4.04, p = 0.004), compared to those with normal peak TRV. After inverse probability of weighting, the risk of HF readmission in patients with high peak TRV was 2.53 (95% CI: 1.35-4.75, p = 0.004) compared to those with normal peak TRV. Additionally, Subgroup analysis revealed very elderly patients, male, and patients with hypertension had a significantly worse prognosis.

Conclusion: Peak TRV is independently associated with HF readmission in hospitalised HFpEF patients. High peak TRV has a higher risk of HF readmission in patients age ≥ 80 years, male and patients with hypertension, indicating that special attention should be paid to these patients.