Cardiology discovery最新文献

The heart-brain axis involves complex interactions between the cardiovascular and nervous systems via a network of cortical and subcortical structures working with the autonomic nervous system and intracardiac nervous system. Heart-brain interactions may be divided into 2 broad categories: cardiac effects of neurological disease and neurological effects of cardiac disease. The pathogenesis of neurogenic cardiac effects is thought to involve a neurogenic cascade where sudden shifts in autonomic balance lead to an exaggerated catecholamine release. This can occur in acute neurological conditions such as ischemic stroke, intracranial hemorrhage, and epilepsy. Cardiovascular complications include the stroke-heart syndrome, neurogenic pulmonary edema and cardiomyopathy, Takotsubo syndrome, arrhythmias, and even sudden cardiac death. Certain areas of the brain, such as the insular cortex, play key roles in cardiac autonomic regulation, and disorders affecting these areas have greater effects on the heart. On the other hand, cardiac conditions can also adversely impact the neurological system. Atrial fibrillation and left ventricular thrombus can cause cardioembolic strokes, whereas heart failure and severe aortic stenosis have been linked to the development of cognitive impairment. This review aims to provide a broad overview of key topics in neurocardiology as well as delve into the evidence and pathophysiology behind these conditions.

Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide and is associated with poor clinical outcomes and a huge economic burden on healthcare systems. Optimized anticoagulation, better symptom control via rhythm or rate control, and comprehensive comorbidity/risk factor management are 3 essential pillars of current AF management, where much progress has been made during the past decades. However, numerous challenges in AF management remain at the disease, patient, and population levels, including an incomplete understanding of basic mechanisms that can be clinically targeted; heterogenous progressive natural history; poor correlation between rhythm and symptoms/outcomes; as well as suboptimal detection methods and treatment options. Recent advances in disease perception in combination with modern monitoring devices, state-of-the art computational models, and novel antiarrhythmic drugs and ablation strategies can contribute to addressing these issues, ultimately leading to a paradigm shift in AF diagnosis, classification, and treatment. This narrative review summarizes these key challenges and future opportunities in the field of AF management.

[This corrects the article DOI: 10.1097/CD9.0000000000000139.].

The assessment of cardiac function using echocardiography has gained a strong foothold in clinical practice. Cardiac magnetic resonance (CMR) imaging harbors distinct advantages over echocardiography, as it is not affected by limitations of acoustic windows and operator dependence. CMR is also designed to non-invasively assess cardiac morphology, ventricular geometry, myocardial wall motion, and intra-cardiac flow quantification without the use of ionizing radiation. These inherent features make CMR appropriate for diagnosing cardiovascular diseases, monitoring patients after treatment, and providing longitudinal follow-up. In this paper, the state-of-the-art work that has demonstrated the aspects of cardiac function by CMR is reviewed, and acquisition techniques and clinical applications are covered.

Objective: Home blood pressure monitoring (HBPM) is viewed as a facilitating factor in the initial diagnosis and long-term management of treated hypertension. However, evidence remains scarce about the effectiveness of HBPM use in the real world. This study aimed to examine the associations of HBPM use with blood pressure (BP) control and medication adherence.

Methods: This prospective cohort study included hypertensive patients with high cardiovascular risk who were aged ≥50 years. At baseline, information about types of BP monitor, frequency of HBPM, perception of anti-hypertensive treatment, and measured office BP were collected. During the 1-year follow-up (visits at 1, 2, 3, 6, and 12 months), information on medication adherence was collected at each visit. The 2 major outcomes were BP control at baseline and medication adherence during the 1-year follow-up. A log-binomial regression model was used to examine the association between frequency of HBPM and outcomes, stratified by the perceptions of anti-hypertensive treatment.

Results: A total of 5,363 hypertensive patients were included in the analysis. The age was (64.6 ± 7.2) years, and 41.2% (2,208) were female. Of the total patients, 85.9% (4,606) had a home BP monitor and 47.8% (2,564) had an incorrect perception of anti-hypertensive treatment. Overall, 24.2% (1,299) of patients monitored their BP daily, 37.6% (2,015) weekly, 17.3% (926) monthly, and 20.9% (1,123) less than monthly. At baseline, the systolic BP and diastolic BP were (146.6 ± 10.8) mmHg and (81.9 ± 10.6) mmHg, respectively, and 28.5% (1,527) of patients had their BP controlled. Regardless of whether the patients had correct or incorrect perceptions of anti-hypertensive treatment, there is no significant association between HBPM frequency and BP control at baseline. During the 1-year follow-up, 23.9% (1,280) of patients had non-adherence to medications at least once. In patients with an incorrect perception of anti-hypertensive treatment, those monitoring BP most frequently (daily) had the highest non-adherence rate (29.9%, 175/585). Compared with those monitoring their BP less than monthly, patients who monitored their BP daily were more likely not to adhere to anti-hypertensive medications (adjusted relative risk = 1.38, 95% confidence interval: 1.11-1.72, P = 0.004).

Conclusions: HBPM performance among hypertensive patients in China is, in general, sub-optimal. No association was observed between using HBPM alone and hypertension control, indicating that the effects of HBPM could be conditional. Patients' misconceptions about anti-hypertensive treatment may impair the role of BP monitoring in achieving medication adherence. Fully incorporating the correct perception of hypertension into the management of hypertensive patients is needed.