American journal of cardiovascular disease最新文献

Objectives: Postoperative pulmonary complications (POPC) are common after cardiac surgeries such as coronary artery bypass grafting (CABG) and are influenced by factors including anesthesia and surgical trauma. Inspiratory muscle training (IMT) with visual biofeedback may mitigate these complications. This study investigates the impact of threshold loading inspiratory muscle training (TL-IMT) combined with respiratory biofeedback on the dynamic strength of inspiratory muscles (S-index) in patients undergoing CABG surgery during their hospitalization phase.

Methods: A single-blind study was conducted with 38 CABG candidates at Shahid Modares Hospital, Tehran. Participants were randomized into two groups: the TL-IMT with biofeedback group and the placebo IMT group. TL-IMT exercises were performed at 30% of maximum dynamic inspiratory strength using the Power Breath K5 device, with visual biofeedback displayed on the screen. The placebo group performed the same exercises at minimal load without biofeedback. Both groups received standard respiratory physiotherapy. Measurements of S-index, peak inspiratory flow (PIF), and vital capacity (VC) were taken before surgery (T1), one day after surgery (T2), and at discharge (T3).

Results: Both groups showed significant changes, with a decrease from T1 to T2 and an increase from T2 to T3. In the study group, T3 values remained the same as at T1, while the placebo IMT group experienced a significant decrease. After surgery, both groups had a drop in the S-index. However, the study group saw more pronounced changes between T3-T2 and T3-T1 compared to the control group, although no significant difference was found between T2-T1. By the time of discharge, the TL-IMT group had higher S-index values than the placebo group, returning to preoperative levels. Additionally, the TL-IMT group showed improvements in PIF and VC.

Conclusion: TL-IMT with visual biofeedback effectively maintains dynamic inspiratory muscle strength and improves key pulmonary parameters in cardiac surgery patients. These findings suggest that integrating TL-IMT with biofeedback can enhance postoperative recovery and reduce the incidence of POPC.

Background and aims: Depression is a prevalent comorbidity among patients with coronary heart disease (CHD). While recent studies have hinted at a possible association between CHD and antidepressant medications like sertraline, the existing evidence remains inconclusive. To investigate this potential link, we conducted a comprehensive systematic review.

Methods: We systematically searched PubMed, Google Scholar, and Scopus for relevant articles published up to March 2023. After a thorough screening of titles and abstracts, 12 studies were included in our review.

Results: The included studies, spanning from 1999 to 2021, comprised 11 randomized controlled trials (RCTs) and one pilot study. A total of 2767 participants with major depressive disorder and a history of cardiovascular disease or at risk for such events were included. The majority of these studies demonstrated improvements in mood status among patients treated with serotonin-targeting antidepressants and a reduced risk of cardiovascular events, as measured by various outcomes. While some cardiac adverse effects were observed with serotonin treatment, these did not reach statistical significance.

Conclusion: Our findings provide evidence supporting the beneficial effects of serotonin-targeting antidepressants for both depressive symptoms and the prevention of coronary adverse outcomes. These results highlight the potential value of serotonin-based treatments for depression in high-risk populations.

Patients presenting with severe acute cardiogenic pulmonary edema with hypoxia commonly require intubation until heart failure treatments take effect. A new term describing similar condition is called sympathetic crashing acute pulmonary edema (SCAPE). It is also called Flash pulmonary edema. Immediate pre- and afterload reduction can abort intubation. Using rapid repeated buccal administrations of nitroglycerin ointments can prevent intubation by rapidly reducing pre- and afterload as long as systolic blood pressure remains adequate without cardiogenic shock. A case series of 6 patients who needed intubation due to severe cardiogenic pulmonary edema and hypoxia despite 100% O2 administration without the presence of cardiogenic shock were successfully treated with repeated buccal administration of nitroglycerin ointments. Approximately half of an inch of nitroglycerin ointment (nitropaste) was buccally administrated every 60 seconds as long as repeated blood pressure measurements every minute before each repeated administration remained above 120 mmHg. Complete response with resolution of dyspnea with minimal oxygen requirement achieved in less than 30 minutes in all patients. Intubation was prevented in all 6 patients. No adverse events occurred in any of the patients. A treatment protocol and algorithm are developed based on these patients and reported cases in the literature for prevention of intubation in these patients. Rapid repeated buccal administration of nitroglycerin ointment is highly effective in preventing intubation and mechanical ventilation in patients with any acute pulmonary edema or SCAPE and hypoxia without cardiogenic shock.

Objectives: This systematic review aimed to review existing evidence to evaluate the effects of physical cardiac rehabilitation on cardio-pulmonary outcomes in the patients with hypertrophic cardiomyopathy (HCM).

Methods: We conducted a systematic search of the databases PubMed, Web of Science, Embase, Scopus, and Google Scholar. The initial search led to 1222 citations after removing duplicate results. We included only English-written studies published since 2013 (2013-2023). Ultimately, we retrieved five studies, involving 235 participants. We used the Cochrane Risk of Bias Tool for randomized trials (RoB2) and risk of bias in non-randomized studies of intervention (ROBINS-I) for evaluating the risk of bias in randomized and non-randomized studies, respectively.

Results: Results showed that four training programs improved participants' functional capacity by up to 46%. Improvements in weight, BMI, echocardiography, and remodeling parameters (left atrium volume index, premature ventricular contraction burden, pulmonary artery systolic pressure), exercise test results (minute ventilation/carbon dioxide production, peak workload, heart rate reserve, exercise duration, peak heart rate, peak systolic pressure, and blood pressure response to exercise normalization), and a decrease in N- Terminal Pro-Brain Natriuretic Peptide (NT-pro BNP) were reported in these studies. No major adverse events, including sustained tachyarrhythmia, implantable cardioverter-defibrillator discharge, and sudden cardiac death were reported.

Conclusion: Supervised exercise training is safe and helpful for patients diagnosed with HCM. It can improve exercise capacity and is considered an adjunctive therapeutic option.

Objectives: To our knowledge, there is no clear consensus on a definitive cardiac rehabilitation method for patients undergoing Coronary Artery Bypass Graft (CABG). We conducted this systematic review to compare and evaluate the effects of two of the most frequent cardiac rehabilitation modalities, high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT), on cardiopulmonary variables.

Methods: We carried out a systematic search of the databases PubMed, Web of Science, Embase, Scopus, and Google Scholar. Following the removal of duplicate results, the original search yielded 385 citations. We identified four randomized clinical trials after reviewing titles, abstracts, and potential full-text studies. We utilized the Cochrane Risk of Bias Tool (RoB2) to assess the risk of bias.

Results: We included four randomized clinical trials involving 143 people. All trials included individuals who had CABG and completed HIIT or MICT sessions for at least four weeks. The findings indicated that HIIT programs may improve functional capacity, heart rate variability indices, and blood pressure management while lowering brain natriuretic peptide (BNP_1-32) and N-terminal pro-b-type natriuretic peptide (NT-proBNP_1-76) levels.

Conclusion: Given the findings, it appeared that supervised high-intensity exercise regimens could be more useful to patients. Following the surgery, HIIT therapy improves exercise capacity, the autonomic nervous system, volume overload, and blood pressure regulation.

Background and aim: Sodium-glucose cotransporter two inhibitors can reduce cardiovascular events by modulating lipid profiles in patients with heart failure, irrespective of diabetes status. In this study, we aimed to assess the effects of SGLT-2 inhibitors on the lipid profiles of patients with heart failure via a meta-analysis.

Methods: The PubMed, Scopus, Web of Science, and Google Scholar databases were searched up to 2023 to retrieve relevant article titles, abstracts, and full texts. STATA software was used to conduct the meta-analysis.

Result: The Forest plot of fasting blood sugar levels in patients receiving SGLT-2 inhibitors differed significantly from those the in control group (mean difference = -0.08, 95% CI [-0.13, -0.02], P < 0.05). Analysis of lipid profile parameters, including total cholesterol, triglyceride, HDL, and LDL in patients with HF receiving SGLT-2 inhibitors, did not show a notable difference from the control group (P > 0.005). However, the mean difference was towards the reduction of LDL, cholesterol, and triglycerides and showed an increase in HDL levels. Egger's test for publication bias revealed some publication bias (P < 0.05).

Conclusion: Our topic analysis did not reveal any notable alterations in the lipid profile. To arrive at a more definite agreement, further research on subjects with heart failure is necessary because there is currently insufficient evidence.

Objectives: Cardiogenic shock is a significant economic burden on healthcare facilities and patients. The prevalence and outcome of cardiogenic shock in the South Bronx are unknown. The aim of the study was to examine the burden of non-AMI CS in Hispanic and Black population in South Bronx and characterize their in-hospital outcomes.

Methods: We reviewed patient charts between 1/1/2022 and 1/1/2023 to identify patients with a primary diagnosis of cardiogenic shock (ICD codes R57.0, R57, R57.8, R57.9) residing in the following zip codes: 10451-59 and 10463. Student's T-test was used to assess differences for continuous variables; chi-square statistic was used for categorical variables. A logistic regression analysis model was used to assess independent predictors of mortality. A P-value of < 0.05 was considered significant.

Results: 87 patients were admitted with cardiogenic shock (60% African American, 67% male, mean age =62±15 years) of which 54 patients (62%) died. Those who died were older, had > 1 pressor, out-of-hospital arrest, arrested within 24 hours of admission, and had higher SCAI class, lactate, and ALT levels than those who were discharged. The logistic regression analysis model showed that older age ((RR=3.4 [95% CI: 3.3-3.45]), > 1 pressor (RR=3.4 [95% CI: 2.6-4.2]) and higher SCAI class (2.1 [95% CI: 1.5-2.1], all P < 0.05)) were independent predictors of mortality in patients with cardiogenic shock. Additionally, most of the patients had either Medicare or Medicaid insurance in predominantly African American study population.

Conclusions: Cardiogenic shock carries a significant risk of death. Factors such as advanced age, the administration of more than one vasopressor, and a higher SCAI classification have been identified as independent predictors of mortality among inpatients with cardiogenic shock. Additionally, the progression and outcomes of the condition are influenced by variables like race (e.g., African American individuals in this study) and economic challenges, including the type of insurance coverage (e.g., Medicaid or Medicare). Further research is essential to explore strategies that could enhance survival rates in cardiogenic shock patients, with a particular focus on addressing economic and racial disparities.

Background: We compared long-term clinical outcomes between patients with cardiac sarcoidosis (CS) who received no treatment (NT), steroid treatment (ST), disease-modifying anti-rheumatic drugs (DMARDs), or tumor necrosis factor alpha inhibitors (TNF).

Methods: Patients from SSM healthcare system's data warehouse were identified using ICD codes. Inclusion criteria included at least 6 months of follow-up. Outcomes studied were heart failure (HF) admissions, ventricular tachyarrhythmias (VTA), and pacemaker/defibrillator placement. Statistical analysis included multivariate logistic regression and Kaplan-Meier curves.

Results: We identified 198, 174, 66, and 19 patients in NT, ST, DMARDs, and TNF groups respectively. Mean age was 62.4, 60.2, 56, and 54.4 respectively. There was no significant difference in the rate of medical comorbidities including pulmonary sarcoidosis between the groups. Mean follow up was 92.3 months. Percent incidences of VTA were 17.5, 16.3, 12.5, and 5.6 (P 0.57) in the NT, ST, DMARDs and TNF groups respectively. DMARDs and TNF groups had a lower incidence of HF admission (43.9% and 36.8%) compared to NT and ST (59.1% and 59.2%). In the multivariate model, compared to NT group, the odds ratio for HF admission was 1.08 (CI: 0.70-1.65), 0.64 (0.36-1.14) and 0.45 (0.17-1.20) in the ST, DMARDs and TNF groups respectively. There was no significant difference in the rate of pacemaker/defibrillator placement between the groups.

Conclusion: In this retrospective study from a large healthcare system, CS patients treated with DMARDs or TNF had a trend for lower incidence of HF admission than those on NT or ST.

Calcium channel antagonists, specifically long-acting nifedipine formulations, play a crucial role in treating hypertension and angina. Originally used for angina, nifedipine has been widely employed as an antihypertensive medication for over 40 years. It offers rapid action and oral bioavailability with minimal maternal or fetal side effects, making it suitable for treating hypertensive crises during pregnancy. However, it can cause a sudden drop in blood pressure and tachycardia. Long-acting formulations, such as gastrointestinal therapeutic systems, gradually release nifedipine over 24 hours, mitigating these issues. This review aims to assess the clinical efficacy and safety of long-acting nifedipine formulations in managing essential hypertension, with a focus on improving blood pressure control and addressing challenges in uncontrolled and resistant hypertension. Furthermore, long-acting nifedipine provides therapeutic advantages beyond hypertension management, showing efficacy in treating comorbid conditions such as chronic kidney disease and diabetes. Global studies support its efficacy, suggesting that a shift toward the use of long-acting nifedipine can help address the global hypertension problem and enhance the quality of life for hypertensive patients.

Background: Transthyretin cardiac amyloidosis (ATTRCA) is a prevalent disease, and it can be associated with heart failure (HF), left ventricle hypertrophy (LVH), atrial fibrillation (AF), and aortic stenosis (AS).

Aim: The study aims to detect the prevalence of ATTRCA in the symptomatic AS population.

Method: A single-center prospective study screening for ATTRCA in patients diagnosed with symptomatic severe AS undergoing aortic valve (AV) intervention.

Results: A total of 27 patients were enrolled, of which 15 (56%) were men. The mean age was 72.8 ± 10.5 years. HF symptoms were present in 11 (40.7%) patients at New York Heart Association (NYHA) class II, while 15 (55.6%) patients had NYHA class III symptoms. AF was present in 6 (22.2%) patients. The mean left ventricle ejection fraction (LVEF) was 49.4 ± 9.75%, and the mean stroke volume (SV) was 37.4 ± 8.7 ml/m². The interventricular septal thickness (IVS) was 1.2 ± 0.18 cm. The AS mean gradient was 46 ± 12 mmHg, and the aortic valve area (AVA) was 0.69 ± 0.16 cm². The ATTRCA was diagnosed by bone scintigraphy in 5 (18.5%) AS patients. Perugini scores of 2 and 3 were considered positive for ATTRCA with the heart/contralateral lung (H/CL) ratio of 1.48 ± 0.35. There was no difference in LVEF between patients with ATTRCA and those without ATTRCA 50 ± 9.8% vs 47 ± 9.3%; p-value 0.55. The ATTRCA had a lower SV of 33.9 ± 6.9 ml/m² compared to patients without ATTRCA 37.5 ± 8.8 ml/m²; p-value of 0.34. There was no significant difference in LVH or IVS thickness between the patients with ATTRCA and those without ATTRCA. The left ventricle (LV) mass index in ATTRCA was 87 ± 21 g/m² compared to patients without ATTRCA 98.7 ± 26 g/m², with a p-value 0.38, and the IVS thickness was 1.1 ± 0.22 cm compared to patients without ATTRCA 1.2 ± 0.18 cm; p-value 0.17. The left atrial (LA) volumes were significantly higher in the ATTRCA group 55.5 ± 25.6 ml/m² compared to patients without ATTRCA 37.5 ± 10.9 ml/m² with a significant p-value 0.028. The mean AV gradient was lower in ATTRCA patients at 40.8 ± 8.4 mmHg, compared to patients without ATTRCA at 46.1 ± 12.1 mmHg; it did not reach a statistical significance p-value 0.3. There was a significant difference in LV relative longitudinal strain (LS) between patients with ATTRCA 11.8 ± 3.2 and those without ATTRCA 63.3 ± 22.6 with a significant p-value 0.001.

Conclusion: ATTRCA is prevalent in AS patients; bone scintigraphy is recommended for screening AS patients for ATTRCA.