American journal of cardiovascular disease最新文献

Introduction: The first-generation Watchman 2.5 (W 2.5)^TM presented several limitations, such as challenges in implantation within complex left atrial appendage (LAA) anatomies, higher incidence of peri-device leak, device recapture, and device-related thrombus (DRT). The newer generation Watchman FLX (W-FLX)^TM was introduced with a modified design aiming to overcome these limitations. The purpose of this meta-analysis is to conduct a comparative assessment of the safety and efficacy of the W-FLX and 2.5 devices in clinical practice.

Method: The meta-analysis was conducted according to the preferred reporting items for systematic review and meta-analysis protocols (PRISMA). Studies were located through a search strategy utilizing PubMed, Cochrane, Google scholar and MEDLINE from inception to March 2023, with a primary objective to compare the safety and efficacy of the W-FLX and W 2.5 devices. After applying the selection criteria, five studies were included in this analysis.

Results: The analysis included five studies comprising 54,727 patients. The W-FLX is associated with an increase in procedural success (OR 7.49 [95% CI 1.98-28.26, P = 0.02; I² = 0%]), and a significant reduction in mortality (OR 0.52 [95% CI 0.51-0.54, P<0.01; I² = 0%], major bleeding 0.57 [95% CI 0.51-0.64, P<0.01; I² = 0%]), device embolism (OR 0.35 [95% CI 0.18-0.70, P = 0.02; I² = 0%]), and pericardial effusion (OR 0.33 [95% CI 0.26-0.41, P<0.01; I² = 0%]). The rates of DRT and stroke were similar between the two groups.

Conclusion: Compared to the W 2.5, the W-FLX was associated with a higher procedural success rate and significantly reduced adverse outcomes including mortality, major bleeding, device embolization, and pericardial effusion.

Background: The purpose of this research was to investigate and compare the utilization of the revised Geneva score, original PESI, and simplified PESI in predicting the long-term mortality rate of patients with pulmonary embolism (PE).

Methods: This retrospective investigation was conducted in Isfahan between June 2014 and July 2015 on patients with PE who were referred to our medical center. In this study, the revised Geneva score, the original PESI scales, and the simplified PESI scales were utilized. Additionally, diagnostic and treatment procedures were done in accordance with the standard protocol. We collected data of patients including gender, age, any risk factors for venous thromboembolism. After the primary data collection, contacts were made to the patients or their relatives for gathering information about patient's survival. The mortality rates of patients were determined within 10 years after the PE.

Results: We analyzed data of 224 patients. Over a 131-month course of following up 224 patients, 105 deaths occurred that were related to PE. The initial PESI factor had a positive and negative predictive value of 83%. Patients with PE who scored extremely high on the PESI had a mortality and morbidity rate 42 times (9.22-87.32) greater than those with PE who scored very low. Furthermore, the death and morbidity rate of high-risk PE patients was 5% (0.67-1.70) in the Geneva score and 62% (0.30-2.31) in the simplified PESI score.

Conclusion: The use of original PESI score could predict the long-term mortality of PE patients more accurately than other scores.

Sarcoidosis and systemic sclerosis are two inflammatory multisystemic disorders of unknown etiology that may be life-threatening especially when there is cardiac involvement. Both diseases may coexist, however, there are very few case reports of patients with both cardiac sarcoidosis and systemic sclerosis in the literature. We report the case of a 72-year-old female who was initially referred for dyspnea. A chest computed tomography scan showed multiple hilar and mediastinal adenopathy with a non-specific opacity in the middle pulmonary lobe. FDG-PET-scan showed increased FDG uptake in the adenopathy, the middle lobe and the right ventricular free wall. Sarcoidosis was confirmed with a lung biopsy. Both electrocardiogram and echocardiogram were normal. Four months later, the patient developed a high-grade atrioventricular block deemed secondary to her cardiac sarcoidosis. Two years later, the patient was referred to a rheumatologist for severe Raynaud's symptoms, sclerodactyly and acrocyanosis. After thorough investigations, a diagnosis of limited cutaneous systemic sclerosis with systemic and cardiac sarcoidosis was made. This case demonstrates that both cardiac sarcoidosis and systemic sclerosis may coexist. In the literature, either disease may come first. In cases where cardiac symptoms appear after the diagnosis of concomitant sarcoidosis and systemic sclerosis, it might be difficult for clinicians to confirm which disease is responsible for the heart involvement. This is important since early cardiac sarcoidosis treatment should be done to prevent major complications and may well differ from systemic sclerosis treatment. In this review, we discuss the main clinical manifestations and imaging findings seen with cardiac disease secondary to sarcoidosis and systemic sclerosis.

Background: Cardiovascular diseases (CVDs) are the main cause of morbidity and mortality in the world. Previous studies disagree about the prevalence of cardiovascular risk factors (CVRFs) among medical students.

Objectives: Determine the CVRFs prevalence in medical students. Compare the FRCVs percentage from initial and advanced course stages. Evaluate whether the CVRFs percentage was similar to that from population in the same age group, as previously described in another studies.

Method: This is a cross-sectional observational study that evaluated the CVRFs prevalence in medical students using a semi-structured questionnaire, in addition to physical examination and laboratory tests. For statistical analysis, statistical package for the social science software (SPSS, version 22.0) was used.

Results: 115 students were evaluated: 74.8%, female; mean age, 22.4±3.1 years. In the general sample was found altered dosages of total cholesterol (27.0%), high density lipoprotein cholesterol (HDL, 5.2%), triglycerides (12.2%), low density lipoprotein cholesterol (LDL, 8.7%), fasting glucose (4.3%), overweight (17.4%), obesity (5.2%), inadequate physical activity (45.2%), family history of cardiovascular disease (44.3%), stress (68.7%), anxiety (83.5%), insomnia (28.7%), sleep deprivation (60.0%), alcohol use (91.3%) and low cardiovascular risk (100.0%). The average score from PSS-14 questionnaire showed greater stress in the basic (27.0±6.7) and clinical cycle (28.3±7.1) and less stress in the internship (22.3±6.4). There was a statistical difference between the clinical cycle and internship (P < 0.05). During internship, there was a lower association between stress and graduation (33.3%), especially when compared to the clinical cycle (75.4%) (P < 0.01; ra=2.9).

Conclusion: CVRFs exposure and the risk of negative cardiovascular outcomes are lower in medical students when compared to young adult population. Suggestive of medical training contributes to self-care, health promotion, stress reduction and disease prevention, reducing the cardiovascular diseases prevalence, especially in the internship.

Background: The goal of this study was to evaluate any association between blunt chest trauma and occurrence of ST-elevation myocardial infarction and non-ST-elevation myocardial infarction.

Methods: Data from the National Inpatient Sample (NIS) database from 2010-2014, of patients over the age of 40, hospitalized for blunt chest trauma (ICD 959.11), with STEMI or NSTEMI, was used in this study. We performed a chi-squared test to analyze this association. We also performed a multivariant analysis adjusting for race, gender, and age.

Results: We found that there is not an increased risk of STEMI/NSTEMI following blunt chest trauma, P > 0.05. We also found no correlation between STEMI or NSTEMI and chest trauma after adjusting for race, gender, and age. For STEMI after adjustments in 2010 (P=0.52), 2011 (P=0.19), 2012 (P=0.60), 2013 (P=0.88), and 2014 (P=0.14). For NSTEMI adjustments in 2010 (P=0.03), 2011 (P=0.06), 2012 (P=0.01), 2013 (P=0.21), and 2014 (P=0.03).

Conclusion: Both ST-elevation myocardial infarction and non-ST-elevation myocardial infarction were not significantly associated with blunt chest trauma.

Background: Despite high surgical risk among heart transplant (HTx) recipients, who develop aortic valve diseases (AVD), transcutaneous aortic valve replacement (TAVR) has been scarcely reported as a viable option in this patient population.

Methods: A systematic review was conducted to identify studies reporting the outcomes of HTx recipients who developed AVD of the donor heart and underwent TAVR. Studies were eligible if they provided individual-level data for HTx recipients, who underwent TAVR on the donor heart. Review articles, editorials or commentaries, studies lacking original data, or those reporting surgical valve replacement for AVD in HTx recipients were excluded.

Results: A total of 15 case reports, encompassing 15 patients, describing characteristics and outcomes of HTx recipients undergoing TAVR were included. These included 13 males and 2 females with an average age of 63.6±15 years. The indications for HTx were non-ischemic dilated cardiomyopathy, ischemic cardiomyopathy and ischemic dilated cardiomyopathy in 42.9%, 35.7%, and 21.4% of the patients, respectively. The main indication for aortic valve replacement (AVR) among HTx recipients was aortic stenosis (73.3%). The transcutaneous approach was preferred over surgical AVR due to high surgical risk in > 50% of the patients. Both pre-TAVR transvalvular pressure gradient and the peak aortic pressure gradient decreased after the TAVR. Paravalvular leak was minimal/none to mild in all the patients post-TAVR. Most patients had an uneventful post-TAVR recovery with no recurrence of the symptoms or echocardiographic finings at a median follow-up of 6 months.

Conclusions: TAVR seems to be a viable option for HTx recipients who develop donor aortic valve diseases. However, there is a paucity of knowledge on the long-term survivability of the replaced aortic valves and the clinical and echocardiographic outcomes of HTx recipients undergoing TAVR.

Background: Female-specific factors of grand multiparity (≥5 births) and early menopause age are associated with an increased risk of cardiovascular disease (CVD). However, mechanisms are incompletely understood. Carotid plaque is a marker of subclinical atherosclerosis and associated with increased CVD risk. We evaluated the association of female-specific factors with plaque burden.

Methods: We included 2,313 postmenopausal women in the Multi-Ethnic Study of Atherosclerosis, free of clinical CVD, whose parity and menopause age were ascertained by questionnaires and carotid plaque measured by ultrasound at baseline and 10 years later. Parity was categorized as nulliparity (reference), 1-2, 3-4 and ≥5 live births. Menopause age was categorized as <45, 45-49, 50-54 (reference) and ≥55 years. Multivariable regression was performed to evaluate the association of parity and menopause age with carotid plaque presence (yes/no) and extent [carotid plaque score (CPS)].

Results: The mean age was 64±9 years; 52.3% had prevalent carotid plaque at baseline. Compared to nulliparity, grand multiparity was significantly associated with prevalent carotid plaque after adjustment for CVD risk factors (prevalence ratio 1.17 (95% CI 1.03-1.35)) and progression of CPS over 10 years [percent difference 13% (95% CI 3-23)]. There was not any significant association of menopause age with carotid plaque presence or progression in fully-adjusted models.

Conclusion: In a multiethnic cohort, grand multiparity was independently associated with carotid plaque presence and progression. Early menopause, a known risk factor for CVD, was not captured by carotid plaque in this study. These findings may have implications for refining CVD risk assessment in women.

Patent ductus arteriosus (PDA) is a congenital heart disorder in which a vascular structure between the pulmonary artery and the aorta remains open. PDA normally closes shortly after birth. The treatment in adults is surgical or transcatheter closure. A 47-year-old woman presented to our hospital with a diagnosis of PDA and was treated with transcatheter closure. Although the recovery period of adult patients is long, this patient recovered completely after one day.

Background: Genetic factors contribute to the variability in individual response to antihypertensive medications. We sought to investigate the frequencies of allele and genotype for CYP2D6 and ADRB1 genetic polymorphisms and explore their potential impact in influencing the selection of antihypertensive beta-receptor blockers.

Methods: The study population was selected from the Han Chinese patients in Zhongda Hospital, which contained 2419 Han Chinese hypertensive individuals and 151 normotensive controls. Each of the above participants underwent venous blood sampling. Then, the gene chip platform was adopted to evaluate the CYP2D6 and ADRB1 genetic polymorphisms. The allele as well as genotype frequencies for each gene, along with the combined genotypes, were subjected to analysis.

Results: The frequency of *1/*1 wild-type homozygous for CYP2D6 was 9.71%, while the frequency of *1/*10 heterozygous or *10/*10 mutant homozygous was 59.16% or 31.13%, respectively, as established by gene chip analysis. Similarly, we observed that the genotype frequencies of GG wild-type homozygous for ADRB1 was 10.29%, while that of GC heterozygous, or CC mutant homozygous was 44.98%, or 44.73%, respectively. Notably, combined genotypes *1/*10 + CC (25.88%) and *1/*10 + CG (27.78%) had the highest frequencies. Importantly, no substantial differences in the distributions of CYP2D6 and ADRB1 polymorphism were noted between hypertensive patients and normotensive controls, or among all different grades of hypertension.

Conclusion: These findings provide insights into the CYP2D6 and ADRB1 polymorphisms in hypertensive patients from Han Chinese, which show significant differences compared to other geographic groups of Han Chinese hypertensive patients. These results offer valuable information for future prospective clinical studies on the antihypertensive effects of beta-receptor blockers in Han Chinese hypertensive patients.

Enhanced ventricular arrhythmogenesis is commonly experienced by patients in the end-stage of heart failure spectrum. A high burden of ventricular arrhythmias can affect the ventricular systolic function, lead to unexpected hospitalizations and further deteriorate the prognosis. Management of ventricular arrhythmias in this population is challenging. Implantable cardioverter-defibrillators are protective for the immediate termination of life-threatening arrhythmias but they have no impact in reducing the arrhythmic burden. Combination treatment with invasive (catheter ablation, mechanical hemodynamic support, sympathetic denervation) and noninvasive (antiarrhythmic drugs, medical therapy for heart failure, programming of implantable devices) therapies is commonly required. The aim of this review is to present the available therapeutic options, with main focus on recently published data for catheter ablation and provide a stepwise treatment approach.