American journal of cardiovascular disease最新文献

Objectives: Atrial Fibrillation and atrial flutter (Afib/Aflut) are the most common arrhythmias that present in the emergency department. This study aimed to evaluate in-hospital mortality based on weight categories in patients with Afib/flut.

Methods: Using ICD-10 codes from the large Nationwide Inpatient Sample (NIS) database in the years 2016-2020, we evaluated any association between the presence of Afib/Aflut and mortality in different weight categories in adults over the age of 18.

Results: A total of 23,037,013 Afib/flut patients were found in the NIS database. Total mortality in patients with Afib/Aflut was 5.03%. Mortality in patients with normal weight was 5.26%. Mortality was lowest in overweight (2.3%) followed by Obesity (2.97%) and morbid obesity (2.97%). It was highest in cachectic patients (15.89%), all p-values were P<0.001. These associations persisted after multivariate adjustment for demographics and co-morbid conditions. Furthermore, Mortality was highest during the COVID-19 year of 2020, regardless of weight categories.

Conclusions: The obesity paradox is present in patients admitted to the hospital with Afib/Aflut. Regardless of comorbid conditions or demographics, the lowest mortality was seen in overweight patients. Furthermore, the COVID-19 pandemic year independently increased inpatient mortality from Afib/Aflut.

Objectives: Research on the relationship between celiac disease (CD) and cardiovascular disease (CVD) is still ongoing, and different studies have reported contradictory findings. To carry out a meta-analysis and systematic review to look into the connection between CD and CVD risk.

Methods: A thorough search was conducted in PubMed, Scopus, and Google Scholar databases up to February 19, 2024. Relevant articles were extracted, and the titles, abstracts, and full texts of the related articles were screened. The quality of the studies was assessed using the Joanna Briggs Institute critical appraisal tools.

Results: Nine cohort and one case-control studies involving 49,621,333 individuals were included in the meta-analysis. The pooled analysis revealed a 7% increased risk of CVD in CD patients compared to controls (OR: 1.07, 95% CI: 1.03-1.10, P < 0.05). Significant heterogeneity was observed among studies (I² = 76%, P < 0.001).

Conclusion: This meta-analysis provides evidence of a modest but significant increase in CVD risk in patients with CD. The results highlight the importance of considering cardiovascular health in CD treatment and the need for further research to elucidate the mechanisms underlying this association and to develop targeted prevention strategies.

Objectives: Coronary artery disease and valvular heart disease are leading causes of mortality globally. This study aimed to investigate the correlation between expected mortality rates (EMRs) and observed mortality rates (OMRs) for common cardiac interventions using recent national data on percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and cardiac valve surgeries.

Methods: This multi-institutional, retrospective observational study analyzed in-hospital/30-day mortality outcomes for 106,836 patients who underwent PCI, CABG, or cardiac valve procedures across 64 non-federal hospitals in New York State between December 2012 and November 2015. The procedures included emergency and non-emergency PCI, CABG, valve or valve-CABG surgeries, and transcatheter aortic valve replacement (TAVR).

Results: Among the 106,836 patients, a 3.21% 30-day mortality rate was observed (n=3,436). To assess the disparity between OMR and EMR, a one-sample t-test was performed. Effect sizes were determined using Cohen's d and Hedges' correction. With a 95% confidence interval, the t-value for the OMR (mean difference =2.037±1.728, CI: 1.95-2.12) was 47.270, whereas the EMR (mean difference =1.930±1.284, CI: 1.86-1.99) yielded a t-value of 60.279. The OMR was significantly greater than the EMR (P<0.001).

Conclusion: The OMR was significantly greater than the EMR across all cardiac procedures, suggesting potential influences from patient demographics, comorbidities, and variations in hospital practices. Further research is needed to understand these factors and improve the quality of cardiac care.

A coronary artery calcium (CAC) score of 0 is generally indicative of a low risk for both all-cause mortality and cardiovascular events, often serving as a basis for excluding obstructive coronary artery disease (CAD). Although isolated cases of coronary involvement have been reported in patients with a CAC score of 0, the incidence of extensive multivessel disease under these circumstances is exceedingly rare. A 48-year-old man with diabetes and hypercholesterolemia presented with atypical non-exertional left-sided chest pain. Despite a nonspecific ECG, a HEART score of 3, and a zero CAC score on echocardiography, coronary computed tomography angiography (CCTA) revealed multiple non-calcified plaques in the right coronary artery (RCA), right posterior descending coronary artery (RPDA), and left circumflex artery (LCX). The patient underwent staged percutaneous coronary intervention with drug-eluting stents, resulting in complete resolution of the stenosis. At the one-month follow-up, he remained symptom-free and tolerated the medication regimen well. This case report demonstrates that a zero CAC score should not preclude further evaluation in high-risk symptomatic patients. Extensive non-calcified plaques causing significant luminal obstruction underscore the limitations of CAC scoring, highlighting the need for additional imaging modalities, such as CCTA, to achieve timely and accurate diagnoses and appropriate therapeutic interventions.

Objectives: This study aimed to analyze two decades heart failure (HF) mortality data in Non-Alcoholic Fatty Liver Disease (NAFLD), now known as Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), in the United States (US), identifying patterns and disparities in mortality rates.

Methods: A retrospective analysis was conducted using mortality data from the CDC WONDER database spanning 1999-2020. Age-adjusted mortality rates (AAMRs) per 1,000,000 persons were calculated, and trends were assessed using Average Annual Percentage Change (AAPC) and Annual Percent Change (APC) using Joinpoint 5.0.2. Data were stratified by year, sex, race/ethnicity, urbanization, and census regions.

Results: From 1999-2020, 68,436 HF-related deaths occurred among US adults with NAFLD. The overall AAMR increased from 12.49 in 1999 to 24.30 in 2020, with an AAPC of 3.05 (95% CI: 2.80 to 3.31, P < 0.001), with a steep rise in AAMR from 2017-2020 and an APC of 12.35 (95% CI: 9.71 to 15.99). American Indian or Alaskan natives had the highest AAMRs (28.63), followed by Hispanics (20.05), and African Americans or Blacks (14.51). The highest mortality regionally was in the Southern region (AAMR: 16.05) and nonmetropolitan areas had higher AAMRs than metropolitan areas (16.63 vs. 13.76).

Conclusions: This analysis demonstrated increasing mortality rates from HF in NAFLD, with a sharper increase in recent years. This also showed nonmetropolitan areas, the Southern region of the US, and minority populations had higher mortality rates, which highlights at-risk populations and opportunities for important public health interventions.

Objective: Pathological changes in the endothelium are the earliest determinants of endothelial dysfunction and atherosclerosis in hypertension (HT). The diagnostic and prognostic role of copeptin in various diseases is well-recognized. This study aims to investigate the relationship between serum copeptin levels and non-invasive endothelial function indicators determined by flow-mediated dilation (FMD) and pulse wave analysis (PWA) in dipper and non-dipper HT patients.

Methods: In this study, 30 dipper HT, 31 non-dipper HT patients and 30 healthy control subjects were included. Blood samples were taken for copeptin level determination. All participants underwent detailed cardiovascular and transthoracic echocardiography examinations and measurements of FMD and PWA.

Results: Copeptin levels of the non-dipper HT group were significantly higher than the control group and dipper HT groups (P=.001, P=.010, respectively). No significant difference was found between the dipper and non-dipper HT groups regarding FMD and PWA measurements, and both groups significantly differed from the control group. In the whole group evaluation by partial correlation analysis, a significant correlation was found between serum copeptin levels and reflection index (RI) after adjustment for age and body mass index (r=0.24, P=.039). Stepwise linear regression analysis revealed RI as an independent predictor of copeptin (β=0.285, P=.015).

Conclusion: The correlation between copeptin levels and RI in HT patients, especially in the non-dipper HT group, suggests that copeptin can be used as a biomarker to indicate endothelial dysfunction in hypertensive patients.

Objectives: Hypertension is a prevalent risk factor for cardiovascular mortality and morbidity, often leading to left ventricular hypertrophy (LVH). As ambulatory blood pressure monitoring (ABPM) gains prominence in hypertension management, it is crucial to explore its association with LVH occurrence to enhance clinical understanding and treatment strategies. This study aims to investigate the correlation between nocturnal blood pressure patterns and presence of LVH in hypertensive patients, offering insights into optimizing hypertension management strategies.

Methods: Fifty-four patients with confirmed hypertension were included in this study. All participants underwent transthoracic echocardiography within two days of admission and 48-hour ABPM within one week of admission. Based on the presence of LVH, patients were categorized into LVH and non-LVH groups. Nocturnal systolic/diastolic BP were compared between the two groups using the appropriate statistical tests.

Results: Among the 54 hypertensive patients, those with LVH (n = 22) demonstrated a significantly higher nocturnal average SBP (124.04 ± 11.92 mmHg) and DBP (76.24 ± 9.76) compared to those without LVH (n = 32, SBP = 116.78 ± 13.92 mmHg, DBP = 72.45 ± 9.76, P < 0.001).

Conclusion: This research shows a significant association between nocturnal BP patterns and the presence of LVH in hypertensive individuals. Nocturnal SBP and DBP were identified as independent risk factors for LVH. Further research, particularly on the timing of antihypertensive medication, is warranted to confirm causal relationships and improve management strategies.

Objectives: Diastolic pulmonary arterial pressure should be the same as wedge pressure in patients with cardiomyopathy without a known history of pulmonary vein occlusive disease. The goal of this study was to study the correlation between reported wedge pressure and pulmonary arterial diastolic pressure in patients with end-stage cardiomyopathy to evaluate the accuracy of right heart pressure reporting.

Methods: Pre-cardiac transplant patients who underwent cardiac catheterization before their heart transplantation at our institution between 2003 and 2005 (n = 159) were retrospectively reviewed. Reported diastolic pulmonary arterial pressure was correlated with reported wedge pressure.

Results: The correlation between reported diastolic pulmonary arterial pressure with wedge pressure was modest with r² = 0.75. There was wide variation with some division up to 40 mmHg. Most discrepancies occurred in the lower and higher-pressure measurements.

Conclusions: Among patients referred for heart transplant evaluation, a correlation between reported diastolic pulmonary pressure and wedge pressure is only modest suggesting a significant error in the reporting or measuring right-sided pressures during right heart catheterization warranting further investigation to reduce errors.

Myocardial infarction with non-obstructed coronary arteries (MINOCA) occurs when patients experience a heart attack without significant coronary artery blockage despite showing acute coronary syndrome symptoms. Unlike stable atherosclerosis, MINOCA involves acute myocardial infarction (MI) without obstructive coronary artery disease (CAD). The diagnostic criteria included meeting the universal MI definition, non-obstructive coronary arteries on angiography (< 50% stenosis), and no apparent cause of the acute event. The causes include coronary, cardiac, and extracardiac origins, such as plaque rupture, coronary spasm, myocarditis, or pulmonary embolism. MINOCA affects 5-6% of patients with acute MI undergoing angiography, with variations based on demographic factors. Although MINOCA was initially believed to have a favorable outcome, recent findings have indicated that MINOCA patients have a worse prognosis than the general population. Current guidelines strongly advocate the use of cardiac magnetic resonance imaging (CMR) to evaluate suspected MINOCA cases. However, multiple studies have demonstrated that CMR may fail to detect some instances of MINOCA, particularly in cases of mild inflammation or minor infractions. This could lead to a false-negative diagnosis requiring further testing. This review aimed to evaluate the diagnostic and prognostic value of CMR in patients with potential MINOCA.