American journal of cardiovascular disease最新文献

Objectives: Permanent pacemaker (PPM) implantation is a standard intervention for bradyarrhythmias, yet the long-term hemodynamic consequences of right ventricular (RV) lead positioning remain underexplored. While apical pacing has traditionally been favored, emerging evidence suggests that septal positioning may offer more physiological activation and better preserve cardiac function. This study aimed to compare the early echocardiographic effects of apical versus septal RV lead placement on right heart structure, function, and tricuspid valve competence in patients undergoing PPM implantation.

Methods: In this prospective observational study, 20 patients were divided equally into two groups: apical and septal pacing. Comprehensive echocardiographic evaluations were performed pre- and one month post-implantation. Parameters included RV and right atrial (RA) size, RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery pressure (PAP), inferior vena cava (IVC) diameter, tissue Doppler indices (E', A'), and tricuspid regurgitation (TR) severity. Statistical analyses included Mann-Whitney U tests and visualizations using radar plots and p-value heatmaps.

Results: Post-implantation, the apical group demonstrated significantly greater RV and RA dilation, elevated PAP, and reduced E' velocities, indicative of impaired diastolic function and increased right-sided load. In contrast, the septal group exhibited more stable dimensions and preserved diastolic function. Although baseline mild TR was more prevalent in the apical group (P<0.024), no significant intergroup differences in TR severity were observed at follow-up. Other clinical risk factors were comparable between groups.

Conclusions: Septal lead positioning is associated with more favorable right heart geometry and hemodynamics than apical pacing in the early post-implantation period. These preliminary findings support septal pacing as a potentially superior strategy for long-term cardiac preservation, but the small sample size limits generalizability and warrants confirmation in larger, randomized trials.

It is well established that video monitoring is effective in promoting self-care among patients with heart failure during the intervention period. However, its long-term impact on sustaining self-care behaviors after discontinuation remains unclear. This article describes a randomized clinical trial protocol designed to assess the effectiveness of a video monitoring strategy in maintaining self-care behaviors in patients with heart failure with reduced ejection fraction (HFrEF). This is a randomized, parallel trial with blinded outcome assessment. During hospitalization, eligible patients will be invited to participate. Data collection will include sociodemographic and clinical variables, laboratory test results, current medications, and cardiovascular physical examination. Validated instruments will measure clinical congestion, self-care (European HF Self-Care), HF knowledge, treatment adherence, quality of life, and cardiorespiratory fitness. The control group (CG) will receive standard care after discharge. In the intervention group (IG), the discharge summary will be shared with primary healthcare providers (nurse and physician) to facilitate transitional care. IG participants will receive structured video monitoring sessions with specialized cardiovascular nursing support at 7, 30, 60, 180, and 365 days post-discharge, focusing on self-care reinforcement. The primary outcome is the self-care score at one year. Secondary outcomes include quality of life, HF knowledge, treatment adherence, cardiorespiratory fitness, mortality, and hospital readmissions. Unlike mobile-based or voice telemonitoring strategies, video monitoring fosters a stronger connection between patients and healthcare professionals, which may enhance self-care maintenance over time. This approach aligns with personalized nursing interventions, reinforcing education and behavioral changes beyond the intervention period. This study highlights the role of video monitoring in sustaining self-care practices in heart failure management. By strengthening the nurse-patient relationship and promoting long-term adherence, it has the potential to reduce readmissions and mortality rates. Video monitoring may enhance global nursing practices, improving outcomes and quality of life for heart failure patients.

Evolocumab is a human monoclonal antibody that effectively reduces low-density lipoprotein (LDL) cholesterol levels by inhibiting proprotein convertase subtilisin-kexin type 9 (PCSK9). Although generally well tolerated, evolocumab may rarely lead to severe hypersensitivity reactions, including angioedema. To the best of our knowledge, severe angioedema requiring airway intervention has not been reported previously in the US population. A 64-year-old woman with hypertension, hypothyroidism, hyperlipidemia, and active tobacco use presented with acute chest pain and was diagnosed with ST-segment elevation myocardial infarction. She underwent percutaneous coronary intervention with two stents placed in the right coronary artery. Despite maximum lipid-lowering therapy, her LDL level remained elevated at 125 mg/dL, prompting the addition of evolocumab (Repatha). Within 24 hours, she experienced progressive tongue and facial swelling, with oropharyngeal edema threatening airway obstruction. Urgent laryngoscopy confirmed early oropharyngeal involvement, which necessitated endotracheal intubation. She received intravenous corticosteroids and antihistamines in the intensive care unit, with symptoms resolving within 48 hours, allowing for extubation and discharge after three days. This case highlights a rare but potentially life-threatening adverse effect of evolocumab.

Rotational atherectomy device entrapment is a rare but challenging complication of peripheral vascular interventions. This case report details a novel dual-access endovascular technique for retrieving an entrapped atherectomy burr from the posterior tibial artery of a 70-year-old man with severe peripheral arterial and chronic kidney disease. When conventional retrieval methods failed, retrograde posterior tibial access was established as an adjunct to the existing femoral access, enabling sequential balloon angioplasty with progressively larger balloons (1.5-2.5 mm) around the entrapped device. This dual-access approach successfully liberated the burr without requiring surgical extraction or arteriotomy. Following device retrieval, definitive treatment with balloon angioplasty and stent placement was completed immediately, achieving excellent restoration of flow. This minimally invasive technique offers several advantages over traditional surgical approaches, including vessel patency preservation, reduced procedural morbidity, avoidance of general anesthesia, and protection of potential future bypass targets. The described methodology expands the endovascular options for managing complex device-related complications and demonstrates particular value in high-risk patients with significant comorbidities.

Coronary angiography and cardiac catheterization using the right radial arterial access have lower complication rates but are associated with unique challenges that can lead to procedural failure. One of the major challenges can be the wire advancement into the ascending aorta with a tortuous subclavian artery, particularly in the case of arteria lusoria. The deep inspiratory maneuver can help navigate the guiding wire into the ascending aorta. However, in extreme tortuosity or the case of arteria lusoria, it can be very difficult to advance the wire in the ascending aorta. In this manuscript, the second successful case of guide wire advancement in the ascending aorta in a very tortuous subclavian artery is described by instructing the patient to move her head to the left. This maneuver will straighten the subclavian artery, thus facilitating wire advancement into the ascending aorta by reducing the tortuosity of the subclavian artery. This can save radial cardiac catheterization and prevent changing the access route. This report describes this easy-to-perform maneuver in a difficult case of severe subclavian tortuosity, enabling us to complete the right radial cardiac catheterization.

Objective: The present study aimed to assess the efficacy and safety of a fixed-dose combination (FDC) of Azelnidipine 16 mg and Telmisartan 40 mg compared to FDC of Amlodipine 5 mg and Telmisartan 40 mg in Indian essential hypertensive patients with a special focus on the impact on micro-albuminuria.

Methods: This prospective, randomized, open-label 12-week study enrolled 225 patients with treatment-naive stage II hypertensive patients or hypertensive patients not controlled on Telmisartan 40 mg monotherapy. The eligible participants were randomized to receive either FDC of Azelnidipine-Telmisartan (Test group; n=115) or FDC of Amlodipine-Telmisartan (Reference group; n=110). Efficacy was assessed via changes in systolic and diastolic blood pressure (SBP/DBP), pulse rate (PR), and urinary albumin-to-creatinine ratio (UACR), a marker of microalbuminuria. Safety parameters were evaluated by documenting the adverse effects.

Results: Both groups showed significant reductions in SBP and DBP from baseline, with no statistical difference among the groups. However, the test group expressed a more favorable effect on pulse rate, displaying a significant reduction compared to the reference group. Additionally, the occurrence of pedal edema was significantly lower in the test group vs. the reference group (1.7% vs. 9.1%). Changes in UACR were nominal and comparable in both groups, indicating limited renoprotective effects.

Conclusion: Collectively, the study confirms that FDC of Azelnidipine-Telmisartan is as effective as the commonly used FDC of Amlodipine-Telmisartan combination for management of hypertension, with additional safety benefits related to heart rate and edema. These findings support the clinical utility of Azelnidipine in hypertensive patients with concerns associated with tachycardia or pedal edema.

Objective: Given the elevated mortality in individuals with acute coronary syndrome and increased adiposity, delineating the molecular mechanisms underlying obesity-associated adverse cardiac remodeling is critical for the identification of novel pathophysiological biomarkers and potential therapeutic targets. Circulating extracellular RNAs (ex-RNAs) regulate important biological processes and can serve as biomarkers of disease. This study aims to discover circulating extracellular RNAs (ex-RNAs) that serve as biomarkers of obesity-associated adverse cardiac remodeling in ACS survivors.

Methods: We analyzed extracellular RNA (ex-RNA) profiles in 296 survivors of acute coronary syndrome enrolled in the Transitions, Risks, and Actions in Coronary Events - Center for Outcomes Research and Education (TRACE-CORE) cohort. A total of 317 ex-RNAs were quantified, selected a priori based on prior findings from a large population-based study. We employed a two-step, mechanism-driven approach to identify ex-RNAs associated with echocardiographic phenotypes, including left atrial (LA) dimension, LA volume index, left ventricular (LV) ejection fraction, LV mass, and LV end-diastolic volume, then tested the relations of these ex-RNAs with obesity. We performed further bioinformatics analysis of the gene ontology categories and molecular pathways associated with predicted miRNA targets.

Results: We identified 45 ex-RNAs associated with at least one echocardiographic phenotype, of which miR-1185-1-3p, miR-550a-3p, and miR-885-5p were also associated with prevalent obesity. Bioinformatic analysis of their predicted gene targets (n=1,930) revealed enrichment in key pathways related to inflammation, fibrosis, and cellular toxicity, including Wnt/β-catenin signaling, TGF-β signaling, and hypoxia-inducible factor (HIF) signaling. Targets such as DICER1, VEGF, and EPO were implicated. Gene ontology analysis further highlighted associations with angiogenesis, FGF signaling, and interleukin pathways.

Conclusions: Among ACS survivors, we observed that miR-1185-1-3p, miR-550a-3p, and miR-885-5p were associated with both echocardiographic markers of adverse cardiac remodeling and elevated BMI. Relevance for patients: miR-1185-1-3p, miR-550a-3p, and miR-885-5p were associated with echocardiographic phenotypes and obesity and are potential biomarkers for adverse cardiac remodeling in obesity.

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.