American journal of cardiovascular disease最新文献

Objectives: Sarcoidosis is a multisystem granulomatous disorder, with pulmonary sarcoidosis (PS) affecting approximately 90% of patients and cardiac sarcoidosis (CS) being less common but associated with severe clinical implications. While PS is primarily characterized by respiratory symptoms, CS can lead to serious complications like heart failure and arrhythmias, contributing to sarcoidosis-related mortality. This study aims to compare the prevalence, in-hospital mortality, 30-day readmission rates, and healthcare costs between PS and CS patients using data from the Nationwide Readmissions Database (NRD).

Methods: Data were extracted from the NRD for adult patients diagnosed with PS or CS from January 2016 to December 2020. Baseline demographics, comorbidities, in-hospital outcomes, and 30-day readmission rates were analyzed. Statistical comparisons were made using appropriate tests for categorical and continuous variables.

Results: Among 101,365 patients, 96,905 had PS and 4,460 had CS. CS patients experienced significantly higher rates of cardiovascular complications, such as heart failure (77.1% vs. 31.1%) and arrhythmias (75.8% vs. 27.7%), and incurred higher hospital charges ($59,520 vs. $40,249; P < 0.001). In-hospital mortality was similar between groups (CS: 2.4% vs. PS: 2.8%; P = 0.090). The 30-day readmission rate was comparable (CS: 12.9% vs. PS: 11.9%; P = 0.400), but PS patients were more likely to be readmitted for respiratory complications, while CS patients were readmitted primarily for heart failure.

Conclusions: This study underscores the distinct clinical profiles of PS and CS. Although CS is less prevalent, it is associated with a higher cardiovascular burden and healthcare costs. Both groups exhibited similar mortality and readmission rates, though their readmission causes differed. These findings highlight the need for targeted management strategies for PS and CS to optimize patient outcomes and resource utilization.

Objectives: Chagas disease, caused by Trypanosoma cruzi, is a parasitic infection endemic to Latin America and is increasingly prevalent in the United States. This study examines mortality, heart failure, arrhythmias, cardiogenic shock, and the need for heart transplantation in Chagas patients over five years in the United States.

Methods: We selected all non-ischemic cardiomyopathy (NICM) patients from the National Inpatient Sample Database from 2016 to 2020 and compared them to Chagas-induced NICM.

Results: A total of 783,535 patients had non-ischemic cardiomyopathy (NICM), with 250 cases being secondary to Chagas disease. Chagas NICM was predominantly seen in the Hispanic population. Patients with Chagas NICM have significantly higher odds of receiving a heart transplant (OR 15.48; P<0.05), particularly in the context of a high incidence of cardiogenic shock due to end-stage heart failure or severe myocarditis (OR 2.7; P<0.05). Furthermore, these patients demonstrate a higher incidence of ventricular fibrillation (OR 4.87; P<0.05) and pericardial effusion (OR 3.75; P<0.05) compared to other forms of NICM. They are frequently associated with the need for pacemaker placement (OR 2.80; P<0.05), likely due to ventricular fibrillation and conduction blocks. The odds of in-hospital mortality were similar between patients with Chagas NICM and those with other NICM patients.

Conclusion: Patients with Chagas cardiomyopathy are more likely to experience cardiogenic shock, ventricular fibrillation, and pericardial effusion. They also face an increased risk of needing an ICD and heart transplant. Further research is necessary on this subject.

Most recent large-scale global analyses on transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS) showed favorable survival outcomes in patients with high body mass index (BMI). We performed a meta-analysis pooling all clinical studies to assess the validity of improved post-TAVI prognosis in obese patients. MEDLINE and Scopus were queried till January 2023 to identify studies comparing AS patients with BMI≥30 kg/m², and BMI 18.5 to <25 undergoing TAVI. Data were analyzed using a random-effects model to derive odds ratios (ORs) for all outcomes, and hazard ratios (HRs) for long-term overall survival with 95% confidence intervals. The primary outcomes of interest included 30-day all-cause mortality and long-term overall survival while secondary outcomes consisted of myocardial infarction (MI), major bleeding, major vascular events and acute kidney injury (AKI). A total of 24 studies comprising 38,743 patients were included in this meta-analysis. All-cause mortality at 30-days was significantly reduced in patients with BMI>30 kg/m² (OR 0.71, P<0.0001) vs. normal BMI. Every 1 kg/m² increase in BMI was associated with better overall survival (HR 0.96, P<0.0001). Obese patients had greater long-term overall survival (HR 0.87, P<0.00001) compared with non-obese patients. No significant differences in MI (OR 0.84, 95% CI 0.52-1.34), major bleeding (OR 0.94, 95% CI 0.72-1.21), major vascular events (OR 1.18, 95% CI 0.97-1.43) and AKI (OR 1.17, 95% CI 0.87-1.56) were observed between the two groups. Obese AS patients might have similar procedural complications, but reduced mortality, and increased overall survival in comparison with normal weight individuals.

Objectives: The effect of gender on outcome in post-cardiac transplant morbidity and mortality including the occurrence of transplant vasculopathy is not well established. The goal of this study was to evaluate adverse post-transplant outcomes based on gender with a focus on cardiac allograft vasculopathy (CAV).

Methods: Using our post-transplant database at the University of Arizona, the effect of gender after heart transplantation on death, major adverse cardiac events (MACE defined as the combined occurrence of myocardial infarction, percutaneous coronary intervention, coronary bypass surgery, re-transplantation, and death) and the occurrence of CAV was evaluated retrospectively over 3 years.

Results: A total of 149 patients were evaluated in our database. Over the study period after the first year post-transplantation, a total of 4,7% deaths occurred. There were no differences in death between males and females (4.3% vs 6.1%, p = ns). MACE occurred in similar degrees between males and females (7.8% vs 9.1%, p = ns). Furthermore, the occurrence of an abnormal coronary angiogram or significant intima thickening seen during intracoronary ultrasound studies was similar between the genders for every year studied.

Conclusions: Gender does not effect on the occurrence of CAV at any year's post-cardiac transplantation. Furthermore, it has no effect on MACE and mortality.

Objectives: Coronary angiography and emergency coronary revascularizations are critical for decreasing morbidity and mortality linked to coronary artery disease. Establishing and maintaining this service in armed conflict and on the battlefield poses challenges; however, it remains achievable. This study aimed to evaluate the results of coronary angiography in Sudan amid the armed conflict of 2023-2024.

Methods: This study utilized a retrospective descriptive analysis conducted at El-Obeid International Hospital (Aldaman) in North Kordofan State, Sudan. Patient data was obtained from the hospital for the period spanning April 15, 2023, to April 30, 2024.

Results: Out of 314 diagnostic coronary angiograms, 32% had PCI with DES implantation, 18% showed normal coronary arteries, and the other 50% were treated with medication and advice from heart surgeons (CTC). Among the 100 patients who underwent PCI, 64% were male and 36% were female. The predominant age group was 50-59 years, succeeded by 60-69 years, under 50 years, and over 60 years, with incidence rates of 30%, 29.9%, 20.3%, and 18.2%, respectively.

Conclusions: The offering of cardiac catheterization laboratory services amid armed conflict poses challenges but is nonetheless feasible. Despite the tragedy, constrained resources, and the impact of wartime conditions, our findings were consistent with prior reports both locally and globally.

Objectives: Elderly patients who present with acute myocardial infarction are at increased risk for adverse outcomes owing to higher comorbidity burden and complicated coronary anatomy. We evaluated the three-year outcomes following coronary revascularization compared to conservative management among elderly patients presenting with acute myocardial infarction.

Methods: 155 patients over 75 years of age who were admitted for acute myocardial infarction underwent invasive treatment with coronary angioplasty (n=58) or only medical treatment (n=97). The Kaplan-Meier log rank test was used to compare 3-year survival and rehospitalization probability and the Mantel-Cox log rank test was used to compare mean survival time between groups.

Results: In the Invasive treatment group (ITG) cohort, 3-year survival probability was 74.1% as compared to 29.9% in the Conservative treatment group (CTG) cohort (P<0.001). Mean survival time at 3 years of follow-up was 31.50 (95% CI 29.35-33.65) months among ITG patients versus 24.65 (95% CI 22.71-26.59) months among CTG patients (P<0.001). Mean time to rehospitalization at 3 years was 34.05 (95% CI 32.37-35.72) in the ITG cohort compared to 30.03 (95% CI 28.13-31.93) in the CTG cohort (P=0.004).

Conclusion: Coronary revascularization among elderly patients with acute myocardial infarction reduces both all-cause mortality and cardiovascular events at 3-year follow-up. However, rates of rehospitalizations remain statistically similar between groups. Moreover, invasive treatment imparted improved rehospitalization probability compared to conservative treatment. This observation can be partially explained by a reduction in the frequency of myocardial infarction among those who underwent invasive treatment. While a thorough clinical assessment is required prior to treatment determination among elderly patients with acute myocardial infarction, coronary revascularization should be strongly considered as an intervention that likely improves overall survival probability.

Brugada Syndrome (BrS) is a hereditary cardiac condition associated with an elevated risk of lethal arrhythmias, making precise and prompt diagnosis vital to prevent life-threatening outcomes. The diagnosis of BrS is challenging due to the requirement of invasive drug challenge tests, limited human visual capacity to detect subtle electrocardiogram (ECG) patterns, and the transient nature of the disease. Artificial intelligence (AI) can detect almost all patterns of BrS in ECG, some of which are even beyond the capability of expert eyes. AI is subcategorized into several models, with deep learning being considered the most beneficial, boasting its highest accuracy among the other models. With the capability to discriminate subtle data and analyze extensive datasets, AI has achieved higher accuracy, sensitivity, and specificity compared to trained cardiologists. Meanwhile, AI proficiency in managing complex data enables us to discover unclassified genetic variants. AI can also analyze data extracted from induced pluripotent stem cell-derived cardiomyocytes to distinguish BrS from other inherited cardiac arrhythmias. The aim of this study is to present a synopsis of the evolution of various algorithms of artificial intelligence utilized in the diagnosis of BrS and compare their diagnostic abilities to trained cardiologists. In addition, the application of AI for classification of BrS gene variants is also briefly discussed.

Objectives: We tested whether management with metabolic cytoprotective and antiischemic agent trimetazidine may reduce readmissions in advanced heart failure (HF) patients through the possible improvement of left ventricular ejection fraction (LV EF) and filling pressure.

Methods: This was a single-center prospective open-label study. The study population included initially 40 patients with advanced HF and EF <30%, NYHA III-IV functional class, significant restriction of physical activity and at least 1 hospitalization during the last 12 months. After discharge patients were assigned to additional treatment with trimetazidine 80 mg/daily dose (20 patients) or standard guideline-based pharmacological therapy (20 patients). After enrollment patients underwent a total of four outpatient clinical and echocardiographic examinations (baseline before discharge, 2 weeks, 1, 3 and 6 months after the discharge). The echocardiographic assessment of EF and LV filling pressure by Tissue Doppler were performed blindly.

Results: At 6 months, trimetazidine-treated patients had an improvement of LV EF (from 23.7% to 25%) as compared to controls (from 22.5% to 22.6%). Tissue Doppler study showed a decrease of LV filling pressure in trimetazidine treated group from 15.1 at baseline to 13.7 after 6 months of treatment. In the control group, LV filling pressure remained unchanged (from 16.78 to 16.7) (P<0.001). The rate of hospitalizations for cardiovascular causes was reduced at 6 months (83.3% vs 70.0%).

Conclusions: Treatment with trimetazidine 80 mg/daily in addition to standard guideline-based therapy for 6-months decreased hospitalization, improved systolic function and LV filling pressure in advanced HF patients.

We report a case of a 57-year-old male with narrow QRS tachycardia exhibiting the alternance of the cycle length. Differential diagnoses include orthodromic atrioventricular reciprocating tachycardia with alternating antegrade atrioventricular (AV) nodal pathways, atrioventricular nodal re-entrant tachycardia (AVNRT) with alternating AV nodal pathways, and atrial tachycardia with alternating antegrade AV nodal pathways or with Wenckebach periodicity. In electrophysiological study the tachycardia showed alternance in the retrograde atrial conduction sequence and the cycle length. The alternation was caused by that of the HA intervals, between the shorter HA interval with the earliest atrial activation recorded in coronary sinus (CS), and the longer HA interval with that in His bundle region. The tachycardia was diagnosed with fast-slow form of AVNRT exhibiting the alternance of the earliest atrial activation sites. Electroanatomical 3D mapping further revealed that the exit site of retrograde slow pathway (SP) alternated between the left inferior extension (LIE) inside the CS, and the right inferior extension (RIE) in the posterior tricuspid annulus although among conventional electrode catheters the earliest site was the His bundle region. After ablation of the exit site of LIE, the alternation disappeared and fast-slow AVNRT showing a uniform retrograde atrial activation for which the earliest atrial activation site was the exit of RIE sustained. A single application of ablation at this point was insufficient, thereafter conventional SP ablation was added. Then, the ventriculoatrial conduction disappeared and no tachycardia was inducible even with isoproterenol administration. This case is followed by a review of the literature.

Introduction: Prevalence of different valvular pathologies has not been reported in female and male patients in large population-based studies. The goal of this study was to report the gender-specific prevalence of various valvular pathologies.

Methods: We retrospectively analyzed 24,265 echocardiograms performed between 1984 and 1998. The prevalence of mitral regurgitation (MR) aortic valve regurgitation (AR) and stenosis (AS), and tricuspid regurgitation (TR) were calculated in female and male patients.

Results: Echocardiograms were performed on 12,926 (53%) female and 11,339 (47%) male patients. Gender-specific echocardiographic prevalence of different valvular abnormalities was as follows: Prevalence of mitral regurgitations was similar in women and men (25% vs 24.7%). Aortic regurgitation was higher in males (5.5 vs 14.9%, P < 0.001). Aortic stenosis prevalence was similar between both genders (2.1 vs 2.3%). Tricuspid valve regurgitations were slightly higher in females (18.5 vs 16.7%, P < 0.001).

Conclusion: In this study, we found a significantly higher prevalence of tricuspid valve regurgitation in women. Aortic regurgitation was more prevalent in men. Aortic stenosis and mitral regurgitation had similar prevalence in both genders.