American journal of cardiovascular disease最新文献

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.

Background: Diabetes mellitus (DM), a worldwide disease affecting more than 400 million people, is associated with high blood pressure (BP). In addition to macrovascular complications, high BP in DM patients is potentially linked to microvascular complications. More than 70% of DM patients have retinopathy. To our knowledge, no systematic review and meta-analysis has been conducted on the relationship between visit-to-visit variability in blood pressure and diabetic retinopathy risk.

Methods: This systematic review and meta-analysis study was performed on the related articles. The search strategy, screening, and data selection were all checklist-based. A comprehensive search was done in three databases, including PubMed, Google Scholar, and Scopus. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) were followed. English clinical studies published up to January 2023 contained diabetic patients as the population, retinopathy as the outcome, and visit-to-visit blood pressure as the intervention. Using the QUIPS technique, two authors independently quantify the risk of bias in included publications. The meta-analysis was conducted using R version 4.4.1. We calculated relative risk (RR) as the effect size, applying the random effect model. Standard deviation (SD) and coefficient of variation (CV), were used as measures of BP variability.

Results: A total number of 8 studies with 743,315 participants were covered in this systematic review. After meta-analysis, we concluded that the group with higher SD of BP variability had 2 percent higher risk than the control group (RR = 1.02, 95% CI = 1.01-1.03, I-squared = 41%); however, results of our analysis for CV of BP variability showed no significant contrast with control group thus no increased risk was reported (RR = 1.04, 95% CI = 0.94-1.15, I-squared = 32%, P-value = 0.23).

Conclusion: In conclusion, an increased SD of BP variability significantly increased the relative risk for the development of retinopathy.

Objectives: Current thin-strut 2^nd generation drug eluting stents (DES) are considered as optimal standard of care for revascularization of coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI). Ultrathin (≤ 70 μm strut thickness) strut DES have recently been shown to reduce target lesion failure (TLF) compared to thin-strut DES. Therefore, in order to assess the validity of improved outcomes associated with ultrathin-strut DES, we conducted an updated meta-analysis that includes recently published follow-ups of previously conducted randomized controlled trials (RCTs).

Methods: MEDLINE and Scopus were queried from their inception to May 2024 to identify studies comparing outcomes between ultrathin and current thin-strut 2^nd generation DES groups. A random-effects meta-analysis was conducted to derive risk ratios (RR) from dichotomous data. The primary endpoint was long-term TLF defined as a composite of cardiac death, target vessel myocardial infarction (TV-MI) and clinically driven target lesion revascularization (CD-TLR). The secondary outcome was target-vessel failure (TVF) defined as a composite of cardiac death, TV-MI and clinically driven target-vessel revascularization (CD-TVR).

Results: A total of 17 RCTs (n=22141) with a mean follow-up of 34 months were included. The risk of TLF was significantly lowered in the ultrathin DES group in comparison to thin-strut DES. A significant decrease was also noted in rates of TVF, CD-TLR and CD-TVR in the ultrathin DES vs thin-strut DES group.

Conclusion: The results of our analysis demonstrate a significantly reduced risk of TLF in the ultrathin DES group in comparison with thin-strut DES. Ultrathin DES was also associated with a significantly decreased risk of TVF, CD-TLR and CD-TVR.

Introduction: In-stent restenosis (ISR) and aggravated non-intervened coronary lesions (ANL) are two pivotal aspects of disease progression in patients with coronary artery disease (CAD). Established risk factors for both include hyperlipidemia, hypertension, diabetes, chronic kidney disease, and smoking. However, there is limited research on the comparative risk factors for the progression of these two aspects of progression. The aim of this study was to analyze and compare the different impacts of identical risk factors on ISR and ANL.

Methods: This study enrolled a total of 510 patients with multiple coronary artery lesions who underwent repeated coronary angiography (CAG). All patients had previously undergone percutaneous coronary intervention (PCI) and presented non-intervened coronary lesions in addition to the previously intervened vessels.

Results: After data analysis, it was determined that HbA1c (OR 1.229, 95% CI 1.022-1.477, P=0.028) and UA (OR 1.003, 95% CI 1.000-1.005, P=0.024) were identified as independent risk factors for ISR. Furthermore, HbA1c (OR 1.215, 95% CI 1.010-1.460, P=0.039), Scr (OR 1.007, 95% CI 1.003-1.017, P=0.009), and ApoB (OR 1.017, 95% CI 1.006-1.029, P=0.004) were identified as independent risk factors for ANL. The distribution of multiple blood lipid levels differed between the ANL only group and the ISR only group. Non-HDL-C (2.17 mmol/L vs. 2.44 mmol/L, P=0.007) and ApoB (63.5 mg/dL vs. 71.0 mg/dL, P=0.011) exhibited significantly higher values in the ANL only group compared to the ISR only group.

Conclusions: Blood glucose levels and chronic kidney disease were identified as independent risk factors for both ISR and ANL, while elevated lipid levels were only significantly associated with ANL. In patients with non-intervened coronary lesions following PCI, it is crucial to assess the concentration of non-HDL-C and ApoB as they serve as significant risk factors.

Pulmonary artery aneurysms (PAAs) are rare, more prevalent in younger population with equal sex incidence. Congenital, idiopathic, autoimmune, infectious, inflammatory, and malignant etiologies have been linked to PAAs. Commonly, patients with PAA are asymptomatic, even those with large PAAs. Presenting symptoms, if any, are non-specific. The management should target the underlying conditions and serial imaging follow-up. Signs and symptoms of disease progression should prompt a change in treatment strategy. Though there is no consensus, those who are symptomatic with a PAA diameter > 5 cm generally should undergo surgical repair. More recently, endovascular interventions are available for certain PAAs. We present a 78-year-old female who was referred to the cardiology clinic for cough and dyspnea. Using computed tomography (CTA) of the chest, she was diagnosed with aneurysm of the main pulmonary artery (PA), without involvement of distal pulmonary arteries or thoracic aorta. She underwent repair of the pulmonary artery using a 34-mm tubular graft with a complete resolution of her symptoms.

Background: The implantation of cardiac implantable electronic devices (CIEDs) carries a known risk of infection. Two devices (TYRX and TauroPace) have been proposed to reduce this risk.

Methods: The aim of our study was to compare the effectiveness of TauroPace and TYRX. Real-world comparative studies were included. Data analysis was based on reconstruction of individual patient data from Kaplan-Meier curves using an artificial intelligence algorithm. The endpoint was CIED infection or systemic infection. Statistical tests included heterogeneity assessment, superiority testing, and non-inferiority testing. The primary outcome measure was the hazard ratio (HR) with confidence interval (CI).

Results: Our literature search identified two real-world studies suitable for our analysis. Follow-up was 12 months for TauroPace (654 patients) and 60 months for TYRX (872 patients), with a total of 2,083 controls. There was no heterogeneity among controls. Compared to the pooled control group, patients treated with TYRX or TauroPace had fewer CIED infections (HR, 0.3892; 95% CI, 0.2042-0.7419; P=0.00414; HR, 0.3313; 95% CI, 0.1005-1.0925; P=0.06958, respectively). When testing for non-inferiority of TauroPace vs. TYRX, the comparison yielded a HR of 0.8494 (in favor of TYRX) with a 90% CI of 0.27-2.63; this CI of TauroPace did not meet the non-inferiority criterion set at HR>0.75 (i.e., relative difference ≤25%).

Conclusions: Both treatments had some important drawbacks. Regarding TYRX, more selective use in higher-risk patients should be advocated to improve its cost-effectiveness, but robust evidence is still lacking. Regarding TauroPace, our analysis testing for a non-inferiority margin of ≤25% did not meet this demonstration.

Background: In this study, we aimed to construct a robust diagnostic model that can predict the early onset of heart failure in patients with ST-elevation myocardial infarction (STEMI) following a primary percutaneous coronary intervention (PCI). This diagnostic model can facilitate the early stratification of high-risk patients, thereby optimizing therapeutic management.

Methods: We performed a retrospective analysis of 664 patients with STEMI who underwent their inaugural PCI. We performed logistic regression along with optimal subset regression and identified important risk factors associated with the early onset of heart failure during the time of admission. Based on these determinants, we constructed a predictive model and confirmed its diagnostic precision using a receiver operating characteristic (ROC) curve.

Results: The logistic and optimal subset regression analyses revealed the following three salient risk factors crucial for the early onset of heart failure: the Killip classification, the presence of renal insufficiency, and increased troponin T levels. The constructed prognostic model exhibited excellent discriminative ability, which was indicated by an area under the curve value of 0.847. The model's 95% confidence interval following 200 Bootstrap iterations was found to be between 0.767 and 0.925. The Hosmer-Lemeshow test revealed a chi-square value of 3.553 and a p-value of 0.938. Notably, the calibration of the model remained stable even after 500 Bootstrap evaluations. Furthermore, decision curve analysis revealed a substantial net benefit of the model.

Conclusion: We have successfully constructed a diagnostic prediction model to predict the incipient stages of heart failure in patients with STEMI following primary PCI. This diagnostic model can revolutionize patient care, allowing clinicians to quickly identify and create individualized interventions for patients at a higher risk.

Background: Heart failure (HF) and coronary heart disease (CHD) are major causes of morbidity and mortality worldwide. While traditional risk factors such as hypertension, diabetes, and smoking have been extensively studied, the role of metabolite functions in the development of these cardiovascular conditions has been less explored. This study employed a Mendelian randomization (MR) approach to investigate the impact of metabolite functions on HF and CHD.

Methods: To assess the causal impacts of specific metabolite risk factors on HF and CHD, this study utilized genetic variants associated with these factors as instrumental variables. Comprehensive genetic and phenotypic data from diverse cohorts, including genome-wide association studies (GWAS) and cardiovascular disease registries, were incorporated into the research.

Results: Our results encompass 61 metabolic cell phenotypes, with ten providing strong evidence of the influence of metabolite functions on the occurrence of HF and CHD. We found that elevated levels of erucate (22:1n9), lower levels of α-tocopherol, an imbalanced citrulline-to-ornithine ratio, elevated γ-glutamyl glycine levels, and elevated 7-methylguanine levels independently increased the risk of these cardiovascular conditions. These findings were consistent across different populations and robust to sensitivity analyses.

Conclusion: This MR study provides valuable insights into the influence of metabolite functions on HF and CHD. However, further investigation is needed to fully understand the precise mechanisms by which these metabolite factors contribute to the onset of these conditions. Such research could pave the way for the development of targeted therapeutic strategies.

Takotsubo cardiomyopathy (TCM) is a cardiac condition that is usually characterized by sudden heart failure (HF) or chest pain that resembles acute coronary syndrome (ACS). It is identified by severe systolic dysfunction of the left ventricle (LV) and can be caused by physical, medical, or emotional stress. The pathophysiological mechanisms leading to TCM have not yet been clearly determined. TCM is a complex condition to diagnose and may go undetected during cancer treatment due to the wide variety of cardiotoxic effects associated with antineoplastic therapies. Consequently, timely identification and effective treatment are critical to enhancing the prognosis. Nevertheless, TCM is a more prevalent condition in oncology than was previously believed; therefore, clinicians who treat cancer patients should consider it in their differential diagnosis. The purpose of this manuscript is to provide physicians with a summary of the available evidence regarding the ramifications of the association between TCM and cancer to aid in improving patient management.