American Journal of Cardiology最新文献

Absence of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is commonly used to distinguish takotsubo syndrome (TTS) from other myocardial diseases. However, case series have reported the presence of LGE in TTS. The present study aimed to summarize the evidence on the frequency of LGE in TTS and identify potential variables that may influence the detection of LGE. Electronic databases were systematically searched for studies reporting LGE frequency in TTS patients. The overall frequency was estimated using the inverse variance method and a random-effect model for single proportion. Factors influencing LGE detection were analyzed. Among 490 studies screened, 21 were included (703 patients, 90% female). The estimated overall frequency of LGE was 22.4% (95% CI 8.7-39.6%). Among TTS patients who underwent CMR within three days of symptom occurrence, the frequency of LGE was 40.7% (95% CI 18.8-64.5%), significantly higher than among those who performed CMR after three days (3.9%, p<0.010). The sensitivity threshold used in the imaging protocols had a statistically significant impact on the frequency of LGE detection (p=0.030). Ten studies performed a follow-up CMR after at least three months, reporting a frequency of LGE of 1.7 % (95% CI 0.0-8.9%). In conclusion, published studies report the presence of LGE in TTS at presentation among a significant proportion of patients. However, its detection is strongly influenced by the duration between symptom onset and CMR acquisition, and by the sensitivity threshold used for the imaging protocol. LGE is rarely present at follow-up.

The Duke Activity Status Index (DASI), a self-administered 12-item questionnaire has been used to estimate functional capacity and recently demonstrated prognostic information. We sought to develop an abbreviated version for clinical applications. Leveraging the Cleveland Clinic GeneBank Study, we developed an abbreviated DASI questionnaire (aDASI) with the machine learning XGBoost algorithm with the goal of maintaining the accuracy and reliability of the original DASI. We validated the prognostic value of aDASI in a subset of patients with heart failure from GeneBank, as well as an independent dataset from the GUIDE-IT trial. The results confirmed the congruence and accuracy between the original and the abbreviated scores while reducing the number of questions (R=0.97, p<0.001). Both the original DASI score and the aDASI exhibited a strong correlation in both GeneBank and predictive value for all-cause mortality at different time points in the GUIDE-IT cohort. In conclusion, the abbreviated DASI tracks with original DASI assessment and performs comparably to the original DASI questionnaire in predicting all-cause mortality.

Introduction: Vitamin K antagonists remain the mainstay of therapy in patients with left ventricular thrombus (LVT) because the efficacy of direct oral anticoagulants (DOACs) is not well established.

Methods: We performed a multicenter retrospective analysis of adults admitted between January 2015 and December 2021 and diagnosed with LV thrombus to compare the safety and efficacy of Warfarin vs DOACs. The primary outcome was thrombus resolution. Secondary outcomes included all-cause mortality, bleeding events and stroke or systemic embolism.

Results: A total of 189 patients were included. The rate of thrombus resolution was similar in patients with LVT treated with DOACs when compared to those treated with warfarin (DOACs 73.9%vs warfarin 68.5%, p=0.489). Additionally all-cause mortality (DOACs 13.04% vs warfarin 9.79%, p=0.583), bleeding events (DOACs 19.57% vs warfarin 13.99%, p=0.361), and SSE (DOACs 10.87% vs warfarin 15.38%, p=0.446) were all similar in the two groups. In the propensity matched group, 90 patients were included. Multivariate analysis showed no significant difference of using warfarin or DOACs on thrombus resolution (OR 0.94, 95% CI 0.858-1.029, p=0.18), all-cause mortality (OR 1.032, 95% CI 0.906-1.176, p=0.6354), bleeding events (OR 1.694, 95% CI 0.168-17.097, p=0.655), or SSE (OR 1.947, 95% CI 0.087-4.756, p=0.6747).

Conclusion: In our retrospective analysis, DOACs had similar efficacy and safety when compared to warfarin in the treatment of LV thrombi.

Objective: Coronary computed tomography angiography (CCTA) has emerged as a non-invasive alternative to invasive coronary angiography (ICA) for diagnosing coronary artery disease (CAD). Hence, the question of CCTA's ability to guide surgical decision-making moves into the center of attention. CCTA is specifically powerful in ruling out CAD. We therefore performed a meta-analysis and systematic review to compare clinical endpoints between patients who received ICA or CCTA to rule out CAD before valve surgery.

Methods: Three databases were assessed. The primary outcome was perioperative mortality. Secondary outcomes were acute kidney injury (AKI), myocardial infarction (MI), stroke and major adverse cardiovascular events (MACE). Odds ratio (OR) and the respective confidence interval (CI) was calculated. Random effects model was performed.

Results: A total of 5 studies with 6,654 patients qualified for the analysis. There was no significant difference between the two groups regarding the primary endpoint (OR= 1.20, 95% CI, 0.67-2.15, p= 0.53). The secondary outcomes also did not show any significant differences in AKI (OR= 1.14, 95% CI, 1.14, 0.88-1.49, p=0.32), MI (OR= 0.89, 95% CI, 0.65-1.22, p= 0.45), stroke (OR= 1.12, 95% CI, 0.48-2.60, p= 0.79) or MACE (OR= 1.17, 95% CI, 0.86-1.59, p= 0.33) incidences.

Conclusions: The analysis suggest that CCTA is a safe and reliable non-invasive alternative to ICA for coronary imaging before valve surgery. Conceivable differences in imaging modalities were not associated with increases in perioperative mortality, AKI, MI, stroke or MACE.

Several novel software systems have been developed for the reconstruction of the coronary tree and the calculation of fractional flow reserve from coronary angiography images without coronary instrumentation: FFRangio, Computational pressure-flow dynamics derived FFR (caFFR), Quantitative flow ratio (QFR) and vessel fractional flow reserve (vFFR). In this article we review the current evidence on each software, their contemporary use and future directions.

Artificial intelligence-enhanced electrocardiography (AI-ECG) can identify hypertrophic cardiomyopathy (HCM) on 12-lead ECGs and offers a novel way to monitor treatment response. While the surgical or percutaneous reduction of the interventricular septum (SRT) represented initial HCM therapies, mavacamten offers an oral alternative. We aimed to assess the use of AI-ECG as a strategy to evaluate biological response to SRT and mavacamten. We applied an AI-ECG model for HCM detection to ECG images from patients who underwent SRT across 3 sites: Yale New Haven Health System (YNHHS), Cleveland Clinic Foundation (CCF), and Atlantic Health System (AHS); and to ECG images from patients receiving mavacamten at YNHHS. A total of 70 patients underwent SRT at YNHHS, 100 at CCF, and 145 at AHS. At YNHHS, there was no significant change in the AI-ECG HCM score before versus after SRT (pre-SRT: median 0.55 [IQR 0.24-0.77] vs post-SRT: 0.59 [0.40-0.75]). The AI-ECG HCM scores also did not improve post SRT at CCF (0.61 [0.32-0.79] vs 0.69 [0.52-0.79]) and AHS (0.52 [0.35-0.69] vs 0.61 [0.49-0.70]). Among 36 YNHHS patients on mavacamten therapy, the median AI-ECG score before starting mavacamten was 0.41 (0.22-0.77), which decreased significantly to 0.28 (0.11-0.50, p <0.001 by Wilcoxon signed-rank test) at the end of a median follow-up period of 237 days. In conclusion, we observed a lack of improvement in AI-based HCM score with SRT, in contrast to a significant decrease with mavacamten. Our approach suggests the potential role of AI-ECG for serial point-of-care monitoring of pathophysiological improvement following medical therapy in HCM using ECG images.

Stent implantation has become the treatment of choice in patients with coarctation of the aorta (CoA). However, long-term results are limited. We sought to evaluate the long-term results after CoA intervention based on a 12-year experience. The aims of the study were to evaluate the long-term outcomes of CoA patients after transcatheter intervention and our innovative techniques. All patients undergoing transcatheter intervention of CoA at our institution between January 2010 and October 2022 were included. Clinical and echocardiographic follow-ups were carried out. A total of 103 patients with a median age of 27 (range: 21-days to 63-year-old) year-old underwent transcatheter intervention of CoA. Among them, 15 patients with concomitant cardiac anomalies underwent hybrid (n = 5) or staged (n = 10) procedures. In all 6 (5.8%) patients, subclavian artery protection techniques were used and successfully avoided subclavian artery obstruction. Systolic blood pressure decreased from 148.5±21.9 mmHg to 121.7±14.5 mmHg (P<0.001), which remained stable during a median follow-up of 37.7 months. The left ventricular mass index decreased from 128.6 [100.9, 181.7] g/m² to 99.1[82.1, 137.4] g/m² in males (P=0.006), and from 106.2 [93.5, 140.8] g/m² to 78.8[59.2, 99.5] g/m² in females (P<0.001). Overall survival during the follow-up was 98.1%. Six (5.8%) patients required re-intervention, otherwise there was no cardiac, aortic or neurological events. In conclusion, this study provides promising long-term results of transcatheter intervention in CoA patients. The subclavian artery protection and hybrid strategy appeared valuable in complex anatomies.

Transthyretin cardiac amyloidosis (ATTR-CA) is disproportionately diagnosed in older adult men. However, studies suggest that the true prevalence of ATTR-CA in women may be higher than previously reported. The Screening for Cardiac Amyloidosis with Nuclear Imaging in Minority Populations (SCAN-MP) study utilizes nuclear scintigraphy to identify ATTR-CA in self-identified Black and Caribbean Hispanic participants ≥60 years old with heart failure and left-ventricular hypertrophy. We characterized the sex distribution and phenotypic characteristics of ATTR-CA in this active ascertainment cohort in comparison to a population of ATTR-CA patients who were referred to a tertiary care academic center outpatient clinic. Compared to the referral clinic cohort, the active ascertainment SCAN-MP cohort had a greater proportion of women (31.3% vs 13.3%, p=0.016). This was mainly attributed to the higher proportion of women with wild-type disease [ATTRwt-CA] (27.8% vs 7.1%, p=0.012). Women with ATTR-CA in the active ascertainment cohort exhibited higher left ventricular ejection fraction than those in the referral cohort (61% vs 50%, p = 0.011); lower left ventricular mass index (110 g/m² vs 148 g/m², p = 0.014); and lower posterior wall thickness (1.4 cm vs 1.6 cm, p = 0.01). An active ascertainment strategy for ATTR-CA identification demonstrated a greater proportion of women than did a referral cohort, driven predominantly by the greater proportion of women with ATTRwt-CA, and echocardiographic evidence of a less severe phenotype. In conclusion, efforts for early identification of ATTR-CA in women are critical for reducing sex disparities in this clinically treatable disease.