Anatolian Journal of Cardiology最新文献

Hypertrophic cardiomyopathy (HCM) is a prevalent genetic cardiovascular disease characterized by asymmetric thickening of the left ventricular wall, frequently occurring in families predisposed genetically. While HCM in twins is rare, it presents a unique opportunity to explore the disease's genetic and epigenetic underpinnings due to the phenotypic heterogeneity observed even among genetically identical individuals. This review collates and analyzes global clinical studies that focus on the twin phenomena in HCM. It explores the genetic foundations of HCM, examines the influence of environmental and epigenetic factors on disease expression, and emphasizes the crucial role of genetic screening in the early and differential diagnosis of HCM. By focusing on twin cases in HCM, this review aims to enhance our understanding of HCM's complex genetic background, which could lead to more personalized approaches in the management and treatment of this condition, thus drawing significant interest from researchers and clinicians alike.

Background: Atrial fibrillation (AF) is a common arrhythmia in patients with atrial septal defect (ASD). Cryoballoon ablation (CA) is a safe and efficient method for pulmonary vein (PV) isolation in the treatment of AF. Achieving left atrial access may be difficult in patients with atrial septal occluders (ASO) or surgical repair of ASD. The aim of this study was to present our experience with the efficacy and safety of transseptal puncture and AF ablation in CA in this subset of patients.

Methods: We retrieved our data about patients with ASO or surgical repair of ASD undergoing cryoballoon AF ablation procedures at our center between August 2019 and January 2022.

Results: Nine patients (age 43.88 ± 9.73 years) with AF (5 paroxysmal and 4 persistent) and ASO or surgical repair of ASD were enrolled. All three patients had a 28 mm Amplatzer ASO device which occupied the whole septum, and direct puncture through the ASO was performed. Sequential balloon dilatation was performed in 2 patients with surgical ASD repair and all 3 patients with ASO. Four of 6 patients (66.7%) in the surgical repair group required transesophageal echocardiography during transseptal puncture. The endpoint of the procedure, isolation of all PVs, was achieved in all 9 patients. None of the patients had evidence of an interatrial shunt or pericardial effusion at the end of the procedure. Total procedural time (123 ± 28 minutes vs. 63 ± 21 minutes, P = .024) and total fluoroscopy time (41 ± 5 minutes vs. 23 ± 8 minutes, P = .024) were significantly higher in the percutaneous closure group.

Conclusions: In patients with ASO or surgical repair of ASD, CA of AF might be feasible, safe, and effective. The balloon dilatation of the interatrial septum (IAS) might assist transseptal access through the ASO or a surgically repaired thickened IAS.

Background: To investigate the relationship between anxiety and white coat hypertension (WCH) using the hospital anxiety and depression scale-anxiety (HADS-A) score.

Methods: Participants lacking a pre-existing diagnosis of hypertension but displaying increased office blood pressure were included in this study. Subsequently, they were classified as either newly diagnosed sustained hypertension (SustHT) or white coat hypertension (WCH) patients, as determined by 24-hour ambulatory blood pressure monitoring measurements. The assessment of their anxiety levels was conducted using the HADS-A questionnaire. We performed regression, comparative, and sensitivity analyses to elucidate the association between anxiety and WCH.

Results: In this cohort of 303 consecutive individuals (mean age 54 years, 46% female), 81 (26.7%) patients were diagnosed with WCH. Those with WCH were younger (49 vs. 56 years, P < .001), had higher heart rate (85 vs. 76 bpm, P < .001) and exhibited a female predominance (56% vs. 43%, P = .049) compared to individuals with SustHT. The HADS-A was higher in WCH than in SustHT (9.0 ± 2.9 vs. 6.6 ± 2.6, P < .001). Furthermore, HADS-A showed positive correlation with systolic and diastolic pressures measured in the out-patient clinic (r = 0.523 and r = 0.387, respectively; P < .001 for both). The full model with HADS-A had better discriminatory power (Harrell's c-index 0.82 vs. 0.77, P = .0025), increased calibration, and a greater net benefit than the base model without. The ROC curve analysis, using a cut-off of >6 for HADS-A, demonstrated a sensitivity of 76.5% and specificity of 53.6% in detecting WCH (Area Under the Curve = 0.72, P < .001).

Conclusions: Our study revealed that individuals with WCH, in comparison to those with SustHT, exhibit a higher level of anxiety as indicated by HADS-A.

Background: Twenty-four-hour mean arterial pressure (MAP) is underutilized for the diagnosis and risk assessment of hypertension in clinical settings. The objective of this study is to assess the relation of MAP with systolic and diastolic blood pressure (BP) in diagnosing hypertension on 24-hour ambulatory blood pressure monitoring (ABPM), while also examining its diagnostic effectiveness.

Methods: This retrospective study analyzed 24-hour ABPM of 532 adults. Hypertension diagnosis was made based on 2 criteria: the standard 24-hour systolic/diastolic BP measurement criteria and the 24-hour MAP measurement criteria. The relation of the 24-hour MAP with systolic and diastolic measurements and the predictors affecting its accuracy were evaluated.

Results: A total of 532 patients were included, and 409 (76.9%) were diagnosed with hypertension based on 24-hour ambulatory systolic/diastolic BP criteria. Among hypertensive patients, 191 (46.7%) were overlooked by 24-hour MAP criteria. Multiple logistic regression analysis identified age ≥52.4 (OR = 3.23, 95% CI:2.02-5.16, P < .001), female gender (OR = 2.54, 95%CI:1.61-4.02, P < .001), and less variation in daytime/nighttime systolic/diastolic BP as significant independent predictors of overlooked hypertension by 24-hour MAP criteria.

Conclusion: Our study highlights a relation between 24-hour MAP and systolic/diastolic BP measurements in diagnosing hypertension via 24-hour ABPM, especially in older adults and women. Systolic/diastolic criteria offer greater sensitivity for hypertension detection compared to MAP alone. This underscores the need for refined diagnostic criteria and suggests that reliance on MAP alone may lead to underdiagnosis in these vulnerable populations, necessitating further investigation.