Anatolian Journal of Cardiology最新文献

Background: The association of body mass index (BMI) and an "obesity paradox" with cardiovascular risk prediction is controversial. This study aimed to evaluate the impact of elevated BMI on the outcome of transcatheter aortic valve replacement (TAVR) for aortic stenosis.

Methods: This retrospective study included 1019 patients with a BMI of ≥18.5 kg/m2 divided into 3 groups: 1) normal BMI (18.5-24.9 kg/m2), 2) overweight (25-29.9 kg/m2), and 3) obese (≥30 kg/m2). Propensity score matching was used to compare normal BMI with overweight and normal BMI with obese.

Results: The median age of the cohort was 82 years, and 348 patients had a normal BMI, while 319 and 352 patients were overweight and obese, respectively. After 1 : 1 propensity score matching, 258 and 192 pairs between normal BMI and overweight, and normal BMI and obese patients, respectively, were analyzed. Both overweight and obese patients had higher post-transaortic mean gradients and lower indexed effective orifice areas compared to normal BMI patients. During a median follow-up of 25 (range: 0.1-72) months, all-cause mortality was similar between overweight or obese patients and patients with a normal BMI. However, in a subgroup analysis of patients with moderate/severe chronic lung disease, all-cause mortality was significantly higher in obese patients compared with normal BMI patients (hazard ratio = 3.49, 95% confidence interval, 1.21-10.0, P = .021).

Conclusions: In this study, the "obesity paradox" was not observed in patients undergoing TAVR; rather, in patients with significant lung disease, obesity may be associated with worse midterm outcomes after TAVR.

Background: Home blood pressure monitoring (HBPM) is commonly used to diagnose hypertension (HT), with a diagnostic threshold of ≥135/85 mm Hg, the same as daytime ambulatory BP monitoring (ABPM). This study hypothesizes that training and adherence to HBPM guidelines will yield more accurate BP readings compared to ABPM.

Methods: The study involved 129 patients with elevated office BP but no prior HT diagnosis. After a two-week observation period with lifestyle advice, HBPM was conducted over a week before and after structured measurement training, with ABPM performed in each period. Adherence to instructions post-training was also assessed.

Results: Post-training, mean systolic and diastolic home BP values significantly decreased (from 128 ± 13.1/84.9 ± 8.2 to 122.6 ± 12.7/81.8 ± 7.8; P < 0.001 for both), while daytime ABPM values remained unchanged (131.7 ± 11.1/86.7 ± 9.3 before vs. 130.7 ± 11.7/85.9 ± 8.6 after; P = 0.185). Although HBPM values were consistently lower than ABPM values, the discrepancy grew post-training. The number of patients reaching the HT threshold via HBPM decreased significantly post-training [71 (55%) to 54 (41.9%); P = 0.006], whereas the number via daytime ABPM remained similar [82 (64.3%) vs. 84 (65.1%); P = 1.000].

Conclusion: Training and adherence to HBPM guidelines led to lower BP readings and fewer HT diagnoses. Contrary to the hypothesis, this method under "ideal conditions" underestimated HT prevalence when compared to daytime ABPM. Further studies with clinical endpoints are needed to refine HBPM methods and establish new BP thresholds for more accurate HT detection.

Background: Postoperative atrial fibrillation (POAF) remains a common complication after cardiac surgery. The ability to accurately identify patients at risk through previous risk scores is limited. This study aimed to evaluate the new HARMS2-AF risk score to predict POAF after coronary artery bypass grafting (CABG) surgery.

Methods: In this retrospective cohort study, we included 265 patients undergoing CABG surgery from 2022-2023. Data were obtained from the medical files of the patients and hospital records. Each patient was assigned a HARMS2-AF risk score. A univariate and multivariate regression analyses were done to analyze independent predictors of POAF.

Results: Of 265 patients, 49 had postoperative atrial fibrillation. HARMS2-AF score was significantly higher in patients with POAF. Age, sleep apnea,a left atrial diameter (LAd), and HARMS2-AF score were independently associated with POAF. A HARMS2-AF score ≥ 4.5 predicted POAF with 91% sensitivity and 64% specificity (AUC = 0.787, 95% CI = 0.731-0.842, P < .001).

Conclusion: The HARMS2-AF score is a strong predictor of atrial fibrillation (AF) development after isolated CABG surgery. It can be used as a novel stratification tool to estimate AF after cardiac surgery.

Background: Low-intensity training with blood flow restriction (BFR) training could induce endurance adaptations, its impact on myocardial markers is still unclear compared to training without BFR. Consequently, the influence of low-intensity interval exercise with and without BFR and high-intensity interval exercise (HIIE) on cardiac troponin was determined in this study.

Methods: Twelve physically active males between 18 and 26 years volunteered as participants. The participants completed 3 exercise tests in random order, which included 40% VO2max low-intensity cycling without BFR (group L), 40% VO2max low-intensity cycling with BFR set at 60% limb occlusion pressure (LOP) (group B), and 80% VO2max high-intensity cycling without BFR (group H). Participant muscle oxygen, blood flow, oxygen uptake, heart rate (HR), perceived exertion (RPE) rating, and pain levels were determined before and after exercise, after cuff inflation, and pre- and post-each exercise. Moreover, before each protocol, immediately after the exercises, and 3-4 hours after each exercise, elbow vein blood samples were collected to evaluate lactate (LA) and high-sensitivity cardiac troponin T (cTnT).

Results: Increased LA was recorded after exercise by the individuals in group H, which was more significant than in group B. Moreover, group B documented a more significant LA increment than group L (P < .05). The peak cTnT of groups B and H after exercise was significantly higher (P < .05). Furthermore, the increase was more significant than the values recorded by group L (P < .05).

Conclusion: The present study demonstrated that low-intensity interval exercise combined with BFR could cause cTnT elevations compared to training without BFR. The increase was similar to HIIE protocols.

Background: Duchenne muscular dystrophy (DMD)-related cardiomyopathy is associated with hemodynamic and conduction abnormalities and begins at an early age with subtle symptoms.

Methods: The study population included 55 patients with DMD and 54 healthy controls. We compared electrocardiogram (ECG), conventional echocardiography, and tissue Doppler imaging (TDI) assessments between patients with DMD and healthy controls. Also, we investigated atrial electromechanical delay, which has not been previously studied in DMD patients. Mitral, septal, and tricuspid segments were analyzed by TDI.

Results: The mean age was 13.6 ± 2.5 years (range, 9.3-17.9 years) in the patient group and 12.8 ± 2.6 years (range, 8-17.5 years) in the control group (P = .1). Patients had higher heart rates, longer QTc intervals, and P-wave dispersion (PWD) than controls (P < .001, P = .004, P < .001, respectively). The patient group had larger left ventricular end-systolic dimension (P < .001), lower left ventricular ejection fraction (EF) (P < .001), MAPSE (P < .001), TAPSE (P < .001), and mitral-E/A (P = .029) values than control subjects. Myocardial performance index (P < .001) was higher, and the E'/A' ratio (P < .001) was lower at all 3 segments in the patient group. Also, atrial electromechanical delay was longer in the patient group at these segments (P < .001). Patients had significantly longer interatrial (P = .033) electromechanical conduction delays. EF was negatively correlated with atrial conduction time variables.

Conclusion: We have shown deterioration in systolic and diastolic function in both ventricles, PWD, and atrial conduction in children with DMD. Patients with DMD may be at risk of atrial arrhythmias due to disturbed atrial conduction.

Background: The aim is to investigate the clinical efficacy of Alprostadil in diabetes mellitus (DM) combined with peripheral atherosclerosis and to investigate the molecular mechanisms.

Methods: Patients included 154 cases with DM combined with peripheral atherosclerosis and were divided into the conventional group (77 cases) and the Alprostadil group (77 cases). Both groups of patients were given conventional treatment, and the Alprostadil group was given Alprostadil treatment on the basis of the conventional group. The therapeutic efficacy and clinical symptom improvement were compared, and the adverse reactions were observed. An in vitro cell model was constructed using high glucose (HG) (50 mM) and oxidized low-density lipoprotein (50 μg/mL) treatment.

Results: The total effective rate of treatment in the Alprostadil group was higher than that in the conventional group. The biochemical indices of whole blood viscosity, plasma viscosity, erythrocyte pressure volume, and fibrinogen, as well as the level of inflammatory factors in the Alprostadil group were lower than those in the conventional group. The incidence rate of adverse reactions of Alprostadil administration was lower than that in the conventional group (P = .030). Alprostadil inhibited platelet aggregation and promoted platelet spreading. Alprostadil had an ameliorative effect on HG- and oxidized low-density lipoprotein cholesterol (ox-LDL)-induced human umbilical vascular endothelial cells (HUVECs), and promoted apoptosis and inflammatory response of HUVECs.

Conclusion: Clinically, the use of Alprostadil as an adjunct to conventional therapy for the treatment of DM combined with peripheral atherosclerosis has high clinical efficacy. In addition, Alprostadil has a significant ameliorative effect on high glucose- and ox-LDL-induced HUVECs.