Anatolian Journal of Cardiology最新文献

Background: The hemoglobin-to-red blood cell distribution width ratio (HRR) is a new inflammatory marker in evaluating tumor prognosis. However, its application in cardiovascular diseases (CVDs) is relatively limited. This research was designed to illuminate the relationship between HRR and mortality in patients with aortic dissection (AD).

Methods: The Medical Information Mart for Intensive Care-IV (MIMIC-IV) database was applied in this retrospective cohort study. The primary outcome was the 30-day mortality rate. The Cox proportional hazards model was utilized to explore the relationship between HRR and mortality in AD patients. Through restricted cubic splines (RCS), the relationship between mortality and HRR levels was analyzed. The ROC curves were graphed to evaluate the prognostic value of HRR.

Results: This retrospective cohort study included 292 patients. A significant negative linkage between HRR quartiles and 30-day mortality was identified (P < .05). Kaplan-Meier analysis demonstrated that participants in the low-HRR group exhibited worse survival rates than those in the high-HRR group (Q1 vs. Q2, log-rank P = .005; Q1 vs. Q3, log-rank P < .001; Q1 vs. Q4, log-rank P = .014). No great difference was observed between other groups. In RCS analysis, a non-linear linkage between HRR and 30-day mortality rate was observed (P < .05). Through analyzing ROC curves, HRR was found to perform well in predicting AD mortality, with AUC values of 0.628, 0.662, and 0.669 at 7, 14, and 30 days, respectively.

Conclusion: Low levels of HRR may elevate the risk of death in AD patients. The research pinpointed the potential of HRR as a prognostic biomarker for AD patients, which can provide reliable auxiliary indicators for clinical routine and interventional treatment.

Background: Managing comorbidities alongside guideline-directed medical therapy is essential in heart failure (HF) treatment. Intravenous (IV) iron therapy is recommended for HF patients with left ventricular ejection fraction (LVEF) <50% to correct iron deficiency. Traditional markers such as ferritin and transferrin saturation (TSAT) are affected by inflammation and have delayed responses, limiting their clinical utility. This study aimed to evaluate early response to IV iron therapy by monitoring reticulocyte counts, a parameter unaffected by inflammation.

Methods: Hospitalized HF patients with LVEF <50% meeting CONFIRM-HF criteria for IV iron therapy were included. Reticulocyte counts were measured at admission and 72-120 hours post treatment. Associations with hemoglobin (Hb) increase at 1 month, hospital stay duration, emergency department (ED) readmissions, and mortality were assessed.

Results: Patients with ≥1 g/dL Hb increase at 1 month had higher reticulocyte levels at admission (2.0% vs. 1.5%, P = .04) and 72-120 hours post treatment (2.2% vs. 1.3%, P = .004). A ≥9% reticulocyte increase at 72-120 hours predicted Hb rise ≥1 g/dL with 90% specificity (area under the curve: 0.79, P = .002). Those with higher reticulocyte increases had shorter hospital stays (7 vs. 10 days, P = .023) and fewer ED readmissions (24% vs. 66%, P = .004). Higher reticulocyte and Hb levels correlated with reduced mortality over 2 years.

Conclusion: Reticulocyte increase within 72-120 hours after IV iron therapy offers an early, inflammation-independent marker of treatment response in HF patients, outperforming ferritin and TSAT. Elevated baseline reticulocytes may indicate active bone marrow and predict therapeutic benefit.

Background: Calcific aortic valve stenosis (CAVS), the predominant valvular heart disease in developed countries, arises primarily from metabolic and inflammatory dysregulation. The triglyceride-glucose (TyG) index, a composite biomarker of insulin resistance and systemic inflammation, has been associated with cardiovascular diseases. However, its causal association with CAVS remains unclear. This study employs bidirectional Mendelian randomization (MR) to elucidate the potential causal relationship between the TyG index and CAVS.

Methods: Genome-wide association study) summary statistics of TyG index and CAVS were obtained from UK-biobank cohort (n = 273 368) and FinnGen database (cases = 12 418 and controls = 487 930). Two-sample MR and multiple MR analyses were conducted to evaluate the association of TyG index with CAVS. The primary method was inverse variance weighted (IVW), complemented by MR-Egger, weighted median, and sensitivity analyses to ensure robustness.

Results: The MR analysis demonstrated a significant causal effect of the higher TyG index (per 1-unit increment of TyG index) on CAVS risk (odds ratio [OR] = 1.50, P = .007, 95% CI: 1.12-2.02). Similar causal relationships were observed for triglyceride and glucose levels with CAVS. Sensitivity analyses confirmed robustness with no evidence of horizontal pleiotropy (P > .05). This association remained statistically significant in multiple MR analyses after adjusting for potential confounders (OR = 1.64, P = .003, 95% CI: 1.18-2.28). No reverse causality from CAVS to the TyG index was detected.

Conclusion: This MR study provides evidence supporting the causal effect of higher TyG index on CAVS.

Background: Hypertrophic cardiomyopathy (HCM) is characterized by asymmetric left ventricular hypertrophy and myocardial fibrosis, which significantly increases the risk of sudden cardiac death (SCD). Existing risk stratification models are limited in predicting SCD risk in patients within the "gray zone"-those with intermediate risk. This study investigates the prognostic utility of the Index of Cardiac Electrophysiological Balance (ICEB) and its corrected variant (ICEBc) in predicting ventricular arrhythmias (VAs) in HCM. To evaluate the predictive value of ICEB and ICEBc for Life-Threatening Arrhythmias (LTA) and non-sustained ventricular tachycardia (NSVT) in HCM and compare their performance with traditional repolarization parameters and the European Society of Cardiology (ESC) SCD Risk Score.

Methods: A retrospective observational study was conducted at a single center, including 127 HCM patients categorized into 3 groups: LTA (n = 45), NSVT (n = 29), and control (n = 53). Electrocardiographic parameters, including ICEB, ICEBc, Tp-e interval, Tp-e/QTc ratio, and QRS-T angle were measured. Multiple logistic regression and receiver operating characteristic (ROC) curve analyses were performed to identify independent predictors of VAs.

Results: The ICEB and ICEBc were significantly lower in LTA and NSVT groups compared to the control group (P < .001), indicating increased arrhythmogenic risk. The ROC curve analysis showed that ICEB and ICEBc had superior predictive power for LTA and NSVT compared to traditional markers and the ESC SCD Risk Score, with the highest area under the curve (AUC) for the Base + ICEB Model (AUC = 0.79).

Conclusion: The ICEB and ICEBc are robust markers of repolarization heterogeneity and effective predictors of VAs in HCM patients. Their integration into existing risk stratification models could enhance predictive accuracy, particularly for gray zone patients.

Background: While both sarcopenia and obesity independently elevate cardiovascular disease (CVD) risk, their combined effects, known as sarcopenic obesity (SO), remain incompletely understood. This systematic review and meta-analysis aimed to evaluate the association between SO and the risk of CVD and CVD-related mortality.

Methods: A comprehensive search of scientific databases was conducted from inception to May 2025, including observational studies assessing SO in relation to incident CVD or CVD mortality. Pooled odds ratios (ORs) with 95% CIs were calculated using random-effects models. Subgroup analyses examined variations by age, sex, geography, study design, and CVD subtypes, with P-values for interaction being assessed.

Results: Sixteen studies involving 578 408 participants were included. Sarcopenic obesity was significantly associated with a 95% higher CVD risk (OR = 1.95, P < .001, 95% CI: 1.62-2.36) and a 64% increased CVD mortality risk (OR = 1.64, P = .007, 95% CI: 1.15-2.34). Subgroup analyses revealed stronger associations in males and diabetic subgroups. The highest risks were observed for myocardial infarction (OR = 4.07, P = .015, 95% CI: 1.31-12.63) and atrial fibrillation (OR = 2.93, P < .001, 95% CI: 2.23-3.86). Significant interactions were detected by sex (P = .032) and cardiovascular outcome type (P = .001), but not by age, region, or study design.

Conclusion: Sarcopenic obesity is a high-risk phenotype associated with significantly elevated CVD incidence and mortality, with effect modification by sex and outcome type. These findings highlight the need for standardized diagnostic criteria and targeted interventions to mitigate cardiovascular risk in this growing population.

Background: Myocardial ischemia-reperfusion (I/R) injury is aggravated in type 2 diabetes mellitus (T2DM) due to metabolic dysfunction, inflammation, and apoptosis. This study investigated the cardioprotective role of alirocumab, a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, compared with atorvastatin.

Methods: Type 2 diabetes mellitus was induced in rats by a high-fat/high-sugar diet plus streptozotocin injection, followed by myocardial I/R through transient ligation of the left anterior descending artery. Rats (n = 6/group) were randomized into Control, non-diabetic I/R, T2DM + I/R, T2DM + I/R + alirocumab, and T2DM + I/R + atorvastatin groups. Alirocumab (10 mg/kg/week, intraperitoneal injection) or atorvastatin (10 mg/kg/day, oral) was administered for 21 days. Outcomes included lipid deposition, myocardial fibrosis, metabolic parameters, inflammatory cytokines, apoptosis, and expression of PCSK9, nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3), and Caspase-3, assessed by histology, enzyme-linked immunosorbent assay, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay, western blotting, and quantitative reverse transcription polymerase chain reaction.

Results: Non-diabetic I/R rats showed increased lipid accumulation, fibrosis, inflammation, and apoptosis compared with controls, while these effects were markedly exacerbated in T2DM + I/R, confirming the amplifying effect of diabetes. Both alirocumab and atorvastatin significantly reduced lipid accumulation, improved hepatic and renal function, lowered free fatty acids and HbA1c, and restored insulin and C-peptide levels (P < .001). Treatments also decreased pro-inflammatory cytokines (interleukin-1β [IL-1β], interleukin-6 [IL-6], tumor necrosis factor-α [TNF-α]), inhibited NLRP3 inflammasome activation, reduced myocardial apoptosis and caspase-3 activity, and downregulated myocardial PCSK9, NLRP3, and caspase-3 expression. Protective effects were comparable between alirocumab and atorvastatin.

Conclusion: Alirocumab and atorvastatin effectively attenuated myocardial I/R injury in T2DM by modulating lipid metabolism, inflammation, and apoptosis. Diabetes substantially intensified I/R-induced cardiac injury, underscoring the importance of metabolic control in cardioprotection. #Means they contributed equally to the article.

Background: Atrial tachycardia (AT) is a commonly encountered rhythm disorder and most patients require catheter ablation. In this study, the aim was to evaluate the outcomes of catheter ablation in patients with symptomatic AT, define acute and long-term outcomes, and determine the clinical and electrophysiological features that affect these outcomes.

Methods: A total of 666 (mean age: 55 ± 16, gender: 344 (51.7%) female) symptomatic patients with AT were enrolled. Activation mapping was performed using 3-dimensional electroanatomical mapping as well as entrainment mapping when needed. Atrial tachyarrhythmia (ATa) recurrence was defined as the presence of atrial fibrillation or AT (≥ 30 seconds) detected by electrocardiogram, Holter, or implantable device interrogation.

Results: Macroreentry was the primary mechanism in right and left atrium (70.2% and 52.8%, respectively). Cavotricuspid isthmus dependent macroreentry was the most frequent mechanism in right ATs, whereas perimitral reentry and roof-dependent macroreentry were the most common mechanisms in left ATs. Acute procedural success was 96.3% after catheter ablation. Freedom from ATa was 72.8% after index procedure and 84.5% after multiple procedures during a mean follow-up of 39 ± 23 months. In multivariable Cox regression analysis, history of atrial fibrillation [HR: 2.43, 95% confidence interval (CI): 1.78-3.30; P < .001], previous cardiac surgery (HR: 1.68, 95% CI: 1.22-2.30; P = .001) and moderate to severe tricuspid regurgitation (HR: 1.47, 95% CI: 1.08-2.01; P = .014) were significant predictors of ATa recurrence.

Conclusion: The findings demonstrated that catheter ablation of tachycardia has a high acute success rate and favorable long-term outcomes in patients with symptomatic AT.