Anatolian Journal of Cardiology最新文献

Background: Nurse-led cardiac rehabilitation (NLCR) is a patient-centered approach for managing cardiovascular disease (CVD) risk factors, but its physiological effects are unclear. This study evaluates NLCR's impact on key physiological parameters, including systolic and diastolic blood pressure (SBP, DBP), body mass index (BMI), body weight, and waist circumference (WC).

Methods: PubMed, Scopus, Embase, Cochrane Library, Web of Science, Google Scholar, ClinicalTrials.gov, and International Clinical Trials Registry Platform were searched from inception to May 30, 2025, to identify randomized controlled trials (RCTs) comparing NLCR to usual care in adult patients with CVDs (e.g., coronary heart disease, acute coronary syndrome, myocardial infarction, chronic heart failure, and atrial fibrillation). Standardized mean differences (SMDs) were pooled using random-effects models, and heterogeneity, subgroup, and sensitivity analyses were performed.

Results: Eleven RCTs (15 records, N = 1146 participants) were included, with mean ages of ~59 years in both intervention (133 male, 415 female) and control groups (126 male, 407 female). Nurse-led cardiac rehabilitation significantly reduced SBP (SMD = -0.20; 95% CI: 0.34 to -0.05) and DBP (SMD = -0.20; 95% CI: -0.37 to -0.03) compared to usual care, with low heterogeneity across studies. A significant reduction in body weight was also observed (SMD = -0.27; 95% CI: -0.46 to -0.07), while changes in BMI and WC did not reach statistical significance. A 12-week follow-up optimized blood pressure improvements, while longer durations better influenced anthropometric outcomes.

Conclusion: Nurse-led cardiac rehabilitation improves hemodynamics and modestly reduces weight in cardiac patients, supporting its inclusion in standard rehab protocols. Optimizing program duration may enhance outcomes. Future research should assess NLCR's components and long-term benefits. #W.Z. and Q.W. contributed equally in this study.

Background: Left atrial ejection force (LAEF) represents the force exerted by the left atrium (LA) to push blood into the left ventricle (LV) at the end of diastole. It is calculated as LAEF = 1/3 × mitral orifice area × (peak A velocity)2.

Methods: The primary endpoint was to assess changes in LAEF after 6 months of sodium-glucose co-transporter-2 inhibitor (SGLT-2 inhibitor) therapy in patients with heart failure with preserved ejection fraction (HFpEF). Secondary endpoints include changes in diastolic function, LV global longitudinal strain (LV-GLS), and LA strain parameters.

Results: In this single-center, prospective, randomized open-label study, 100 HFpEF patients were divided into 2 groups (n = 50 each). The study group received Dapagliflozin 10 mg daily along with guideline-directed medical therapy (GDMT) for 6 months, while the control group received only GDMT. The study group showed a significant reduction in LAEF (143.74 ± 10.33 to 134.4 ± 8.82; P < .001), LV-GLS improvement (-15.9 ± 4.13 to -17.1 ± 3.53; P < .001), and enhanced LA strain parameters (LA reservoir strain: 28.74 ± 9.31% to 36.39 ± 12.3%; LA contractile strain: -12.8 ± 5.41 to -17.89 ± 6.85; LA conduit strain: -15.97 ± 5.49 to -22.5 ± 8.25; all P < .001). Additionally, left ventricular mass index (199.9 ± 21.17 to 186.24 ± 16.77; P < .001) and left atrial volume index (36.17-32.21 mL/m2; P < .001) significantly decreased.

Conclusion: Dapagliflozin significantly reduces LAEF while improving LA strain and LV-GLS, reinforcing its role in LA and LV reverse remodeling in patients with HFpEF.

Patients with connective tissue diseases (CTDs) are at increased risk for the development of pulmonary hypertension (PH) and pulmonary arterial hypertension (PAH), which is a specific subtype of PH characterized by progressive remodeling of precapillary pulmonary arterioles. Evidence suggests that early detection of PH through screening in this patient group may be associated with better outcomes. Various methods, including cardiac and thoracic imaging, blood biomarkers, pulmonary function tests, and composite algorithms, have been employed for screening of PH. Here, a multidisciplinary consensus group composed of 10 rheumatologists, 4 cardiologists, and 3 pulmonologists was formed with the objective of developing recommendations and a screening algorithm for PH in patients with CTD. A systematic literature review in the PubMed database focusing on the studies evaluating the performance of different screening methods on detecting PH in CTDs was conducted. The literature review identified 33 relevant articles after title, abstract, and full-text evaluation. The included studies had considerable heterogeneity regarding hemodynamic definitions of PH and PAH, the diagnostic cutoff values of screening methods utilized, and the symptom status of the patients. With the exception of 2 studies, the populations in included studies consisted of only patients with systemic sclerosis (SSc). Consensus-based recommendations and an algorithm prioritizing echocardiography for screening and early detection of PH in patients with SSc and patients with CTD exhibiting overlap features of SSc were developed based on literature data and incorporating the perspectives of group members. No recommendations could be made for asymptomatic patients with CTDs without overlap features of SSc due to limited data.

Objective: Although opportunistic infections and malignancies have declined due to antiretroviral therapy, the prevalence of cardiovascular disease (CVD) among people with human immunodeficiency virus (PWH) has increased. This study examines early markers of CVD using transthoracic echocardiography (TTE) performed at rest and after a 6-minute walk test (6-MWT) in PWH. This prospective study was conducted in Türkiye between 2019 and 2022.

Methods: The PWH and healthy individuals were evaluated for demographic and laboratory analysis and examined using TTE at rest and after 6-MWT.

Results: The interventricular septum (IVS) and posterior wall (PW) were significantly thicker in the PWH group than in healthy controls. Pulmonary pulse transit time (pPTT) was markedly reduced in PWH (127.5 ms vs. 457 ms, P < .001). In the PWH group, the E/e' ratio increased after 6-MWT [6.26 (IQR: 5.1-7.3) vs. 5.9 (IQR: 4.9-6.9) at rest (P = .028)]. The PWH with CD4+ counts <350/mm3 exhibited a higher E/e' ratio [6.91 (IQR: 5.05-8.62)] than those with CD4+ counts >350/mm3 [5.41 (IQR: 4.87-6.17); P = .035]. A weak inverse correlation was observed between CD4+ count and E/e' ratio (P = .010, r = -0.348).

Conclusions: The IVS thickness, PW thickness, E/e' ratio, and pPTT may serve as valuable parameters for the early detection of CVD in PWH. Changes in diastolic indices may offer insights into disease progression. The pPTT may be a promising marker for evaluating the pulmonary vascular status and right ventricular function. These findings underscore the need for further research into the diagnostic and prognostic utility of diastolic parameters and pPTT in the clinical management of PWH.