Anatolian Journal of Cardiology最新文献

Background: The authors aimed to evaluate the effects of pulmonary rehabilitation (PR) on respiratory and echocardiographic parameters in patients with primary lung disease.

Methods: This retrospective cohort study included 55 patients who were admitted to the authors' hospital between January 2018 and December 2019 with respiratory complaints, diagnosed with primary lung disease and underwent PR. Echocardiographic parameters, respiratory parameters, 6-minute walk distance (6-MWT), body mass index, Modified Medical Research Council (mMRC) dyspnea score, and quality of life measurement score values measured before and after PR were retrieved from the patient database.

Results: After PR, a significant improvement was observed in systolic pulmonary artery pressure (PABs), Tricuspid annular plane systolic excursion (TAPSE), TAPSE/PABs, and 6-minute walk test (6-MWT) compared to before PR. As the effectiveness of PR at quality of life was evaluated with the SF-36 test, improvement was found in all variables in the asthma group. However, a statistically significant improvement was found in parameters other than general health and pain in the chronic obstructive pulmonary disease (COPD) group.

Conclusion: Pulmonary rehabilitation in patients with chronic lung disease is associated with improvement in both respiratory and cardiac functions and quality of life.

Background: Atrial fibrillation (AF) is the most common type of heart arrhythmia. Hypertension (HTN) is known as the most common risk factor for AF. The purpose of this study is to compare clinical results of combined renal denervation (RDN) and pulmonary vein isolation (PVI) in AF patients with HTN.

Methods: A systematic search was conducted on patients with AF and HTN, comparing the differences between RDN and PVI with PVI alone. The risk ratio (RR) of categorical variables and the mean difference of continuous variables with a 95% confidence interval were applied.

Results: This meta-analysis included 10 studies with a total of 875 patients. 420 patients were in the RDN + PVI group (48%) while 455 (52%) were in the PVI group. 694 patients had paroxysmal AF (79.3%) and 181 patients had persistent AF (20.7%). At 12 months follow-up, the treatment of RDN + PVI reduced the overall risk of AF recurrence in HTN patients (RR = 0.64, P < .001, 95% confidence interval [CI]: 0.55-0.75). When pooled, the patients in the RDN + PVI group showed significant mean reductions in systolic blood pressure (BP) (-13.39 mm Hg, P < .001) and diastolic BP (-7.14 mm Hg, P < .001) compared to PVI alone. Meanwhile, PVI + RDN significantly increased the estimated glomerular filtration rate (+8.72 mL/min/1.73 m2, P < .001) compared with PVI alone. There was no significant difference in complications between the 2 groups.

Conclusion: Combined therapy of RDN + PVI seems more efficacious and superior to PVI alone in treating AF. Further and larger trials are needed to fully prove these outcomes.

Background: Cardiovascular disease (CVD) significantly increases in postmenopausal women. This study aims to investigate the potential association between red cell distribution width (RDW), the RDW-to-albumin ratio (RAR), and the prevalence of CVD in postmenopausal women.

Methods: This study analyzed data extracted from the National Health and Nutrition Examination Survey (NHANES) database spanning the years 2003-2016. Weighted multiple logistic regression models were used to evaluate the associations between RDW, RAR, and CVD. Smoothing curve fitting and generalized additive models were applied to explore potential nonlinear relationships. Subgroup analyses and interaction tests were conducted to investigate whether the associations between RDW, RAR, and CVD varied across different subpopulations. Sensitivity analyses were performed to assess the robustness of the findings.

Results: This study included a total of 7619 postmenopausal women, of whom 1181 had CVD. Logistic regression models revealed that for each unit increase in RDW and RAR, the risk of total CVD in postmenopausal women increased by 11% and 42%, respectively. When RDW and RAR were categorized into groups, the risk of CVD significantly increased with higher levels of RDW and RAR. Smoothing curve fitting demonstrated a nonlinear relationship between RDW, RAR, and total CVD. Subgroup analyses revealed that the positive associations between RDW, RAR, and CVD were particularly significant in individuals aged ≥60 years and with a body mass index (BMI) ≥25 kg/m².

Conclusion: Higher RDW and RAR in postmenopausal women are positively associated with an increased risk of CVD, supporting the potential use of RDW and RAR as risk bio-markers for CVD in this population.

Background: Intra-abdominal pressure (IAP) may increase in acute decompensated heart failure (ADHF) due to fluid accumulation in the splanchnic system, contributing to renal venous congestion and impaired diuresis. This study aimed to evaluate the predictive value of IAP for early diuretic response in patients with ADHF.

Methods: This prospective, single-center study included 83 patients (mean age 71.6 ± 13.6 years, 58.9% female) admitted to the intensive care unit for ADHF. Patients requiring renal replacement therapy or in refractory shock were excluded. Guideline-directed medical therapy including intravenous loop diuretics was administered. The IAP was measured intravesically via Foley catheter and pressure transducer before treatment initiation. Elevated IAP was defined as >8 mm Hg. Abdominal perfusion pressure (APP) was calculated as mean arterial pressure minus IAP.

Results: Patients were divided into elevated IAP (n = 44) and normal IAP (n = 39) groups. Baseline demographics were comparable. The APP was significantly lower in the elevated IAP group (65.3 vs. 74 mm Hg; P = .008). The IAP showed a moderate negative correlation with 24-hour and 48-hour urine output (R2 = 0.192 and 0.131). Each 1 mm Hg increase in IAP was associated with a 213 mL and 310 mL decrease in urine output at 24 and 48 hours, respectively.

Conclusion: Intravesical IAP measurement may serve as a practical tool to predict short-term diuretic response in ADHF. Elevated IAP and reduced APP could help identify patients requiring intensified decongestive strategies.

Background: Cardiac amyloidosis (CA) is an increasingly recognized disease. Several recent advanced imaging techniques and parameters have been introduced into the diagnosis of CA. However, the first step in using those techniques is clinical suspicion. Left ventricular hypertrophy (LVH) is the main entity in rising the suspicion of CA in routine echocardiography, although it is not a diagnosis for CA. The aim of this study is to investigate the prevalence of CA and its subtypes and predictive value of clinical and echocardiographic red flags of CA among consecutive adult patients with LVH identified during routine echocardiographic examination in 25 tertiary institutions in Türkiye.

Methods: This was a prospective observational multicenter, national registration study. Patients with LVH (interventricular septum thickness ≥13 mm or >15 mm in those with hypertension) were screened for CA stepwise. The first step was a clinical questionnaire for the red flags of CA. Those having ≥2 red flags were further analyzed by detailed echocardiography, blood tests, Tc-pyrophosphate (PYP) bone scintigraphy, and histopathological examination if needed. Parameters associated with CA were evaluated via univariate and multivariate analyses. Wild-type transthyretin (wTTR) vs. mutant-type TTR (mTTR), CA discriminators were also evaluated in the same manner.

Results: A total of 420 patients meeting these criteria were included in the study. With a standardized algorithmic approach, 27.1% (114) of patients received a CA diagnosis. Among these patients with CA, 50.8% (58) were diagnosed with immunoglobulin free chain (AL) CA, 38.6% (44) with wTTR CA, and 7% (8) with mTTR CA. Left ventricular apical sparing pattern and restrictive type LV filling on echocardiography, low QRS voltage on ECG, bilateral carpal tunnel syndrome, low blood pressure, right ventricular diameter, and an increased basal heart rate (HR) were independent predictors for CA diagnosis. When it comes to diagnosis of wTTR CA; advanced age (age >75), lower troponin values, absence of pericardial effusion and absence of proteinuria were the independent predictors.

Conclusion: Cardiac amyloidosis is highly prevalent in a patient population with LVH and 2 red flags who underwent a standardized algorithmic approach, in which apical sparing, restrictive filling pattern, low QRS voltage, carpal tunnel syndrome, low blood pressure, and increased HR are the highly suggestive signs of CA. Among this pool of newly diagnosed CA patients in Türkiye, AL-CA constituted 50.8%, wTTR CA 38.6%, and mTTR CA 7%, emphasizing that approximately 1 in 2 patients diagnosed with CA may have TTR CA.