BMC Cardiovascular Disorders最新文献

Background: In developing countries evidences regarding pulmonary hypertension (PH) in rheumatic heart disease (RHD) patients are lacking, despite being responsible for significant morbidity and mortality. As a result, identifying the factors that influence PH is crucial to improve the quality of care.

Objective: To determine prevalence of pulmonary hypertension and its associated factors among rheumatic heart disease patients at the public hospitals of Bahir Dar city, Ethiopia.

Methods: An institution based prospective cross-sectional study was conducted among RHD patients who had follow up at the two public hospitals of Bahir Dar city from January 2022 to December 2023. It involved 310 patients selected by systematic random sampling technique. Pretested, structured, and interviewer-administered questionnaires were used to collect sociodemographic and diseases related parameters.Transthoracic echocardiography by cardiologist was used to assess PH. Data were entered using Epidata Manager version 4.6 and analyzed using SPSS version 27. Multivariate logistic regression analysis was used to identify determinants of PH, considering with a p-value of < 0.05 as statically significant, with a 95% confidence interval.

Results: The mean systolic pulmonary arterial pressure (sPAP) of the participants was 50.2 mmHg [SD ± 25.0 mmHg]. The prevalence of PH among RHD patients was 56.5% (95% CI 50.9 - 61.9) from which 51.4% had severe PH. Severe mitral valve stenosis (AOR 7.8, 95% CI 2.4-25.7), duration of illness ≥ 3 years (AOR 7.7, 95% CI 2.1-28.5), and diuretics use (AOR 5.6, 95% CI 2.2-14.3) were factors associated with PH. In contrast, valvular intervention (AOR 0.06, 95% CI 0.01-0.29) and LVEF ≥ 50% (AOR 0.14, 95% CI 0.02-0.81) were found to be protective factors.

Conclusions: The prevalence of PH among RHD patients in Ethiopia is high and it's associated with delayed presentation & complications. Special attention should be paid to early surgical or percutaneous valvular intervention for those who have indication, before they develop permanent cardiac remodeling and LVFE become reduced. As a result, access to valvular intervention need to be addressed to improve PH related morbidity & mortality among RHD patients in Ethiopia.

Background: Unlike non-rheumatic atrial fibrillation (AF), where left atrial thrombus (LAT) is predominantly confined to the left atrial appendage (LAA), a significant proportion of LAT in rheumatic AF occurs within the left atrial cavity (LAC). However, LAC thrombosis in rheumatic AF has not been extensively studied. This study aimed to evaluate the prevalence of LAT and its subtypes and identify potential predictors of LAT.

Methods: This retrospective study included adult patients with rheumatic AF who underwent open-heart surgery for mitral valvular abnormalities between January 2019 and December 2020. LAT was identified through intraoperative inspection and categorized as either LAC thrombus or LAA thrombus. The prevalence of LAT and its subtypes was calculated, and logistic regression analysis was performed to identify predictors of LAT.

Results: A total of 530 patients (mean age: 59.7 ± 9.5 years; male: 29.8%) with a predominance of mitral stenosis (59.6%) were included. LAT was identified in 82 patients (15.5%), including 44 (8.3%) with LAA thrombus and 38 (7.2%) with LAC thrombus. In the multivariable logistic regression model, coronary artery disease (OR: 6.35, 95% CI: 2.79-14.46, p < 0.001), larger left atrial diameter (OR: 1.31 per 10 mm increase, 95% CI: 1.02-1.68, p = 0.03), and moderate-to-severe mitral stenosis (OR: 1.77, 95% CI: 1.00-3.13, p = 0.05) were independently associated with an increased risk of LAT, whereas moderate-to-severe mitral regurgitation was independently associated with a decreased risk of LAT (OR: 0.21, 95% CI: 0.11-0.43, p < 0.001).

Conclusion: In patients with rheumatic AF undergoing open-heart mitral valve surgery, LAT can be located in either the LAA or LAC. The presence of LAT was independently associated with coronary artery disease, left atrial enlargement, and mitral valvular abnormalities. Timely screening and management of LAT are crucial to mitigate potentially fatal thromboembolic events.

Background: Different left atrial appendage closure (LAAC) devices have been introduced into the clinical setting. A new dual-seal mechanism LACbes® occluder with isogenous barbs for LAAC has been designed to facilitate easier delivery and improve safety. The purpose of this study is to compare the clinical outcomes of the WATCHMAN with those of the LACbes® device for LAAC.

Methods: Consecutive patients with atrial fibrillation (AF) who had undergone LAAC performed using a WATCHMAN or LACbes® device from June 2016 to February 2022 were included. The primary efficacy endpoint included ischemic stroke, cardiovascular/unexplained death and device-related thrombus, while the primary safety endpoint included major peri-procedural complications and major bleeding events during clinical follow-ups. 1:1 propensity score matching (PSM) was performed.

Results: After PSM, 184 patients were included in each group. The mean CHA₂DS₂-VASc score was 3.1 ± 1.5 (LACbes®) vs. 3.1 ± 1.4 (WATCHMAN), and the HAS-BLED score was 2.7 ± 1.1 vs. 2.7 ± 1.0. At a mean follow-up of 2.5 ± 1.5 vs. 2.4 ± 0.9 years, the defined three endpoints were comparable between the two groups. The occurrence of all-cause stroke was lower in 5/452 (1.8%) with LACbes® vs. 16/433 (3.7%) with WATCHMAN occluders (HR, 0.40, 95% confidence interval (CI), 0.18-0.89, P = 0.023), and the incidence of any bleeding was higher in the WATCHMAN group (41/433, 9.5% vs. 8/452, 1.8%; HR, 0.19, 95% CI, 0.11-0.33).

Conclusion: The LACbes® occluder exhibited comparable safety and efficacy of stroke prevention for AF when compared with the WATCHMAN device.

Background: The transcatheter edge-to-edge repair (TEER) technique, facilitated by the MitraClip device, is a minimally invasive intervention designed for high-risk patients with mitral regurgitation (MR). This study conducts a retrospective analysis of death events associated with MitraClip implantation over a ten-year decade, utilizing data from the FDA's Manufacturer and User Facility Device Experience (MAUDE) database to evaluate trends in safety outcomes.

Methods: A comprehensive search of the publicly accessible MAUDE database was conducted to retrieve reports of deaths and injuries related to MitraClip implantation from October 2013 to September 2023. Duplicate reports and records from unrelated sources were excluded. The Cochran-Armitage test was performed to evaluate trends in the proportion of fatal events over time.

Results: During the 10-year period following FDA approval, the MAUDE database recorded a total of 927 death reports and 9,211 injury reports associated with MitraClip. After excluding duplicates and irrelevant reports, 592 death cases were analyzed. The most commonly reported complications were MR (26.69%), tissue damage (24.16%), and hypotension (22.13%). The most frequent device-related issues were incomplete coaptation (14.70%), difficulty removing the divice (6.42%), and failure to adhere or bond/positioning failure(4.90%). Notably, 76.94% of deaths occurred within one year of implantation. The proportion of fatal events demonstrated a gradual decline, from 15.9% in 2014-2015 to 3.5% in 2020-2021 (p < 0.0001).

Conclusions: This analysis of the MAUDE database indicates a gradual decline in the proportion of fatal events associated with MitraClip implantation, which may be attributed to growing operator experience and advancements in device design. Nonetheless, persistent focus is required on managing complications and addressing potential risks to further enhance device performance and optimize its clinical utility.

Background: Ischemia/reperfusion (I/R) is an inevitable pathophysiological process during heart transplantation, and ferroptosis is an important pathogenic mechanism. Unlike other modes of cell death, ferroptosis depends on the accumulation of iron within the cell and the oxidative degradation of polyunsaturated fatty acids. Dysregulation of this pathway has been linked to the progression of multiple pathological conditions, making it an attractive target for therapeutic intervention. Therefore, this study aims to explore the effect of ferroptosis on I/R during heart transplantation.

Methods: GEO2R was applied to identify differentially expressed genes (DEGs) obtained from GSE50884 data, which was involved in I/R and heart transplantation. And ferroptosis-related DEGs (FRDEGs) were screened by venn diagram with ferroptosis-related genes downloaded from FerDb database. FRDEGs was enriched and analyzed by GO and KEGG, and hub genes related to ferroptosis were screened by Cytoscape software and database STRING. Additionally, considering the relationship between ferroptosis and immunity, CIBERSORTx was to analyze the infiltration of 22 kinds of immune cells in I/R during heart transplantation, and the correlation between each immune cell and the expression of FRDEGs was also discussed. Finally, the mouse model of heart transplantation with I/R was constructed, and the hub genes was verified by RT-qPCR and western blot.

Results: 12 FRDEGs were identified out of 327 DEGs in GSE50844, which were mainly involved in ferroptosis and other pathways. Three hub genes (SLC7A11, PSAT1, ASNS) were obtained by the degree algorithm of cytohubba plug-in. Immunoinfiltration analysis showed that 16 of 22 immune cells changed, and the immune score of heart transplantation with I/R was higher than that without I/R. In addition, hub genes exhibited significant correlation with Eosinophils, NK cells resting, Dendritic cells resting, NK cells activated and T cells CD4 memory activated. We verified the expression of SLC7A11, PSAT1 and ASNS was higher than that in normal tissues using RT-qPCR and western blot in mouse models of heart transplantation with I/R, companied by ferroptosis aggravated is involved.

Conclusions: In short, ferroptosis is involved in I/R injury during heart transplantation, which is related to immune cell infiltration. Three hub genes (SLC7A11, PSAT1 and ASNS) identified in this study provide therapeutic targets for ameliorating I/R injury in heart transplantation.

Background: Respiratory muscle weakness in heart failure (HF) can deteriorate its symptoms such as fatigue, dyspnea, and impaired functional status. Pulmonary rehabilitation can strengthen these muscles. This study aimed to determine the impact of breathing exercises on fatigue severity, dyspnea, and functional classification in HF patients.

Methods: A three-arm single-blind randomized controlled trial was conducted on 90 hospitalized HF patients in three 30-participant groups including diaphragmatic breathing group (DG), incentive spirometry group (SG), and control group (CG). The interventions were performed thrice daily for 10 days in DG and SG. The Fatigue Severity Scale (FSS), Borg dyspnea scale, and New York Heart Association (NYHA) functional classification were used before and after the intervention. Data were analyzed using SPSS-20 software.

Results: After the intervention, the patients' frequency with severe fatigue decreased by 30% in both DG and SG (p < 0.001); the mean dyspnea score in DG and SG respectively reduced by 0.7 and 0.9 units at rest (p < 0.001) and reduced by 2.93 and 2.73 units during activity (p < 0.001); the total patients' frequency in functional class III and IV was significantly decreased by 30% in DG and 33.3% in SG (p < 0.001). The intervention groups were not significantly different regarding fatigue severity, dyspnea, and functional classification. While in CG these outcomes had no significant reduction after the intervention.

Conclusion: In this study breathing exercises could reduce fatigue and dyspnea, and improve NYHA functional classification of HF patients which can be included in nursing care plans for respiratory rehabilitation in HF.

Trial registration: This study was prospectively registered by the Iranian Registry of Clinical Trials ( https://irct.behdasht.gov.ir/ ) on 14/04/2024 with registration ID: IRCT20240306061197N.

Background: Acute Kidney Injury (AKI) is a sudden and often reversible condition characterized by rapid kidney function reduction, posing significant risks to coronary artery disease (CAD) patients. This study focuses on developing accurate predictive models to improve the early detection and prognosis of AKI in CAD patients.

Methods: We used Electronic Health Records (EHRs) from a nationwide CAD registry including 54 429 patients. Initially, univariate analysis identified potential predictors. Subsequently, a stepwise multivariate logistic model integrated clinical significance and data distribution. To refine predictor selection, we applied a random forest algorithm. The top 10 variables, including admission to the surgical department, EGFR, hemoglobin, and others, were incorporated into a logistic regression-based prediction model. Model performance was assessed using the area under the curve (AUC) and calibration analysis, and a nomogram was developed for practical application.

Results: During hospitalization, 2,112 (3.88%) patients in the overall population of both the development and validation groups experienced AKI within 30 days. The final prediction model exhibited strong discrimination with an AUC of 0.867 (95% CI: 0.858 to 0.876) and well calibration capability in both the development and validation groups. Key predictors included surgical department admission, eGFR, hemoglobin, chronic kidney disease history, male sex, white blood cell count, age, left ventricular ejection fraction, acute myocardial infarction at admission, and congestive heart failure history. Bootstrap resampling confirmed model stability (Harrell's optimism-correct AUC = 0.866). The nomogram provided a practical tool for AKI risk assessment.

Conclusion: This study introduced a refined AKI risk prediction model for CAD patients. This model showed adaptability to subgroups and held the potential for early AKI alerts and personalized interventions, thereby enhancing patient care.

Background: The personalized, free-breathing, heart rate-dependent computed tomography angiography (CTA) protocol can significantly reduce the utilization of contrast medium (CM). This proves especially beneficial for patients with chronic obstructive pulmonary disease (COPD) undergoing coronary artery CTA examinations.

Objective: The aim of this study was to evaluate the feasibility of a personalized CT scanning protocol that was tailored to patients' heart rate and free-breathing for coronary CTA of patients with COPD.

Methods: A total of 400 patients with COPD who need to undergo the coronary CTA were prospectively randomized into two groups (patients with vascular occlusion were excluded). Group A (n = 200) underwent CTA following a traditional protocol (70mL). The timing of the scans in Group B (n = 200) was determined according to the patient's HR and free-breathing (30mL).

Results: No difference was found between the two groups in the CT values of RCA, LA, or LCX; (p = 0.131, 0.195 and 0.116). Subjective ratings of image quality (Table 2) were not statistically different between the two groups (p = 0.825).

Conclusion: By adopting a heart-rate dependent and free-breathing protocol, the contrast medium volume were reduced in coronary CTA for patients with COPD, while the image quality was remained comparable to those acquired with routine CTA protocol.