BMC Cardiovascular Disorders最新文献

Background: Concomitant cardiac amyloidosis (CA) and aortic stenosis (AS) may be mistaken for isolated AS, potentially impacting the treatment strategy and patient's prognosis. Therefore, it is crucial to distinguish between these conditions, as failure to promptly diagnose CA may lead to considerable complications. The aim of this study is to investigate the diagnostic value of strain predictors in patients with concomitant CA and AS compared to isolated AS.

Methods: Forty-two patients with severe AS suspected of concomitant CA based on a comprehensive clinical evaluation were selected to undergo ⁹⁹mTc-DPD scintigraphy. Those showing Perugini grade 2 or 3 tracer uptakes without evidence of monoclonal gammopathy were diagnosed with CA and underwent speckle-tracking echocardiography. Furthermore, strain analysis was performed to evaluate myocardial deformation, with a focus on detecting apical sparing and reduction in bull's eye mapping, resulting in the characteristic "cherry on top" sign.

Results: Eight patients were diagnosed with CA, representing 19.0% of those suspected of concomitant CA and 7.8% of the overall cohort with severe AS. AF arrhythmia was significantly more frequent in these patients compared to those with isolated AS. Echocardiography findings revealed that E/E' ratio and RALS were significantly higher in patients with concomitant CA, while GLS and mean basal LS were significantly lower in this group. The "cherry on top" sign was detected in 19 patients (45.2%), present in 100% of those with concomitant CA and AS, versus 32.4% in isolated AS cases (P = 0.04). This sign demonstrated a sensitivity of 100% and a specificity of 67.6% for predicting concomitant CA and AS.

Conclusions: In conclusion, the "cherry on top" sign was significantly more prevalent in patients with concomitant CA and AS, compared to those with isolated AS, demonstrating a sensitivity of 100% and a specificity of 67.6% for predicting concomitant CA. Moreover, RALS and E/E' ratios were significantly higher in patients with concomitant CA, whereas GLS and mean basal LS were significantly lower in this group.

Background: Cardiovascular disease carries the highest mortality rate among diseases, and pharmacological interventions have limited efficacy. Baicalin (Bai) promotes biological metabolic processes, eliminates oxygen free radicals, and is anti-inflammatory. This study aimed to investigate the effect of Bai on the cardiac injury model induced by isoproterenol in mice.

Methods and result: In this study, all groups except the control received intraperitoneal injections of isoproterenol (ISO) to induce a cardiac injury model, with the drug administered continuously for 14 days. hematoxylin and eosin staining and Masson's trichrome staining revealed that Bai significantly mitigated ISO-induced pathological changes in mouse heart tissue and alleviated myocardial hypertrophy. Echocardiography assessments demonstrated that Bai preserved cardiac function in ISO-treated mice. Furthermore, our findings indicated that Bai activated the Nrf2 signaling pathway in vivo and in vitro. To delve deeper, mice were further treated with ML385 (ML) via intraperitoneal injection to inhibit the Nrf2 pathway. Results showed that ML385 blocked the cardioprotective effects of Bai in mouse heart tissue.

Conclusion: Bai protects against ISO-induced cardiac injury, and its mechanism is related to activating the Nrf2/HO-1 signaling pathway to regulate cardiac ferroptosis and improve cardiac remodeling.

Introduction: Congenital heart disease (CHD) represents the most common group of congenital anomalies, constitutes a significant contributor to the burden of non-communicable diseases, highlighting the critical need for improved risk assessment tools. Artificial intelligence (AI) holds promise in enhancing outcome predictions for congenital cardiac surgery. This study aims to systematically review the utilization of AI in predicting post-operative outcomes in this population.

Methods: Following PRISMA guidelines, a comprehensive search of Pubmed, Scopus, and Web of Science databases was conducted. Two independent reviewers screened articles based on predefined criteria. Included studies focused on AI models predicting various post-operative outcomes in congenital heart surgery.

Results: The review included 35 articles, primarily published within the last four years, indicating growing interest in AI applications. Models predominantly targeted mortality and survival (n = 16), prolonged length of hospital or ICU stay (n = 7), postoperative complications (n = 6), prolonged mechanical ventilatory support time (n = 4), with additional focus on specific outcomes such as peri-ventricular leucomalacia (n = 2) and malnutrition (n = 1). Performance metrics, such as area under the curve (AUC), ranged from 0.52 to 0.997. Notably, these AI models consistently outperformed traditional risk stratification categories. For instance, in assessing the risk of morbidity and mortality, the AI models demonstrated superior performance compared to conventional methods.

Conclusion: AI-driven prediction models show significant promise in improving outcome predictions for congenital heart surgery. They surpass traditional risk prediction tools not only in immediate postoperative risks but also in long-term outcomes such as 1-year survival and malnutrition. Further studies with robust external validation are necessary to assess the practical applicability of these models in clinical settings. The protocol of this review was prospectively registered on PROSPERO (CRD42024550942).

Background: Abnormal blood flow patterns are known to contribute to the ascending aortic dilation in patients with bicuspid aortic valve (BAV). The present study elucidated the blood flow characteristics in the dilated ascending aorta before and after transcatheter aortic valve replacement (TAVR) using computational fluid dynamics (CFD) analysis.

Methods: We performed CFD analysis in three BAV patients with ascending aortic dilation (maximum diameter ≥ 45 mm) who underwent TAVR. The blood flow streamline was visualized to evaluate the pre- and post-operative flow velocity, severity of vortex and helix, and wall shear stress (WSS) in the ascending aorta.

Results: Before the procedure, all three patients showed abnormal blood flow patterns, with vortex and helix in the ascending aorta. Regionally elevated WSS was also observed in the lateral or posterior ascending aortic wall (16.7 Pa, 12.2 Pa, and 14.5 Pa in patient 1, 2, and 3, respectively). After the procedure, the blood flow patterns significantly improved, and the maximum WSS also decreased (4.2 Pa, 1.1 Pa, and 3.2 Pa in patient 1, 2, and 3, respectively).

Conclusion: Abnormal blood flow patterns and WSS appeared to improve after TAVR in BAV patients with ascending aortic dilation. The impact on the long-term aortic growth rate and the incidence of aortic dissection requires further studies.

Trial registration: Changes of Ascending Aortic Diameter in Patients Undergoing Transcatheter Aortic Valve Replacement.

Clinicaltrial: gov number NCT05739253. Trial registration date 20,230,212.

Background: Myocarditis is a major public health, social, and economic issue. Currently, few studies have provided comprehensive analyses of the global burden of myocarditis based on GBD (Global Burden Disease) 2021. We therefore analyzed long-term trends in the global burden of myocarditis from 1990 to 2021, described risk factors, examined the impact of COVID-19 (coronavirus infection disease 2019), and predicted future trends to inform health policy development and healthcare resource allocation.

Method: From the GBD 2021 database, incident cases, deaths, and DALYs (disability-adjusted life years) were obtained for countries, regions, ages, and sexes globally. The estimated annual percentage change (EAPC) was used to analyze Trends in age-standardized rates of myocarditis and significant time points were examined using joinpoint regression analysis.

Results: Globally, the age-standardized incidence rate (ASIR), DALYs rate (ASDALYsR), and death rate (ASDR) for myocarditis in 2021 were 16.16 [(13.11 to 19.76) per 100 000 people], 12.41 [10.37 to 14.76) per 100 000 people], and 0.40 [0.32 to 0.47) per 100 000 people], respectively. High-income Asia Pacific had the highest myocarditis ASIR in 2021, whereas Central Europe had the highest ASDALYsR and ASDR. Gender comparison showed myocarditis was more common in men. The burden of myocarditis was larger in the elderly aged 80 and older, but children should not be neglected. Analysis revealed a rise in worldwide ASIR from 2016 to 2021 (APC = 0.0945, 95%CI: 0.0709 to 0.1440, p < 0.001). During COVID-19, myocarditis burden did not peak. Both high and low temperatures increase myocarditis risk. The Bayesian age-period-cohort (BAPC) model predicted that myocarditis ASIR would rise while ASDALYsR and ASDR would decrease.

Conclusions: The global burden of myocarditis remains a health issue that cannot be ignored and shows significant regional and sex-based differences. Effective and targeted strategies for the prevention and management of myocarditis in this population are needed to reduce the overall burden.

Clinical trial number: Not applicable.

Background: High-sensitive Troponin-T (hsTnT) is often increased in acute illness and may be of prognostic importance in patients with atrial fibrillation (AF). The aim of this study was to analyse the characteristics and data of patients attending the emergency department (ED) with AF to determine whether age-adjusted hsTnT levels can predict mortality.

Methods: This retrospective, single centre, register-based cohort study included all patients ≥ 18 years attending the emergency department during 2018 and 2020 with a primary diagnosis at the ED of AF and sampled for hsTnT. Symptoms, comorbidities, lab results, and characteristics were registered. Patients were divided into groups based on hsTnT level (< 15, 15-50, and > 50 ng/L).

Primary outcomes: 30-day and 1-year mortality.

Results: A total of 625 patients were included (median age 72, and 45% female). All-cause mortality was 2% at 30 days and 8% at 1-year. The hazard ratio (HR) for 30-day mortality was 4.17 (95% confidence interval (CI) 0.49-35.79, p = 0.192) for hsTnT 15-50 ng/L and 9.64 (95% CI 0.98-95.30, p = 0.053) for hsTnT > 50 ng/L compared to hsTnT < 15 ng/L when adjusted for age. The HR for 1-year mortality was 4.82 (95% CI 1.81-12.82, p = 0.002) for hsTnT 15-50 ng/L and 9.70 (95% CI 3.27-28.74, p < 0.001) for hsTnT > 50 ng/L compared to hsTnT < 15 ng/L when adjusted for age.

Conclusions: Elevated hsTnT levels increase the risk for 30-day and 1-year mortality independently of age. Both mild and major elevation of hsTnT levels is associated with increased risk for 1-year mortality regardless of age.

Objective: Diffuse coronary artery disease remains a critical issue that heart surgeons continue to research in terms of treatment options. An alternative method applied during coronary bypass surgery to achieve complete revascularization is coronary artery endarterectomy. Since the reliability of this technique and its effects on mortality and morbidity are still debated in the literature. Our objective in conducting this study is to determine the mid-term patency rates in patients who underwent LAD endarterectomy and to explore its future applicability.

Materials and methods: This study reviewed 20 patients who underwent coronary endarterectomy during CABG in our clinic between January 2014 and December 2021. The data, including contrast imaging to check graft patency, were evaluated retrospectively by reviewing hospital archives and patient files. Patients without LAD endarterectomy were excluded from the study.

Results: LAD endarterectomy and patch-plasty were performed on all patients in the study. In 17 patients, the LIMA graft was anastomosed onto the patch applied to the LAD. It was observed that 12 of the grafts anastomosed to the LAD (60%) were patent during a mean follow-up period of 32.8 ± 25.9 months. The average 4-year survival rate was found to be 95%. Perioperative myocardial infarction occurred in 5 patients (25%). There was no need for high-dose inotropic support, IABP, or ECMO in the postoperative period.

Conclusion: Coronary artery endarterectomy should be considered a viable option for surgeons to achieve satisfactory revascularization in cases where suitable anastomosis sites on coronary arteries to ensure adequate outflow are not available. Our findings align closely with literature reports indicating that endarterectomy performed on the LAD, with LIMA used as the conduit, leads to promising outcomes.

Background: Heart failure is a chronic and common disorder worldwide. Patients with heart failure need self-care behaviors to manage their condition. Despite the importance of self-care in positive health outcomes, many patients with heart failure neglect their self-care behaviors. Therefore, the present study was conducted to explain heart failure patients' experiences of self-care neglect.

Methods: This qualitative study was conducted using conventional content analysis method. Participants included 15 patients with heart failure. Data were collected through semi-structured interviews and using purposive sampling method. Sampling continued until data saturation was reached. Data analysis was performed concurrently with data collection. Lincoln and Guba's four criteria were used to ensure the trustworthiness of the data. Data management was performed using MAXQDA version 24 software.

Results: The results were presented in the form of four main categories and 10 subcategories. In analyzing the data of the study, four main categories emerged in the participants' experiences: "false cultural beliefs in self-care", "weakening of mental-psychological power", "synergy of physical problems", and "inappropriate support".

Conclusion: The patients in their experiences of neglect in self-care pointed to false cultural beliefs in self-care, weakening of mental-psychological power, synergy of physical problems, and inappropriate support. Knowing the factors that influence self-care neglect and preventing their occurrence can improve self-care skills and prevent neglect-related side effects in patients with heart failure. Healthcare providers can help improve the health of these patients by developing interventions to mitigate these factors. It is suggested that future research be designed in the form of an intervention to reduce the effect of each of these factors.

Trial registration: This is a qualitative study and has not been registered in Iranian Registry of Clinical Trials.

Background and objective: The white blood cell-to-haemoglobin ratio (WHR) is a comprehensive indicator of inflammation and anaemia status. However, the relationship between the WHR and the risk of 30-day mortality among intensive care unit (ICU) patients with pulmonary hypertension (PH) remains unclear. The purpose of this study was to investigate the association between the WHR and 30-day mortality in critically ill patients with PH.

Methods: Clinical data of patients with PH were extracted from the MIMIC-IV (2.2) database. Restricted cubic splines and logistic regression analysis were used to investigate the relationship between the WHR and 30-day mortality. Subgroup analysis was used to assess the robustness of the results.

Results: A total of 451 patients with PH were enrolled, with 78 (17.3%) dying within 30 days. Restricted cubic spline analysis revealed a linear relationship between the WHR and 30-day mortality. Logistic regression analysis revealed the WHR was an independent predictor for 30-day mortality in critically ill patients with PH (OR, 1.58; 95% CI, 1.05-2.37; P = 0.028). The AUC of the WHR was 0.646 (95% CI: 0.60-0.69).

Conclusions: A higher WHR was an independent predictor for 30-day mortality in critically ill patients with PH.

Clinical trial number: Not applicable.

Background: Cardiovascular and cerebrovascular diseases (CVDs) present a significant challenge in the realm of chronic disease management in China. The objective of this study is to assess the efficacy of a health management model rooted in a three-tier prevention and control system for CVDs.

Methods: From August 2020 to September 2020, this study enrolled 2033 CVDs patients from 105 villages across three townships in central China. All participants underwent a 12-month health management involving monitoring, risk assessment, health education, and interventions. The primary endpoint focused on recurrence and exacerbation, while secondary outcomes encompassed health economic indicators, awareness of prevention and control knowledge, risk factor, lifestyle behavior. Data analysis was conducted using generalized estimating equation models.

Results: After 1 year of follow-up, the odds of recurrence and exacerbation decreased significantly compared to the baseline [odds ratio (OR) 0.30, 95% confidence interval (CI): 0.26, 0.35], accompanied by reduced hospitalization frequency [mean difference (MD) -0.61, 95% CI: -0.66, -0.56] and a monthly average reduction in medication costs (MD, -69.80, 95% CI: -104.55, -35.05). Moreover, patients' awareness of CVDs prevention and treatment knowledge markedly improved (P < 0.01). Diastolic blood pressure, blood lipid and plasma glucose levels, anxiety and depression, lifestyle behavior all demonstrated significant enhancements from baseline levels (P < 0.01). Crucially, health management did not result in an increased abnormality rate of safety indicators.

Conclusions: The health management model, grounded in a three-level prevention and control system, showed potential applicability in reducing recurrence and exacerbation, easing healthcare economic burden, boosting awareness of prevention and treatment, and positively influencing risk factors. Additional multicenter and long-term studies are necessary to validate these findings and support broader implementation of this model.

Trial registration: Chinese Clinical Trial Registry (ChiCTR) ChiCTR2000032243 (24/04/2020) ( https://www.chictr.org.cn/showproj.html?proj=52395 ).