BMC Cardiovascular Disorders最新文献

Background: There is a lack of diagnostic non-invasive imaging technology for assessing the early structural and functional changes of the kidney in type 2 cardiorenal (CRS) patients. This study aims to explore the value of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) for clinical application in type 2 CRS patients, to provide imaging markers for the assessment of kidney damage.

Methods: This is a retrospective observational clinical study conducted in Nanjing, China. The clinical characteristics, including age, gender, medical history, laboratory results, and ultrasound and magnetic resonance imaging results were collected from the electronic medical record. Thirty-one patients with type 2 CRS, 20 patients with chronic heart failure (HF) and 20 healthy controls were enrolled and divided into type 2 CRS, HF and control groups. All the participants underwent magnetic resonance imaging (MRI) scanning. The apparent diffusion coefficient (ADC) value and IVIM-DWI parameters including true diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) were obtained. The correlation between estimated glomerular filtration rate (eGFR), renal size and imaging parameters was evaluated by Spearman correlation analysis.

Results: ADC and D of the renal cortex in patients with type 2 CRS were lower than those in the healthy control group. ADC and f in the HF group were lower than those in the control group. D was positively correlated with the length (r = 0.3752, P = 0.0013) and transverse diameter (r = 0.3258, P = 0.0056) of the kidney. ADC (r = 0.2964, P = 0.0121) and D (r = 0.3051, P = 0.0097) were positively correlated with eGFR. Renal cortical ADC and D values could distinguish type 2 CRS patients from the healthy controls with area under the curve (AUC) of 0.723 and 0.706, respectively.

Conclusion: The ADC and D values were not only correlated with renal function, but also had lower levels in type 2 CRS. The IVIM-DWI parameter D was also related to kidney size, but further research is needed to determine whether it can be used as a novel imaging marker for type 2 CRS.

Objective: The aim of this study was to investigate the relationship between triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) and the risk of cardiovascular disease (CVD) in middle-aged and elderly Chinese population. CVD has high morbidity and mortality in China, with 5.09 million CVD deaths in 2019 and a mortality rate of 364.5 cases per 100,000 people. Existing studies have focused on specific populations and lack studies on the general population.

Methods: This study used data from the China Health and Aged Care Tracking Survey (CHARLS) to analyse the middle-aged and elderly population between 2011 and 2020. The exposure variable was TG/HDL-C ratio, the outcome variable was the occurrence of heart disease (including myocardial infarction, coronary heart disease, etc.), and the covariates included age, gender, education level, and body mass index. The final sample size was 4,551 participants. Weighted Cox regression models were used to assess the association between TG/HDL-C and CVD risk, and nonlinear associations and stratified analyses were performed.

Results: The results demonstrated a significant association between TG/HDL-C ratios and cardiac morbidity, with a risk ratio of 0.71 (95% CI: 0.71-0.71) in the adjusted model II. Nonlinear analysis revealed a threshold effect. Within the TG/HDL-C 0.15-1.5 interval (inflection point LnTG/HDL-C 0.41), each 1-unit increase in Ln (TG/HDL-C) was associated with a 17% reduction in the risk. The inflection point was associated with a 0.83-fold reduction in the risk of CVD (95% CI: 0.75, 0.92; p = 0.0003), but beyond this point, the association was no longer significant (1.00-fold reduction in risk; 95% CI: 0.95, 1.05; p = 0.9701). In contrast, stratified analyses demonstrated that the results were more applicable to women and those younger than 65 years.

Conclusion: In summary, the study found a significant inverse relationship between the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio and the risk of cardiovascular disease in the middle-aged and elderly Chinese population, with a nonlinear threshold effect observed at a TG/HDL-C ratio of around 1.5.

Background: Percutaneous coronary intervention (PCI) helps treat coronary artery disease but only provides short-term relief and doesn't stop disease progression. Exercise rehabilitation can improve outcomes for patients after PCI and lower the risk of death and new heart problems, but many patients struggle to stick with their exercise routines. Spouses play a crucial role in supporting patients and helping them stay committed to their rehabilitation. This study aims to evaluate the effectiveness of a couple-based exercise program in improving exercise adherence among post-PCI patients.

Methods: This study used a quasi-experimental design, 70 dyads were recruited for a 12-week investigation. Participants were divided into an intervention group to receive the Couple-Based exercise program and a control ensemble for conventional exercise-based cardiac rehabilitation. The primary parameter under examination was exercise adherence. Secondary endpoints encompass exercise self-efficacy, the 6-minute walk test, the 9-item Patient Health Questionnaire, and the Generalized Anxiety Disorder Scale. Data were harvested at baseline and post-intervention (12 weeks).

Result: Following a three-month monitoring period, noticeable differences were observed in the Couples exercise group compared to the control group in the realms of exercise adherence, exercise self-efficacy, the 6-minute walk test, and anxiety-depression indices (P < 0.05).

Conclusion: A couple-based exercise program developed based on a developmental-contextual framework improves exercise adherence and exercise self-efficacy, enhances cardiac function and exercise capacity, and improves anxiety and depression in post-coronary arteriography patients. This approach is likely to be an effective way to improve rehabilitation outcomes, leading to the broader goal of improving patient prognosis and reducing adverse cardiovascular events.

Trial registration: The study's registration was recorded with the Chinese Clinical Trials Registry (12/04/2022, registration number ChiCTR2200058600).

Background: In symptomatic high-risk patients with severe mitral valve regurgitation (MR), who are not eligible for surgery, Transcatheter edge-to-edge repair (TEER) or transcatheter mitral valve replacement (TMVR) may be an option, especially when surgical mitral valve repair by annuloplasty has been performed earlier. After TMVR, the appropriate anticoagulation regimen is still matter of debate.

Case presentation: We here report on a 78-year-old frail lady with heart failure and atrial fibrillation who underwent surgical reconstruction of the mitral valve nine years ago. Due to high surgical risk and after heart team discussion, TMVR using a transcatheter aortic valve prosthesis (valve-in-ring concept) was performed successfully via the transapical access route. Several months later, an excellent result could be confirmed. Since surgical excision of the left atrial appendage was carried out during first surgery, oral anticoagulation was withdrawn. Two months later, the patient presented with a massive LA thrombus mass and severe stenosis of the mitral valve prosthesis requiring re-do surgery.

Conclusions: Management of anticoagulation in patients with atrial fibrillation and successfully performed LAA excision is still a matter of debate, in particular after transcatheter heart valve implantation in mitral position. TMVR devices may be very thrombogenic. Thus, caution should be used whenever discontinuing oral anticoagulation in these patients. Despite the lack of evidence, withdrawal of anticoagulation should be avoided here, especially in the absence of bleeding complications. Left atrial appendage closure or excision should not influence this decision.

Background: The global COVID-19 vaccination campaign, with 13.53 billion doses administered by early 2024, has significantly reduced severe illness and mortality. However, potential adverse effects, such as Postural Orthostatic Tachycardia Syndrome (POTS), have raised concerns. This systematic review evaluates the incidence, mechanisms, and clinical implications of POTS following COVID-19 vaccination.

Methods: A systematic search of PubMed, EMBASE, and Web of Science was conducted up to June 7, 2024, following PRISMA guidelines to identify studies related to COVID-19 vaccines and POTS. Eligible studies included randomized controlled trials, cohort studies, cross-sectional studies, case-control studies, case series, and case reports. Screening, data extraction, and quality assessment were independently performed by two reviewers using the Joanna Briggs Institute Checklists and the Newcastle-Ottawa Scale.

Results: Of the 1,531 articles identified, 10 met the inclusion criteria, encompassing a total of 284,678 participants. These studies included five case reports, two case series, one cross-sectional study, one prospective observational study, and one cohort study. The cohort study reported that the odds of new POTS diagnoses post-vaccination were 1.33 (95% CI: 1.25-1.41) compared to the 90 days prior. In contrast, the post-infection odds were 2.11 (95% CI: 1.70-2.63), and the risk of POTS was 5.35 times higher (95% CI: 5.05-5.68) post-infection compared to post-vaccination. Diagnostic findings across studies included elevated norepinephrine levels and reduced heart rate variability. Reported management strategies involved ivabradine, intravenous therapies, and lifestyle modifications.

Conclusion: The risk of POTS following COVID-19 vaccination is lower than that observed post-SARS-CoV-2 infection; however, existing studies are limited by small sample sizes and methodological variability. Further research is needed to clarify the incidence, mechanisms, and long-term outcomes of vaccine-related POTS to inform effective clinical management strategies.

Background: Numerous observational studies consistently highlight a strong association between serum uric acid (sUA) levels and atrial fibrillation (AF). However, the causal relationship and the direction of this association remain elusive, despite extensive research efforts.

Objective: This study aimed to investigate the bidirectional causal relationships between sUA, gout, and the risk of AF using the two-sample Mendelian randomization (MR) approach.

Methods: We conducted a comprehensive analysis utilizing publicly available genome-wide association studies (GWAS) summary statistics, employing stringent criteria to meticulously select genetic variants associated with sUA, gout, and AF. Our primary analytical approach was the inverse-variance weighted (IVW) method, complemented by some sensitivity analyses, including MR-Egger, weighted median, simple mode, and weighted mode, to estimate the causal effects. To identify potential violations, we conducted Egger regression and leave-one-SNP-out analyses. We assessed the strength of instrumental variables using F values to evaluate weak instruments. Additionally, we referenced the Phenoscanner database to exclude single nucleotide polymorphisms (SNPs) associated with confounding factors or outcomes.

Results: Our forward Mendelian randomization analysis suggests that there is no causal relationship between UA levels/gout from different populations and the risk of AF [IVW OR 1.03, 95% CI: 0.97-1.08; p = 0.335; IVW OR 0.99, 95% CI: 0.97-1.02; p = 0.583; and IVW OR 1.07, 95% CI: 0.84-1.37; p = 0.575], respectively. We did not detect significant heterogeneity or potential pleiotropy, and we also excluded the possibility of weak instrumental variables. Furthermore, we did not find any reverse causal effects of AF on sUA levels and gout risk.

Conclusion: Our findings challenge the widely held belief that lowering urate levels is uniformly effective in reducing the risk of atrial fibrillation (AF). Our study fails to substantiate the existence of a causal link between uric acid (UA) levels or gout and the development of AF, regardless of direction.

Objective: The objective of this study was to investigate risk factors for new-onset atrial fibrillation (NOAF) post-percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI), aiming to develop a predictive nomogram for NOAF risk.

Methods: A retrospective cohort study involving 397 AMI patients who underwent PCI at a tertiary hospital in Anhui, China, from January 2021 to July 2022 was performed. Patients were divided into NOAF (n = 63) and non-NOAF (n = 334) groups based on post-PCI outcomes. Clinical data were extracted from the hospital information system (HIS) and analyzed using univariate and multivariate logistic regression to identify independent risk factors. A nomogram was generated utilizing R software (version 3.6.1), with its performance evaluated through receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and Bootstrap resampling.

Results: Independent risk factors for NOAF included age, left atrial diameter (LAD), Gensini score, N-terminal pro-B-type natriuretic peptide (NT-proBNP), alanine transaminase (ALT), low-density lipoprotein cholesterol (LDL-C), left ventricular end-systolic diameter (LVESD), and ventricular rate (P < 0.05). The nomogram's ROC curve demonstrated an area under the curve (AUC) of 0.925 (95% CI: 0.887-0.963), supported by a Bootstrap-verified AUC of 0.924 (95% CI: 0.883-0.954), reflecting strong discriminative capability. The calibration curve indicated a mean absolute error (MAE) of 0.031 and 0.017 prior to and following Bootstrap verification, respectively, signifying robust calibration. The DCA curve illustrated that the nomogram offered optimal clinical net benefit for patients with a threshold probability of NOAF ranging from 0.01 to 0.99.

Conclusion: The nomogram developed from independent risk factors for NOAF exhibits significant predictive accuracy and clinical relevance for evaluating the risk of NOAF in AMI patients following PCI, thereby enabling the identification of high-risk individuals for targeted interventions.

Background: Numerous studies have explored the effects of L-arginine, whether administered in the form of a supplement or through infusion during cardioplegia, on cardiac and inflammatory markers in individuals undergoing coronary artery bypass grafting (CABG). However, these studies presented contradictory findings. Consequently, the objective of this study was to investigate the impact of l-arginine on these markers by analyzing available randomized controlled trials (RCTs).

Methods: We performed an extensive search across various databases, including Embase, Medline/PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar, covering research published until December 2023. To analyze the mean changes in inflammatory and cardiac markers between the L-arginine and control groups, we calculated the weighted mean difference (WMD) along with the corresponding 95% confidence interval (CI) using a random-effects model.

Results: A total of 393 RCTs were identified during the initial search. After screening and selection, 7 trials were included. In a meta-analysis of three trials that reported troponin T levels, we found a significant impact of L-arginine on reducing troponin T levels (WMD = -0.61 ng/ml; 95% CI: -1.07, -0.15). Our analysis also showed that L-arginine had a noticeable impact on decreasing interleukin-6 (IL-6) levels (WMD = -7.72 pg/ml; 95% CI: -15.05, -0.39). However, we found no considerable impact of L-arginine treatment on creatine phosphokinase-MB (CPK-MB), tumor necrosis factor-alpha (TNF-α), and troponin I compared to the placebo groups.

Conclusions: Our findings suggest that L-arginine may benefit patients undergoing CABG, as it helps reduce inflammatory reactions and limits myocardial ischemia. This study registered in the PROSPERO database (Registration No. CRD42024508341).

A 17-year-old boy complaining of progressive dyspnea, fever, palpitations, a 22 mm Hg blood pressure difference between the 2 arms, and arm claudication. He had a history of psoriasis-like skin lesions and bronchiectasis. Echocardiography revealed a reduced left ventricular ejection fraction, severe eccentric aortic insufficiency, circumferential aortic wall thickening, and a dilated ascending aorta with severe atherosclerotic changes. Based on imaging findings, a TA diagnosis was suggested. During his follow-up, the patient developed strabismus, blurred vision, and right sixth cranial nerve paralysis and went into a deep coma. Unfortunately, after 6 months of treatment, he expired due to COVID-19 infection.