BMC Cardiovascular Disorders最新文献

Background: The presence of dedicated intensive care unit (ICU) physicians is associated with reduced ICU mortality. However, the information available on the role of cardiac intensivists in cardiac ICUs (CICUs) is limited. Therefore, we investigated the association of cardiac intensivist-directed care with clinical outcomes in adult patients admitted to the CICU.

Methods: In this retrospective study, we extracted data from the SMART-RESCUE registry, a multicenter, retrospective, and prospective registry of patients presenting with cardiogenic shock. Overall, 1,247 patients with CS were enrolled, between January 2014 and December 2018, from 12 tertiary centers in Korea. The patients were categorized into two groups based on the involvement of a cardiac intensivist in their care. The primary outcome was in-hospital mortality rate.

Results: The all-cause mortality rate was 33.6%. The in-hospital mortality rate was lower (25.4%) in the cardiac intensivist group than in the non-cardiac intensivist group (40.1%). Cardiac mortality rates were 20.5% and 35.4% in the cardiac intensivist and non-cardiac intensivist groups, respectively. In patients undergoing extracorporeal membrane oxygenation, the mortality rate at centers with cardiac intensivists was 38.0%, whereas that at centers without cardiac intensivists was 62.2%. The dopamine use was lower, norepinephrine use was higher, and vasoactive-inotropic score was lower in the cardiac intensivist group than in the non-cardiac intensivist group.

Conclusions: Involvement of a cardiac intensivist in CICU patient care was associated with a reduction in in-hospital mortality rate and the administration of a low dose of vasopressors and inotropes according to the cardiogenic shock guidelines.

Background: Chronic diseases such as obesity, hypertension, and metabolic syndrome are major health concerns worldwide. Ursodeoxycholic acid (UDCA) is a bile acid that is naturally produced in the liver and has been used for the treatment of various liver disorders. In this systematic review and meta-analysis, we investigated how UDCA might affect inflammation, blood pressure, and obesity.

Methods: Five major databases were searched from inception to August 2024. The investigated outcomes included body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). A random effect was carried out to estimate pooled weighted mean difference (WMD) with 95% confidence intervals (CI). The registration code is CRD42023428064.

Results: Of the 7912 articles in the initial search, 12 were included in the systematic review and meta-analysis. UDCA consumption significantly decreased BMI (WMD: -0.29 kg/m², 95% CI: -0.58, -0.01, P = 0.044), and DBP (WMD: -2.16 mmHg, 95% CI: -3.66, -0.66, P = 0.005). It also increased SBP (WMD: 5.50 mmHg, 95% CI: 3.65, 7.35, P < 0.001); however, it was not associated with weight loss (WMD: -0.3 kg, 95% CI: -1.3, 0.71, P = 0.561). Our systematic review showed that UDCA consumption has no effect on IL-6 and TNF-α.

Conclusion: This systematic review and meta-analysis suggest that UDCA supplementation may improve BMI and DBP, whereas it may increase SBP and have no effect on weight or inflammation. Further long-term and well-designed RCTs are needed to further assess and confirm these results.

Objective: Sivelestat may reduce postoperative pulmonary injury after total arch replacement (TAR). This study aimed to evaluate whether the preoperative PaO₂/FiO₂ (P/F) ratio affects the efficacy of sivelestat in reducing postoperative pulmonary injury in patients with acute aortic dissection (AAD) who underwent TAR using deep hypothermic circulatory arrest (DHCA).

Methods: Data of patients with AAD who underwent TAR using DHCA in a tertiary hospital between February 1, 2022, and December 30, 2022, were retrospectively reviewed. The patients were divided into the sivelestat and control groups. Three subgroup analyses were performed based on the postoperative P/F ratio. The primary clinical outcomes were assessed to determine the efficacy and safety of sivelestat in managing postoperative pulmonary dysfunction in patients undergoing cardiopulmonary bypass.

Results: A total of 187 patients were included, with 95 in the sivelestat group and 92 in the control group. No significant differences were found in the clinical variables between the two groups (all P > 0.05), except for some improvements in the inflammatory biomarker levels (including white blood cell count, neutrophil count, and C-reactive protein). Subgroup analysis revealed that sivelestat treatment significantly increased the P/F ratio on the 4th day and 3rd day after TAR in patients with mild lung injury (P = 0.02) and moderate lung injury (P = 0.03), respectively. Additionally, sivelestat reduced the levels of several postoperative inflammatory biomarkers in both subgroups.

Conclusions: Among patients with AAD with mild or moderate preoperative lung injury, defined by a low P/F ratio, sivelestat significantly improved the postoperative P/F ratio and attenuated inflammatory responses after TAR. These findings suggest an important avenue for further research.

Introduction: Atrial fibrillation (AF) is characterized by high frequency stimulation of the atrium, causes dyssynchronous atrial contraction and irregular ventricular excitation. It is the most known cardiac arrhythmia in adults, doubles the risk of stroke five times and is associated with an increasing public health burden. This study was aimed to assess the magnitude and associated factors of atrial fibrillation and its complication among adult rheumatic heart diseases patients in governmental hospitals in Bahir Dar town, Northwest Ethiopia 2024.

Methods: An institutional based cross-sectional study design was conducted with a sample size of 421. A simple random sampling technique was used to select participants. The data were entered into the Statistical Package for the Social Sciences (SPSS) version 26 for analysis. Adjusted Odds Ratio (AOR) with a 95% confidence interval was used to determine associated factors of atrial fibrillation. A binary logistic regression model was used, and a P-value < 0.05 in multivariate was considered as a statistically significant.

Results: The response rate was 95% and atrial fibrillation was developed in 51.2% of patient. Majority of them were Female (56%). The median age of patients was 41, with an interquartile range (IQR) of 26-51. Age > 50 years old (AOR = 7.20(2.03-25.46)), sever tricuspid regurgitation 4.50(1.18-17.20)), and left ventricular ejection fraction (LVEF) % (AOR = 0.94(0.89-0.99)), left atrium size (AOR = 1.23(1.14-1.33)) were independently associated with atrial fibrillation. For every unit increment of left ventricular ejection fraction in percent, the odds of developing atrial fibrillation decreased by 6%. For every unit increment of left atrial size in millimeter² (mm²), the odds of developing atrial fibrillation increased by 23%. The present study showed that complication related to AF was heart failure (HF) (72.8%), ischemic stroke (34.4%), systemic thromboembolism (12.1).

Conclusion: More than half of the study participants were found to have atrial fibrillation in patients with rheumatic heart disease. Being age > 50 years old, left atrium size, severity of tricuspid regurgitation (severe), and LVEF% were associated in developing atrial fibrillation. The atrial fibrillation was linked to an increased risk of ischemic stroke, heart failure, systemic thromboembolism, and death.

Background: Frailty and inflammation may increase the risk of cardiovascular disease (CVD), but their interacting and joint effects on CVDs remain unclear. To explore the interaction effects of frailty and inflammation on CVDs and the role of inflammation in the relationship between frailty and CVDs to provide better understanding of the underlying pathogenesis of CVD.

Methods: A total of 220,608 initially CVD-free participants were recruited from the UK Biobank database and were categorized into non-frailty, pre-frailty, and frailty groups based on Fried's criteria. The participants were also grouped according to the low-grade inflammation (INFLA) score and its components: the neutrophil-lymphocyte ratio, C-reactive protein, white blood cell count, and platelet count. Cox proportional hazards models with hazard ratios (HRs) and 95% confidence intervals (CIs) were used to assess the effects of frailty phenotypes and inflammation on CVD risk. Mediation analysis was used to quantify the role of inflammation in the association between frailty and CVDs. The potential interactions between frailty and inflammation in terms of CVD risk were also evaluated using additive and multiplicative scales.

Results: During a median follow-up of 13.3 years, 48,978 participants developed CVDs. After adjusting for various confounders, participants with pre-frailty and frailty had a higher risk of CVDs than those with non-frailty (HRs: 1.20 (95% CI: 1.18-1.23) and 1.80 (95% CI: 1.69-1.91), respectively). A higher risk of CVDs was observed among participants with moderate and high INFLA scores than those with low INFLA scores (HRs: 1.09 (95% CI: 1.07-1.12) and 1.27 (95% CI: 1.24-1.30), respectively). The INFLA score and its components had limited mediating effects in the association between frailty and CVDs. Significant interactions were observed between frailty phenotypes and INFLA scores on CVDs on the multiplicative scale but not on the additive scale.

Conclusion: Inflammation may amplify the harmful effect of frailty on the incidence of CVDs. Improving frailty alone might not substantially reduce the risk of CVDs, but effectively controlling inflammation might help to reduce the negative effects of frailty on cardiovascular health.

Background: Left ventricular noncompaction (LVNC) is a distinct cardiac phenotype characterized by prominent left ventricular trabeculae and deep intertrabecular recesses. It results in thickened myocardium with two layers consisting of non-compacted myocardium and a thin, compacted layer of myocardium. LVNC is a genetic condition associated with various cardiomyopathies, congenital heart disease, and environmental factors.

Case presentation: A 60-year-old Afroamerican male with a past medical history of hypertension and chronic kidney disease stage 3a presented to the emergency department (ED) with sudden-onset abdominal pain and associated symptoms of nausea, vomiting, and diarrhea. The patient was provided antiemetics, antihypertensives, and pain control in the ED. An abdominal x-ray showed the small bowel with multiple fluid levels concerning for obstruction. Contrast-enhanced computed tomography of the abdomen showed a wedge-shaped attenuation in the lower pole of the right kidney concerning for infarction but negative for obstruction. There was also a nonocclusive thrombus in the superior mesenteric artery. A transthoracic echocardiogram (TTE) showed a newly reduced left ventricular ejection fraction of 20-25%, moderate dilatation of the left ventricle, and severe global hypokinesis, but did not reveal any thrombus. Cardiology was consulted and recommended a transesophageal echocardiogram (TEE) along with lifelong anticoagulation with apixaban. The TEE revealed a new finding of LVNC without thrombus. The patient underwent a left cardiac catheterization which showed no significant obstructive coronary artery disease. He was discharged on guideline-directed medical therapy (GDMT). Unfortunately, the patient was noncompliant with his GDMT and anticoagulation regimen. He presented approximately six weeks later with right hemiparesis. A repeat TTE showed a large thrombus in the left ventricle. The patient remained aphasic with right hemiparesis without significant recovery before discharge.

Conclusion: This case highlights a rare cause of heart failure and catastrophic thromboembolism: noncompaction cardiomyopathy. This case is a prime example and reminder of the potential impact of LVNC on patient morbidity and should encourage medical providers to be conscious of this anomaly and its potential for severe clinical consequences.

Background: Cardiorespiratory fitness (CRF) is a critical indicator of overall health, while the glycation gap (G-Gap) emerges as a potential novel biomarker for metabolic and cardiovascular risk assessment. However, the relationship between G-Gap and CRF remains incompletely understood.

Objective: To investigate the association between glycation gap and impaired CRF, and evaluate its potential as an early health risk indicator.

Methods: Using data from the National Health and Nutrition Examination Survey (NHANES, 1999-2004), we conducted a comprehensive analysis of 3,818 adult participants. G-Gap was calculated by standardizing glycated albumin (GA) and glycated hemoglobin (HbA1c) levels, comparing actual and predicted HbA1c values. Cardiorespiratory fitness was assessed through maximal oxygen uptake (VO2 max), with impaired CRF defined as performance below the 20th percentile for gender and age-specific thresholds. Multivariate logistic regression models were employed, adjusting for demographic characteristics, laboratory parameters, and potential confounding factors.

Results: In unadjusted models, For every 1 increase in G-Gap as a continuous variable, the chance of CRF damage increased by 65% (OR 1.65, 95% CI 1.29-2.11). After comprehensive covariate adjustment, the association remained statistically significant, with odds ratios of 1.87 (95% CI 1.41-2.49) in partially adjusted and 1.41 (95% CI 1.01-1.98) in fully adjusted models. Quartile analysis revealed significantly higher risks of impaired CRF in the third and fourth G-Gap quartiles compared to the first quartile.

Conclusions: This study demonstrates an association between higher G-Gap values and an increased likelihood of impaired CRF.

Alignment of advanced cutting-edge technologies such as Artificial Intelligence (AI) has emerged as a significant driving force to achieve greater precision and timeliness in identifying cardiovascular diseases (CVDs). However, it is difficult to achieve high accuracy and reliability in CVD diagnostics due to complex clinical data and the selection and modeling process of useful features. Therefore, this paper studies advanced AI-based feature selection techniques and the application of AI technologies in the CVD classification. It uses methodologies such as Chi-square, Info Gain, Forward Selection, and Backward Elimination as an essence of cardiovascular health indicators into a refined eight-feature subset. This study emphasizes ethical considerations, including transparency, interpretability, and bias mitigation. This is achieved by employing unbiased datasets, fair feature selection techniques, and rigorous validation metrics to ensure fairness and trustworthiness in the AI-based diagnostic process. In addition, the integration of various Machine Learning (ML) models, encompassing Random Forest (RF), XGBoost, Decision Trees (DT), and Logistic Regression (LR), facilitates a comprehensive exploration of predictive performance. Among this diverse range of models, XGBoost stands out as the top performer, achieving exceptional scores with a 99% accuracy rate, 100% recall, 99% F1-measure, and 99% precision. Furthermore, we venture into dimensionality reduction, applying Principal Component Analysis (PCA) to the eight-feature subset, effectively refining it to a compact six-attribute feature subset. Once again, XGBoost shines as the model of choice, yielding outstanding results. It achieves accuracy, recall, F1-measure, and precision scores of 98%, 100%, 98%, and 97%, respectively, when applied to the feature subset derived from the combination of Chi-square and Forward Selection methods.

Hypopituitarism is a rare condition that can be particularly challenging to diagnose in individuals aged 65 and older. It is characterized by a reduced production of one or more hormones by the pituitary gland, resulting in a deficiency of the hormones that normally regulate various bodily functions. While hypopituitarism can affect multiple systems in the body, it is uncommon for it to present with cardiovascular symptoms. This rarity often leads to the condition being overlooked in clinical practice. Therefore, healthcare professionals must maintain a high level of suspicion for hypopituitarism to ensure timely diagnosis and appropriate management. In this study, we present a case of hypopituitarism caused by a tumor in the sellar region, which uniquely manifested with cardiovascular symptoms.

Background: Distal radial artery access, which involves puncturing the radial artery at the anatomical snuffbox, is increasingly being adopted in interventional cardiology. This approach offers several advantages over traditional standard transradial access, including improved procedure positioning, a lower incidence of radial artery occlusion, and shorter hemostasis.

Objective: To study the benefit of distal radial access during coronary angiography (CAG) or percutaneous coronary intervention (PCI) with palpation technique in terms of success rate, first attempt success, number of attempts, time to access, and complications.

Method: A prospective cohort study was performed between June 2022 and June 2023. Two hundred thirty-three patients received coronary intervention by three experienced transradial operators through right or left distal radial access.

Result: The mean age of patients was 62.9 years old. 58% of patients were male. Most patients had chronic coronary syndrome (35.6%), valvular heart disease (30.9%), and acute coronary syndrome (24.9%). The most used site was the right distal radial artery, and 6 Fr sheaths were mainly used. The median diameter of the distal radial artery measured by ultrasound was 0.26 (0.23-0.28) cm. First attempt success rate was 171 (73.4%). The median number of attempts was one (1.0-2.0). The median time to access the distal radial access was 1.15 (0.57-1.64) min. Puncture times were stabilized and improved after a higher number of procedures. Access site crossover was 25 (10.7%), mainly performed via the right radial artery 18 (7.7%). However, ultrasound guidance for bailout situations during puncture was done in 10 (4.3%), which achieved successful cannulation. The success rate of distal radial cannulation by palpation technique was 201(86.3%), and the overall success rate after the ultrasound-guided bailout situation was 211 (90.6%). There were 34 (14.6%) minor hematomas after the procedures, and one patient had thumb numbness.

Conclusion: Distal radial access at the anatomical snuffbox is an effective and viable alternative for coronary interventions in patients with a favorable radial pulse, demonstrating a high success rate. Ultrasound-guided puncture is an important bailout strategy when blind palpation appears difficult, significantly improving procedure success and reducing complications.