BMC Cardiovascular Disorders最新文献

Background: Despite the established association between the triglyceride-glucose (TyG) index and outcomes in some cardiovascular and cerebrovascular diseases, its prognostic role for all-cause mortality (ACM) in non-diabetic patients with ischemic stroke (IS) is not well-defined. Given the significant burden of IS, identifying such a marker in this specific subgroup is important. This study aimed to investigate the relationship between the TyG index and ACM in non-diabetic patients with IS using data from the MIMIC database.

Methods: This retrospective cohort study analyzed data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV, version 3.1) database to investigate the association between the TyG index and ACM in non-diabetic adult patients with IS. Patients were categorized into quartiles based on their TyG index, calculated from fasting triglyceride and glucose levels. ACM was assessed at the intensive care unit (ICU), during hospitalization, and at 30, 90, 180 days, and 1 year. Cox proportional hazards regression analysis, Kaplan-Meier survival curves, restricted cubic spline (RCS) analysis, and subgroup analyses were utilized to evaluate this association and explore its characteristics.

Results: This retrospective study included 1073 non-diabetic IS patients (51.2% female) from the MIMIC-IV database. The ACM rates at ICU, in-hospital, 30, 90, 180 days, and 1 year were 5.7%, 9.7%, 17.1%, 21.7%, 24.1%, and 26.6%, respectively. Multivariate Cox regression analysis showed that the highest TyG index quartile was significantly associated with increased HR for ACM compared to the lowest quartile: in-hospital (HR: 2.00; 95% CI: 1.09-3.65; P = 0.025), 30-day (HR: 1.59; 95% CI: 1.02-2.47; P = 0.041), 90-day (HR: 1.61; 95% CI: 1.09-2.38; P = 0.017), 180-day (HR: 1.65; 95% CI: 1.13-2.39; P = 0.009), and 1-year (HR: 1.53; 95% CI: 1.07-2.18; P = 0.020). RCS analysis showed a linear relationship between TyG index and mortality risk across all time points (p for non-linearity > 0.05). Subgroup interactions were significant for hypertension (ICU and 90-day mortality) and sex (30-day, 180-day, and 1-year mortality).

Conclusions: Higher TyG index is an independent predictor of increased ACM in non-diabetic patients with IS. These findings suggest that TyG index may be a readily available marker for risk stratification in this patient population.

Objective: This study aimed to explore the effects of the left atrial appendage closure (LAAC) procedure or LAAC combined with Radiofrequency Catheter Ablation (RFCA) on the cardiac structure and function in patients with atrial fibrillation (AF).

Methods: This retrospective cohort study included 130 patients with AF, of whom 83 underwent simple LAAC and 47 underwent LAAC combined with RFCA. Echocardiographic parameters, including left ventricular end-diastolic diameter (LVEDs), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), and fractional shortening (FS), were assessed at baseline and at 3, 6, and 12 months postoperatively. Analyses were performed for the overall cohort and stratified by the presence of chronic heart failure (CHF).

Results: In the overall cohort, postoperative echocardiographic assessments demonstrated time-dependent changes in cardiac systolic function and structure. Changes in systolic function were predominantly observed during the early follow-up period (3-6 months), whereas structural parameters, particularly ventricular dimensions and volumes, exhibited more sustained changes throughout follow-up. When treatment strategies were compared, patients undergoing LAAC combined with RFCA showed more pronounced postoperative changes in indices of systolic function and ventricular volumes at multiple follow-up time points compared with those treated with simple LAAC. In subgroup analyses, remodeling trajectories differed according to heart failure status. Patients with CHF generally exhibited attenuated functional changes over time, whereas patients without CHF demonstrated more apparent early systolic functional changes, while structural parameters showed relatively consistent trends across subgroups.

Conclusion: In this retrospective cohort, LAAC combined with RFCA was associated with more favorable cardiac remodeling patterns than simple LAAC. These differences likely reflect rhythm restoration achieved through RFCA rather than a direct effect of LAAC itself.

Background and aims: Assessment of mortality trends and real-world outcomes are important for monitoring acute myocardial infarction (AMI) care, although there is limited data beyond 1-year post incident AMI.

Methods: We used Clinical Practice Research Datalink Aurum to identify patients ≥ 35 with incident AMI between 1 Jan 2006 to 31 Dec 2014. Data was also extracted from three other sources. Risk of all-cause and cardiovascular (CV)-related mortality, incident heart failure (HF), recurrent AMI, and cerebrovascular accidents (CVA) were calculated at 1- and 5-years using regression analysis-2006 was the comparator.

Results: We identified 94,241 patients with AMI. The 1-year risk for multiple outcomes fell by 2014, including all-cause mortality (hazard ratio (HR): 0.82, 95% CI: 0.75-0.90), CV-related mortality (HR: 0.69, 95% CI: 0.60-0.78), and recurrent AMI (HR 0.72, 95% CI: 0.66-0.79). The 1-year risk for incident HF increased (HR: 1.18, 95% CI: 1.08-1.28) whilst CVA risk did not change (HR: 1.11, 95% CI: 0.98-1.26). At 5-years, the risk fell for all-cause mortality (HR: 0.82, 95% CI: 0.79-0.87), CV-related mortality (HR: 0.68, 95% CI: 0.62-0.74), and recurrent AMI (HR: 0.71, 95% CI: 0.65-0.75) by 2014. The 5-year risk for incident HF increased (HR: 1.15, 95% CI: 1.08-1.23), whilst CVA risk also increased significantly (HR: 1.16, 95% CI: 1.07-1.26) by 2014.

Conclusions: Across 2006-2014, we observed a falling risk of all-cause mortality, CV-related mortality, and recurrent AMI at 1- and 5-years post incident AMI. Countervailing trends were seen for incident HF, where the risk for CVA also increased significantly by 5-years.

Background: Congenital heart defects (CHD) are the leading cause of infant mortality associated with birth defects in Brazil. Access to prenatal diagnosis is still considered low, and treatment is limited to referral centers, especially in large urban centers.

Objectives: To characterize the profile of live births diagnosed with CHD in three university hospitals in Rio Grande do Sul, a state in southern Brazil.

Methodology: This study was based on an active surveillance system, and data were collected between November 2021 and February 2024 through medical record searches and maternal interviews. Statistical differences between CHD and maternal risk factors during pregnancy and neonatal variables were assessed using Fisher's exact test and Poisson regression with robust variance.

Results: From 381 CHD cases identified, 64.3% were classified as isolated (iCHD) and 35.7% as associated with other anomalies or syndromes (aCHD). The most frequent CHD was atrial and ventricular septal defects. Down syndrome was the most common genetic condition observed among associated cases. Maternal age, low birth weight and infant mortality were significantly more frequent in the aCHD group. Illicit drug use was more frequent in the iCHD. The rate of prenatal diagnosis by fetal echocardiography was low (15%) in both groups, and the rate of false negative results was high 14 (7.5%) iCHD and 17 (15.9%). Mortality was observed in the iCHD (n = 9; 3.7%) and in the aCHD group (n = 24; 17.8%).

Conclusions: These findings highlight the importance of improving access to specialized prenatal care and implementing multidisciplinary strategies for managing CHD.

Background: A complex high-risk indicated percutaneous coronary intervention (CHIP) score was recently developed from the British Cardiovascular Intervention Society (BCIS) database to define CHIP cases and their risk of in-hospital major adverse cardiac or cerebrovascular events (MACCE). However, the effectiveness and reliability of this model in predicting the risk of MACCE in CHIP patients after discharge require further validation.This study aims to clinically validate the prognostic value of the CHIP Score in patients with NSTE-ACS undergoing PCI.

Methods: In this study, a total of 348 patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) who underwent percutaneous coronary intervention (PCI) at the People's Hospital of Ningxia Hui Autonomous Region from January 1st to December 31st, 2019, were consecutively enrolled. The patients were stratified into four groups according to CHIP Score: Group A (0), B (1-2), C (3-4), and D (≥ 5). The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of cardiovascular mortality, unplanned revascularization, and stroke, over 36 months. Secondary endpoints included individual MACCE components, acute coronary syndrome (ACS) rehospitalization, acute heart failure hospitalization(AHF) hospitalization, and gastrointestinal bleeding. The Kaplan-Meier (KM) survival curve was used to compare the survival differences between groups. The optimal cut-off value for predicting high-risk patients with CHIP was determined through the receiver operating characteristic (ROC) curve. Patients were then divided into a high-risk group and a low-risk group based on the cut-off value. The KM curve was employed to compare the survival differences between the high-risk and low-risk groups. Additionally, the Cox proportional hazards regression model was applied to identify the independent risk factors for MACCE in patients with NSTE-ACS.

Results: Elevated CHIP Scores showed a significant association with increased MACCE risk (P < 0.05). Through ROC curve analysis, patients with CHIP score ≥ 3 were classified as the high-risk group. Compared with the low-risk group, the high-risk group had a significantly increased risk of MACCE (HR = 3.298, 95%CI:1.939-5.610, P < 0.05). Hyperlipidemia (HR = 1.817, 95%CI:1.072-3.081, P < 0.05) and coronary chronic total occlusion (CTO) (HR = 1.966, 95%CI:1.063-3.634, P < 0.05) were identified as independent risk factors for an elevated risk of MACCE.

Conclusion: In this study, the CHIP score demonstrated moderately satisfactory predictive efficacy in forecasting the risk of MACCE among NSTE-ACS patients. Hyperlipidemia and coronary CTO were independent risk factors for MACCE in CHIP patients.