BMC Cardiovascular Disorders最新文献

Purpose: Pacemaker-related infections are serious complications of cardiac implantable electronic devices (CIEDs). This case report aims to describe the occurrence of pacemaker pocket infection and recurrent ventricular tachycardia (VT) in a Chinese amateur violinist with sick sinus syndrome (SSS), and to explore the possible connection between occupational habits and the infection, as well as VT.

Methods: A 76-year-old male violinist with a Biotronik Evia DR dual-chamber pacemaker presented with syncope and signs of a pacemaker pocket infection three years after implantation. Despite initial antibiotic treatment, the infection persisted with slightly elevated C-reactive protein (CRP) and negative cultures. The VT originated from the right ventricular outflow tract (RVOT), as confirmed by echocardiography and ECG findings. The infection was treated with debridement and extraction of the pacemaker and leads.

Results: Debridement and extraction of the pacemaker and leads successfully resolved both the VT and the infection. The VT was likely linked to the infected lead, while the pacemaker infection was attributed to the patient's violin playing, which caused mechanical stress and skin damage at the pacemaker site. Postoperative recovery was uneventful, with no recurrence of infection or arrhythmias at follow-up.

Conclusion: This case highlights the importance of considering a patient's occupational habits when selecting pacemaker pocket sites to prevent infections and complications. In this case, the patient's violin playing likely contributed to mechanical stress at the pacemaker site, leading to infection. Early identification and appropriate management, including device removal, are crucial to prevent further complications.

Background: Covid-19 is a pandemic viral disease that directly or indirectly affects multiple organ systems, including the cardiovascular system. SPECT GATED MPI is a non-invasive nuclear imaging modality used to assess myocardial perfusion and function. The aim of this study was to evaluate the effect of Covid-19 pandemic on myocardial perfusion imaging in ischemic heart disease.

Methods: This was a cross-sectional (descriptive-analytical) study of 750 patients requiring myocardial perfusion imaging (MPI) who were referred to the nuclear medicine center of Kowsar Hospital, a teaching hospital in Sanandaj, the center of Kurdistan Province in north-western Iran. Data collection was performed during the Covid-19 pandemic, between 6 April 2020 and 21 March 2021. Data analysis was performed in SPSS using independent samples t-test and chi-squared.

Results: A total of 750 patients, including 328 (43.7%) Covid-19 positive and 422 (56.3%) Covid-19 negative, were included in the analysis. Although Covid-19 infected obese patients had a significantly higher rate of abnormal MPI (P < 0.0001), no significant difference in abnormal MPI was observed between the two groups (p = 0.551).

Conclusion: The lack of a significant difference in the incidence of abnormal MPI between the two groups suggests that there may be Covid-19 patients with potentially abnormal MPI who have gone undetected. In addition, Covid-19 patients with pleural chest pain, myalgia or dyspnea may have been misdiagnosed as having chest pain secondary to heart disease.

Objective: This study aimed to evaluate the predictive performance of inflammatory and nutritional indices for adverse cardiovascular events (ACE) in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) using a machine learning (ML) algorithm.

Methods: AMI patients who underwent PCI were recruited and randomly divided into non/ACE groups. Inflammatory and nutritional indices were graded according to the laboratory examination reports. Logistic Regression was used to screen for factors that were significant for ML model establishment. The performances of the algorithms were evaluated in terms of accuracy, kappa, F1, receiver operating characteristic, precision recall curve, etc. RESULTS: Age, LVEF%, Killip Grade, heart rate, creatinine, albumin, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and prognostic nutritional index (PNI) were significantly correlated with ACE by Logistic regression analysis (P < 0.05). These nine factors were employed to establish stepwise regression (SR), random forest (RF), naïve Bayes (NB), decision trees (DT), and artificial neutron network (ANN), whose performances were evaluated in terms of accuracy, kappa, F1, receiver operating characteristic, precision recall curve, etc. The accuracy of the decision tree was greater than that of other trees. The area under the curves was the highest in the ANN model compared with the other models.

Conclusion: ANN predictive performance had an advantage over other ML algorithms based on age, LVEF%, Killip Grade, heart rate, creatinine, albumin, NLR, PLR, and PNI.

Background: Cardiovascular disease (CVD), a non-communicable condition, stands as the primary cause of death globally. This study seeks to evaluate the predictive power of atherogenic indices, which are recognized for their influence on CVD, alongside a newly developed index encompassing all three principal risk factors for CVD, referred to as the triglyceride-total cholesterol-body weight index (TCBI). The primary outcomes evaluated include both the incidence and mortality rates associated with CVD.

Methods: A prospective cohort study was conducted on Mashhad stroke and heart atherosclerotic disorder (MASHAD) study data, involving 9704 healthy participants. Baseline variables were measured, and TCBI, Atherogenic Index of Plasma (AIP), Atherogenic Coefficient (AC), Castelli risk index I and II (CRI-I & II) were calculated using specific formulas.

Results: Following a 10-year follow-up period, a significant positive relationship was observed between TCBI (HR: 1.078, 95% CI: 1.012-1.15), CRI-I (HR: 1.16, 95% CI: 1.007-1.337), and CRI-II (HR: 1.199, 95% CI: 1.001-1.437) with CVD mortality. However, no significant relationship was identified between TCBI and atherogenic indices related to CVD incidence, and neither AIP nor AC was associated with CVD mortality.

Conclusion: In conclusion, TCBI, in contrast to AC and AIP, was linked to increased CVD mortality. However, the more substantial predictive capabilities of CRI-I and CRI-II compared to TCBI emphasize the importance of traditional atherogenic indices for accurate risk assessment. These findings underscore the necessity of enhancing the TCBI formula to improve its effectiveness in assessing CVD risk.

Context: The triglyceride-glucose (TyG) index, a novel health indicator, has been widely employed to assess insulin resistance (IR). However, its relationship with fine particulate matter (PM) exposure remains inadequately investigated.

Objective: This study endeavors to probe the association between PM_2.5 and TyG within the population of eastern China and to determine whether there are disparities in this association among diverse subgroups.

Methods: We conducted an ecological study on a cohort comprising 39,011 individuals who had undergone at least two physical examinations between 2017 and 2019 at the First Affiliated Hospital of Nanjing Medical University, China. TyG levels concerning short-term PM_2.5 exposure were examined using a generalized additive model.

Results: In the overall population, at lags of 0-7 and 0-14 days in the single-pollutant model, it was observed that a 10 µg/m³ rise in PM_2.5 corresponded to a 0.0021 elevation in TyG levels. In the multi-pollutant models, at 0-7 and 0-14 days lags, a comparable increase in PM_2.5 resulted in an increase in TyG of 0.0073 and 0.0044, respectively. The association remained significant in the subgroup analyses.

Conclusion: PM_2.5 exposure is related to the TyG index. Controlling air pollution might contribute to maintainin normal lipid metabolism function.

Background: The relationship between oxidative balance score (OBS) and heart failure (HF) is controversial. The OBS was used to assess systemic oxidative stress status, with higher OBS scores implying exposure to more antioxidants. This study aimed to explore whether OBS is associated with heart failure in US adults.

Methods: A cross-sectional investigation was carried out using information from the National Health and Nutrition Examination Survey 2007-2018. The linear link between OBS and HF in adults aged ≥ 45 years was investigated using multivariate linear regression models. Interaction tests and subgroup analysis were also conducted.

Results: The prevalence of HF was 3.84%. There was a significant negative relationship between OBS (OR: 0.96 ,95%CI: 0.95-0.98, P < 0.0001) and HF. In the fully adjusted model, compared to the lowest quartile of OBS, subjects in the highest quartile had a 45% lower likelihood of developing HF (OR: 0.55, 95% CI: 0.41-0.74, p < 0.0001). In stratified analysis, OBS and HF showed no obvious negative correlation.

Conclusion: OBS was strongly negatively associated with heart failure. The findings underline the significance of adhering to an antioxidant diet and lifestyle, which helps prevent heart failure.

Purpose: Catheter ablation (CA) for atrial fibrillation (AF) in heart failure patients with preserved ejection fraction (HFPEF) has shown promising results in reducing mortality and improving heart function. However, previous studies have been limited by a lack of control groups and significant heterogeneity in their methodologies.

Hypothesis: CA for AF in HFPEF patients may not increase the complications and had similarly the rate of freedom from AF vs. patients without HFPEF, and it may reduce hospitalizations and mortality and improve heart function VS medical treatment.

Methods: Three groups of AF patients were included in the study: 187 patients with HFPEF for their first CA (AFPHF-CA), 187 patients with HFPEF who were undergoing medical therapy (AFPHF-Med), and 196 patients without HFPEF for their first CA (AF-CA).

Results: After a mean (± SD) follow-up of 36 ± 3 months, 50.8% of patients in the AFPHF-CA group and 52.0% in the AF-CA group remained in sinus rhythm (P = 0.94), compared to only 12.5% in the AFPHF-Med group (P < 0.001). Age (OR: 1.09, 95% CI: 1.02-1.08, P = 0.016), duration of AF history (OR: 1.01, 95% CI: 1.00-1.02, P = 0.017), left atrial diameter (OR: 1.52, 95% CI: 1.06-2.19, P = 0.024), and the type of atrial fibrillation (OR: 4.02, 95% CI: 1.28-12.62, P = 0.017) were consistent multivariable predictors for sinus rhythm maintenance in AFPHF. HF hospitalization was significantly lower in the AFPHF-CA group (0.38 (0,2)) than in the AFPHF-Med group (1.28(0,3), P < 0.001) during the follow-up. Stroke occurred in 18 of 187 (9.63%) patients in the AFPHF-CA group, significantly lower than the AFPHF-Med group, with approximately 31 of 187 (16.58%) (P < 0.01), but not statistically different from AF-CA, where approximately 17 of 196 (8.67%) experienced stroke (P = 0.65). Regarding mortality, death occurred in 12.8% of patients in the AFPHF-Med group, higher than 7.5% in the AFPHF-CA group and 6.6% in the AF-CA group (P = 0.49). Significant improvements in heart function were observed in the AFPHF-CA group compared to the AFPHF-Med group, including reductions in left ventricular end-diastolic diameter (P < 0.001), New York Heart Association classification (P < 0.001), left ventricular mass index (P < 0.001), and left atrial volume index (P < 0.001). HF hospitalization was significantly lower in the AFPHF-CA group compared to AFPHF-Med (P < 0.001).

Conclusion: CA for AF has showed significant benefits in patients with HFPEF compared to medical treatment alone. These benefits include improvements in heart function, reduced mortality, incidence of stroke, and hospitalizations. Importantly, CA in HFPEF patients showed comparable maintenance of sinus rhythm (SR) and safety outcomes when compared to CA in individuals with normal heart function.

Background: Previous studies have shown that epicardial edipose tissue(EAT) appears to be associated with myocardial inflammation and fibrosis, but this is not clear in patients with new-onset atrial arrhythmias after STEMI. The present study focused on using CMR to assess the association of epicardial fat with myocardial inflammation and fibrosis and its predictive value in patients with new-onset atrial arrhythmias after STEMI.

Methods: This was a single-centre, retrospective study. We consecutively selected patients who completed CMR during their hospitalisation for PCI after STEMI from May 2019-January 2023, and then underwent regular follow-up, grouped by the presence or absence of new atrial arrhythmias, and enrolled patients were divided into atrial arrhythmia and non-atrial arrhythmia groups.

Results: In the atrial arrhythmia group, age, heart rate, Peak hs-TnT, PeakNT-proBNP, EATV, LAES, LAED, T1 native, T1*, ECV, and T2 were higher than those in the non-atrial arrhythmia group, and LVEF was lower than those in the non-atrial arrhythmia group. EATV showed a positive and significant correlation with T1native, T1*, ECV, and T2. (T1 native: r = 0.476,p < 0.001; ECV: r = 0.529,p < 0.001; T1*: r = 0.467,p < 0.001; T2: r = 0.538,p < 0.001). Multifactorial logistic regression analysis showed age, LVEF, EATV, T1*,ECV, T2 as independent risk factors for atrial arrhythmia. (p < 0.05) ROC analysis showed that the AUC for age was 0.568; AUC for LVEF was 0.656; AUC for EATV was 0.768; AUC for ECV was 0.705; AUC for T1* was 0.612; and AUC for T2 was 0.772.

Conclusion: In patients with STEMI, EAT is associated with myocardial inflammation, fibrosis. Age, LVEF, EATV, T1*,ECV, T2 are independent risk factors for new onset atrial arrhythmias and have good predictive value.

Aims: This study explores the clinical application of lung ultrasound scoring(LUS) combined with echocardiography in assessing right heart function in patients undergoing maintenance hemodialysis(MHD) and those with elevated pulmonary artery systolic pressure(PASP), as well as the correlation between LUS and right ventricular(RV) function.

Methods: Eighty five patients who underwent MHD combined with elevated PASP, at the First Central Hospital of Baoding City were selected. Divided into three groups based on PASP, and perform echocardiography and lung ultrasound examinations. Compare the right heart function parameters and LUS among the three groups. Using Pearson correlation analysis to examine the relationship between LUS and right heart function parameters. Perform multivariate logistic regression analysis to identify predictive factors for RV systolic dysfunction. A receiver operating characteristic (ROC) curve and calculate the area under the curve(AUC) to compare the diagnostic efficacy of various parameters.

Results: Patients undergoing MHD exhibited varying degrees of reduced left ventricular (LV) and RV systolic function. Correlation analysis revealed that Tricuspid annular plane systolic excursion (TAPSE), Fractional area change (FAC), and Tricuspid annular peak systolic velocity(S') were negatively correlated with LUS(r = -0.81, -0.86, -0.69), while Right ventricular free wall longitudinal strain(RVFWLS) was positively correlated with LUS (r = 0.85, P < 0.05). The ROC curve indicated that the combination of LUS and RVFWLS had the highest area under the curve (AUC = 0.963), followed by the combination of LUS and TAPSE (AUC = 0.847), LUS and FAC(AUC = 0.937), and LUS combined with S'(AUC = 0.940). All combinations demonstrated higher AUC values than the individual indicators.

Conclusions: Patients with MHD combined with elevated PASP, the RV function parameters are associated with LUS, which may serve as a valuable reference indicator for assessing RV function. The use of LUS to evaluate right heart function in these patients, alongside traditional two-dimensional parameters, holds significant clinical value.