BMC Cardiovascular Disorders最新文献

Background: Myocardium at risk (MaR) can be evaluated by cardiovascular magnetic resonance (CMR) imaging using contrast-enhanced steady state free precession (CE-SSFP) in patients after ST-elevation myocardial infarction (STEMI). However, CE-SSFP utilizes gadolinium contrast, which is contraindicated in patients with severe renal insufficiency. Native T1-mapping is a non-contrast CMR method which has been shown feasible in assessing MaR, enabling patients with gadolinium contrast contraindications to be examined. However, native T1-mapping data have been presented in the sub-acute phase suggesting to also depict infarct size (IS), as assessed by late gadolinium enhancement (LGE). Therefore, it is unclear whether native T1-mapping depicts MaR or IS during the first week after reperfusion. We hypothesized that native T1-mapping agrees with MaR as assessed by CE-SSFP and overestimates IS as assessed by LGE in an experimental pig model and in patients during the first week after STEMI.

Methods: A retrospective analysis was performed using CMR images from an infarct/reperfusion experimental pig model. CMR imaging was performed at 2 h, 24 h and 7 days after reperfusion in a serially imaged group (n = 7) and at 4 days in a single-timepoint imaged group (n = 4). Also, STEMI patients with a single vessel LAD occlusion (n = 11) were CMR imaged between 3 to 7 days after reperfusion. Native T1-mapping MOLLI, CE-SSFP and LGE were acquired for each scan in both animals and patients. In animals, images with an additional T1-mapping sequence, SASHA, were acquired. Enhanced areas on T1-maps, CE-SSFP and LGE images were quantified and compared.

Results: In pigs, native T1-mapping MOLLI agreed with CE-SSFP in the single-timepoint- and serially imaged groups (bias: 0.3 ± 6.6% (mean ± 2SD), and 0.9 ± 18%), respectively. Native T1-mapping SASHA also agreed with CE-SSFP in the serially imaged group (bias: -0.1 ± 18%). However, MOLLI overestimated IS by LGE in pigs in the serially- and single-timepoint imaged groups (bias: 21 ± 26%, and 18 ± 17%), respectively. Similar results were seen in patients (MOLLI vs. CE-SSFP: 0.8 ± 7.5%, and MOLLI vs. LGE: 31 ± 22%).

Conclusion: Our findings suggest that native T1-mapping agrees with CE-SSFP during the first week after myocardial infarction when evaluating MaR. Also, native T1-mapping overestimates the LGE hyperintense area, indicating that native T1-mapping does not primarily depict infarct size.

Background: Ethnic disparities in heart failure (HF) outcomes have been widely documented, but data from countries with universal healthcare systems, such as Israel, are limited. This study assessed whether long-term clinical outcomes differ between Jewish and non-Jewish patients hospitalized for acute decompensated heart failure (ADHF).

Methods: We conducted a retrospective cohort study of adults hospitalized with ADHF at a tertiary medical center in Israel between 2007 and 2017. Patients were categorized by self-reported ethnicity. Baseline characteristics, in-hospital treatments, discharge medications, and clinical outcomes were compared. The primary outcome was 5-year all-cause mortality. Secondary outcomes included in-hospital mortality, 30-day readmission, 30-day mortality, 1-year mortality, and treatment patterns.

Results: Of 7,199 patients, 90.3% were Jewish and 9.7% non-Jewish. Non-Jewish patients were younger (median age 74 vs. 80 years, p < 0.001) and had higher rates of smoking and obesity. Most comorbidities, procedures, and discharge therapies were comparable. Unadjusted short-term outcomes were similar between groups. Although unadjusted 5-year survival appeared higher in non-Jews (p = 0.002), multivariable Cox regression showed that non-Jewish ethnicity was independently associated with increased 5-year mortality (HR 1.13, 95% CI 1.02-1.25, p = 0.021).

Conclusions: In this large cohort of patients hospitalized with ADHF in Israel, non-Jewish ethnicity was independently associated with worse long-term survival despite younger age and similar in-hospital care. These findings underscore the need for targeted follow-up strategies to mitigate ethnic disparities in chronic HF outcomes.

Background: Improving quality of life (QOL) is a major therapeutic goal for patients with advanced heart failure undergoing left ventricular assist device (LVAD) therapy or heart transplantation. In Japan, prolonged LVAD support due to donor shortage makes long-term QOL outcomes uncertain.

Objective: To evaluate longitudinal changes in QOL before and after LVAD implantation and heart transplantation, and to examine associations with physical function.

Methods: From 2013 to 2025, 95 patients underwent LVAD implantation at our institution, of whom 23 subsequently received heart transplantation. After excluding 4 patients with incomplete data, 19 were included in the final analysis. QOL was assessed using the Short Form-36 (SF-36) at baseline, during LVAD support, and after transplantation. Physical function was evaluated by grip strength, leg strength, 6-min walk distance (6MWD), and peak oxygen uptake. Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were analyzed.

Results: Baseline QOL was impaired in the physical domain but relatively preserved in the mental domain (PCS 22.9 ± 10.4; MCS 49.1 ± 15.0). During LVAD support (mean 64.1 ± 14.1 months), PCS improved significantly (40.1 ± 7.1, p = 0.008), whereas MCS remained stable (52.4 ± 6.3, p > 0.99). After transplantation (mean 33.6 ± 30.4 months), PCS further improved (46.3 ± 7.9, p = 0.006), while MCS continued to remain stable (53.3 ± 5.8, p = 0.466). Post-transplant PCS showed positive but non-significant correlations with physical function measures.

Conclusion: BTT-LVAD and subsequent heart transplantation markedly improve physical QOL in patients with advanced heart failure, while mental QOL, which is relatively preserved at baseline, remains stable throughout long-term follow-up. These findings suggest that, despite stable overall mental well-being, device- and transplant-specific psychological burdens may persist and should be addressed as part of comprehensive long-term care.

Objectives: This study was performed to evaluate the current status and to analyze the associated factors of intraoperative pain experience during radiofrequency ablation of atrial fibrillation (AF) with conscious sedation and analgesia.

Methods: This cross-sectional observational study employed convenience sampling of AF patients underwent their first radiofrequency ablation. General information questionnaire, intraoperative status sheet, Wong-Baker faces pain rating scale, hospital anxiety and depression scale, and the Connor-Davidson Resilience Scale were employed for data collection and analysis.

Results: A total of 428 patients (mean age 66.5 ± 9.6years; 59.8% male) were enrolled in this study. At ablation start, 62.9% of patients had moderate pain. When ablating specific regions, moderate pain and severe pain was encountered in 76.2% and 11.7% patients, respectively. Female patients had higher pain score than male patients at the followed 3 time-points: ablation start, ablating specific regions, and sheaths removal (z =-2.923, -4.349, -2.385, respectively, all P < 0.05). A negative correlation between the interoperative pain scales and the psychological resilience scales was confirmed at the time-point of before sedation, during ablation, ablating specific regions, and sheaths removal (r=-0.161, -0.464, -0.773, -0.352, respectively, all P < 0.05). Multivariable logistic regression analysis revealed that the strength and resilience dimensions of psychological resilience were significant protective factors against pain during radiofrequency ablation, with low levels of strength and tenacity associated with 2.32-fold and 2.17-fold increased risks of moderate pain, respectively, while optimism and clinical factors showed no significant effects.

Conclusion: Most of AF patients undergoing radiofrequency ablation with conscious sedation and analgesia experienced significant intraoperative pain experience, particularly when specific cardiac regions were ablated. Enhancing psychological resilience before the procedure may help reduce intraoperative pain scores.

Trial registration: This trial is registered on Mar 17th, 2022, in the Chinese Clinical Trial Registry (ChiCTR2200057810).