BMC Cardiovascular Disorders最新文献

Objective: This study aimed to investigate the relationship between domestic water hardness and risk of symptomatic abdominal aortic aneurysm (AAA) and explore whether this association was modified by genetic predisposition to AAA.

Methods: Exposures of interest included concentration of calcium (Ca), magnesium (Mg), calcium carbonate (CaCO₃) as well as water hardness. Symptomatic AAA was identified through ICD code and operation code. Multivariable Cox proportional-hazard models were used for outcome analysis. Subgroup analysis was performed by the levels of genetic susceptibility to AAA.

Results: This study included 371,668 participants. Over a median follow-up duration of 15.2 years, 2,154 new cases of symptomatic AAA were recorded. A negative association was observed between exposure to Ca and CaCO₃ and water hardness and risk of symptomatic AAA (all p values < 0.050). No significant interaction was observed between genetic risk, as determined by AAA polygenic risk score (PRS), and any water mineral exposure in relation to AAA risk.

Conclusion: Our study found that exposure to domestic hard water was associated with a reduced risk of symptomatic AAA, regardless of individuals ' genetic risk. These findings reinforce the recommendations on the importance of maintaining and supplementing minerals in drinking water, such as using filtered or desalinated water.

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.