BMC Cardiovascular Disorders最新文献

Background: Coronary Artery Spasm (CAS) often presents in the epicardial coronary arteries. The anterior septal branch is distributed within the myocardium, and occurrences of spasms are rare. Currently, there is no available literature on this topic, and the onset of symptoms remains elusive, potentially leading to misdiagnosis.

Case presentation: We present a case of acute myocardial infarction (AMI) caused by spasm in the anterior septal branch, accompanied by transient right bundle branch block (RBBB). The administration of nitroglycerin via intracoronary injection resulted in the alleviation of spasm in the anterior septal branch and the disappearance of RBBB. After the administration of anti-coronary spasm medications, the patient exhibited favorable recovery outcomes. No episodes of myocardial ischemia were observed during the six-month follow-up.

Conclusions: The presence of new RBBB in patients may warrant consideration of anterior septal coronary artery spasm, which necessitates urgent coronary angiography to clarify the underlying cause and facilitate the prompt initiation of anti-spasm treatment.

Background: Few studies investigated the implications of post-PCI QFR and post-PCI ΔQFR (absolute increase of QFR) in de novo lesions of small coronary disease after drug-coated balloon (DCB).

Objectives: We sought to investigate the prognostic implications of post-PCI QFR and post-PCI ΔQFR in patients who received DCB only.

Methods: Patients were divided according to the optimal cutoff value of the post-PCI QFR and the post-PCI ΔQFR. The primary outcome was major adverse cardiovascular events (MACE), including target vessel revascularization (TVR), cardiac death, and myocardial infarction (MI).

Results: The optimal cutoff values of QFR and ΔQFR for the MACE rate were 0.86 and 0.57, respectively. There were 175 patients (61.2%) with a high QFR (≥ 0.86) and 113 patients (39.5%) with a high ΔQFR (≥ 0.57) after PCI. The MACE rate was significantly higher in patients with a low QFR compared to a high QFR (5.7% vs. 27.0%, hazard ratio [HR]: 3.632, 95% confidence interval [CI]: 1.872 to 7.044, P < 0.001). The MACE rate was higher in patients with a low ΔQFR increase compared to those with high ΔQFR (4.4% vs. 20.2%, HR: 4.700, 95%CI: 2.430 to 9.089, P = 0.001). In multivariable model, a low post-PCI QFR and a low post-PCI ΔQFR was independent predictor of MACE (adjusted HR: 4.071, 95%CI: 2.037 to 8.135, P = 0.001).

Conclusions: After DCB in de novo lesions of small coronary disease, both post-PCI QFR and ΔQFR showed similar prognostic implications in MACE.

Objective: The aim of this study was to investigate the dynamic changes in QTc interval duration among patients with COVID-19 infection before, during, and after infection, in order to assess the short- and potential long-term impact of COVID-19 on cardiac electrophysiology.

Methods: A retrospective analysis was conducted on 303 inpatients diagnosed with COVID-19 who visited a tertiary Grade A hospital in China between August 2022 and December 2023. Inclusion criteria required patients to have at least two electrocardiogram (ECG) recordings at three specific time points: before COVID-19 infection, during acute infection, and after recovery (more than one month post-infection).

Results: The mean age of participants was 72.8 ± 14.7 years, with a male preponderance (62%, n = 188). A significant prolongation of QTc interval was observed during COVID-19 infection compared to pre-infection levels (438.3 ± 26.7 ms vs. 433.9 ± 26.6 ms, p = 0.025). QTc interval was positively correlated with age both before (r = 0.23, p = 0.001) and during infection (r = 0.19, p = 0.001). In short-term follow-up (≤ 6 months), QTc interval remained unchanged from the infectious period (p > 0.05), whereas it significantly decreased during long-term follow-up (> 6 months; 429.6 ± 32.5 ms vs. 437.5 ± 28.2 ms, p = 0.002). Additionally, P-wave duration significantly decreased from the infectious period to long-term follow-up (99.5 ± 14.8 ms to 96.4 ± 15.2 ms, p = 0.024).

Conclusions: COVID-19 infection demonstrated a significant correlation with prolonged QTc interval, persisting in the short term but gradually returning to normal in the long term. Similarly, P-wave duration shortened over time, suggesting potential cardiac electrophysiological recovery.

Clinical trial number: Not applicable.

Background: Health-related Quality of life (HRQoL) assessment is essential for optimizing patient care, treatment adjustments, and medical decision-making, particularly in post-Myocardial Infarction (MI) patients, but limited data exists on HRQOL post-MI from Pakistan. This study aimed to assess HRQoL and its determinants in the Pakistani population.

Methods: A single-center cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan. Patients ≥ 18 years old with a primary diagnosis of acute MI (ICD-9 codes: 410.0-410.9 and ICD-10 codes: 121.0-121.9) discharged from the Cardiology Service from January 2019 to December 2020 who could be contacted and consented to participate were included. Data was collected from electronic records, and patients were interviewed via phone calls using a validated Urdu version of the WHOQOL-BREF questionnaire. Statistical analysis was performed using non-parametric tests via RStudio (Version 1.4.1717).

Results: The final study cohort was 440 patients with a median age of 63.0 (IQR: 56.0,72.0) years, with a male predominance (68.2%). Physical health was the most affected domain. Females, lower-income individuals, and those with lower levels of education had lower HRQoL scores in all domains. Diabetes and the presence of multiple co-morbidities were associated with lower HRQoL. Marital and socioeconomic status, along with psychosocial factors were significantly associated with HRQoL scores. Notably, 62.0% of post-MI patients rated their overall HRQoL as good (4-5 on a Likert scale of 1-5). Cronbach's alpha values indicated good internal consistency, with an overall Cronbach's alpha of 0.902.

Conclusion: Although a significant proportion of patients in our cohort reported good HRQoL post-MI, several social factors were associated with lower HRQoL. These factors must be investigated further in discharge planning and post-discharge of patients with MI.

Background: Heart failure with preserved ejection fraction (HFpEF) poses a significant clinical challenge, especially in older patients with HT. This study aimed to identify the factors influencing HFpEF occurrence in elderly patients with HT.

Methods: Elderly patients with HT were categorized into two groups: no HFpEF group and HFpEF group based on HFpEF diagnosis. Demographic, clinical, laboratory and echocardiographic data was conducted. Logistic regression analysis and joint prediction modeling were used to identify predictive factors for HFpEF.

Results: Several factors were associated with HFpEF, including age, body mass index, duration of HT, atrial fibrillation (AF), chronic kidney disease (CKD), stroke, systolic blood pressure (SBP), serum creatinine (SCr), N-terminal pro brain natriuretic peptide (NT-proBNP), heart rate, serum sodium, low density lipoprotein cholesterol (LDL-c), triglyceride, left ventricular ejection fraction (LVEF), E/e' ratio, left atrial diameter, tricuspid regurgitation velocity, mitral regurgitation and C-reactive protein (CRP) levels. The joint prediction model shown high accuracy, with an area under the curve (AUC) of 0.840.

Conclusions: This study provided insights into the incidence rate and risk factors of HFpEF in elderly patients with HT. Key determinants included age, blood pressure, biomarkers, and echocardiographic parameters.

Background: Heart Failure (HF) is a global public health issue with high morbidity and mortality rates. Symptom management improves HF patients' quality of life and demonstrates a potential reduction in hospitalisation, particularly among individuals aged 65 and over. Early identification of patients at higher risk of hospitalisation is essential to guide patient-centred interventions. This study aimed to translate, cross-culturally adapt and evaluate the psychometric properties of the Heart Failure Symptom Tracker (HFaST) tool for the Portuguese population. Additionally, it aimed to test the hypothesis that higher scores of the HFaST are associated with increased hospitalisations due to HF decompensation.

Methods: This cross-sectional study was conducted in two phases. The first phase involved the linguistic translation and cross-cultural adaptation of the HFaST tool into European Portuguese. Content validity was assessed by a panel of ten experts, who evaluated the clarity, relevance and equivalence of the pre-final version. A pre-test, using cognitive interviews with a sample of forty individuals was conducted to assess the item comprehensibility of the adapted tool. The second phase involved the psychometric validity in a sample of sixty HF patients. Participants completed a demographical and clinical assessment, the Portuguese version of the HFaST tool and the Portuguese version of the KCCQ-23 questionnaire. Additionally, the association between HFaST scores and HF hospitalisations were analysed.

Results: Equivalence between versions showed substantial to perfect agreement, with Fleiss' k ranging from 0.678 to 1.000. Necessary adjustments were performed. Pre-test confirmed 95% comprehensibility. Internal consistency was acceptable, with a Cronbach's Alpha of 0.724, moderate to strong inter-item correlations, and significant correlations between the HFaST and the KCCQ-23 items were observed. Higher HFaST scores were significantly associated with increased hospitalisations, highlighting its role as a predictive tool for clinical risk stratification.

Conclusions: The Portuguese version of the HFaST demonstrated to be a reliable and valid self-management tool for HF patients in Portugal. By predicting the likelihood of hospitalisation risk, the HFaST enables clinicians to implement early interventions, potentially reducing hospital admissions, improving patients' outcomes and contributing to a better quality of life.

Clinical trial number: not applicable.

Background: The aim of this study was to evaluate the prognostic impact of computed tomography (CT)-based body composition parameters in metabolically unhealthy normal-weight patients (MUHNW) with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).

Methods: This prospective cohort study involved adults with normal weight scheduled for TAVR. Patients were divided into two groups: metabolically healthy normal-weight (MHNW) and MUHNW. The primary outcome was major adverse cardiovascular events (MACEs), and the secondary outcomes were all-cause mortality and prolonged hospital stay. Logistic regression was used to explore the relationships between variables and outcomes, and Cox regression models were applied to examine the effects of different parameters on patient prognosis. Incremental discriminative improvement (IDI) and the C-index were used to determine the influence of hybrid parameters on the predictive efficiency of the model.

Results: The cohort study included 182 patients divided into two groups: MHNW metabolically healthy normal-weight (n = 97) and MUHNW (n = 85). Over a median follow-up of 0.8 years, multivariable logistic regression analysis revealed significant associations of the skeletal muscle index (SMind) (HR: 0.50, 95% CI: 0.29 - 0.84, p = 0.01), subcutaneous adipose tissue index (SATind) (HR: 0.63, 95% CI: 0.45 - 0.88, p = 0.01), and visceral adipose tissue index (VATind) (HR: 1.34, 95% CI: 1.10 - 1.63, p < 0.01) with the risk of experiencing MACEs, whereas epicardial adipose tissue (EAT) was not significantly associated with the risk of experiencing MACEs in the multivariable model (HR: 1.10, 95% CI: 0.97 - 1.24, p = 0.14). For the primary outcome, adjusted for significant covariates, the model had an IDI of 0.25 and a C-index of 0.8, with significant associations of SMind (HR: 0.73, 95% CI: 0.62 - 0.87, p < 0.01), SATind (HR: 0.87, 95% CI: 0.78 - 0.97, p = 0.01), and VATind (HR: 1.25, 95% CI: 1.12-1.40, p < 0.01) with the risk of experiencing MACEs. For the secondary outcome, the model had an IDI of 0.36 and a C-index of 0.93, with EAT showing a significant protective effect against all-cause mortality and prolonged hospital stay (HR: 0.97, 95% CI: 0.93 - 0.99; p = 0.04).

Conclusions: Body composition parameters, including, VATind, SMind, and SATind, are significant predictors of MACEs in patients undergoing TAVR. Additionally, EAT shows a significant protective effect against all-cause mortality and prolonged hospital stay. These findings highlight the potential importance of comprehensive body composition assessments in the risk stratification and management of AS patients.

Background: Familial hypercholesterolemia (FH) is a genetically inherited disorder caused by monogenic mutations or polygenic deleterious variants. Patients with FH innate with significantly elevated risks for coronary heart disease (CHD). FH prevalence based on genetic testing in Chinese CHD patients is missing. Whether classical index of coronary atherosclerosis severity can be used as indicators of FH needs to be explored. To investigate the FH prevalence in Chinese CHD patients and the association of SYNTAX I score with FH genotype.

Methods: The monogenic and polygenic FH related genes were genotyped in 400 consecutively enrolled CHD patients. The clinical characteristics and SYNTAX I scores were analyzed in a retrospective nested case-control study.

Results: The prevalence of genetically confirmed FH in our CHD cohort was 8.75%. The cLDL-C level, SYNTAX I scores and incidences of triple vessel lesions in FH patients were significantly higher, while cLDL-C and SYNTAX I scores were independent risk factors for FH. Furthermore, cLDL-C levels of polygenic FH were significantly lower than monogenic FH, while their severity of coronary atherosclerosis was comparable.

Conclusions: Our study revealed that the SYNTAX I score was an independent risk factor for FH. Besides, polygenic origin of FH should be taken into consideration for CHD patients suspected of FH.

Background: The associations between the albumin-corrected anion gap (ACAG) and all-cause mortality in patients with congestive heart failure in the intensive care unit remain uncertain. This study aimed to investigate this unknown.

Methods: The MIMIC-IV (version 3.0) database was used to analyze critically ill patients with congestive heart failure. Patients were grouped into tertiles (T1-T3) on the basis of the ACAG. The association between ACAG levels and 1-year all-cause mortality was assessed using Kaplan-Meier survival analyses, multivariate adjusted Cox regression models, and restricted cubic spline curves. An analysis of subgroups was performed to evaluate ACAG's prognostic impact across diverse populations. Mediation analysis was conducted to identify and elucidate potential causal pathways linking ACAG to all-cause mortality.

Results: A cohort of 7787 patients was analyzed. On the basis of Kaplan-Meier curves, Cox regression, restricted cubic spline curves and subgroup analysis, T2 (hazard ratio 1.09, 95% confidence interval 1.02 ~ 1.16) and T3 (hazard ratio 1.25, 95% confidence interval 1.17 ~ 1.33) individuals presented a greater mortality risk compared to T1 individuals (p for linear trend < 0.001), and most subgroups consistently observed this relationship, except for those with different levels of left ventricular ejection fraction. Mediation analysis indicated that the red cell distribution width, stage of acute kidney injury, chloride and acute physiology score III partially mediated the relationship between ACAG and mortality, accounting for 12.4%, 7.0%, 12.9%, and 31.2% of the mediating effect, respectively.

Conclusions: The ACAG was associated with higher 1-year all-cause mortality in critically ill patients with congestive heart failure, with stronger impact in those with lower left ventricular ejection fractions. The ACAG may serve as an indicator in high-risk groups.

Clinical trial number: Not applicable.

Objectives: Triglyceride-glucose (TyG) index, which is a valuable measure of insulin resistance, has been found to have predictive value for cardiovascular disease (CVD). However, its relationship with CVD among individuals with chronic kidney disease (CKD) has not been thoroughly investigated. This study focused on examining the relationship of the TyG index and CVD among CKD patients in United States.

Methods: 3507 eligible participants from the National Health and Nutrition Examination Survey (2003-2018) were surveyed in this study. Methods such as multivariable logistic regression analysis and smooth curve fitting were employed to estimate how the TyG index is linked to CVD in CKD populations. Subgroup and interaction analyses were conducted in order to figure out potential moderating effects of various factors.

Results: In this cross-sectional study which based on a population with CKD, 29.5% of patients also had CVD. An independent and positive link of TyG and CVD was revealed (OR 1.213, 95% CI 1.059, 1.389). This association was nonlinear, with a threshold effect observed at a TyG index of 8.98. The results of subgroup analysis suggested that the relationships of TyG and CVD differed according to CKD stage: (OR 1.048, 95% CI 0.857, 1.282) in CKD stages 1-2; (OR 1.267, 95% CI 1.030-1.560) in stage 3; and (OR 2.131, 95% CI 1.224-3.709) in stages 4-5. Interaction analyses further suggested the potential moderating effects of CKD stage. Additionally, among specific CVD types, only coronary heart disease (CHD) had a significant and positive relationship with TyG (OR 1.617, 95% CI 1.123, 2.327).

Conclusions: TyG index was identified to be independently and positively related to the likelihood of CVD, specifically in populations with an eGFR < 60 mL/min/1.73 m². The association had a threshold effect. The results highlight the potential of the TyG index as a tool for screening and risk assessment of CVD in populations suffering from CKD, warranting further investigation.