Cardiology最新文献

Introduction: Left ventricular (LV) remodelling and fibrosis is known to occur in patients with aortic stenosis (AS) and is linked to post-intervention outcomes. These myocardial changes may be detected upon the routine 12-lead electrocardiogram by the presence of a LV strain pattern (LVS-ECG). Although LVS-ECG has been related to excessive cardiovascular morbidity and mortality in multiple patient populations, there is currently a dearth of data upon its impact in patients undergoing transcatheter aortic valve implantation (TAVI). The aim of the current study was to investigate the prevalence, predictors and prognostic value of LVS-ECG.

Methods: Between 2012 and 2019, 640 consecutive patients underwent TAVI at Haukeland University Hospital, Bergen. Of these, 600 patients with severe AS were included in the TAVI-NOR study. Patients with known bundle branch block (n=85) or permanent pacing (n=25) were excluded, leaving 490 patients (mean age 81±6years, 52% females) eligible for the analyses. LVS-ECG was defined as down-sloping, convex ST-segment depression with asymmetric T-wave inversion in V5 or V6.

Results: LVS-ECG was present in 25.7% patients. Higher levels of NT-proBNP (OR 1.96; 95% CI:1.08-3.55, p=0.028), LVEF<50% (OR 3.14; 95% CI:1.61-6.13, p=0.001), increase in LV mass index per SD (32g/m2) (OR 1.37; 95 CI:1.06-1.76, p=0.014), and the presence of LV hypertrophy on ECG (OR 3.23; 95% CI:1.97-5.32, p<0.001) were independent predictors of LVS-ECG in the multivariable-adjusted analysis. Although all-cause mortality was significantly higher in patients with LVS-ECG compared to those without (54.8% vs 44.2%, p=0.041), the presence of LVS-ECG did not predict all-cause mortality during a median follow-up of 64±24 months (HR 1.05; 95% CI:0.79-1.39, p=0.742). Patients with LVEF <50% and concomitant LVS-ECG had a worse prognosis than those with LVEF >50% and no LVS-ECG (p<0.001).

Conclusions: LVS-ECG may represent a simple marker of structural and functional LV remodelling that signals a propensity to excess mortality during long-term follow-up after TAVI, as it is strongly associated with other prognosticators such as reduced LVEF and increased levels of NT-proBNP.

Objective: To investigate the differences in safety and efficacy between high-frequency stimulation (HFS) and anatomically guided endocardial catheter ablation (AA) of the ganglionated plexi (GPs) for treating vasovagal syncope (VVS) in individuals engaged in high-intensity physical training.

Methods: Forty-five patients (age 22.5 ± 4.4 years) undergoing high-intensity physical training were included from January 2020 to January 2023 at our hospital. Patients underwent GP ablation for recurrent syncope. Comprehensive evaluations, including head MRI, cardiac ultrasound, electrocardiogram (ECG), ambulatory ECG (Holter), ambulatory blood pressure monitoring, plate motion tests, and head-up tilt tests (HUT), were conducted to exclude other systemic disorders causing syncope. HFS and AA-guided GP ablation were performed on 10 and 35 patients, respectively, all of whom tested positive for HUT. Differences between the two groups were compared regarding ablation sites, ablation time, safety, and effectiveness.

Results: The ablation time was significantly shorter in the AA group compared to the HFS group (P < 0.001). The number of GPs selected for ablation using the AA method was reduced (P < 0.001). All patients in the HFS group experienced palpitations and discomfort, whereas only 31.43% of patients in the AA group reported these symptoms (P = 0.001). Fentanyl analgesia was administered in both groups, and no significant complications arose from the ablation. The longest follow-up duration was 52 months, while the shortest was 15 months. One case of pre-syncope occurred in the HFS group 8 months post-ablation, and one case of pre-syncope and two cases of syncope occurred in the AA group at 1 and 3 months post-ablation, respectively. There were no statistically significant differences in heart rate variability (HRV) and cardiac deceleration capacity (DC) between the two groups after ablation (P > 0.05). Two cases in the AA group still exhibited type II second-degree atrioventricular block during sleep. Both groups of patients were able to complete high-intensity physical training and showed significant symptom improvement post-ablation.

Conclusion: Young individuals with VVS engaged in high-intensity physical training can benefit from GP ablation using both HFS and AA methods. The AA method requires relatively simple equipment, shorter procedure time, and results in less discomfort during the ablation.

Introduction: There is a lack of consensus on diagnosing coronary microvascular dysfunction (CMD) using the angiography-based index of microcirculatory resistance (Angio-IMR) due to the absence of evidence. This study aims to explore the efficacy of Angio-IMR in diagnosing CMD.

Methods: A systematic search was conducted in PubMed, Embase, Scopus, and Cochrane Library for studies primarily focusing on Angio-IMR diagnosing CMD, using IMR as the gold standard. The primary results were pooled sensitivity, specificity, and the area under curve (AUC).

Results: A total of 15 studies involving 2202 individuals and 2330 vessels were included in our study, Angio-IMR demonstrated high performance in predicting IMR with overall pooled sensitivity and specificity of 0.84 (95% confidence interval (CI): 0.81 to 0.87) and 0.87 (95%CI: 0.83 to 0.99), respectively, and AUC=0.91 (95%CI: 0.89 to 0.94). This indicates that Angio-IMR has good diagnostic characteristics. Subgroup analysis by indirect meta-analysis showed higher sensitivity in the rest state. However, there is no significant difference in sensitivity and specificity between the hyperemic and rest states when using the AccuIMR system. Furthermore, sensitivity and specificity were more pronounced in the group without coronary pressure monitoring compared to the group with monitoring.

Conclusion: Angio-IMR is an alternative tool to identify CMD.

Introduction: Cardiomyopathy, is a complex condition influenced by multiple genes and environmental factors. It has been suspected that cardiomyopathy is affected by the ACE gene's I/D polymorphism. Our study aimed to evaluate the association between this polymorphism and cardiomyopathy risk in the Jammu population of North India, alongside a meta-analysis to determine the specific risks associated with different types of cardiomyopathy.

Method: In the case-control study, we opted for a convenient sampling technique to gather patients from hospitals. Meanwhile, for the meta-analysis registered under PROSPERO with CRD42024519763, and in line with PRISMA guidelines, we accessed online databases and applied predefined inclusion criteria. Data extraction and quality assessment were performed using the Newcastle-Ottawa scale. Statistical analysis included genotypic frequencies, Hardy-Weinberg equilibrium testing, logistic regression models, and assessments for heterogeneity and publication bias.

Result: The case-control study revealed a significant association between the ACE I/D risk variant and cardiomyopathy risk in the Jammu population (OR: 1.30, CI [1.04-1.63], p-value=0.021). Furthermore, a total of 34 studies were fund-eligible for the meta-analysis and demonstrated a significant association between the risk variant and both dilated (OR: 1.25, CI [1.03-1.50], p-value=0.022) and hypertrophic (OR: 1.31, CI [1.0876-1.5776], p-value = 0.004446) cardiomyopathy.

Conclusion: Our study found a significant association between the I/D polymorphism and cardiomyopathy risk in the Jammu population. Further, the meta-analysis strengthens the findings by consistently linking the ACE I/D polymorphism to both dilated and hypertrophic cardiomyopathy. These results underscore the importance of genetic factors in cardiomyopathy risk assessment and further research is needed to understand the underlying mechanisms and potential therapeutic implications.

Introduction: The diagnosis of myocardial infarction (MI) needs to be swift and accurate, but definitively diagnosing it based on the first test encountered in clinical practice, the electrocardiogram (ECG), is not an easy task. The purpose of the study is to develop a deep learning (DL) algorithm using multitask learning method to differentiate patients experiencing MI from those without coronary artery disease using image-based ECG data.

Methods: A DL model was developed based on 11,227 ECG images. We developed a new ECG interpretation algorithm through signal-guided multitask learning, building on a previously published single-task algorithm. The utility of this model was evaluated by testing 51 physicians in interpreting ECGs with and without the assistance of the DL model.

Results: The proposed model demonstrated superior performance, achieving 90.56% accuracy, 83.82% sensitivity, 93.02% specificity, 81.44% precision, and an F1 score of 82.61% in discriminating MI ECG. Overall, the median accuracy of ECG interpretation improved from 62% to 68% with the DL algorithm. Trainees and specialists in internal medicine experienced significant accuracy increases (60% to 66% for trainees, 72% to 80% for specialists). In the MI group, NSTEMI accuracy was notably lower than STEMI (33% vs. 80%, p < 0.001), but the DL algorithm improved interpretative capabilities in both NSTEMI and STEMI.

Conclusions: Signal-guided multitask DL algorithm demonstrated superior performance compared with previous single-task algorithm. The DL algorithm supports the physicians' decision discriminating MI ECGs from non-MI ECGs. The improvement was consistent in subgroups of STEMI and NSTEMI.

Introduction Fibrinolysis is often wrongly believed to be due to tissue plasminogen activator (tPA) alone. Instead, both endogenous plasminogen activators are required, but only a mini bolus of tPA is needed to initiate fibrinolysis. This is due to tPA's unique high fibrin affinity binding site located on the fibrin D-domain. Both activators are present in all normal plasma, consistent with both being involved in biological fibrinolysis, which is also the model for optimal therapeutic fibrinolysis. Methods This uses a sequential combination of a 5 mg mini bolus of tPA followed by an infusion of proUK (40 mg/hr) for 90 minutes. This treatment is both highly effective and free of side effects. Results By contrast, due to a misunderstanding of fibrinolysis, tPA is often administered alone. This requires doses of 90-100 mg of tPA over 60 minutes, which is neither very effective nor safe, due to a risk of bleeding complications from the lysis of hemostatic fibrin by tPA's fibrin affinity. Due to this problem, fibrinolysis was replaced by interventional procedures, like percutaneous coronary intervention (PCI), which is much slower, limited to clots larger than the catheter, but is generously reimbursed by third party payers.

Introduction: To identify the optimal QT correction formula for generating corrected QT (QTc) and cutoffs for prolonged QTc, and examine the associations with mortality and cardiovascular disease (CVD) in older Chinese.

Methods: A prospective study included 24,611 Chinese aged 50+ years and without CVD at 2003-2008 from Guangzhou Biobank Cohort Study. QT interval was corrected by Bazett, Fridericia, Framingham and Hodges formulas. The slope and R2 of the QTc and heart rate regression were used to determine the optimal correction formula. The 95th percentile of QTc was used to defined prolonged QTc. Cox regression was used to examine associations of prolonged QTc with mortality and CVD. The net reclassification index was calculated to assess risk reclassification.

Results: During an average follow-up of 15.3 years, 5,261 deaths and 5,539 CVD occurred. Optimal heart correction was observed for the Hodges formula, and Bazett formula performed the worst. Prolonged QTc corrected by Fridericia, Framingham and Hodges formulas had similar association strength with all-cause mortality, CVD mortality and incident CVD (especially coronary heart disease, myocardial infarction and ischemic stroke), with hazard ratios approximately being 1.25, 1.40 and 1.15, respectively. They also improved risk reclassification for all-cause mortality, CVD mortality and incident CVD by approximately 5%, 10% and 6%, respectively. However, prolonged QTc corrected by Bazett formula was not associated with incident CVD and did not improve risk reclassification.

Conclusions: Hodges formula outperformed other formulas for heart rate correction. Fridericia, Framingham and Hodges formulas can be used for death and cardiovascular risk prediction.