Cardiology最新文献

Introduction: Assessing the severity of mitral stenosis (MS) is crucial for predictive and therapeutic purposes. While methods like planimetry and Pressure half time (PHT) are considered gold standard for measuring mitral valve area (MVA), they can be operator-dependent or influenced by hemodynamic factors. Our study evaluates the accuracy of mitral leaflet separation index (MLSI) as an alternative tool for assessing rheumatic MS severity, considering its independence from hemodynamic variations. The limitations of conventional methods are discussed to underscore the need for alternative approaches.

Methods: This retrospective study, conducted at a single-center adult echocardiography laboratory. We included 148 patients with rheumatic MS who underwent transthoracic echocardiography (TTE) between January 2016 and December 2020. MLSI was compared to traditional methods for determining MVA by measuring the distance between the tips of mitral valve leaflets in two-dimensional echocardiographic views which then was averaged to obtain the MLS index.

Results: Of the 148 patients (mean age 51.4 years ± 14.2 years, 76.4% female), Atrial Fibrillation (AF) was present in 20.3%. Among these patients, 70 reported symptoms ranging from shortness of breath on exertion (SOBOE) class II to III. There are moderate positive correlations between averaged MVA and MLSI by PLX (r = 0.640, P < 0.001) and MLSI by A4C (r = 0.608, P < 0.001). The mean MLSI was 10.2 ± 2.3 mm, with a range of 7.8 to 13.3 mm. Subgroup analyses revealed stronger correlations between MLSI and MVA in patients without AF or Mitral Regurgitation (MR). AUROC analysis identified an MLSI threshold of <0.81 cm for severe MS, yielding an AUC of 0.84. Reproducibility analysis demonstrated excellent agreement for MLSI (ICC = 0.92, 95% CI: 0.87-0.96). Subgroup analyses also showed that the correlation between MLSI and mean gradient was stronger in patients without MR (r = -0.58) compared to those with moderate-to-severe MR (r = -0.41). Subgroup analyses showed weaker correlations in patients with significant MR or AF.

Conclusion: Our findings suggest that MLSI correlates moderately positively with MVA measured by planimetry and PHT. Thus, MLSI can serve as an additional method for assessing the severity of rheumatic MS in adult patients. This index is useful in cases of discordance between MS severities estimated by existing methods, in the presence of atrial fibrillation, and alongside mitral regurgitation.

Introduction: Inflammation plays a central role in myocardial infarction (MI) and subsequent cardiac remodeling. The TETHYS study assessed the long-term effects of methotrexate (MTX) in ST-segment elevation MI (STEMI) patients, focusing on ventricular function and major cardiovascular events.

Methods: This was a prospective, observational follow-up study of 81 patients from the TETHYS trial, randomized to receive either MTX or placebo. The primary objective was to evaluate the long-term effects of MTX on cardiovascular outcomes using a win ratio (WR) approach, including death, reinfarction, stroke, rehospitalization, and the difference in left ventricular ejection fraction (LVEF) at five years. The secondary objective was to assess LVEF improvement after 180 days. A WR analysis was performed to assess cardiovascular outcomes. LVEF changes over time were analyzed using ANCOVA for repeated measures. Statistical significance was set at p<0.05.

Results: MTX treatment resulted in significantly fewer wins in the WR analysis compared to placebo (WR 0.56, 95% CI: 0.34-0.93; p = 0.026). There was no significant difference in LVEF trajectory over time (p = 0.308). However, MTX showed a significant improvement in LVEF when comparing 180 days to 3 months: 0.009% (MTX) vs. -0.105% (placebo), p = 0.020.

Conclusions: MTX did not improve long-term cardiovascular outcomes and was associated with more adverse events compared to placebo. No significant differences were found in LVEF trajectory over time. A transient improvement in LVEF was observed at 180 days but did not translate to better long-term outcomes. .

Introduction Novel point-of-care (POC) high-sensitivity cardiac troponin (hs-cTn) tests could enhance acute myocardial infarction (MI) assessment outside hospital. This pilot study evaluates the efficacy, feasibility, and precision of the QuidelOrtho TriageTrue hs-cTnI POC assay when used by non-laboratory personnel in emergency primary care. Methods A prospective pilot study was conducted from April to June 2024 at the main emergency primary care clinic in Oslo, Norway. Patients ≥18 years with acute non-traumatic chest pain were eligible. The 0/1-hour diagnostic algorithms for the POC TriageTrue hs-cTnI and the Roche Elecsys hs-cTnT central laboratory assay (routine protocol) were compared to assess the efficacy and potential safety issues for patients triaged to MI rule-out. Results Over two months, 199 patients (median age 54 years (IQR 45-70); 52.8% female) were included. Five patients (2.5%) were hospitalised with acute MI. After a single hs-cTnI measurement, the POC algorithm categorised more patients to direct rule-out than the hs-cTnT assay (65% vs 32%). The rule-out efficacy was similar for both assays after adding the one-hour measurement (hs-cTnT 74%; POC hs-cTnI 73%). Device-related error rates were low (0.5%), with high reproducibility and repeatability (coefficients of variation <10%) when performed by non-laboratory personnel. Conclusion The 0/1-hour algorithm for the TriageTrue hs-cTnI POC assay appears efficient, feasible, and robust when applied by personnel without laboratory expertise in an emergency primary care setting. Further research is warranted, but given the high proportion of single sample rule-outs, 1-hour measurements could likely be avoided, improving patient management. Trial registration: not applicable.

Introduction: Heart failure (HF) is a major global health concern with complex pathophysiological mechanisms. Iron, a crucial micronutrient for cardiac function, has been increasingly researched for its potential link with HF. This study aims to investigate the association between serum iron levels and congestive heart failure (CHF) using cross-sectional data from the NHANES database (2017-2020), thereby contributing to the understanding and management of HF.

Methods: This cross-sectional analysis utilized data from the National Health and Nutrition Examination Survey (NHANES), focusing on American adults. CHF status was identified through self-reported medical history. Serum iron levels were measured using the Roche Cobas 6000 analyzer. Covariates included demographics, lifestyle factors, and comorbidities. Statistical analyses involved logistic regression models, adjusting for potential confounders to evaluate the association between serum iron and CHF.

Results: Among 7,298 participants (240 with CHF and 7,058 without CHF), those with CHF had significantly lower serum iron levels. Higher serum iron levels were associated with a reduced incidence of CHF, even after adjusting for covariates. Subgroup analyses revealed this association to be particularly significant in older adults, hypertensive, diabetic, smokers, obese, and those with renal impairment. The optimal serum iron cutoff value for CHF risk was identified as 15.1μmol/L.

Conclusion: This study demonstrates a negative association between serum iron levels and CHF occurrence, suggesting serum iron as a potential marker for CHF diagnosis and management.

Introduction Refractory vasospastic angina (VSA) includes patients with disabling angina despite maximally tolerated calcium channel blocker and nitrate therapy. Randomised clinical trial evidence confirms the efficacy of cilostazol in refractory VSA, yet its use in real-world clinical practice is limited. This study evaluated the impact of cilostazol therapy on patient-reported outcomes in patients with refractory VSA. Methods Between June 2016 and May 2022, 15 consecutive refractory VSA patients were initiated on cilostazol (50mg twice daily), with baseline and 3-month responses assessed via the Seattle Angina Questionnaire (SAQ). The primary outcome was a clinically significant reduction in angina frequency (ie >10-point improvement in SAQ angina frequency score) at 3 months. Results A clinically significant reduction in angina frequency was reported in 13 patients (86%) at 3-months, with 3 (20%) becoming angina free. Moreover, over 3 months, median SAQ scores improved for angina frequency (25 [IQR 15,46] to 75 [30,82]), physical limitation (53 [44,67] to 83 [56,92]), and quality-of-life (17 [4,29] to 50 [35,58]). Additionally, a 54% reduction in angina-related emergency department presentations and 50% reduction in angina-related hospital admissions was noted. Minor medication-related adverse effects were experienced by 3 patients, with no serious adverse effects noted. Cilostazol was continued in 14 patients (93%) beyond the 3-month follow-up period. Conclusions In patients with refractory VSA, cilostazol is well tolerated, improves patient-reported outcomes, reduces healthcare utilisation, and thus is an effective therapy in real-world clinical practice.

Introduction: This study aimed to establish a core set of confounders for real-world essential hypertension studies to improve the reasonable control of confounding bias.

Methods: Controlled clinical studies of essential hypertension published between January 2001 and June 2020 were retrieved from PubMed. Matched or adjusted confounders from these studies were compiled to form a pool of potential candidates. The importance of each confounder was assessed through Delphi expert consultation, considering its statistical significance for impacting the prognosis of essential hypertension in published studies and its applicability in real-world essential hypertension studies. The most essential confounders were ultimately selected to constitute the core confounder set.

Results: Following a comprehensive literature review and group discussion, a total of 50 confounders were included in the Delphi questionnaire. Twenty-nine cardiologists from across China were invited to participate in the Delphi consultation, and consensus was reached after two rounds of consultation. As a result, a core set of 13 confounders was established comprising three confounders in the demographic characteristic and lifestyle domain, four in the baseline hypertension status domain, three in the comorbidity domain, one in the cointervention domain, and two in the common factor domain (study center and time). Additionally, a recommendation regarding the prioritization of controlling these confounders was formulated.

Conclusion: This study established a core set of confounders for real-world essential hypertension studies that can effectively control confounding bias and are readily accessible. These findings can serve as valuable references for protocol design and data analysis in real-world essential hypertension studies.

Background: Transcatheter aortic valve replacement (TAVR) has emerged as the recommended treatment for older patients with pure severe aortic regurgitation (PSAR). However, the efficacy of TAVR in younger patients with aortic regurgitation (AR) remains unclear. This study explored the therapeutic efficacy and safety of TAVR in these two groups and compared their outcomes.

Methods: Patients with AR who underwent TAVR at Zhongshan Hospital between June 2021 and September 2023 were included and categorized into younger- and older age groups based on whether they were ≥75 years old. The baseline characteristics, clinical test information, and follow-up data of the patients were collected.

Results: A total of 82 patients were included in this study (72.7±7.60 years old, 52[63.4%] male). The younger and older age groups each comprised 41 patients. Young patients had better clinical conditions (diabetes mellitus [0% vs. 17.1%, p=0.006], symptoms [29.3% vs. 70.7%, p=0.025], and permanent pacemaker implantation [PPMI] [0% vs. 9.8%, p=0.040]). Significant improvements in AR as well as left and right heart functions were observed in both groups. A reduced occurrence rate of mild perivalvular leaks (PVL) was observed in the younger age group at the 1-month follow-up visit (2.4% vs. 14.6%; p=0.048).

Conclusion: TAVR is safe and effective for both younger and older patients undergoing PSAR. Younger patients who underwent AR-TAVR experienced fewer perivalvular leaks compared to those experienced by older patients. Therefore, TAVR may be an alternative for younger patients with PSAR. Further Large-scale multicenter prospective studies are needed to validate our findings.

Background: Patients with prostate cancer are at increased risk of cardiovascular events. A non-electrocardiogram gated CT scan of the thorax is part of the diagnostic workup, allowing for assessment of coronary calcifications. However, the prognostic impact of a coronary artery calcium score (CACS) obtained from such CT scans is uncertain.

Objectives: To investigate the association between CACS and a combined endpoint of all-cause death, myocardial infarction, or stroke in patients with recently diagnosed prostate cancer.

Methods: The primary analysis included patients (N=571) with recently diagnosed prostate cancer and without known coronary artery disease undergoing prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT). Patients were stratified into four CACS groups. Cox proportional hazard models adjusted for risk factors were used to examine the association between CACS and the combined endpoint.

Results: Patients were distributed in the four CACS groups as follows: CACS 0-10 (26%), 11-99 (21%), 100-399 (24%) and ≥400 (29%). An increased risk of the combined endpoint was found with increasing CACS. Compared with CACS 0-10, the hazard ratios for CACS 11-99, 100-399 and ≥400 were 0.95 (95% CI: 0.37-2.42), 2.39 (95% CI: 1.13-5.09) and 3.14 (95% CI: 1.52-6.48), respectively. Only 53% of patients in the CACS ≥400 group received statins.

Conclusion: In patients with prostate cancer, assessment of a CACS from the initial PET/CT scan allows for the identification of patients with a threefold higher risk of death, myocardial infarction, or stroke. Initiation of preventive statin treatment in these patients could reduce cardiovascular events.

Objective: The definition of low-flow/low-gradient aortic stenosis (AS) using the stroke volume index (SVI) alone overlooks factors like vascular resistance and valve stiffness. Consequently, an SVI indicating a normal flow might indicate a low flow when used with the transvalvular flow rate (TFR), which incorporates ejection time. We compared the SVI (35 ml/m2) and TFR (250 ml/m2), and analyzed the outcomes for patients with and without aortic valve replacement (AVR).

Methods: From 2013 to 2016, we retrospectively evaluated the clinical data of patients with moderate-to-severe and severe AS, defined as a maximum aortic valve velocity ≥ 3.5 m/s or a valve area ≤ 1.3 cm². Patients were categorized into AVR and non-AVR groups. The non-AVR group was further classified by a TFR above or below 250 ml/m2. Moreover, we compared the SVIs with TFRs. We examined the rates of all-cause mortality and heart failure hospitalizations.

Results: Among 135 patients, 42 (31%) had mismatched SVIs and TFRs; 41 had a high SVI and a low TFR, whereas one had a low SVI and a high TFR. Among the 59 non-AVR patients, 25 (71.4%) of the 35 patients with a low TFR died, whereas 4 (16.7%) of the 24 patients with a high TFR died. The TFR in the 76 AVR patients was similar to that in the non-AVR patients, 3 of whom died (3.9%). The Kaplan-Meier analysis revealed that non-AVR patients with a low TFR had worse outcomes and the AVR patients fared best. The SVI was significantly less suitable than the TFR for risk stratification.

Conclusion: This study highlights that a high TFR, rather than a high SVI, is associated with a better prognosis, even among non-AVR patients, suggesting that the TFR is better for risk assessment and complements the SVI.