Cardiology最新文献

Introduction: This meta-analysis was to evaluate the efficacy and safety of radiofrequency catheter ablation (RFCA) in treating children with paroxysmal supraventricular tachycardia (PSVT).

Methods: From inception to December 16, 2023, PubMed, Embase, Cochrane Library, Web of Science, CNKI (China National Knowledge Infrastructure), VIP (Chinese Science and Technology Periodical Database), and WanFang were searched for this meta-analysis. Children under the age of 18, diagnosed with atrioventricular reentrant tachycardia (AVRT) and atrioventricular nodal reentrant tachycardia (AVNRT) were enrolled. The outcomes included the success rate of RFCA, the recurrence rate of PSVT following RFCA treatment, and any complications associated with the procedure. Newcastle-Ottawa Scale (NOS) was used to assess the quality of studies. The outcome data were represented as rates (RATE), and corresponding 95% confidence intervals (CIs). Subgroup analyses were conducted based on regions and follow-ups.

Results: Fourteen articles encompassing 6,032 children were included in the study. RFCA demonstrated remarkable efficacy in children patients, achieving success rates of 98% (RATE: 0.98, 95% CI: 0.96 to 0.99) for AVRT and 99% (RATE: 0.99, 95% CI: 0.98 to 1.00) for AVNRT. The analysis also reveals that post-RFCA, the recurrence rates for AVRT were 5% (RATE: 0.05, 95% CI: 0.03 to 0.07), while for AVNRT, they were slightly lower at 4% (RATE: 0.04, 95% CI: 0.02 to 0.08). In the subset of Asian children patients, these recurrence rates were observed to be 5% for AVRT and 3% for AVNRT. Monitoring for a duration of up to 12 months post-RFCA indicated recurrence rates of 4% for AVRT and 3% for AVNRT. However, for follow-up periods extending beyond one year, there was a slight increase in these rates to 4% for AVRT and 6% for AVNRT. Additionally, the complication rates associated with RFCA in the children population were relatively minimal, recorded at 2% (RATE: 0.02, 95% CI: -0.01 to 0.06) for AVRT and 1% (RATE: 0.01, 95% CI: 0.00 to 0.02) for AVNRT.

Conclusion: RFCA appears to be a highly effective and safe treatment option for AVRT and AVNRT in children, with high success rates and relatively low recurrence and complication rates. However, long-term follow-up may be necessary to monitor for potential recurrences. These findings are valuable for clinicians and patients in making informed decisions about the treatment of these cardiac arrhythmias in pediatric patients.

Background: Floppy mitral valve/mitral valve prolapse (FMV/MVP) is a complex entity in which several clinical manifestations are not directly related to the severity of mitral regurgitation (MR).

Summary: Patients with FMV/MVP and trivial to mild MR may have exercise intolerance, orthostatic phenomena, syncope/presyncope, chest pain, and ventricular arrhythmias, among others. Several anatomical and pathophysiologic consequences related to the abnormal mitral valve apparatus and to prolapse of the mitral leaflets into the left atrium provide some explanation for these symptoms. Further, it should be emphasized that MVP is a non-specific finding, while FMV (redundant mitral leaflets, elongated/rupture chordae tendineae, annular dilatation) is the central issue in the MVP story.

Key message: The purpose of this review is to highlight the clinical manifestations of FMV/MVP not directly related to the severity of MR and to discuss the pathophysiologic mechanisms contributing to these manifestations.

Introduction: The exercise-based cardiac rehabilitation program (CRP) represent a multidisciplinary therapeutic approach tailored to improving cardiorespiratory fitness and overall health-related quality of life, while reducing cardiovascular hospitalizations and mortality. Our aim is to determine changes in exercise capacity and cardiac events according to the left ventricular ejection fraction (LVEF) following a CRP.

Methods: This single-center cohort study of 131 patients who completed a center-based CRP from 2015 to 2022. Cardiopulmonary exercise testing (CPET), transthoracic echocardiography, and laboratory analysis were conducted before and after program completion.

Results: Of 232 enrolled patients, 131 were included in our cohort analysis, with 36.6% having a reduced LVEF. These patients exhibited higher rates of atrial fibrillation (p=0.019) and NT-proBNP values (p<0.001). Patients with reduced LVEF had lower peak VO2 (p=0.046), ppVO2 (p<0.001) and VO2 at anaerobic threshold (p=0.015) during baseline CPET. Completion of the CRP lead to comparable improvements in exercise performance between groups, assessed through Δ pVO2 (p=0.990), Δ ppVO2 (p=0.610), and Δ VE/VCO2 slope (p=0.200). In the study population, male gender and hypertension independently predicted variation in VE/VCO2 slope (p=0.017) and oxygen uptake efficiency slope (p=0.048), respectively, post-CRP. During follow-up, 9.2% of all patients had hospital admissions for cardiac events, and 3.8% died, with no group differences.

Conclusion: Patients with reduced LVEF admitted to our CRP showed lower functional status based on specific CPET parameters. After CRP, both reduced and preserved LVEF groups experienced similar functional improvements. Therefore, strategies to increase participation of patients with reduced LVEF in such programs are warranted.

Background: Thromboembolic events (TE) associated with left ventricular (LV) thrombus (LVT) are of clinical concern; however, further investigation into their prevalence and risk predictors is warranted.

Methods: We retrospectively identified 256 patients diagnosed with LVT by echocardiography between 2010 and 2021. The primary outcome was the occurrence of TE, including stroke and arterial thromboembolism. Patients were divided into TE (+) and TE (-) groups for clinical comparison, with a focus on factors related to TE.

Results: The TE event rate was 9% over a median period of 4±3 years. Notably, most TE occurred within 3 months and became scarce after 2 years of follow-up; based on this, LVT chronicity was defined as LVT persistency for ≥2 years. A prior TE history proved to be a positive predictor of TE (hazard ratio, HR:5.92, Confidence Interval, CI:1.45-24.18, p=0.01), while LVT chronicity showed to be a negative predictor (HR:0.04, CI:0.01-0.15, p<0.001). LVT chronicity accurately predicted TE (area under curve of 0.86 [95% CI: 0.80-0.93], cutoff value of 794 days [sensitivity: 69%, specificity: 91%]).

Conclusion: TE associated with LVT occurs in the early period of recognition, and a history of TE is an independent predictor for future TE. Once LVT becomes chronic (≥2 years), TE is rare.

Introduction Heart Failure (HF) may induce bowel hypoperfusion, leading to hypoxia of the villa of the bowel wall and the occurrence of Clostridioides difficile infection (CDI). However, the risk factors for the development of CDI in HF patients have yet to be fully illustrated, especially because of a lack of evidence from real-world data.

Methods: Clinical data and survival situations of HF patients with CDI admitted to ICU were extracted from the Medical Information Mart for Intensive Care (MIMIC)-IV database. For developing a model that can predict 28-day all-cause mortality in HF patients with CDI, the Recursive Feature Elimination with Cross-Validation (RFE-CV) method was used for feature selection. And nine machine learning (ML) algorithms, including logistic regression (LR), decision tree (DT), bayesian, adaptive boosting (AdaBoost), random forest (RF), gradient boosting decision tree (GBDT), XGBoost, light gradient boosting machine (LightGBM), and categorical boosting (CatBoost) were applied for model construction. After training and hyperparameter optimization of the models through grid search 5-fold cross-validation, the performance of models was evaluated by the area under curve (AUC), accuracy, sensitivity, specificity, precision, negative predictive value, and F1 score. Furthermore, the SHapley Additive exPlanations (SHAP) method was used to interpret the optimal model.

Results: A total of 526 HF patients with CDI were included in the study, of whom 99 cases (18.8%) experienced death within 28 days. 18 of the 57 variables were selected for the model construction algorithm for model construction. Among the ML models considered, the RF model emerged as the optimal model achieving the accuracy, F1-score, and AUC values of 0.821, 0.596, and 0.864 respectively. The net benefit of the model surpassed other models at 16%~22% threshold probabilities based on decision curve analysis. According to the importance of features in the RF model, red blood cell distribution width, blood urea nitrogen, Simplified Acute Physiology Score II, Sequential Organ Failure Assessment, and white blood cell count were highlighted as the five most influential variables.

Conclusions: We developed ML models to predict 28-day all-cause mortality in HF patients associated with CDI in the ICU, which are more effective than the conventional logistic regression model. The RF model has the best performance among all the ML models employed. It may be useful to help clinicians identify high-risk HF patients with CDI.