Cardiology最新文献

Introduction: Mendelian randomization (MR) is an innovative epidemiological research method. In order to summarize and clarify the research status of MR related to cardiovascular disease (CVD) and point out the possible future development direction, we conducted a comprehensive and multidimensional bibliometric analysis of the literature published in this field from 2003 to 2024.

Methods: We analyzed 1,870 articles published between 2003 and 2024 from the Web of Science Core Collection (WoSCC) using VOSviewer, R software, bibliometric online analysis tool, and CiteSpace software.

Results: CVD-related MR research demonstrated an overall upward trend, with the USA leading in terms of publication output, followed by the UK and China. The most prolific institution in this field was the University of Bristol, and Smith GD, who had the highest number of publications (n = 103), was also affiliated with this institution. The European Heart Journal (36 publications, 5,023 citations) was the most cited journal. Related topics of frontiers will still focus on MR, coronary heart disease, heart failure, C-reactive protein, cholesterol, and body mass index.

Conclusions: As the scope of MR studies continues to expand, especially the number of measurable features continues to increase, the need for rigorous methods and critical interpretation of MR findings becomes increasingly apparent. However, this ease of use can compromise the reliability of study results due to methodological flaws and publication bias, thereby affecting the perceived significance of the results. Nonetheless, with the emergence of large genetic datasets supporting two-sample MR, resources such as MR-Base and PhenoScanner, MR remains a powerful method for identifying potential pathogenic features in cardiometabolic and other diseases. In addition, it plays a crucial role in prioritizing drug targets for entry into clinical trials.

Introduction: While Takotsubo syndrome (TTS) is less common in men, their mortality rates surpass those of women. The influence of socioeconomic factors and psychological distress remains unexplored. This study aimed to investigate gender differences in socioeconomic profiles and psychological distress among patients with incident TTS and to examine gender differences in survival after discharge, accounting for socioeconomic and psychological factors.

Methods: A nationwide cohort study using national registers included all patients discharged from Danish hospitals with an incident TTS diagnosis were eligible. Socioeconomic factors, including marital status, cohabitation status, labour market attachment, highest formal education, family income, and psychological distress, were assessed and compared. Cox regression models were applied to analyse the data.

Results: Of 662 patients with TTS discharged alive 79 (11.9%) were men with a median age of 67 years (interquartile range: 62-77). Men with TTS were socioeconomically disadvantaged compared to women. Unadjusted analyses indicated that male gender was associated with increased mortality (hazard ratio [HR]: 2.61, 95% confidence interval [CI]: 1.18-3.25, p = 0.009). Low income, living alone, being widowed, and receiving a retirement pension were all significantly associated with 3-year mortality risk. However, in the main adjusted model, aside from the gender difference, only the Charlson comorbidity index was significantly associated with a higher mortality risk (HR: 1.26, 95% CI: 1.15-1.39, p < 0.001). No significant interactions between gender and socioeconomic variables were observed.

Conclusion: Men with TTS experienced greater socioeconomic disadvantages and higher 3-year mortality than women, with comorbidity scores significantly influencing outcomes in both genders.

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 the 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 was conducted at a single-center adult echocardiography laboratory. We included 148 patients with rheumatic MS who underwent transthoracic echocardiography 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 was then 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 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 apical four-chamber (r = 0.608, p < 0.001). The mean MLSI was 10.2 ± 2.3 mm, with a range of 7.8-13.3 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 AF, and alongside MR.

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 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 5 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) versus -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 nontraumatic chest pain were eligible. The 0/1-h 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 2 months, 199 patients (median age 54 years [interquartile range 45-70]; 52.8% female) were included. Five (2.5%) patients 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 1-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-h 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-out cases, 1-h measurements could likely be avoided, improving patient management.

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 aimed 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 15.1 μmol/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 (50 mg 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 (i.e., >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 were 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.