Cardiology最新文献

Introduction: Contemporary methods of cardiovascular (CV) risk stratification are frequently inaccurate. Biomarkers such as high-sensitivity troponin I (hsTnI) have the potential to improve risk stratification. However, uncertainties exist regarding factors that determine hsTnI concentration. Our aim was to investigate the prevalence of elevated hsTnI in a large contemporary Canadian cohort and describe the effect of comorbidities on hsTnI concentration.

Methods: We report a large dataset of 41,602 visits in which hsTnI was measured routinely in ambulatory outpatients. hsTnI was remeasured in 28% of patients, with a mean time between measurements of 387 days (IQR 364-441). Low-, medium-, and high-risk categories were created based on hsTnI cutoffs for each sex. Laboratory data, blood pressure, and anthropomorphic measures were extracted from the electronic medical record.

Results: Remeasurement of hsTnI did not change risk category in 92.7% of cases. Male sex, higher HDL-C, higher Hgb A1c, decreasing eGFR, and increasing systolic blood pressure were significant predictors of increased hsTnI. High non-HDL-C and the use of statins were associated with lower hsTnI. The inverse relationship between hsTnI and non-HDL-C was partially corrected when the confounding effect of statin therapy was considered. Model fit was poor (adjusted R-squared = 0.0091).

Conclusion: Traditional CV risk factors were predictors of serum hsTnI levels; however, a significant amount of the variance in hsTnI cannot be explained by these factors alone. This suggests that hsTnI adds additional information that is not provided by traditional risk stratification methods and supports ongoing study of hsTnI as a biomarker for CV risk stratification.

Background: Autonomic innervation of the heart plays a pivotal role not only in regulating the heart rate but also in modulating the cardiac cell microenvironment via cell-cell interactions and influencing the heart's repair capabilities. Currently, the primary clinical approach for treating myocardial infarction (MI) is percutaneous coronary intervention. However, the myocardial salvage rate remains low for patients with advanced disease. MI is recognized as an autonomic nervous system disorder, marked by sympathetic hyperactivity and the loss of parasympathetic nerves. Following MI, ventricular sympathetic nerve sprouting occurs, leading to an increase in ventricular sympathetic innervation and, consequently, an increased risk of ventricular arrhythmia, which is the primary cause of sudden cardiac death in patients with a history of MI. The vagus nerve positively regulates cardiomyocyte proliferation and regeneration, enhancing ventricular remodeling and cardiac function post-MI. This process is highly significant in the treatment and rehabilitation of MI. Cardiac autonomic nerves are influenced by factors such as inflammation, immunity, intercellular communication, metabolism, genetics, epigenetics, and cytokine secretion related to cardiac mesenchymal nerves. In recent years, significant advancements have been made regarding treatment for MI, specifically in the fields of autonomic nervous system therapies, stem cell and extracellular vesicle treatments, traditional Chinese medicine acupuncture and moxibustion, and peripheral electrophysiological stimulation and bioengineering materials.

Summary: The balance of dominance between the sympathetic and parasympathetic nervous systems in the heart affects tissue regeneration and cardiac remodeling after MI. The secretion of neurons regulates the microenvironment of cardiac repair. The neural therapy of MI involves multiple fields such as traditional Chinese medicine, biomaterials, stem cell therapy, and drug research and development and has broad development prospects.

Key messages: The regulation exerted by the cardiac autonomic nervous system on the heart significantly influences the prognosis of MI. This involves nervous system modulation of inflammation and heart rate and complex interactions between neurons and cardiomyocytes, immune cells, fibroblasts, adipocytes, stem cells, and other cellular components. Genetic and epigenetic modifications, as well as shifts in energy metabolism, also play crucial roles.

Introduction: In patients with acute myocardial infarction and cardiogenic shock (AMICS), the intra-aortic balloon pump (IABP) remains the most commonly used form of mechanical circulatory support. However, information on the characteristics of nonresponders is limited. This study evaluated the risk factors associated with 30-day mortality in a cohort of patients with AMICS, on IABP support.

Methods: The medical records of patients admitted for AMICS, who underwent IABP insertion over a period of 5 years, were extracted from the electronic database of a tertiary cardiovascular disease center. The primary endpoint was 30-day all-cause mortality.

Results: A cohort of 62 patients was included in the analysis. Mechanical complications were diagnosed in 54.8% of the patients. At 30-day follow-up, mortality reached 69.3%. High arterial lactate at the time of IABP insertion (OR: 1.04; 95% CI: 1.01-1.09; p = 0.04), high arterial lactate after 24 h of circulatory support (OR: 1.07; 95% CI: 1.02-1.17; p = 0.03), and low lactate clearance at 24 h (OR: 0.51; 95% CI: 0.22-0.83; p = 0.03) were associated with 30-day mortality independent of infarct type, mechanical complications, baseline SCAI stage, creatinine, and bicarbonate value at the time of support initiation. Lactate at the time of IABP insertion and lactate at 24 h predicted 30-day mortality at a cutoff value >50 mg/dL and >27 mg/dL, respectively.

Conclusion: In a cohort of patients with AMICS who underwent IABP therapy, dynamic arterial lactate values both pre- and post-IABP insertion were independently associated with increased 30-day all-cause mortality. The dynamic changes in arterial lactate could help establish the optimal timing of circulatory support initiation and guide treatment escalation in patients at risk for adverse outcomes.

Introduction: Insufficient statin/ezetimibe effectiveness for low-density lipoprotein cholesterol (LDL-C) reduction is not uncommon. A novel gene-silencing medication inclisiran has been introduced. Near-infrared spectroscopy (NIRS) allows to assess the dynamics of plaque lipid content in the context of optimal lipid-lowering pharmacotherapy. The aim of this study was to evaluate the impact of optimal hypolipidaemic pharmacotherapy, including add-on inclisiran, on the plasma lipid profile and plaque lipid content.

Methods: This study enrolled patients with stable coronary artery disease, admitted for elective percutaneous coronary intervention (PCI). NIRS of the segment of interest was performed during index PCI and 15 months later. Patients having LDL-C >1.8 mmol/L after 4-6 weeks of maximum tolerated statin/ezetimibe therapy received add-on inclisiran. Lipid profile changes within 15 months were also evaluated.

Results: Among 42 included patients, 24 drug-resistant hypercholesterolaemia participants were assigned to inclisiran therapy. After 15 months, a significant LDL-C decrease of 26.42% was established (p = 0.006), with 12 participants reaching the LDL-C goal of <1.8 mmol/L. Average 15-month LDL-C reduction was 36.03%. NIRS data demonstrated a significant reduction in maximum lipid-core burden index within 4 mm (maxLCBI4 mm) in the inclisiran group (-117.64, p = 0.004) and statin/ezetimibe group (-141.88, p = 0.004), with no significant difference between the groups (p = 0.213).

Conclusion: Results demonstrate an association between better LDL-C control and coronary plaque lipid burden reduction. Addition of inclisiran leads to remarkable LDL-C reduction in patients who have run out of statin and ezetimibe treatment options.

Introduction: Few studies have evaluated different patterns of in-stent restenosis by optical coherence tomography (OCT). This study aimed to identify in vivo predictors for focal restenosis in patients with in-stent restenosis (ISR).

Methods: The study recruited patients with ISR who underwent OCT examination in the Cardiology Department of the Affiliated Hospital of Zunyi Medical University from October 2018 to December 2022. Based on the angiographic classification of ISR lesions, the patients were divided into two groups: the focal group (n = 58) and the non-focal group (n = 158).

Results: The white blood cell count was higher in the non-focal group than those in focal type (7.8 ± 3.0 vs. 6.6 ± 2.1, p = 0.007). The prevalence of lipid-rich plaque was higher in patients with focal ISR (65.5% vs. 42.4%, p = 0.003). The occurrence of red thrombus (27.8% vs. 12.1%, p = 0.016) and white thrombus (41.1% vs. 24.1%, p = 0.021) was higher in the non-focal group. Multivariate analysis showed that low-density lipoprotein cholesterol C (odds ratio [OR]: 3.341, 95% confidence interval [CI]: 1.714-9.784, p = 0.046) was independently associated with focal restenosis. While white blood cell count (OR: 0.814, 95% CI: 0.657-0.913, p = 0.047) and stent malapposition (OR: 0.228, 95% CI: 0.057-0.896, p = 0.037) were independently associated with non-focal restenosis.

Conclusion: There were significant differences in clinical baselines and OCT identified morphological characteristics in patients between focal and non-focal groups. Low-density lipoprotein cholesterol C was independently associated with focal restenosis. White blood cell count and stent malapposition were correlated with non-focal restenosis.

Introduction: Primary immunodeficiency diseases (PIDs) are a growing group of rarely seen diseases. Various clinical conditions like autoimmunity, lymphoproliferative/malignant diseases, chronic lung, and gastrointestinal system diseases have been identified which accompanies PIDs besides recurrent infections. However, there is a lack of information about accompanying cardiovascular diseases. We aimed to determine the frequency of cardiovascular diseases and arrhythmias in PID patients.

Methods: Forty-eight PID patients and 48 control group patients were included to this single-center, prospective controlled study. All patients underwent resting electrocardiogram, echocardiogram and 7-lead 24-h ambulatory electrocardiogram (Holter) monitoring assessed by an experienced cardiologist.

Results: Both supraventricular and ventricular extrasystoles were found to be statistically significantly higher in patient group in terms of frequency and sustained, non-sustained, and runs compared to control group. The median of total supraventricular extrasystoles was 8 (0-65) in patient group which was 0.5 (0-4.5) in control group (p < 0.001) while the median of total ventricular extrasystoles was 2 (0-45.5) and 0 (0-2) in two groups, respectively (p = 0.022). Eighteen patients (37.5%) had supraventricular and/or ventricular arrhythmias. The patient group had a statistically significantly higher systolic pulmonary artery pressure value compared to control group (20 [16-28] vs. 17.5 [15-25]; p = 0.036). We found 7 patients had 13 structural heart diseases including second degree or above valve pathologies in patient group whereas none of the control group patients had these diseases (p = 0.013).

Conclusion: With the positive findings of higher frequency and risk of arrhythmias and various structural heart diseases, we hope that our study will provide a new perspective on the management of PID patients, contributing positively to their survival and early prevention of cardiovascular comorbidities.

Introduction: A new and noninvasive technology of left ventricular pressure-strain loop (LV-PSL) has recently been used to provide information on myocardial work (MW) and identify subtle modifications in cardiac function. This study aimed to use LV-PSL for early identification of changes in left ventricular (LV) structure and MW in patients with end-stage renal disease (ESRD).

Methods: Seventy-two patients with ESRD were divided into two groups based on undergoing maintenance hemodialysis (MHD), namely, the dialysis group (ESRD-D group) and non-dialysis group (ESRD-ND group). Thirty age- and sex-matched control participants were enrolled in the N group. Traditional echocardiography and LV-PSL measurements were conducted. The values of global longitudinal strain (GLS), peak strain dispersion (PSD), global constructive work (GCW), global wasted work (GWW), global work index (GWI), and global work efficiency (GWE) were assessed.

Results: The most prevalent anomaly in ESRD patients was LV hypertrophy. The GLS value was significantly lower, and PSD was higher in patients with ESRD than in controls. Furthermore, patients with ESRD had severely higher GWW values and lower GWE than the N group (p < 0.05). No significant differences were found in GWI and GCW between the three groups (p > 0.05). Correlation analysis showed that GCW, GWI, and GWE were positively correlated with LV ejection fraction (EF) and negatively correlated with GLS. GWW was negatively correlated with LVEF and positively correlated with GLS and PSD. In addition, GWE was negatively correlated with PSD (all p < 0.05).

Conclusions: Patients with ESRD have LV structural and functional abnormalities. LV-PSL measurement can be helpful in identifying these subclinical abnormalities. MHD did not change myocardial workload in patients with ESRD.

Background: Approximately 7.6 million individuals experience a new ischemic stroke each year, and roughly 25% of all ischemic strokes are cardiogenic in origin, carrying a high risk of recurrence, death, and disability. To prevent future ischemic strokes, especially in younger individuals, it is crucial to detect and treat direct and indirect cardioembolic sources.

Summary: Cardiac imaging is a rapidly evolving field, and post-stroke cardiac imaging is no longer limited to echocardiography but also includes other imaging techniques, such as cardiac magnetic resonance imaging and cardiac computed tomography. Clinicians must be familiar with numerous cardiac and systemic disorders related to stroke and consider the possibilities that imaging diagnostics have to offer. Additional diagnostic tests, such as pre- and transcranial ultrasound with a bubble test, can also increase the diagnostic accuracy for detecting right-left shunt embolisms. Moreover, a patent foramen ovale (PFO) has traditionally been considered as a minor or uncertain risk factor for ischemic stroke. However, PFO-associated strokes are a distinct category among the cardioembolic sources, as in most cases, we do not assume that the thrombus has been developed in situ in the PFO structure or elsewhere intracardially, rather, the PFO merely acts as a mediator for a paradoxical, venous embolism. The article has two parts: Part I, the heart-brain axis, describes multimodality cardiac imaging in the assessment of cardioembolic sources of ischemic stroke, with a special focus on disorders that traditionally have received little attention in the literature. Part II discusses the brain-heart axis, namely, when acute cerebrovascular events lead to cardiac dysfunction, for example, neurogenic stunned myocardium and Takotsubo syndrome.

Key messages: Advances in cardiovascular imaging have significantly enhanced the detection of cardiac disorders associated with stroke. Clinicians involved in post-stroke workup need to be aware of the capabilities of different imaging modalities to ensure high diagnostic accuracy in order to effectively treat and prevent stroke recurrence.

Introduction: Lung transplantation (LT) is a lifesaving procedure in patients with end stage lung failure. The prevalence of coronary artery disease (CAD) in patients with lung disease is comparably high, and coronary angiography is widely used for coronary anatomy assessment prior to LT. Detection of significant CAD usually results in revascularization to minimize posttransplant cardiovascular events. We aim to examine the prognostic significance of CAD interventions on LT candidates pre- and post-LT.

Methods: From a retrospective registry of 450 LT candidates undergoing cardiac catheterization during 2014-2019, patients were assessed for the presence of significant CAD and percutaneous coronary intervention. The primary outcome was defined as occurrence of major advance cardiac events (MACE) in LT candidates while on the waiting list. MACE comprising of cardiovascular mortality, nonfatal myocardial infarction, target-vessel revascularization, and coronary artery bypass graft surgery. Secondary outcomes were the occurrence of MACE posttransplant according to the coronary intervention status.

Results: MACE was recorded in 22 LT candidates, with a higher incidence in the intervention group compared to the nonintervention group (8.3% vs. 4.4%, p = 0.007). 28.6% of MACE events in the intervention group occurred in the first month after intervention. Cardiovascular mortality accounted for 8.6% of all deaths, without significant difference between the intervention and nonintervention group (16.0% vs. 7.2%, p = 0.155). The rates of MACE post-LT were mildly and nonsignificantly increased in the intervention group compared to the nonintervention group (11.1% vs. 4.5%, p = 0.18).

Conclusion: Pre-LT routine coronary intervention does not necessarily protect patients from experiencing MACE while on the waiting list or post-LT.

Introduction: The swift uptake of new medications into clinical practice has many benefits; however, slow uptake has been seen previously with other guideline-directed medical therapies (GDMT) in heart failure (HF). Sodium glucose co-transporter 2 inhibitors are a novel therapy in HF proven to be efficacious and will have beneficial clinical outcomes if prescribed. Understanding physician perspectives on prescribing GDMT in HF can help target strategies to bridge the gap between guidelines and practice.

Methods: The study followed the PRISMA guide for scoping reviews. A search was conducted using EMBASE, Medline, and PubMed databases in April 2024. Studies included were those using qualitative methods to assess physician perspectives towards prescribing any HF medication. Common themes were identified through thematic synthesis following the methods from Cochrane Training and using software MAXQDA Analysis Pro.

Results: 708 studies were found in the search, with 23 full studies included. The most pertinent barriers identified were concern for medication adverse effects, unclear role responsibilities between physicians of different specialities, patient co-morbidities, and unwillingness to alter therapies of stable patients. The most identified enablers included awareness of efficacy, influence from colleagues, and the use of multi-media approaches for information dissemination. Perceptions were also found to change over time and vary among prescriber groups.

Conclusions: Physicians perceive common barriers and enablers of prescribing GDMT in HF, despite differences in prescriber groups and time periods. The identified barriers and enablers may be targeted to improve implementation of GDMT into clinical practice.