Cardiology最新文献

Introduction: Vascular endothelial growth factor inhibitors are key drugs for cancer treatment as they inhibit angiogenesis. However, they also promote atherosclerosis in normal vessels, though the clinical relevance of this phenomenon is unreported. In this study, we investigated whether long-term multikinase inhibitor (MKI) administration is associated with incident atherosclerosis.

Methods: We evaluated 63 patients with thyroid cancer; 39 patients received MKIs for more than 1 year (MKI group) and 24 had never received MKIs and underwent computed tomography (CT) follow-up (non-MKI group). Using medical records, we retrospectively observed vessel walls on CT scans and investigated the appearance of new plaques. We also studied all new-onset major adverse cardiac events (MACE; cardiac death, nonfatal myocardial infarction, worsening of angina, coronary revascularization, and acute heart failure) that occurred during the observation period in both groups.

Results: The median observation period for the Kaplan-Meier curve for new plaques was 43 months. New plaques appeared in significantly more patients in the MKI group (44%) than in the non-MKI group (0%). A multivariate analysis revealed that only MKI administration correlated with new plaque appearance. A history of hypertension, diabetes mellitus, or statin administration was not significantly associated with new plaque appearance. The carotid artery was the predominant site for new plaques. Two patients in the MKI group and none in the non-MKI group developed MACE.

Conclusion: MKI administration may be an independent risk factor for atherosclerosis in patients with thyroid cancer. Complications associated with atherosclerotic disease should be monitored during long-term MKI administration.

Introduction: The lipid accumulation product (LAP) is a sex-specific index that reflects visceral adiposity and lipid imbalance. This study aimed to investigate the longitudinal association between LAP and cardiometabolic multimorbidity (CMM) and to assess its value in risk prediction.

Methods: Data were analyzed from 3,348 individuals (mean age = 64 years; 54.9% female) enrolled in the English Longitudinal Study of Ageing who had no prior history of hypertension, coronary heart disease, diabetes, or stroke at baseline (wave 4: 2008-2009). LAP was calculated using waist circumference (cm) and fasting triglyceride levels (mmol/L) via standardized sex-specific formulas. CMM was operationally defined as the coexistence of two or more of the following cardiometabolic disorders by wave 10 (2021-2023): hypertension, cardiovascular disease, diabetes, or stroke. Odds ratios (ORs) with 95% confidence intervals (CIs) were derived using logistic regression models with multivariable adjustment, and model performance was evaluated using discrimination metrics.

Results: During follow-up spanning 12-15 years, 197 cases of CMM were recorded. Analysis using restricted cubic splines demonstrated a linear trend between LAP and CMM risk, with no evidence of nonlinearity (p = 0.23). Each one standard deviation rise in LAP was significantly associated with elevated odds of developing CMM (OR = 1.31; 95% CI: 1.16-1.49), which remained significant after adjusting for physical activity (OR = 1.30; 95% CI: 1.14-1.47). Trends were similar across LAP tertiles. Incorporating LAP into a model with conventional risk factors modestly improved discrimination (ΔC-index = 0.0064; p = 0.32), but significantly improved model fit (-2 log likelihood test, p < 0.001).

Conclusion: Higher LAP was linearly and independently associated with increased risk of CMM in older adults. While the inclusion of LAP modestly improved model fit, its added value in enhancing risk discrimination beyond established cardiometabolic risk factors was limited in this cohort.

Introduction: Atrial fibrillation (AF) is the most common arrhythmia among patients undergoing transcatheter aortic valve replacement (TAVR). Post-TAVR permanent pacemaker implantation (PPI) predictors for patients in sinus rhythm were studied. However, scarce data are available about patients with AF. The aim of the study was to assess the prevalence of AF among patient undergoing TAVR, to identify predictors of PPI, and to study the association between PPI and long-term mortality.

Methods: A historical cohort study of all patients who underwent TAVR between 2008 and 2022 in a large tertiary medical center was conducted. Patients with prior aortic valve bioprosthesis or pacemakers were excluded. Thirty-day PPI and 3-year mortality were studied. Univariate and multivariable analyses were performed.

Results: Of the 1,579 patients who met the inclusion criteria, 405 (25.6%) had a history of AF either paroxysmal (17.1%) or persistent (8.4%). Among them, 49.9% were male and the mean age was 82 ± 6 years. The 30-day PPI rate was 21.7%. Right bundle branch block (RBBB, aOR 5.34, 95% CI: 2.79-10.21) and CoreValve/Evolut valve (aOR 2.51, 95% CI: 1.40-4.51) were significantly associated with 30-day PPI. PPI was not statistically significant associated with increased 3-year mortality.

Conclusion: AF is prevalent among TAVR patients and PPI rates among this population are high. Predictors for PPI among patients with AF are similar to prior known predictors in patients with sinus rhythm and include baseline RBBB and transcatheter heart valve type. Despite the high PPI rates, there is no association between PPI and long-term mortality among patients with AF.

Introduction: Bedaquiline improves treatment outcomes in drug-resistant tuberculosis (DR-TB), but prolongs the QT interval; the cardiac safety must be thoroughly evaluated in clinical applications. This study aims to assess the cardiac safety and possible risk factors of bedaquiline-containing regimen in patients with DR-TB.

Methods: This retrospective cohort study assessed cardiac safety in 202 patients diagnosed with DR-TB and treated with a bedaquiline-containing regimen between March 2019 and May 2024. Follow-up was conducted from 2nd to 24th weeks after treatment, including cardiovascular-related symptoms, electrocardiogram (ECG) testing, serum electrolyte testing, combined use of medicines, etc. Results: Among 202 participants, 40 (19.80%) patients experienced an absolute change from baseline (ΔQTcF) ≥60 ms (including 1 patient QTcF >500 ms), 4 patients discontinued bedaquiline due to adverse events. QTcF prolongation peaked at the 20th week, and the average QTcF values at each monitoring time point showed significant differences compared to baseline. According to the Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Events (Corrected Version 2.1) (DAIDS AE Grading Table, v2.1), 139 (68.81%) had no adverse cardiac events, 18 (8.91%) experienced grade 1-2 events, 44 (21.78%) had grade 3 events, and 1 (0.5%) developed grade 4 events. No heart failure cases or deaths were reported. Over 1,022.7 person-months of follow-up, 45 patients experienced grade ≥3 cardiac events, corresponding to an incidence rate of 4.40 events per 100 person-months. Compared to regimens without clofazimine, the concomitant use of clofazimine was significantly associated with an increased risk of grade ≥3 cardiac adverse events (OR = 3.66, 95% CI: 1.59-8.39, p = 0.002). Patients who experienced hypokalemia (4 of 202; 1.98%) during treatment showed 24-fold higher odds of grade ≥3 adverse cardiac events compared to those without hypokalemia (OR = 24.77, 95% CI: 2.44-251.78, p = 0.007).

Conclusion: QT interval prolongation is common in patients with DR-TB treated with bedaquiline-containing regimens, but the incidence of discontinuation is low. The concomitant use of clofazimine and the occurrence of hypokalemia during treatment will increase the risk of adverse cardiac events. It is recommended routine electrolyte monitoring, aggressive potassium supplementation, and cautious co-prescription of clofazimine or other QT-prolonging drugs for DR-TB patients on bedaquiline.

Introduction: Secondary tricuspid regurgitation (STR) is increasingly prevalent in heart failure (HF) patients and independently predicts adverse outcomes. This retrospective study aimed to stratify severe STR patients based on right ventricular fractional area change (RVFAC) and elucidate echocardiographic parameters influencing prognosis.

Method: Overall, 106 hospitalized HF patients with severe STR were analysed post-stabilization using transthoracic echocardiography. Patients were categorized into preserved RVFAC (≥35%, n = 75) and reduced RVFAC (<35%, n = 31) groups. Long-term outcomes were assessed over 60 months for cardiac-related events.

Results: Among 106 patients, those with reduced RVFAC had significantly worse outcomes than those with preserved RVFAC (log-rank test, p = 0.0016). In the preserved RVFAC group, independent predictors of cardiac events included age, prior HF hospitalization, lower TAPSE, higher RV sphericity index, and greater tricuspid tenting height. In the reduced RVFAC group, only TAPSE remained a significant prognostic factor. ROC analyses identified TAPSE ≤13.1 mm (AUC 0.897) and ≤13.9 mm (AUC 0.907) as optimal cutoffs for predicting cardiac events in preserved and reduced RVFAC groups, respectively.

Conclusion: RVFAC serves as an effective prognostic marker in severe STR patients, with additional assessment of TAPSE and morphological parameters enhancing risk stratification. These findings underscore the importance of comprehensive right heart evaluation in managing STR-associated HF, facilitating tailored therapeutic strategies, and improving patient outcomes.

Introduction: We aimed to review the published references regarding cardiac lead perforation subsequent to pacemaker implantation. This study evaluated the risk factors, clinical presentations, and management strategies of patients with perforated cardiac lead after pacemaker implantation.

Methods: A systematic search was performed in PubMed from its inception to September 16, 2024. The search focused on cardiac lead perforation following pacemaker implantation. The quality of the case reports and case series was assessed using Joanna Briggs Institute (JBI) Evidence-Based Health Care Center about different types of research Quality Evaluation Tool.

Results: A total of 120 case reports and 16 case series studies with 153 participants met the inclusion criteria. We found that active bipolar lead appears to be associated with cardiac perforation. Cardiac perforation was symptomatic in 88.8% of patients and asymptomatic in 11.2%. Unremarkable clinical manifestations of delayed lead perforation may range from chest pain, dyspnea, syncope or presyncope, abdominal discomfort, phrenic nerve stimulation to nausea. Imaging findings may not be limited to pericardial effusion but also include pleural effusion, cardiac tamponade, pneumopericardium, and pneumothorax. Surgical intervention was utilized in 47.1% of all included cases for pacemaker lead perforation management.

Conclusion: The incidence of cardiac lead perforation after pacemaker implantation is often underestimated. Our findings highlight the importance of vigilant monitoring for both symptomatic and asymptomatic presentations, particularly in cases involving active bipolar leads. Critically, nearly half of all cases required surgical intervention, underscoring the severity of this complication.

Introduction: Left ventricular (LV) ejection fraction (LVEF) and LV end-diastolic diameter (LVEDd) are well-established predictors of adverse cardiovascular events. However, the possible association with survival in patients with infective endocarditis (IE) treated with aortic valve replacement (AVR) is underexplored. Additionally, it is important to investigate whether sex modifies these associations.

Methods: We retrospectively recruited 170 consecutive patients with IE treated with AVR from three cardiac surgery tertiary hospitals in Scandinavia. Echocardiography was performed both pre- and postoperatively. Baseline characteristics, preoperative blood samples, postoperative complications, echocardiographic, and angiographic data were compared between surviving and deceased patients at both short- (1-year) and long-term (5-year) follow-up.

Results: The mean age in the entire study population was 58.5 ± 15.1 years, and 80.0% were males. The mean LVEF was 54 ± 11% preoperatively, decreasing to 51 ± 11% postoperatively. The mean baseline LVEDd was 5.8 ± 0.9 cm in males and 5.0 ± 0.9 cm in females (p < 0.001), decreasing to 5.2 ± 0.9 cm in males and 4.7 ± 0.6 cm in females after surgery (p = 0.006). At short-term follow-up, reduced postoperative LVEF (<50%) was more common in non-survivors (46.2% vs. 26.2%, p = 0.040), with the strongest association observed in females (71.4% vs. 25.9%, p = 0.025). Similarly, during long-term follow-up, deceased female patients had a higher prevalence of reduced preoperative LVEF (<50%) compared to surviving female patients (30.0% vs. 4.2%, p = 0.033). LVEDd was significantly greater in female non-survivors compared to survivors at both short-term (5.7 ± 1.1 cm vs. 4.9 ± 0.8 cm, p = 0.043) and long-term follow-up (5.5 ± 0.9 cm vs. 4.8 ± 0.8 cm, p = 0.046), an association not observed in male patients.

Conclusion: Our study found that both pre- and postoperative LVEF, as well as preoperative LVEDd, were associated with poorer outcomes in patients with IE undergoing AVR, particularly among female patients. These results highlight the importance of tailored clinical management strategies based on sex-specific risk profiles. Further research is needed to validate these findings and develop interventions to mitigate the observed risks.