Cardiology最新文献

Introduction Inflammatory bowel disease (IBD) is a chronic inflammatory condition affecting approximately 2.39 million individuals in the United States. IBD is associated with extraintestinal manifestations (EIMs), among which pericarditis is prominent, comprising 70% of cardiac EIMs. The onset of pericarditis in these patients is primarily attributed to IBD medication-related adverse effects and is predominantly documented through case reports. This highlights the need for an epidemiological study in a large, propensity-matched cohort, given the significant morbidity and mortality of pericarditis. Methods Using the National Institutes of Health's (NIH) All of Us Research Program, we conducted a cross-sectional study and propensity-matched 5,178 IBD cases to 15,534 controls (1:3). We compared demographics, clinical characteristics, prevalence of autoimmune diseases, and rates of pericarditis. Logistic regressions assessed the association between IBD and pericarditis, adjusting for confounders (p < 0.15), and a sensitivity analysis confirmed the association (p < 0.001). A Kaplan-Meier analysis compared the incidence of pericarditis in various IBD severity cohorts, including mild (n=620) and moderate/severe (n=1,908), stratified by IBD medication exposure. Results Pericarditis was significantly more prevalent in IBD cases (1.3% vs. 0.6%; absolute risk difference (ARD) 0.7%, 95% confidence interval (CI) 0.37%-1.03%), with significant associations in univariable (odds ratio (OR) 2.2, 95% CI 1.6-3.0, p < 0.001) and multivariable analyses (OR 1.9, 95% CI 1.3-2.6, p < 0.001). IBD preceded pericarditis in 65% of cases. There was no difference in pericarditis-free survival between mild and moderate/severe cohorts (p = 0.90). Conclusion This study uniquely provides evidence of a significant association between IBD and pericarditis, establishing pericarditis as a clinically significant EIM in a large, diverse U.S. cohort, independent of disease severity. This highlights the need for heightened screening to enhance pericarditis management and patient outcomes.

Background: Patients with acute tachypnea pose diagnostic challenges in the Emergency Department (ED). Biomarkers such as N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT) improve diagnostic accuracy and risk stratification in patients with cardiovascular disease but may not be optimally assessed by clinicians in the ED.

Objectives: The aim of the Akershus Cardiac Examination 4 (ACE 4) Study is to test whether early biomarker measurements with structured feedback in patients' electronic health records using a pre-determined biomarker algorithm improves clinical outcomes in unselected patients hospitalized with tachypnea compared to standard care. The primary outcome is time to mortality or re-hospitalization.

Design: The ACE 4 Study is a single-center, pragmatic, non-pharmacological, randomized clinical trial including patients with acute tachypnea within 24 hours of hospitalization. Patients will be randomized to either early biomarker measurements and feedback in the patient electronic medical health record using a pre-defined biomarker-based algorithm to assess the risk of heart failure (intervention group) or biomarker measurements without structured feedback (control group). We will pre-register the study protocol and statistical analysis plan, and we will monitor data extraction and study execution.

Conclusion: We hypothesize that early biomarker measurements and structured feedback in the patients' electronic health records using a pre-determined biomarker algorithm will improve clinical outcomes in patients hospitalized with tachypnea compared to the standard of care. We will test this hypothesis in the ACE 4 Study using a pragmatic, electronic health record-randomized controlled design, which enables inclusion of large patient groups in daily clinical practice.

Trial registration: ClinicalTrials.Gov: NCT05699564.

Background: Transcatheter edge-to-edge repair (M-TEER) has emerged as an effective treatment for high-risk patients suffering from mitral regurgitation (MR), alleviating symptoms and improving outcomes. However, the prognostic relevance of left ventricular ejection fraction (LVEF) in this population remains unclear.

Methods: We analyzed data from 821 patients undergoing M-TEER at four German tertiary care centers between 2011 and 2022. Patients were stratified into heart failure subgroups based on LVEF: heart failure with preserved ejection fraction (HFpEF, LVEF ≥50%), mildly reduced ejection fraction (HFmrEF, LVEF 41-49%), and reduced ejection fraction (HFrEF, LVEF ≤40%). Propensity score matching was used to balance baseline characteristics. The primary endpoint was all-cause mortality, with secondary endpoints including cardiovascular mortality and major adverse cardiac and cerebrovascular events (MACCE).

Results: HFrEF patients exhibited greater comorbid burden, including higher rates of coronary artery disease and functional MR. Despite these differences, no significant association was observed between LVEF and long-term mortality, even after propensity score matching. Long-term survival rates at three years were similar across subgroups: 50.8% for HFrEF, 60.6% for HFmrEF, and 58.9% for HFpEF (p=0.2). Patients with HFrEF experienced higher in-hospital mortality (5.2%) than HFmrEF (0%) and HFpEF (2.5%), primarily due to non-cardiac causes. The overall rate of major adverse cardiac and cerebrovascular events (MACCE) was low at 3.8% (31/821) without significant difference between the respective subgroups. Multivariable analysis identified high-grade tricuspid regurgitation, chronic obstructive pulmonary disease, and impaired renal function as stronger predictors of mortality than LVEF.

Conclusions: LVEF demonstrated limited prognostic value for long-term outcomes following M-TEER, challenging its role as a standalone marker in this population. Procedural safety and efficacy were consistent across subgroups, underscoring the viability of M-TEER in surgically inoperable patients. Given the significant higher in-hospital mortality rate due to non-cardiac causes in the HFrEF subgroup, tailored therapeutic strategies addressing the underlying diseases should be pursued to optimize outcomes. Future studies should explore possible improvements in risk assessment and patient selection, for example by integrating emerging imaging modalities and accounting for comorbidities, to improve treatment outcomes.

Background: With more specific indications and improved technical support, chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has achieved substantial breakthroughs in recent years. Procedural success rates have risen steeply, accompanied by a growing number of patients who are willing to undergo CTO PCI.

Summary: Although several large observational studies and randomized clinical trials have demonstrated the trend of relief of angina after CTO PCI, robust evidence for additional benefits such as improvements in left ventricular ejection fraction, mortality, and myocardial infarction (MI) still lacks.

Key messages: Given the aforementioned issues, we sought to review latest developments in the CTO PCI patients and to provide a comprehensive discussion of the indications, safety, efficacy, and what directions for future research.

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: Graves' disease is associated with cardiovascular alterations. Data on the left ventricular (LV) function and left atrial (LA) mechanics in Graves' disease remain limited. This study investigated the relationship between disease duration and myocardial deformation parameters, including LA strain and LV global longitudinal strain (LV-GLS).

Methods: In this cross-sectional study, 90 patients with Graves' disease underwent comprehensive echocardiographic assessment. Disease duration was classified as short (≤2 years) or long (>2 years) based on receiver operating characteristic analysis. LA reservoir strain (LASr), conduit strain (LAScd), contractile strain (LASct), and LV-GLS were measured. In addition, strain parameters were compared between patients according to thyroid status (euthyroid vs. hyperthyroid).

Results: Patients with longer disease duration showed significantly reduced LASr (36.9 ± 12.0% vs. 46.3 ± 11.0%, p = 0.001), LAScd (-20.2 ± 9.3% vs. -26.3 ± 9.4%, p = 0.007), LASct (-17.0 ± 6.4% vs. -19.9 ± 5.9%, p = 0.045), and absolute LV-GLS (20.8% [18.4%-24.9%] vs. 24.3% [21.7%-27.4%], p = 0.007). Disease duration correlated negatively with LASr (r = -0.340, p < 0.001) and absolute LV-GLS (r = -0.311, p = 0.003). Multivariate analysis identified LASr (OR = 0.947, p = 0.017) and LV-GLS (OR = 0.838, p = 0.020) as independent predictors of prolonged disease duration. In euthyroid patients with longer disease duration, strain parameters were significantly lower than in hyperthyroid patients with shorter duration.

Conclusion: Longer Graves' disease duration is associated with progressive subclinical impairment of atrial and ventricular mechanics, with strain abnormalities evident even in euthyroid patients. These findings highlight the cumulative impact of disease chronicity and support the use of speckle-tracking echocardiography for early detection of myocardial dysfunction and closer cardiovascular monitoring in this population.

Introduction: A small left ventricular (LV) chamber size may reflect adverse cardiac remodeling and have prognostic implications. The prognostic significance of reductions in LV size in hearts with normal baseline LV size remains unclear. This study investigated clinical characteristics and outcomes associated with longitudinal decreases in LV size in this population.

Methods: We analyzed echocardiographic data from 6,232 adults with normal baseline left ventricular end-diastolic diameter (LVEDD), with a mean interval of 4.8 years between baseline and follow-up echocardiograms. Participants were categorized by LVEDD change from baseline: no change (<5 mm), decreased (≥5 mm), and increased (≥5 mm).

Results: A decrease in LVEDD was observed in 24% of participants (mean change -9 ± 3 mm) and was significantly associated with older age, female sex, decreased volumes, concentric remodeling, and diastolic dysfunction. LVEDD increase (13%, 9 ± 4 mm) was associated with higher prevalence of cardiovascular comorbidities and reduced LVEF. Multivariable Cox regression showed decreased LVEDD was independently associated with increased mortality (HR 1.19, 95% CI: 1.03-1.37, p = 0.02). Sensitivity analysis using annual LVEDD change (>1 mm/year) demonstrated a significant association with mortality (HR 1.45, 95% CI: 1.26-1.66, p < 0.001) and the combined endpoint of death/cardiovascular hospitalization (HR 1.26, 95% CI: 1.12-1.41, p < 0.001). Restricted cubic spline analysis confirmed a U-shaped relationship between continuous LVEDD change and mortality. Furthermore, increase or decrease in LV end-diastolic volumes was associated with increased mortality and death/cardiovascular hospitalization.

Conclusions: A progressive decrease in LVEDD in normal-sized hearts was independently associated with adverse outcomes, highlighting the prognostic importance of declining LV size.