Cardiology最新文献

Introduction: Congenital heart disease (CHD) is a common congenital anomaly with a significant global health impact, but its genetic underpinnings remain partially understood. TBX20 gene mutations have been implicated in CHD pathogenesis, with effects on cardiac development and function. This study investigates the impact of TBX20 mutations on CHD risk through a combination of experimental analysis and meta-analysis.

Methods: Genetic screening of 353 CHD patients and 350 healthy children was conducted using high-throughput sequencing technology to identify TBX20 gene mutations. Homology modeling and molecular dynamics simulations were employed to assess the mutations' effects on the structure and function of the TBX20 protein. The impact of these mutations on the cardiac cell phenotype was further verified through in vitro experiments. A meta-analysis, incorporating literature search and quality assessment, was conducted to quantitatively evaluate the relationship between TBX20 gene mutations and CHD risk.

Results: Two critical mutations in the TBX20 gene (missense mutation I121F and synonymous mutation T262T) were identified, and bioinformatics predictions along with molecular modeling revealed potential decreases in protein structural stability. The meta-analysis, including five studies, indicated that TBX20 gene mutations significantly increase CHD risk (pooled OR = 5.73, 95% CI = 2.54, 12.91). The influence of mutant TBX20 on its mRNA expression levels and downstream target gene ANF promoter activity further supported this finding. Sensitivity analysis and publication bias assessment confirmed the robustness of the results.

Conclusion: This study confirms that TBX20 gene mutations play a significant role in the pathogenesis of CHD, affecting protein structure and function and significantly increasing CHD risk. These findings offer new insights into the genetic basis of CHD and may impact future diagnostic and therapeutic strategies.

Background: The clinical outcomes of adjunctive posterior wall isolation (PWI) beyond pulmonary vein isolation (PVI) for non-paroxysmal atrial fibrillation (AF) remain unclear. This meta-analysis was conducted to evaluate the role of PWI in non-paroxysmal AF by pooled analysis of most updated randomized controlled trials (RCTs).

Methods: A literature search in PubMed, Embase, and the Cochrane Library was performed to identify RCTs comparing the outcomes of PVI with and without PWI in non-paroxysmal AF patients. The primary outcomes were recurrence rates of all atrial arrhythmias, AF, and atrial tachycardia/flutter (AT/AFL). The secondary outcomes included total procedure time, ablation time, fluoroscopy time and procedure-related complications. Estimated risk ratios (RRs) and 95% confidence intervals (CIs) were evaluated.

Results: Nine RCTs with a total of 1,243 non-paroxysmal AF patients were included in our analysis. There were no significant differences in all atrial arrhythmias recurrence (RR: 0.86, 95% CI: 0.66-1.11, p = 0.24, I2 = 49%) and AF recurrence (RR: 0.74, 95% CI: 0.51-1.08, p = 0.12, I2 = 62%) between stand-alone PVI group and PVI plus PWI group. Adjunctive PWI increased the AT/AFL recurrence rate (RR: 1.62 95% CI: 1.08-2.42, p = 0.02, I2 = 0%). In the subgroup analysis, PWI using cryoballoon ablation was associated with a significantly lower recurrence rate of all atrial arrhythmias (p = 0.01) and AF (p = 0.02) recurrence and similar recurrence rate of AT/AFL (p = 0.15). Additional PWI was associated with an increased AT/AFL recurrence (p = 0.03) in patients with left atrial diameter (LAD) <44 mm. Adjunctive PWI needed longer ablation time, fluoroscopy time, and total procedure time. The incidence of procedural adverse events was low and similar between both groups.

Conclusion: Adjunctive PWI beyond PVI did not improve the freedom from all atrial arrhythmias and AF with an increased recurrence rate of AT/AFL in non-paroxysmal AF patients. The ablation energy and LAD might affect the clinical outcome of PWI. However, larger more RCTs were needed to verify our findings.

Background: Acute myocardial infarction (AMI) is one of the critical and serious diseases in the cardiovascular system, and reperfusion therapy is the preferred treatment for AMI, but it often worsens cardiac injury and leads to myocardial ischemia reperfusion injury (MIRI), which can further result in arrhythmia, heart failure, and death.

Summary: More and more studies have found that mesenchymal stem cells (MSCs)-derived exosomes play an important role in improving the cardiac injury after MIRI, and can exert anti-apoptosis, anti-inflammation, anti-fibrosis, and promotion of endothelial cells and angiogenesis functions. This review summarizes the mechanisms of action of exosomes in the treatment of MIRI and discusses exosomes as a new approach for the treatment of MIRI.

Key messages: 1) Exosomes play a variety of protective roles in MIRI by carrying miRNAs and other bioactive substances. 2) Exosomes can be used as carriers of drugs or active substances for the treatment of cardiovascular diseases.

Introduction: Left ventricular (LV) remodelling and fibrosis are known to occur in patients with aortic stenosis (AS) and are linked to post-intervention outcomes. These myocardial changes may be detected upon the routine 12-lead electrocardiogram (ECG) by the presence of a LV strain pattern (LVS-ECG). Although LVS-ECG has been related to excessive cardiovascular morbidity and mortality in multiple patient populations, there is currently a dearth of data upon its impact in patients undergoing transcatheter aortic valve implantation (TAVI). The aim of the current study was to investigate the prevalence, predictors, and prognostic value of LVS-ECG.

Methods: Between 2012 and 2019, 640 consecutive patients underwent TAVI at Haukeland University Hospital, Bergen. Of these, 600 patients with severe AS were included in the TAVI-NOR study. Patients with known bundle branch block (n = 85) or permanent pacing (n = 25) were excluded, leaving 490 patients (mean age 81 ± 6 years, 52% females) eligible for the analyses. LVS-ECG was defined as down-sloping, convex ST-segment depression with asymmetric T-wave inversion in V5 or V6.

Results: LVS-ECG was present in 25.7% patients. Higher levels of NT-proBNP (OR 1.96; 95% CI: 1.08-3.55, p = 0.028), left ventricular ejection fraction (LVEF) <50% (OR 3.14; 95% CI: 1.61-6.13, p = 0.001), increase in LV mass index per SD (32 g/m2) (OR 1.37; 95 CI: 1.06-1.76, p = 0.014), and the presence of LV hypertrophy on ECG (OR 3.23; 95% CI: 1.97-5.32, p < 0.001) were independent predictors of LVS-ECG in the multivariable-adjusted analysis. Although all-cause mortality was significantly higher in patients with LVS-ECG compared to those without (54.8% vs. 44.2%, p = 0.041), the presence of LVS-ECG did not predict all-cause mortality during a mean follow-up of 64 ± 24 months (HR 1.05; 95% CI: 0.79-1.39, p = 0.742). Patients with LVEF <50% and concomitant LVS-ECG had a worse prognosis than those with LVEF >50% and no LVS-ECG (p < 0.001).

Conclusions: LVS-ECG may represent a simple marker of structural and functional LV remodelling that signals a propensity to excess mortality during long-term follow-up after TAVI, as it is strongly associated with other prognosticators such as reduced LVEF and increased levels of NT-proBNP.

Introduction: The aim of the study was to investigate the differences in safety and efficacy between high-frequency stimulation (HFS) and anatomically guided endocardial catheter ablation (AA) of the ganglionated plexi (GPs) for treating vasovagal syncope (VVS) in individuals engaged in high-intensity physical training.

Methods: Forty-five patients (age 22.5 ± 4.4 years) undergoing high-intensity physical training were included from January 2020 to January 2023 at our hospital. Patients underwent GP ablation for recurrent syncope. Comprehensive evaluations, including head MRI, cardiac ultrasound, electrocardiogram (ECG), ambulatory ECG (Holter), ambulatory blood pressure monitoring, plate motion tests, and head-up tilt tests (HUT), were conducted to exclude other systemic disorders causing syncope. HFS- and AA-guided GP ablation were performed on 10 and 35 patients, respectively, all of whom tested positive for HUT. Differences between the two groups were compared regarding ablation sites, ablation time, safety, and effectiveness.

Results: The ablation time was significantly shorter in the AA group compared to the HFS group (p < 0.001). The number of GPs selected for ablation using the AA method was reduced (p < 0.001). All patients in the HFS group experienced palpitations and discomfort, whereas only 31.43% of patients in the AA group reported these symptoms (p = 0.001). Fentanyl analgesia was administered in both groups, and no significant complications arose from the ablation. The longest follow-up duration was 52 months, while the shortest was 15 months. One case of pre-syncope occurred in the HFS group 8 months post-ablation, and one case of pre-syncope and 2 cases of syncope occurred in the AA group at 1 and 3 months post-ablation, respectively. There were no statistically significant differences in heart rate variability and cardiac deceleration capacity (DC) between the two groups after ablation (p > 0.05). Two cases in the AA group still exhibited type II second-degree atrioventricular block during sleep. Both groups of patients were able to complete high-intensity physical training and showed significant symptom improvement post-ablation.

Conclusion: Young individuals with VVS engaged in high-intensity physical training can benefit from GP ablation using both HFS and AA methods. The AA method requires relatively simple equipment, shorter procedure time, and results in less discomfort during the ablation.

Introduction: There is a lack of consensus on diagnosing coronary microvascular dysfunction (CMD) using the angiography-based index of microcirculatory resistance (Angio-IMR) due to the absence of evidence. This study aimed to explore the efficacy of Angio-IMR in diagnosing CMD.

Methods: A systematic search was conducted in PubMed, Embase, Scopus, and the Cochrane Library for studies primarily focusing on Angio-IMR diagnosing CMD, using IMR as the gold standard. The primary results were pooled sensitivity, specificity, and the area under the curve (AUC).

Results: A total of 15 studies involving 2,202 individuals and 2,330 vessels were included in our study, Angio-IMR demonstrated high performance in predicting IMR with overall pooled sensitivity and specificity of 0.84 (95% confidence interval (CI): 0.81-0.87) and 0.87 (95% CI: 0.83-0.99), respectively, and AUC = 0.91 (95% CI: 0.89-0.94). This indicates that Angio-IMR has good diagnostic characteristics. Subgroup analysis by indirect meta-analysis showed higher sensitivity in the rest state. However, there is no significant difference in sensitivity and specificity between the hyperemic and rest states when using the AccuIMR system. Furthermore, sensitivity and specificity were more pronounced in the group without coronary pressure monitoring compared to the group with monitoring.

Conclusion: Angio-IMR is an alternative tool to identify CMD.

Introduction: Cardiomyopathy is a complex condition influenced by multiple genes and environmental factors. It has been suspected that cardiomyopathy is affected by the ACE gene's I/D polymorphism. Our study aimed to evaluate the association between this polymorphism and cardiomyopathy risk in the Jammu population of North India, alongside a meta-analysis to determine the specific risks associated with different types of cardiomyopathy.

Method: In the case-control study, we opted for a convenient sampling technique to gather patients from hospitals. Meanwhile, for the meta-analysis registered under PROSPERO with CRD42024519763, and in line with PRISMA guidelines, we accessed online databases and applied predefined inclusion criteria. Data extraction and quality assessment were performed using the Newcastle-Ottawa scale. Statistical analysis included genotypic frequencies, Hardy-Weinberg equilibrium testing, logistic regression models, and assessments for heterogeneity and publication bias.

Result: The case-control study revealed a significant association between the ACE I/D risk variant and cardiomyopathy risk in the Jammu population (odds ratio [OR]: 1.30, confidence interval [CI] [1.04-1.63], p value = 0.021). Furthermore, a total of 34 studies were fund-eligible for the meta-analysis and demonstrated a significant association between the risk variant and both dilated (OR: 1.25, CI [1.03-1.50], p value = 0.022) and hypertrophic (OR: 1.31, CI [1.0876-1.5776], p value = 0.004446) cardiomyopathy.

Conclusion: Our study found a significant association between the I/D polymorphism and cardiomyopathy risk in the Jammu population. Further, the meta-analysis strengthens the findings by consistently linking the ACE I/D polymorphism to both dilated and hypertrophic cardiomyopathy. These results underscore the importance of genetic factors in cardiomyopathy risk assessment and further research is needed to understand the underlying mechanisms and potential therapeutic implications.

Introduction: The diagnosis of myocardial infarction (MI) needs to be swift and accurate, but definitively diagnosing it based on the first test encountered in clinical practice, the electrocardiogram (ECG), is not an easy task. The purpose of the study was to develop a deep learning (DL) algorithm using multitask learning method to differentiate patients experiencing MI from those without coronary artery disease using image-based ECG data.

Methods: A DL model was developed based on 11,227 ECG images. We developed a new ECG interpretation algorithm through signal-guided multitask learning, building on a previously published single-task algorithm. The utility of this model was evaluated by testing 51 physicians in interpreting ECGs with and without the assistance of the DL model.

Results: The proposed model demonstrated superior performance, achieving 90.56% accuracy, 83.82% sensitivity, 93.02% specificity, 81.44% precision, and an F1 score of 82.61% in discriminating MI ECG. Overall, the median accuracy of ECG interpretation improved from 62% to 68% with the DL algorithm. Trainees and specialists in internal medicine experienced significant accuracy increases (60-66% for trainees, 72-80% for specialists). In the MI group, NSTEMI accuracy was notably lower than STEMI (33% vs. 80%, p < 0.001), but the DL algorithm improved interpretative capabilities in both NSTEMI and STEMI.

Conclusions: Signal-guided multitask DL algorithm demonstrated superior performance compared with previous single-task algorithm. The DL algorithm supports the physicians' decision discriminating MI ECGs from non-MI ECGs. The improvement was consistent in subgroups of STEMI and NSTEMI.