Cardiology最新文献

Introduction: This study aimed to investigate the diagnostic significance of plasma transient receptor potential vanilloid 1 (TRPV1) levels in patients with acute myocardial infarction (AMI) and to evaluate its prognostic value.

Methods: A total of 152 patients diagnosed with AMI at Zhongda Hospital between May 2023 and March 2024, forming the AMI group, along with 62 non-AMI patients as the control group. Plasma TRPV1 levels were measured using enzyme-linked immunosorbent assay (ELISA) upon admission. All patients with AMI were followed up for 6 months.

Results: Plasma TRPV1 levels were significantly higher in the AMI group compared to the control group (p < 0.05). Pearson correlation analysis demonstrated that TRPV1 levels positively correlated with diabetes, lactate dehydrogenase (LDH), white blood cell count, creatine kinase, blood urea nitrogen, serum creatinine (sCr), glycated hemoglobin (HbA1c), brain natriuretic peptide (BNP), cardiac troponin I (cTnI), Gensini scores, and the number of affected vessels, while showing a negative correlation with hemoglobin and left ventricular ejection fraction. Multiple linear regression analysis identified LDH, sCr, and HbA1c as independent factors influencing TRPV1 levels. Receiver operating characteristic curve analysis demonstrated a significant diagnostic value of TRPV1 for AMI (p < 0.001). Furthermore, Cox regression analysis revealed that elevated TRPV1 levels were significantly associated with the occurrence of major adverse cardiac events (MACEs) within 6 months (p < 0.001).

Conclusion: Plasma TRPV1 is a promising biomarker for the diagnosis of AMI, with potential links to renal function and glycemic control. Additionally, TRPV1 holds prognostic value for predicting MACE within 6 months following AMI.

Introduction: Heart failure (HF) imposes a substantial disease burden, where dyskalemia is an established prognostic factor. Although time in target range (TTR) demonstrates clinical utility across cardiovascular conditions, its prognostic significance for potassium in HF with preserved ejection fraction (HFpEF) remains poorly characterized.

Methods: This secondary analysis of the treatment of preserved cardiac function HF with an aldosterone antagonist trial (n = 2,953 HFpEF patients) evaluated potassium TTR using Rosendaal's linear interpolation method (target range: 4.0-5.0 mmol/L). The primary composite endpoint included cardiovascular death and HF hospitalization. Analyses employed multivariable Cox regression.

Results: A total of 373 primary composite endpoint events (12.6%) occurred after the initial 12-month follow-up period post-enrollment. Patients in the highest TTR tertile demonstrated a significantly lower cumulative incidence of the primary composite endpoint compared to the lower tertile. Multivariable regression analyses revealed an inverse relationship between potassium TTR levels and primary composite endpoint risk (HR 0.60, 95% CI 0.46-0.79, p < 0.001), with consistent protection observed for secondary outcomes, including cardiovascular mortality, all-cause mortality, and any hospitalization.

Conclusion: Potassium TTR represents a potent independent predictor of outcomes in HFpEF, demonstrating its potential value in the management of HF.

Introduction: Carcinoid heart disease (CaHD) is a severe complication of neuroendocrine tumors, characterized by progressive fibrotic involvement of right-sided heart valves due to serotonin and other vasoactive substances. This condition significantly worsens prognosis and quality of life, yet therapeutic strategies remain heterogeneous and based on low-level evidence. The objective of this study was to systematically review diagnostic approaches and therapeutic options for right-sided valvular disease in CaHD, assessing indications, advantages, limitations, and outcomes.

Methods: A systematic review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD42023392363). Searches were performed in PUBMED/MEDLINE, LILACS, and EMBASE for studies published between 2002 and 2024. Eligible studies included clinical trials, observational studies, case series, and case reports evaluating pharmacologic, surgical, or percutaneous interventions for CaHD with reported cardiovascular outcomes. Risk of bias was assessed using ROBINS-I V2 and JBI tools.

Results: Of 183 total records, 45 studies met inclusion criteria (30 case reports, 8 case series, 7 observational studies). Tricuspid regurgitation was the most prevalent lesion (90%), followed by pulmonary regurgitation (73%). Somatostatin analogs were frequently used but did not prevent progression of valve disease. Surgical valve replacement, predominantly with bioprostheses, remains the cornerstone for severe symptomatic cases, providing symptomatic and echocardiographic improvement, but with a perioperative mortality of up to 10%. Percutaneous valve therapies, though limited to small series and case reports, demonstrated promising short-term outcomes without major complications. Additional strategies such as patent foramen ovale (PFO) closure and hepatic resection showed potential prognostic benefit. No significant difference in outcomes was observed between biological and mechanical prostheses.

Conclusions: Surgical valve replacement remains the most effective evidence-based therapy for CaHD, while percutaneous techniques emerge as feasible alternatives in high-risk patients. Adjunctive measures such as PFO closure and hepatic metastasis resection may improve prognosis. Drug therapies control carcinoid syndrome but are insufficient to halt cardiac disease progression. Further prospective studies are needed to define optimal timing, patient selection, and long-term outcomes of interventional strategies.

Introduction: Obstructive sleep apnea (OSA) is more prevalent in men than women, and the exact explanation for this is unknown. The aims of the present study were to explore the prevalence and predictors of OSA in men and women with a focus on clinical characteristics, cardiovascular disease (CVD), and serum biomarkers.

Methods: Between 2016 and 2018, 2,401 patients with suspected OSA underwent respiratory polygraphy and completed questionnaires on medical history (i.e., CVD). Height, weight, blood pressure, and blood samples were collected. OSA was classified according to the apnea-hypopnea index (AHI): no OSA (AHI <5), mild (5-14.9), moderate (15-29.9), and severe OSA (≥30). When dichotomized into no OSA vs. OSA, OSA was defined as AHI ≥15. Cardiometabolic risk factors included obesity, diabetes, dyslipidemia, and hypertension.

Results: The prevalence of OSA was 36.2% (n = 868). There were 77.4% (n = 672) men in the OSA group. The prevalences of overall CVD, atrial fibrillation, diabetes, and chronic obstructive pulmonary disease were comparable between women and men with OSA. A dose-dependent increase in the number of cardiometabolic risk factors according to the OSA severity grade was observed both in women and men. Patients having none or 1 cardiometabolic risk factor tended to have either no OSA or mild OSA, while patients with 2 cardiometabolic risk factors were more likely to have mild to moderate OSA. Patients with ≥3 cardiometabolic risk factors (53.3%) had mainly moderate or severe OSA, equally represented between women and men. In multivariate logistic regression analyses, independent predictors of OSA were age and BMI in both sexes, smoking, hypertension, and excessive sleepiness in men, and estimated glomerular filtration rate <60 mL/min/m2 in women.

Conclusions: More than half of patients with OSA had features of metabolic syndrome, evenly distributed between men and women. This requires strict control of cardiometabolic risk factors in both sexes. There were different predictors of OSA in men and women. This highlights a possible sex difference in the pathophysiology of OSA.

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.