Cardiology最新文献

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.

Introduction: Assessing the severity of mitral stenosis (MS) is crucial for predictive and therapeutic purposes. While methods like planimetry and pressure half-time (PHT) are considered the gold standard for measuring mitral valve area (MVA), they can be operator-dependent or influenced by hemodynamic factors. Our study evaluates the accuracy of mitral leaflet separation index (MLSI) as an alternative tool for assessing rheumatic MS severity, considering its independence from hemodynamic variations. The limitations of conventional methods are discussed to underscore the need for alternative approaches.

Methods: This retrospective study was conducted at a single-center adult echocardiography laboratory. We included 148 patients with rheumatic MS who underwent transthoracic echocardiography between January 2016 and December 2020. MLSI was compared to traditional methods for determining MVA by measuring the distance between the tips of mitral valve leaflets in two-dimensional echocardiographic views which was then averaged to obtain the MLS index.

Results: Of the 148 patients (mean age 51.4 years ± 14.2 years, 76.4% female), atrial fibrillation (AF) was present in 20.3%. Among these patients, 70 reported symptoms ranging from shortness of breath on exertion class II to III. There are moderate positive correlations between averaged MVA and MLSI by PLX (r = 0.640, p < 0.001) and MLSI by apical four-chamber (r = 0.608, p < 0.001). The mean MLSI was 10.2 ± 2.3 mm, with a range of 7.8-13.3 mm. Subgroup analyses revealed stronger correlations between MLSI and MVA in patients without AF or mitral regurgitation (MR). AUROC analysis identified an MLSI threshold of <0.81 cm for severe MS, yielding an AUC of 0.84. Reproducibility analysis demonstrated excellent agreement for MLSI (ICC = 0.92, 95% CI: 0.87-0.96). Subgroup analyses also showed that the correlation between MLSI and mean gradient was stronger in patients without MR (r = -0.58) compared to those with moderate-to-severe MR (r = -0.41). Subgroup analyses showed weaker correlations in patients with significant MR or AF.

Conclusion: Our findings suggest that MLSI correlates moderately positively with MVA measured by planimetry and PHT. Thus, MLSI can serve as an additional method for assessing the severity of rheumatic MS in adult patients. This index is useful in cases of discordance between MS severities estimated by existing methods, in the presence of AF, and alongside MR.

Introduction: Ventricular-arterial coupling (VAC), which refers to harmonious interaction between the ventricles and arteries, is essential for maintenance of optimal cardiovascular function. The ratio of the pulse wave velocity (PWV) to left ventricular global longitudinal strain (GLS) has been established as a reliable noninvasive metric for assessing VAC. This study aimed to assess VAC noninvasively in heart failure (HF) using the estimated pulse wave velocity (ePWV)-to-GLS ratio, defined from speckle tracking imaging.

Methods: According to the HF stages by the American Heart Association, 131 subjects were divided into 4 groups: group 1 (n = 36) at risk of developing HF and pre-HF (American College of Cardiology/American Heart Association stages A and B), group 2 (n = 35) having HF with preserved ejection fraction (HFpEF), group 3 (n = 35) having HF with reduced ejection fraction (HFrEF), and group 4 (n = 30) as controls. To determine the ePWV/GLS ratio, the ePWV was calculated based on the previously established formula using age and mean pressure, and the GLS was derived from speckle tracking echocardiography. The study evaluated the VAC in all groups and compared with the established metrics such as arterial elasticity (Ea) and ventricular end-systolic elasticity (Ees) ratios. The correlation between the ePWV/GLS ratio and other parameters obtained by echocardiography was also assessed.

Results: Significant differences in the ePWV/GLS ratio were observed among the groups, and the severity of VAC impairment correlated with the HF stage. The lowest ePWV/GLS ratio was observed in the control and stage A-B group (0.530 ± 0.100 vs. 0.640 ± 0.10), followed by the HFpEF group (0.992 ± 0.215), whereas the HFrEF group had the highest ratio (1.500 ± 0.369). The ePWV/GLS ratio showed a moderate correlation with the Ea/Ees ratio (r = 0.753 95% CI, 0.665-0.821, p < 0.0001), but performed better in distinguishing HF subtypes. A threshold of 0.625 for the ePWV/GLS ratio was established by the ROC curve to detect the impaired VAC, with an AUROC of 0.923 and 95% CI of 0.876-0.969. In addition, the ePWV/GLS ratio was strongly associated with N-terminal pro-B-type natriuretic peptide and moderately correlated with left ventricular mass index, end-diastolic volume, left ventricular ejection fraction, age, and E/e'.

Conclusion: The ePWV/GLS ratio is an easily accessible parameter for evaluating VAC. It is closely related to the HF stage and can effectively differentiate between HF subtypes. Although the ratio was higher in patients with HFpEF than in healthy individuals, it was lower than in patients with HFrEF.

Introduction: Inflammation plays a central role in myocardial infarction (MI) and subsequent cardiac remodeling. The TETHYS study assessed the long-term effects of methotrexate (MTX) in ST-segment elevation MI patients, focusing on ventricular function and major cardiovascular events.

Methods: This was a prospective, observational follow-up study of 81 patients from the TETHYS trial, randomized to receive either MTX or placebo. The primary objective was to evaluate the long-term effects of MTX on cardiovascular outcomes using a win ratio (WR) approach, including death, reinfarction, stroke, rehospitalization, and the difference in left ventricular ejection fraction (LVEF) at 5 years. The secondary objective was to assess LVEF improvement after 180 days. A WR analysis was performed to assess cardiovascular outcomes. LVEF changes over time were analyzed using ANCOVA for repeated measures. Statistical significance was set at p < 0.05.

Results: MTX treatment resulted in significantly fewer wins in the WR analysis compared to placebo (WR 0.56, 95% CI: 0.34-0.93, p = 0.026). There was no significant difference in LVEF trajectory over time (p = 0.308). However, MTX showed a significant improvement in LVEF when comparing 180 days to 3 months: 0.009% (MTX) versus -0.105% (placebo), p = 0.020.

Conclusions: MTX did not improve long-term cardiovascular outcomes and was associated with more adverse events compared to placebo. No significant differences were found in LVEF trajectory over time. A transient improvement in LVEF was observed at 180 days but did not translate to better long-term outcomes.

Introduction: While Takotsubo syndrome (TTS) is less common in men, their mortality rates surpass those of women. The influence of socioeconomic factors and psychological distress remains unexplored. This study aimed to investigate gender differences in socioeconomic profiles and psychological distress among patients with incident TTS and to examine gender differences in survival after discharge, accounting for socioeconomic and psychological factors.

Methods: A nationwide cohort study using national registers included all patients discharged from Danish hospitals with an incident TTS diagnosis were eligible. Socioeconomic factors, including marital status, cohabitation status, labour market attachment, highest formal education, family income, and psychological distress, were assessed and compared. Cox regression models were applied to analyse the data.

Results: Of 662 patients with TTS discharged alive 79 (11.9%) were men with a median age of 67 years (interquartile range: 62-77). Men with TTS were socioeconomically disadvantaged compared to women. Unadjusted analyses indicated that male gender was associated with increased mortality (hazard ratio [HR]: 2.61, 95% confidence interval [CI]: 1.18-3.25, p = 0.009). Low income, living alone, being widowed, and receiving a retirement pension were all significantly associated with 3-year mortality risk. However, in the main adjusted model, aside from the gender difference, only the Charlson comorbidity index was significantly associated with a higher mortality risk (HR: 1.26, 95% CI: 1.15-1.39, p < 0.001). No significant interactions between gender and socioeconomic variables were observed.

Conclusion: Men with TTS experienced greater socioeconomic disadvantages and higher 3-year mortality than women, with comorbidity scores significantly influencing outcomes in both genders.