Cardiology最新文献

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.

Introduction: This study aimed to examine the effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on cardiac structure and cardiorenal function in older adults with hypertension and pre-heart failure.

Methods: A total of 88 patients with hypertension and pre-heart failure who received care at the hospital between August 2022 and August 2024 were enrolled and randomly assigned to either a dapagliflozin group or a conventional treatment group. Changes in N-terminal pro-brain natriuretic peptide (NT-proBNP), troponin I (TnI), estimated glomerular filtration rate (eGFR), interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP), procalcitonin (PCT), left ventricular end-diastolic volume (LVEDV), ejection fraction, left atrial volume index (LAVI), and left ventricular mass index were assessed and compared between the two groups before and after 3 months of treatment.

Results: No significant differences were observed in NT-proBNP, TnI, eGFR, IL-6, and hsCRP levels between the two groups before treatment. Additionally, there were no differences in PCT, TnI, and LVEDV between the groups at 3 months post-treatment. However, IL-6, hsCRP, and eGFR levels were significantly lower in the dapagliflozin group compared to the conventional treatment group at 3 months post-treatment (p < 0.05). Additionally, the LAVI was significantly lower in the dapagliflozin group relative to the conventional treatment group, with the difference being statistically significant (p < 0.05).

Conclusion: These findings indicate that SGLT2i therapy may contribute to early myocardial remodeling and improvement in cardiorenal function in older adults with hypertension and pre-heart failure. Furthermore, prolonged SGLT2i administration appears to exert anti-inflammatory effects.

Instruction: The aim of this study was to examine the causal relationship between blood pressure and digestive tract cancers in European and Asian populations using Mendelian randomization (MR).

Methods: Summary statistics for blood pressure traits and digestive tract cancers were obtained from large-scale genome-wide association studies in European (UK Biobank, FinnGen) and Asian (Biobank Japan, KoGES) cohorts. The inverse variance weighted (IVW) method was the primary analysis, with sensitivity tests including MR-Egger, weighted median, and MR-PRESSO to assess pleiotropy and robustness.

Results: In European populations, no significant causal associations were observed between blood pressure traits and digestive tract cancers (all p > 0.05). In contrast, genetically predicted higher systolic blood pressure (SBP) was linked to increased colorectal cancer (CRC) risk in Asians (OR = 1.436, 95% CI: 1.102-1.869). Sensitivity analyses supported the robustness of this association.

Conclusions: Elevated SBP appears to be a potential causal risk factor for CRC in Asian populations, whereas no such association was observed in Europeans. Nevertheless, the causal links between blood pressure and other digestive tract cancers, as well as the underlying biological mechanisms, remain to be verified. To advance this understanding, further studies are needed to confirm ancestry-specific mechanisms and to clarify the biological pathways underlying these findings.