Cardiology最新文献

Introduction: The outcome of patients with hypertrophic cardiomyopathy (HCM) largely depends on the presence of ventricular arrhythmias. T2 mapping is a well-documented cardiovascular magnetic resonance (CMR) sequence for edema evaluation and quantification. Our aim was to evaluate whether T2 mapping values might predict ventricular arrythmias and clinical outcome in patients with HCM.

Methods: Consecutive patients (n = 48, mean age 50 ± 18 years) with HCM and healthy volunteers (n = 21, mean age 44 ± 5 years) underwent a CMR scan (3 Tesla scanner). T2 mapping values were presented using a 16-segment AHA model and divided into 3 tertiles. Late gadolinium enhancement (LGE) was calculated as percentage of left ventricular mass. Ventricular tachycardia (VT) was recorded by 24-h Holter monitoring or during exercise stress test. The clinical endpoint was defined as the presence of VT, admission due to arrhythmias, and implantable cardioverter defibrillator insertion.

Results: The clinical endpoint was documented in 69%, 62%, and 50% of the third, second, and first T2 mapping tertiles, respectively (p for trend = 0.03). A multivariate analysis including age, gender, LGE, and T2 mapping demonstrated that T2 mapping was an independent predictor of the clinical endpoint as a continuous variable (OR 1.56; 1.03-2.38, p = 0.04) and the third T2 tertile (OR 22.80; 1.40-361.60, p = 0.03), respectively.

Conclusion: Elevated T2 mapping values were found to be an independent predictor of the clinical endpoint in HCM patients. These results highlight the potential role of edema in HCM arrhythmias.

Introduction: Intracoronary acetylcholine provocative testing is the gold standard method for the assessment of epicardial and/or microvascular spasm, with the latter diagnosed when there are acetylcholine (ACh)-induced chest pain and ischaemic electrocardiogram changes in the absence of epicardial spasm. While epicardial spasm can be visualised, microvascular spasm cannot and remains a presumed diagnosis.

Methods: This article describes a hydrodynamic model developed to calculate the epicardial and microvascular resistances for both pre- and post-ACh administration. The model is based on the concept of two resistances (epicardial and microvascular) located in a series arrangement. The epicardial resistance is obtained as a hydraulic resistance, accounting for the friction resistance between the coronary blood flow and the arterial walls. The microvascular resistance is calculated by subtracting the epicardial resistance from the ratio of the pressure and flow measured using coronary guidewire-based techniques.

Conclusion: This novel methodology provides key insights into the physiological characteristics of epicardial and microvascular spasm during ACh provocation testing. Further clinical validation is required to explore the clinical utility of this methodology.

Introduction: Transition of care (ToC) is a critical time that requires effective management, especially for patients with cardiovascular disease, who have complex health needs. Pharmacists can play an integral role in improving medication safety and care coordination at ToC. This review determined the types of pharmacist-led multidisciplinary ToC services and associated outcomes in patients with cardiovascular disease.

Methods: A systematic literature search of four databases; PubMed, Embase, CINAHL, and Scopus, was undertaken from inception until June 2023. Abstracts and full text were screened against eligibility criteria. Extracted data included study characteristics, ToC service descriptions, primary and secondary outcomes, limitations, and key findings. Study findings were synthesised narratively. The types of in-patient and post-discharge activities and their effect on patient outcomes were critiqued and presented.

Results: Of the 1822 studies identified, 37 were included in the final review. The most common primary outcome reported was 30-day all cause readmissions (n=14). Pharmacist-led ToC services incorporated a diverse combination of inpatient and post-discharge activities. The most common in-patient activities included medication history and reconciliation, patient medication education, and medication review and optimisation. The most common post-discharge activities were medication review and optimisation, adherence assessments, and medication education. Multifaceted ToC services that involved inpatient and post-discharge activities demonstrated statistically significant changes in readmission rates and other patient reported outcomes.

Conclusion: A variety of multifaced approaches to pharmacist-led ToC services have been evaluated within many studies, reporting favourable effects on outcomes for patients with cardiovascular disease. Tailoring ToC services to specific patient populations and settings, targeting activities to high-risk patients, and a multidisciplinary approach, are important to optimise ToC and patient outcomes.

Introduction: Rheumatic heart disease (RHD) is a globally important public health issue. China, as a populous country, has daunting challenges posed by RHD-related morbidity and mortality in the public health system. Evaluating and comparing the differences in the RHD burden of children and adolescents versus adults in China not only helps optimize domestic prevention and control strategies but also provides a reference for regional practices in RHD control.

Methods: Open data from the 2021 Global Burden of Disease database were utilized to analyze the characteristics of the RHD burden of children, adolescents, and adults in China, including changes in morbidity and mortality. Joinpoint was utilized to calculate the average annual percentage change (AAPC). A comprehensive comparative analysis was undertaken on the differences in RHD burden in Chinese children, adolescents, and adults from multiple dimensions such as age, gender, and time.

Results: From 1990 to 2021, the number of deaths of RHD in children and adolescents in China exhibited a declining trend compared to that in adults. In terms of the number of incidences, all age groups showed a declining trend except for those aged 55 and above, which manifested an upward trend. The crude incidence and crude mortality rates both declined during the same period, with their AAPC being -0.53 (95% CI: -0.61, -0.46) and -8.13 (95% CI: -8.65, -7.61) for those aged under 20 years, and -1.92 (95% CI: -2.05, -1.80) and -2.98 (95% CI: -3.18, -2.79) for those aged 20 years and above. The incidence and mortality rates had a bearing on patient age, with higher incidence rates observed in children and adolescents and higher mortality rates observed in adults. According to the analysis of gender differences, the incidence of children and adolescents was higher in men, while women always had a higher crude incidence rate (CIR) and mortality rate (CDR) than men (CIR in 2021: 21.31/100,000 for women vs. 20.08/100,000 for men; CDR: 0.05/100,000 for women vs. 0.06/100,000 for men). The mortality rate of adult women was particularly prominent. The number of cases in children and adolescents exhibited a "W-shaped" fluctuation, while the adult group showed an "M-shaped" trend. The overall CIR and CDR both exhibited a downward trend.

Conclusion: The burden of RHD is linked to age and gender, with a high incidence in young people and a high mortality rate in adults. Women are more prone to develop the disease and have a higher risk of mortality. Given China's large and aging population, RHD remains a major public health challenge in China. Effective prevention and control strategies should be underscored.

Introduction: The effectiveness and safety of oral anticoagulants (OACs) in patients with chronic kidney disease (CKD) and non-valvular atrial fibrillation (NVAF) in frail elderly patients have not been fully established. We aimed to evaluate the safety and effectiveness of OACs in frail elderly patients with atrial fibrillation (AF) and stage II-III CKD.

Methods: Frail elderly patients ≥65 years with AF and CKD who received OAC from January 2022 to June 2024 were retrospectively identified. Primary endpoints were composite of ischemic stroke and systemic embolism (IS/SE), and composite of intracranial hemorrhage (ICH) and/or gastrointestinal (GI) bleeding. Secondary endpoints included any bleeding.

Results: The study enrolled 365 patients, of whom 141 (38.6%) initiated warfarin therapy and 224 (61.3%) initiated DOACs. CHA2DS2-VASc score was nonsignificant (2.6 ± 1.01 vs. 2.8 ± 0.89, p value 0.054), for GFR ≥60 and GFR <60 mL/min/1.73 m2 patients, respectively. HAS-BLED score (1.9 ± 0.67 vs. 2.3 ± 0.70, p value 0.071) for GFR ≥60 and GFR <60 mL/min/1.73 m2 patients respectively. While the observed incidence of ICH/GI bleeding was numerically higher in patients with GFR <60 mL/min/1.73 m2, Cox proportional hazards regression did not demonstrate a statistically significant difference in hazard between the groups. The incidence of composite IS/SE was 8.5% in GFR ≥60 mL/min/1.73 m2 versus 8.7% in GFR <60 mL/min/1.73 m2 (HR 1.02, 95% CI: 0.60-1.74, p = 0.24). Composite ICH/GI bleeding occurred in 7.1% versus 9.3% (HR 2.15, 95% CI: 0.91-4.56, p = 0.41).

Conclusion: In this study comparing frail elderly patients with NVAF and CKD stage II versus stage III receiving OACs, we observed no significant difference in the risk of IS/SE or ICH/GI bleeding between groups. These findings suggest that within moderate CKD (eGFR 30-89 mL/min), renal function stage may not independently influence OAC-related outcomes when anticoagulation is well managed. Our results may not generalize to less frail populations or those with advanced CKD. Further prospective studies with larger sample size are needed to provide clearer guidance on the optimal use of OACs in this challenging clinical scenario.

Introduction: Myocardial infarction (MI) is one of the leading causes of death from cardiovascular diseases (CVDs). Despite various drugs and treatments, the outcomes have often been unsatisfactory. The purpose of this meta-analysis aimed to analyze the effects of polypill intervention on the incidence of MI and the related risk factors, blood pressure, and blood lipids.

Methods: We conducted a systematic search of appropriate randomized controlled trials (RCTs) in various databases, utilizing preset search terms. Then, we performed a meta-analysis of individual participant data, including studies that investigated the effectiveness of polypill (a fixed-dose combination drug) as compared to usual care in preventing MI. The primary outcomes are MI, CVD mortality, major adverse cardiovascular event (MACE), and all-cause mortality. Secondary outcomes include blood pressure levels (systolic blood pressure [SBP], diastolic blood pressure [DBP]), serum lipid levels (total cholesterol [TC], low-density lipoprotein cholesterol [LDL], and high-density lipoprotein cholesterol [HDL]).

Results: A total of 14 trials (N = 59,346) were included, with a mean age of 63.2 ± 10.0 years. The results showed that compared to the usual care group, polypill group was associated with a significant reduction of the incidence of MI (OR = 0.76; 95% CI: 0.59 to 0.99; p = 0.04) and MACE (OR = 0.79; 95% CI: 0.65 to 0.97; p = 0.03). The risk reduction for CVD mortality (OR = 0.85; 95% CI: 0.65 to 1.11; p = 0.20) and all-cause mortality (OR = 0.99; 95% CI: 0.95 to 1.03; p = 0.59) did not reach statistical significance contrast with the usual care group. Participants who were in polypill group was observed that the change of SBP level (SMD = -0.13; 95% CI: -0.25 to 0.00; p = 0.04), DBP level (SMD = -0.13; 95% CI: -0.19 to -0.06; p = 0.00), and LDL level (SMD = -0.21; 95% CI: -0.36 to -0.06; p = 0.01) reached statistical significance. However, the change of HDL level (SMD = -0.01; 95% CI: -0.06 to 0.04; p = 0.62) and TC level (SMD = -0.15; 95% CI: -0.32 to 0.01; p = 0.06) did not show remarkable difference.

Conclusion: These findings suggested that polypill not only is highly effective for preventing MI and reducing the incidence of MACE but also can lower blood pressure levels and blood lipid levels.

Introduction: Patent foramen ovale (PFO) is a prevalent congenital heart malformation closely linked with migraine. The effect of PFO size on migraine remains controversial.

Methods: This study analyzed migraine patients who underwent PFO closure at our institution from January 2020 through December 2022. Based on transthoracic echocardiography findings, the patients were classified into two groups through two distinct classification approaches: method A - permanent shunt (PS) group or non-PS group, and method B - large shunt under Valsalva maneuver (LSVM) group or small-to-moderate shunt under Valsalva maneuver (SMSVM) group. Migraine improvement and adverse events after PFO closure were recorded.

Results: A total of 201 migraine patients were included in this study, 110 (54.7%) had PS and 118 (58.7%) had LSVM. The PS and LSVM groups experienced less migraine burden (57.1 ± 64.5 vs. 88.5 ± 96.5 h, p = 0.035; 59.7 ± 67.3 vs. 88.9 ± 96.6 h, p = 0.039). The LSVM group had shorter headache episode durations (11.0 ± 8.2 vs. 14.4 ± 12.3 years, p = 0.045). The PS and LSVM groups showed less absolute reduction in migraine burden (33.8 ± 55.2 vs. 71.2 ± 84.9 h, p = 0.032; 33.9 ± 50.5 vs. 76.3 ± 92.8 h, p = 0.008). The LSVM group had a lower rate of alleviation (79.7% vs. 95.2%, p = 0.018). Medium-to-large residual shunt (MLRS) and SMSVM were independent predictors of migraine improvement, and a history of cryptogenic stroke (CS) was a predictor of migraine termination.

Conclusion: SMSVM PFO in migraine patients has significant clinical implications and positive intervention outcomes. Both SMSVM and MLRS are associated with migraine relief, and a history of CS is a predictor of migraine termination.

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: Fasting plasma glucose (FPG) fluctuations are increasingly recognized as potential prognostic markers in cardiovascular diseases. However, the association between changes in FPG before and after heart failure (HF) diagnosis and long-term mortality remains unclear. This study aimed to evaluate the impact of FPG changes surrounding HF diagnosis on all-cause mortality to inform individualized HF management strategies.

Methods: This prospective cohort study was conducted using data from the Kailuan study. A total of 3,533 patients newly diagnosed with HF were included after excluding individuals with a history of HF, malignancies, or missing FPG data. FPG levels measured before and after HF diagnosis were used to classify participants into five groups: significant decrease (Q1), mild decrease (Q2), stable (Q3), mild increase (Q4), and significant increase (Q5). The primary outcome was all-cause mortality, with follow-up through December 31, 2021. Survival outcomes were evaluated using Kaplan-Meier curves and multivariate Cox regression models.

Results: During a mean follow-up of 5.63 ± 3.80 years, 1,446 all-cause deaths were recorded. Kaplan-Meier analysis demonstrated a significantly higher mortality risk associated with greater changes in FPG levels (log-rank p < 0.0001). In multivariable Cox models, both the Q1 (significant decrease) and Q5 (significant increase) groups exhibited elevated mortality risks compared to the Q3 (stable) group, with adjusted hazard ratios of 1.37 (95% CI: 1.12-1.67) and 1.35 (95% CI: 1.12-1.62), respectively.

Conclusion: Significant changes in FPG before and after HF diagnosis are independently associated with increased all-cause mortality. These findings highlight the importance of maintaining glycemic stability and support the need for personalized glucose management strategies in patients with HF.