Cardiology最新文献

Introduction: Patients with atrial fibrillation (AF) and history of cancer face unique bleeding risks, complicating the applicability of standard bleeding risk scores like HAS-BLED. This meta-analysis aimed to evaluate the performance of HAS-BLED in predicting bleeding events in this high-risk population.

Methods: The MEDLINE, PubMed, and EMBASE databases were searched from 1st of January 2010 to 30th of November 2024 for relevant studies using keywords, such as "AF" "cancer" "bleeding," and "HAS-BLED." Data on C-statistics were extracted to assess the predictive performance of HAS-BLED score.

Results: Our analysis included seven retrospective cohort studies, recruiting a total of 436,102 patients. The quality of the included studies was deemed acceptable for analysis. The reported C-statistics for HAS-BLED score varied widely across studies, ranging from 0.45 to 0.77. Subgroup analyses demonstrated moderate discrimination in patients with breast cancer (0.56-0.80), prostate cancer (0.58-0.72), and lung cancer (0.59-0.80), while poorer performance was observed in hematological malignancies (0.45-0.70) and in anticoagulated patients (pooled C-statistic = 0.55; 95% confidence interval: 0.54-0.56). Significant heterogeneity was observed in the overall analysis and most subgroups (I2 > 90%), except for the anticoagulated subgroup. A sensitivity analysis excluding the largest study reduced heterogeneity and improved funnel plot symmetry, indicating that study size contributed to variability in HAS-BLED performance.

Conclusion: The HAS-BLED score has shown variable predictive abilities in AF patients with cancer ranging from poor to good, with notable heterogeneity across studies secondary to various contributing factors. This emphasizes the need for individualized risk assessment tailored to the unique characteristics of cancer patients to effectively guide clinical decision-making.

Introduction: The prognostic value of cardiac troponins in revascularized patients with myocardial infarction (MI) is uncertain. This study examined the relationship between peak troponin levels and adverse outcomes in a revascularized cohort from the Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS).

Methods: MENZACS enrolled patients with a first-time acute coronary syndrome from 2015 to 2019. Peak high sensitivity troponin was standardized by dividing the observed peak troponin by the upper limit of normal. The primary outcome was a composite of all-cause death or cardiovascular readmission, determined through national datasets. Troponin's relationship with outcomes was analysed using penalized spline Cox regression.

Results: Among 1,645 revascularized patients (81% male, mean age 61, 74% European, 14% Māori, 5% Pacific, 5% Indian, 3% Other; 46% ST-elevation MI (STEMI), 54% non-STEMI), higher peak troponin was associated with male sex, STEMI, current smoking, and elevated N-terminal pro-B-type natriuretic peptide levels. Over a median of 4.9 years, 402 (24%) people experienced the primary outcome. Peak troponin levels were not significantly associated with this outcome.

Conclusion: In this revascularized cohort surviving a first-time MI, the magnitude of peak troponin elevation was not associated with all-cause death or cardiovascular readmission.

Introduction: Turbulence plays a crucial role in atherosclerosis. However, it is not currently quantified in carotid ultrasound studies due to the lack of a validated method. This study aims to develop a robust method for quantifying blood flow complexity in carotid Doppler ultrasound studies using the fractal dimension of the color Doppler signal.

Methods: This is an observational study of adult outpatients with a clinical indication for carotid Doppler ultrasound. Exclusion criteria were technical difficulties in image analysis and refusal to participate. Color Doppler signal from the internal carotid artery was extracted and analyzed. Green pixels, with high Doppler-frequency variance suggestive of turbulent-like blood flow, were identified in hue-saturation-value color space. The Hausdorff fractal dimension was calculated using the box-counting method to quantify flow complexity. On each image, the goodness of fit of the linear regressions was calculated through the coefficient of determination (R2).

Results: Fifty-four patients were enrolled between August 2020 and March 2022. Critical parameters for the method were a hue range from 7.2° to 208.8° and a minimum pixel occupancy threshold of 0.0025%. The chosen metric was the amplitude of the temporal oscillation of the Hausdorff dimension. This method successfully differentiated patients with plaques with stenosis under 50% (0.24 [0.21-0.31]) from those with normal Doppler ultrasound studies (0.30 [0.24-0.35]; p = 0.0143) and those with increased intima-media thickness (0.31 [0.24-0.35]; p = 0.0405).

Conclusions: This study introduces an innovative method for assessing internal carotid artery blood flow complexity.

Introduction: Coronary angiography and percutaneous coronary intervention are essential for managing coronary artery disease, particularly in acute settings such as ST-elevation myocardial infarction. Mobile cardiac catheterization laboratories provide a potential solution for maintaining interventional cardiology services during hospital renovations, disasters, or in resource-limited settings. This study aimed to evaluate feasibility, safety, and quality of care of a mobile cardiac catheterization laboratory compared to a stationary facility.

Methods: A retrospective analysis was conducted, comparing 1,454 patients treated between 2016 and 2019 at either an interim mobile cardiac catheterization laboratory or a stationary facility. Key endpoints included door-to-balloon time, radiation dose, fluoroscopy time, contrast medium usage, and major adverse cardiac events.

Results: The door-to-balloon time was comparable between mobile and stationary facility (29 vs. 33 min, p = 0.143). Although fluoroscopy time and radiation dose were significantly higher in the mobile unit (p < 0.001), no differences in major adverse cardiac events were observed. The mobile unit demonstrated feasibility and safety for both routine and emergency interventions.

Conclusion: Mobile cardiac catheterization laboratories are a viable alternative for providing interventional cardiology services in various scenarios, including renovations, crises, and underserved regions. Optimizing equipment and workflows could further enhance their performance.

Introduction: Myocardial infarction (MI) and cancer collectively account for over 50% of global mortality. Recent studies have revealed multiple associations between these two diseases, including chronic inflammation and oxidative stress, with particular focus on hypoxia-mediated signaling pathways. In ischemic myocardium, oxygen deprivation triggers apoptosis, fibrosis, and pathological tissue reorganization; in the tumor microenvironment (TME), hypoxia drives angiogenesis, metabolic reprogramming, and immune evasion. Thus, identifying differentially expressed genes related to hypoxia in MI may provide new targets for the treatment of MI and cancer.

Methods: The specimens from MI patients in this study were retrieved from the Gene Expression Omnibus (GEO) database. Using the "limma" package in R and weighted gene co-expression network analysis (WGCNA), a set of hypoxia-related differentially expressed genes was screened out. Subsequently, these hub genes were subjected to functional enrichment analysis, and their expression levels were verified in an independent dataset. Finally, transcriptional regulatory analysis and immune infiltration analysis were conducted for the hub genes, and their expression levels and prognostic values in various cancers were evaluated.

Results: In MI samples, nine genes, namely Immediate Early Response 3 (IER3), Heme Oxygenase 1 (HMOX1), Cyclin-Dependent Kinase Inhibitor 1A (CDKN1A), Plasminogen Activator Urokinase Receptor (PLAUR), MAF BZIP Transcription Factor F (MAFF), Solute Carrier Family 2 Member 3 (SLC2A3), Jun Proto-Oncogene (JUN), Transforming Growth Factor Beta Induced (TGFBI), and 6-Phosphofructo-2-Kinase/Fructose-2,6-Biphosphatase 3 (PFKFB3), were found to demonstrate significant dysregulation and to be closely associated with the occurrence of various cancers. Pan-cancer analysis further revealed the association of hub genes with cancer prognosis. Immune analysis also revealed their associations with resting CD4+ memory T cells and gamma delta T cells in TME.

Conclusion: IER3, HMOX1, CDKN1A, PLAUR, MAFF, SLC2A3, JUN, TGFBI, and PFKFB3 are potential biomarkers for MI and cancer. Research on hypoxia-related genes may provide new therapeutic targets for these two diseases.

Introduction: Trans-thoracoscopic atrial fibrillation (AF) ablation combined with left atrial appendage excision (LAAE) is an alternative treatment approach for nonvalvular AF patients with a history of thromboembolic events. The primary objective of this research was to investigate the electrophysiological characteristics of recurrent atrial tachyarrhythmias and rhythm outcome in patients receiving repeat catheter ablation after surgical AF ablation plus LAAE.

Methods: Nonvalvular AF patients with previous thromboembolic events who underwent trans-thoracoscopic AF ablation plus LAAE and then received radiofrequency catheter ablation were enrolled. During the procedure, the reconnection of the left atrium (LA) and pulmonary veins (PVs) was investigated, and three-dimensional activation mapping of the LA and/or right atrium during atrial tachyarrhythmias was performed.

Results: From January 2014 to December 2021, 173 patients without a history of prior ablation underwent concurrent trans-thoracoscopic AF ablation and LAAE. A total of 74 patients experienced recurrent atrial tachyarrhythmias during a median follow-up period of 3.5 years (interquartile range [IQR]: 2.0 to 5.0 years) after the surgical procedure. A total of 22 patients with atrial tachyarrhythmias recurrence (11 males, aged 60 ± 9 years) underwent radiofrequency catheter ablation. Among them, 10 patients with recurrent AF were identified, and in two of them, non-PV triggers originated from the interatrial septum and the superior vena cava. Reconnected LA-PV conduction was detected in 12 patients, with a total of 27 PV gaps. Eighteen of these PV gaps were located at the roof or the bottom. Thirteen sustained atrial tachycardias (ATs) were mapped in 12 patients, including peri-mitral AT (n = 7), cavotricuspid isthmus-dependent AT (n = 3), remnant LAA-related micro-reentrant AT (n = 1), roof-dependent reentry AT (n = 1), and focal AT (n = 1). At a median follow-up of 9 months (IQR: 3-20 months) after the ablation procedure, the freedom rate from atrial tachyarrhythmias was 77%.

Conclusion: Reconnection of LA-PVs and macro-reentry ATs are common in repeat catheter ablation after surgical treatment for AF, with peri-mitral AT being the most frequently observed AT. PV gaps are most often located at the roof or bottom. Additionally, LAAE may contribute to arrhythmogenesis in certain patients. Catheter ablation targeting these mechanisms resulted in a favorable short- to mid-term rhythm outcome.

Introduction: Coronary heart disease (CHD) and colorectal cancer (CRC) are common comorbidities among the elderly population. However, there is a lack of clinical prediction tools that utilize aging-related genes to forecast the onset and outcomes of these conditions in elderly patients.

Methods: Gene expression data related to CHD and CRC were examined using The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) of the National Center for Biotechnology Information (NCBI). The differentially expressed genes (DEGs) associated with aging, CHD, and CRC were identified. Predictive models for CHD diagnosis and prognostic risk prediction for CRC were constructed using the LASSO, random forest, and SVM-RFE techniques. Nomogram models have been developed to assess the prognosis of patients with CRC. Drug repositioning was performed to evaluate the shared predictive genes for diagnosing CHD and predicting CRC outcomes.

Results: MYL9 and UL16-binding protein 2 (ULBP2) were identified as DEGs associated with aging, CHD, and CRC. Predictive models for CHD diagnosis and CRC risk prediction have been constructed. We developed a nomogram model to assess CRC prognosis and to identify MYL9 and ULBP2 as predictive genes. We assessed the potential of MYL9 and ULBP2 as therapeutic targets in elderly patients with CHD and CRC using a drug repositioning analysis.

Conclusion: We identified MYL9 and ULBP2 as aging-related markers for the diagnosis of CHD and the prognosis of CRC. In addition, we developed clinical tool models to facilitate the diagnosis of CHD and predict the prognosis of CRC, specifically in the elderly population.