Cardiology最新文献

Introduction: Acromegaly is a chronic disorder characterized by excessive secretion of growth hormone (GH) and insulin-like growth factor type 1 (IGF-1), resulting in multisystem involvement. Cardiovascular complications affect up to 80% of cases and represent a major concern in advanced stages of the disease. This study aimed to determine the prevalence of acromegalic heart disease (AHD) and identify factors associated with its development in a Colombian population.

Methods: A retrospective, multicenter case-control study was carried out using data from the national RAPACO registry. Patients aged 16 years or older with confirmed acromegaly and an available echocardiogram were included. AHD was defined by structural or functional cardiac abnormalities attributable to acromegaly.

Results: A total of 193 patients with acromegaly were analyzed; 61 (31.6%) had AHD. Compared with the non-AHD group, these patients were older, had a 4.5 cm larger abdominal perimeter, and had a median time from disease onset to diagnosis of 8 years (vs. 6 years in those without AHD). Among the 61 AHD cases, the most frequent finding was isolated left ventricular hypertrophy (n = 32, 52.4%), followed by biventricular hypertrophy (n = 12, 19.7%), valvulopathy (n = 4, 6.6%), and combined LVH with valvulopathy (n = 4, 6.6%). GH and IGF-1 levels were modestly higher in AHD patients. In multivariate analysis, hypertension (HTN) showed an odds ratio (OR) of 1.75 (95% CI: 0.67-4.65) for AHD, while carpal tunnel syndrome significantly increased the odds of AHD (OR 3.81, p = 0.01, 95% CI: 1.36-11.14).

Conclusions: Despite therapeutic advances, AHD remains common in Colombian patients with acromegaly. Notably, carpal tunnel syndrome was independently associated with AHD, alongside HTN, arrhythmias, and type 2 diabetes mellitus. These findings underscore the need for proactive cardiovascular screening and management strategies in this patient population.

Background: D-dimer is a fibrinogen degradation product formed by the breakdown of cross-linked fibrin in a series of enzyme-mediated steps. Since the D-dimer assay allows for detection of thrombin production and endogenous fibrinolysis, it has been increasingly used in clinics as a screening test to exclude venous thromboembolism and disseminated intravascular coagulation. Additionally, D-dimer has been evaluated for determining the initiation of anticoagulation therapy in patients with selected cardiovascular disease.

Summary: This narrative review has evaluated the updated evidence from several recent clinical studies/trials and provides a reappraisal of the utility of D-dimer assay for disease prognosis and clinical management decisions in patients with stable coronary artery disease, acute coronary syndrome, and heart failure. We further discussed several confounding factors that may affect circulating levels of D-dimer, including those observed during the COVID-19 pandemic.

Key messages: Better understanding of the pathophysiologic mechanisms underlying D-dimer formation would improve accuracy and specificity of D-dimer as biomarker for predicting long-term outcome of the severity of coronary artery disease and heart failure.

Introduction: Clinical profiles based on congestion and perfusion are fundamental to the management of patients with heart failure (HF), but the standard assessment has been underutilized in clinical practice, due in part to its complexity. This study investigated whether congestion and perfusion status by physical examination, such as high jugular venous pressure (JVP) and peripheral cold sensation, would be informative in this context.

Methods: This prospective study consisted of 257 patients who were admitted for the treatment of HF. A body-to-peripheral temperature gradient and the presence or absence of peripheral cold sensation was assessed before discharge. JVP was considered high if visible pulsation of the internal jugular vein was observed in the seated position at rest or with inspiration, and categorized as wet. The primary outcome was a composite of all-cause death and hospitalization for worsening HF.

Results: A total of 132 (51.3%) patients were classified as cold on the peripheral sensation, with a higher temperature gradient (9.0 ± 1.8°C) than patients without peripheral cold sensation (4.8 ± 1.7°C, p < 0.01). On JVP assessment, 54 (21.0%) patients were classified as wet. During a mean follow-up period of 446 ± 280 days, 109 patients experienced a primary outcome event. The presence of peripheral cold sensation and wet condition were associated with a higher incidence of the primary outcome (hazard ratio, 1.70 and 1.62; 95% confidence interval, 1.14-2.52 and 1.04-2.52; both p < 0.01, respectively). The status of congestion and perfusion based on the standard classification and our simple physical method using peripheral sensation and JVP assessment showed similar trends in the incidence of the primary outcome at 1 year.

Conclusions: Physical assessment of congestion and perfusion status based on the presence or absence of peripheral cold sensation and wet condition by JVP assessment was practical and useful for the risk stratification of patients with HF.

Introduction: This study evaluated the effect of subclinical hypothyroidism (SCH) on coagulation parameters and the progression of coronary artery disease in patients with coronary heart disease (CHD).

Methods: A retrospective analysis was conducted on 452 patients who were diagnosed with CHD through coronary angiography between January 2020 and December 2021 at the Department of Cardiology, Jining First People's Hospital. The patients were divided into three groups based on thyroid-stimulating hormone (TSH) levels: a normal thyroid function group (244 cases), a mild SCH group (162 cases), and a severe SCH group (46 cases). General demographic data, coagulation parameters, number of affected coronary vessels, stenosis location, and stenosis severity were compared across the groups.

Results: (1) Significant differences were observed among the three groups in terms of sex, age, TSH, free tri-iodothyronine (FT3), free thyroxine (FT4), triglycerides, total cholesterol, low-density lipoprotein cholesterol, fibrinogen, prothrombin time, activated partial thromboplastin time, D-dimer, mean platelet volume, and platelet distribution width (p < 0.05). (2) The Gensini scores were 27 (17, 43.88) for the normal thyroid function group, 37.5 (25, 52.25) for the mild SCH group, and 48 (32.88, 73.75) for the severe SCH group, showing statistically significant differences (p < 0.05). (3) There was a positive correlation between Gensini score and TSH (r = 0.243, p < 0.05) and negative correlations between Gensini score and both FT3 (r = -0.139, p < 0.05) and FT4 (r = -0.12, p < 0.05). (4) TSH level, hypertension history, and lipoprotein(a) were identified as risk factors for Gensini score (p < 0.05).

Conclusion: Patients with CHD and SCH present a hypercoagulable state and an elevated risk of thrombosis. TSH levels are linked to the severity of coronary artery stenosis, underscoring the importance of early thyroid function testing in patients with CHD to inform treatment decisions.

Introduction: The challenging and restrictive settings have been proposed in the updated indications for endomyocardial biopsy (EMB), but no data shows its performance. This study aimed to evaluate the diagnostic yield and find its clinical predictors.

Methods: All EMB performed between 2018 and 2022 were reviewed. Their clinical scenario and diagnostic yield were categorized retrospectively. Repeated and inadequate biopsies were excluded. Multivariate analysis was used to find the predictors.

Results: A total of 681 cases were collected (median age 44.0 years, 65.5% male) and 230 cases (33.8%) yielded specific diagnosis. The higher yield (52.8%) was found in clinically suspected myocarditis while no significant difference between cases with and without acute unstable hemodynamics (66.7% vs 47.1%; P=0.130). There was a much higher yield in unexplained restrictive or hypertrophic cardiomyopathy (RCM/HCM) with suspected infiltrative or storage disorder compared to those without (86.2% vs 10.3%; P<0.001). Dilated cardiomyopathy showed a lower yield, with or without recent-onset moderate-to-severe cardiac dysfunction (13.6% vs 16.3%; P=1.000). The same was true for unexplained atrioventricular block and ventricular arrhythmias (AVB/VA), with or without obvious structural abnormalities (8.2% vs 10.3%; P=0.675). On multivariate analysis, diffuse late gadolinium enhancement (odds ratio [OR] 4.14, 95% confidence interval [CI] 1.86-9.25; P=0.001), time course of disease ≤12 months (OR 3.31, 95% CI 1.75-5.57; P<0.001), elevated（≥1250 pg/ml）NT-proBNP (OR 2.91, 95% CI 1.67-5.06; P<0.001), and elevated (>0.068 ng/ml) hs-cTnI (OR 2.37, 95% CI 1.33-4.22; P=0.004) were independently associated with diagnostic yield.

Conclusion: Our results partially support the restrictive settings. EMB can achieve higher yield for unexplained RCM/HCM with suspected infiltrative or storage disorder, as well as strictly defined clinically suspected myocarditis, even in hemodynamically stable patients. However, the restrictive settings of unexplained AVB/VA and dilated cardiomyopathy did not show a clear advantage in diagnostic yield. The predictors this study found may help clinicians in selecting adequate candidates.

Background: Imbalances in gut microbiota are linked to chronic diseases, including heart failure, where shifts in microbial composition are evident in patients with reduced ejection fraction (HFrEF). This study compared gut microbiome profiles between HFrEF patients and healthy controls and explored potential links between microbiome composition and patient survival over 6 and 12 months.

Methods: In this longitudinal case-control study, 20 HFrEF patients and 40 healthy controls were recruited, with stool samples collected for gut microbiome analysis. Patients were followed for six and twelve months to assess survival. Gut microbiome composition was analyzed using real-time PCR for specific bacterial taxa. Statistical analyses were performed using R to compare HFrEF and control groups and draw the ROC curve to predict survival at six and twelve months.

Results: HFrEF patients showed a significantly lower abundance of all bacterial taxa, except for A. muciniphila. Decreased levels of Prevotella, F. prausnitzii, Firmicutes, and Bacteroides, as well as a lower Firmicutes/Bacteroidetes (F/B) ratio, were notable in HFrEF patients, with specific taxa correlating with clinical features like ascites and vitamin D levels. Most bacterial taxa and the F/B ratio could distinguish HFrEF patients from controls, though none effectively predicted survival outcomes at six or twelve months.

Conclusion: The study demonstrates that patients with HFrEF exhibit a distinct gut microbiome profile compared to healthy individuals. While specific gut bacteria were effective in distinguishing HFrEF patients from healthy controls, their ability to predict survival outcomes was limited, highlighting the need for further research into the role of the gut microbiome in the progression and prognosis of heart failure.

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 Limited evidence guides clinicians regarding the agent selection between bumetanide and torsemide in patients with heart failure (HF). The present study aimed to compare the efficacy and safety profile of bumetanide and torsemide in patients with HF. Methods Patients aged > 18 years with HF with reduced ejection fraction (HFrEF) receiving either bumetanide or torsemide were included from the TriNetX research network. Patients with end-stage renal disease were excluded from this study. The primary outcome was all-cause mortality, and secondary outcomes included all-cause hospitalization or emergency department visits, acute kidney injury, or hypokalemia over one- year follow-up period. Results After propensity score matching, 16,277 patients in each group were included. The use of bumetanide was significantly associated with a higher risk of all-cause mortality (19.7 vs. 16.0 %; OR 1.28; 95% CI [1,21, 1.36]) compared to the torsemide group. The use of bumetanide was also significantly associated with higher risks of all-cause hospitalization or emergency department visits (53.3 vs. 48.3%; OR 1.22 95% CI [1.17, 1.28]), acute kidney injury (33.4 vs. 27.1 %; OR 1.35; 95% CI [1.29, 1.42]), and hypokalemia (16.6 vs. 13.7%; OR 1.21, 95% CI [1.17, 1.33]) compared to the torsemide group. Conclusion The use of torsemide in patients with HFrEF is associated with lower risks of clinical outcomes than bumetanide. Further investigation of this association is warranted in clinical trials.