Cardiology journal最新文献

Background: Because renal and cardiac function are key to the prognosis of patients with coronary artery disease, we compared three-year clinical outcomes based on the degree of left ventricular ejection fraction (LVEF) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) with or without chronic kidney disease (CKD) METHODS: A total of 4567 patients diagnosed with NSTEMI were enrolled and stratified into CKD (1270 patients) and non-CKD (3297 patients) groups. Each group was further classified into heart failure (HF) with reduced EF (HFrEF), HF with mildly reduced EF (HFmrEF), and HF with preserved EF (HFpEF) subgroups. The primary outcome was all-cause death.

Results: In both the CKD and non-CKD groups, the adjusted rates of all-cause death (both p < 0.001) and cardiac death (CD, both p < 0.001) in the HFrEF subgroup were significantly higher than in the HFmrEF and HFpEF subgroups. However, within the CKD group, the all-cause death rate was comparable between the HFmrEF and HFpEF subgroups. In contrast, within the non-CKD group, the rates of all-cause death (p = 0.005) and CD (p = 0.008) were significantly higher in the HFmrEF subgroup compared to the HFpEF subgroup. The increased all-cause death in the CKD group, relative to the non-CKD group, within the HFpEF subgroup contributed to these outcomes.

Conclusions: Regardless of CKD status, the HFrEF subgroup showed higher mortality rates compared with the HFmrEF and HFpEF subgroups. However, the mortality rate differed between the HFmrEF and the HFpEF subgroups in both the CKD and the non-CKD groups.

Mitral valve regurgitation is the second most common valve defect in Europe among adults. Primary mitral regurgitation (MR) results from structural abnormalities of the valve apparatus (e.g., leaflet prolapse, chordae rupture), often due to myxomatous degeneration or congenital defects. Secondary MR arises from left ventricular remodeling (e.g., after myocardial infarction or heart failure), leading to functional valve incompetence despite normal valve structure. The choice of treatment depends on the degree of valve regurgitation and the severity of the patient's clinical symptoms. The focus herein is on discussing the anatomy of the mitral valve, the pathophysiology of regurgitation, and diagnostic methods. The qualification process is then outlined for invasive treatment and various methods of mitral valve repair, including new minimally invasive techniques. Transcatheter mitral valve repair methods are discussed, among other methods, "edge-to-edge" repair and transcatheter mitral valve replacement. Publicly available data confirms that the latter is a widely available and safe treatment method, that represents a promising alternative to surgical treatment.

Background: Excessive salt consumption is one of the most important and modifiable risk factors for cardiovascular disease (CVD). Despite general awareness of its cardiovascular impact, knowledge about other health consequences of excess sodium varies considerably, even among medical professionals. This study was conducted to examine whether domain-specific knowledge about salt-related health effects is predictive of professional affiliation with the medical community (medical education/degree) and explored its implications for cardiovascular prevention.

Methods: An international online survey (PoLA/ILEP) of 668 adults was conducted using the CAWI method. The questionnaire included 17 items assessing knowledge in five domains - cardiovascular, metabolic, renal, neuropsychiatric, and bone health - as well as awareness of dietary salt sources and self-monitoring of personal health parameters. Associations between domain-specific knowledge and medical education were analyzed using proportional odds logistic regression (POLR), adjusting for age, sex, place of residence, and number of cardiovascular risk factors.

Results: Knowledge of cardiovascular and neuropsychiatric consequences was strongly associated with medical education (OR 21.7 and 1.66; p < 0.05). In contrast, a better understanding of metabolic, renal, and bone effects was linked with lower odds of medical education (OR 0.28-0.54). The strongest predictor was self-awareness of personal cardiovascular parameters (OR = 37.97; p < 0.0001). Among rural residents, these relationships were particularly pronounced.

Conclusions: Medical professional identity is associated with structured, domain-specific knowledge about the health effects of salt consumption, particularly in relation to CVD. Expanding educational efforts to address under-recognized consequences of sodium excess may improve salt-reduction strategies and enhance cardiovascular disease prevention.

Background: Diagnosis of coronary microcirculatory dysfunction with wire-based methodology imposes a risk of unplanned revascularization in patients with ischemia and no obstructive coronary arteries (INOCA). Non-invasive, angiography-based methods are introduced to alleviate this risk. The angiography-based index of microcirculatory resistance (IMRangio) is a computational fluid dynamics (CFD)-based index utilizing high-quality angiography and aortic pressures to calculate a surrogate of the index of microcirculatory resistance (IMR).

Aim of the study: This study aims to assess the correlation between IMRangio and invasive thermodilution-based IMR in INOCA patients qualified to the MOSAIC-COR registry.

Methods: Data from 74 patients (92 coronaries including 52 left anterior descending arteries) from the MOSAIC-COR registry were used for this sub-analysis. All patients had undergone complex coronary physiology assessment using a thermistor-equipped wire and thermodilution-based methodology with subsequent vasomotor acetylcholine vasospasm testing. Post-hoc, CFD-based angiogram analysis was performed to calculate IMRangio values.

Results: The median age of patients was 64 years, and 59.3% were female. The median calculated value of IMRangio was 29 (Q1-Q3: 22-46), whereas the invasively measured IMR median value was 17 (Q1-Q3: 13-26). A significant correlation between IMRangio and invasive-IMR was observed (Spearman rho 0.29, < 0.001). Angiography based index of microcirculatory resistance area under the curve (AUC) was 62.2, and a value > 46.5 U was identified as the best cut-off for prediction of IMR > 25 and provided 38% sensitivity and 82% specificity to detect coronary microcirculatory dysfunction (CMD).

Conclusion: S: The angiography-based index of microcirculatory resistance significantly correlates with invasively measured IMR; however, a higher cut-off value should be considered to improve the specificity of the method to detect CMD.

Background: The global mortality rates due to cardiovascular diseases (CVD) are still alarmingly high, highlighting the need for accurate assessment of the risk of severe cardiovascular (CV) events. To address this, the Pol-SCORE and SCORE2 scales have been developed.

Methods: We conducted an observational and retrospective analysis of 450 patients with LDL ≥ 100 mg/dL admitted to the Clinical Hospital of the Medical University of Warsaw between 2019 and 2020. The objective of our study was to assess the treatment in patients with high levels of LDL cholesterol, without pre-existing CVD, by estimating their CV risk using the Pol-SCORE and SCORE2 scales.

Result: We enrolled a total of 150 patients in the study: 86 women (57.3%) and 64 men (42.7%), with an average age of 55.1 years. The high-risk category in the SCORE2 scale included patients with low, moderate, high, and very high risk estimated in the Pol-SCORE scale. It was statistically significant (p < 0.0001) in the distribution of risk assessment results between groups of CV risk.

Conclusions: According to research, the Pol-SCORE scale has been found to potentially underestimate the likelihood of CV events occurring when compared to the SCORE2 scale, which has a more cautious and restrictive approach. Patients with high and very high risk of fatal and non-fatal CVD are not receiving appropriate treatment. To identify and implement proper recommendations and treatments for patients with elevated risk, the SCORE2 scale should be utilized to estimate CV risk events.

Background: Aortic stenosis (AS) is the most common valvular pathology in Europe and North America, with its prevalence rising due to age-related degeneration and calcification of the aortic valve. The global number of transcatheter aortic valve replacement (TAVR) procedures is rapidly increasing. Nevertheless, the ischemic cerebrovascular events remain among the most significant complications of this procedure. This study aimed to assess the long-term incidence of neurological events and identify the most powerful predictors of stroke following TAVR in a high-volume cardiovascular care center.

Methods: 705 patients who underwent TAVR between January 2016 and September 2022, with a median follow-up of 60 months were analyzed. Baseline patient characteristics, procedural data, and long-term neurological outcomes were evaluated.

Results: At five years the cumulative incidence of any neurological events, strokes and disabling strokes reached 28.5%, 20.3% and 13.2%, respectively. Periprocedural strokes occurred in 1.4% of patients. The multivariable analysis performed was aimed at identifying the relationship between a range of clinical and procedural variables and the incidence of stroke within five years following TAVR.

Conclusions: The findings highlight the importance of long-term neurological follow-up after TAVR, as stroke mechanisms evolve over time - from periprocedural embolization to thrombus formation or chronic conditions like frailty and atherosclerosis. Future research should focus on more targeted stroke prevention and long-term management strategies enhancing safety for the TAVR recipient population.

Background: Iron deficiency (ID) impacts prognosis and quality of life for heart failure (HF) patients. It is essential to actively search for ID in this group and establish its relationship with nutritional status. The aim was to determine the relationship between nutritional status according to the Mini Nutritional Assessment (MNA) questionnaire and the presence of ID in heart failure patients with reduced ejection fraction (HFrEF).

Methods: The study sample comprized 272 HFrEF patients. Collected on admission were: medical history, echocardiographic and biochemical parameters. Iron deficiency was diagnosed if ferritin was < 100 ng/mL or < 300 ng/mL with transferrin saturation (TSAT) < 20%. Nutritional status was assessed using the MNA form and body mass index (BMI).

Results: The cohort was 81.6% male and 18.4% female. The median age was 59 (IQR 50-64) years, and the mean BMI was 28.8 ± 5.3 kg/m². 54.4% of patients showed New York Heart Association (NYHA) class III or IV HF symptoms. Iron deficiency was detected in 55.5% of patients. Participants at risk of malnutrition constituted 45.2%, while 1.8% were malnourished. In the ID group 45% were at risk of malnutrition and 2.6% were malnourished, compared with 45.4% (p = 1.00) and 0.8% (p = 0.39) in the no-ID group. Female sex and atrial fibrillation(AF) were associated with ID.

Conclusions: Nutritional status assessed by the MNA questionnaire is not related to the presence of ID in HFrEF. Female sex and AF are risk factors for ID in this group.