Cardiology journal最新文献

Background: The association between coronary microcirculatory function and long-term outcomes in late-presenting patients with ST-segment elevation myocardial infarction (STEMI) is unclear.

Methods: A total of 340 STEMI patients with late presentation (> 12 hours from the onset of symptoms) who underwent delayed percutaneous coronary intervention (PCI) were consecutively recruited from 2016 to 2021. The coronary microvasculature was assessed by angiography-derived index of microcirculatory resistance (caIMR) using commercial software. The primary endpoint was major adverse cardiovascular events (MACE) defined as a composite of all-cause death and myocardial infarction.

Results: The median symptom-to-angiography time was 149 hours (interquartile range [IQR], 101-192). The culprit vessels were completely occluded in 120 (35.3%) patients. During the follow-up with a median period of 51 months, MACE occurred in 27 patients (7.9%). After adjusting for risk factors, caIMR > 25 U after PCI was independently associated with an increased incidence of MACE (adjusted hazard ratio, 4.31; 95% confidence interval, 1.92-9.67; p < 0.001). The area under the curve (AUC) for caIMR in predicting MACE was 0.675 (p = 0.020).

Conclusions: Our study indicated that caIMR was an important prognostic predictor in late-presenting STEMI patients who underwent delayed PCI. Preservation of coronary microcirculatory function during PCI could provide long-term prognostic benefits.

Drug-coated balloons (DCB) have been developed as an alternative to drug-eluting stents (DES) as a part of the "leave nothing behind" strategy following percutaneous coronary interventions (PCI). DCBs facilitate revascularization and delivery of an antiproliferative agent directly to a coronary artery lesion, without the need for DES implantation. Subsequently, DCBs promote positive vascular remodeling and allow for a shorter duration of dual antiplatelet therapy. Since the first reports on the successful treatment of coronary in-stent restenosis (ISR) with paclitaxel-coated balloon catheters in the year 2006, the use of DCBs has been growing, driven by reports of DCB application to treat ISR, bifurcation lesions, and small vessel disease. Contemporary clinical trials evaluating DCBs in large vessel disease and chronic total occlusions might further expand the indications for this technology. Attention has also been brought to the use of DCBs in patients with diabetes mellitus and acute coronary syndrome, especially those at high bleeding risk. This review aims to discuss the existing evidence and emerging hopes associated with DCBs, including technical aspects of DCB PCI and the use of DCBs in different clinical scenarios.

Background: SARS-CoV-2 infection may lead to myocardial and endothelial damage. The present study sought to characterize the cardiovascular sequel in a large group of consecutive patients admitted for out-patient cardiovascular follow-up after a symptomatic COVID-19 infection.

Methods: The aims of this study were as follows: to evaluate the presence of post-covid cardiovascular symptoms in an unselected population of outpatients referred to a post-COVID outpatient cardiology clinic and to characterize the long-term abnormalities associated with a more severe COVID-19 infection clinical course. A total of 914 patients were included in this single-center, observational, cross-sectional study, of which 163 were hospitalized and 149 required mechanical ventilation for COVID-19 pneumonia. Patients were analyzed at follow-up according to the care setting during the initial presentation.

Results: The median time to follow-up was 126 days. At that time, only 3.5% of patients reported no persistent dyspnea, chest pain, or fatigue on exertion. In a follow-up echocardiographic assessment, patients who required hospitalization showed slight alterations in the pulmonary acceleration time and the tricuspid regurgitation pressure gradient, as well as reduced exercise tolerance during treadmill exercise testing when compared to patients with a benign clinical course. 24-hour Holter EKG monitoring or 24-hour blood pressure monitoring did not identify significant differences between the analyzed subgroups.

Conclusions: The current study reports on an association between COVID-19 severity and the presence of cardiovascular alterations at follow-up. A simple diagnostic protocol, comprising an exercise treadmill test and transthoracic echocardiography is useful in identifying patients who may benefit from regular, structured cardiovascular medical care.

According to the ESC guidelines, cangrelor may be considered in P2Y12-inhibitor-naïve acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). The aim of this review is to summarize available evidence on the optimal maintenance therapy with P2Y12 receptor inhibitor after cangrelor. Transitioning from cangrelor to a thienopyridine, but not ticagrelor, can be associated with a drug-drug interaction (DDI); therefore, a ticagrelor loading dose (LD) can be given any time before, during, or at the end of a cangrelor infusion, while a LD of clopidogrel or prasugrel should be administered at the time the infusion of cangrelor ends or within 30 minutes before the end of infusion in the case of a LD of prasugrel. Administration of any oral antiplatelet agent at the end of a cangrelor infusion will also result in a transient period of increased platelet reactivity. The inter-individual variability of this period is difficult to predict because it depends on many factors related to the patient and the treatment. In addition, experimental studies indicate that cangrelor may exert a cardioprotective effect beyond the blockade of platelet aggregation. Considering the available data, the potential use of cangrelor in ACS patients goes well beyond the current indications. Furthermore, we believe that it might be prudent to avoid use of thienopyridines during and soon after a cangrelor infusion until conclusive data on the effect of the DDI on the clinical outcome are available. On the other hand, ticagrelor seems to be an optimal oral agent for continuation of P2Y12 inhibition in patients receiving cangrelor infusion.

An emerging field in cardiovascular research is the translational investigation of transfer RNA-derived small RNAs (tsRNAs). TsRNAs, a class of small non-coding RNA molecules, have been shown to modulate cellular functions by regulating gene expression post-transcriptionally. They are implicated in diverse pathological conditions, including cancer, cardiovascular disease (CVD), infectious disease, diabetes, neurological disease, and metabolic disorder. Accumulating evidence suggests tsRNAs as important players and biomarkers in CVD. Dysregulated tsRNAs are identified in atherosclerosis, heart failure, hypertension and other types of CVD. Bioinformatics and in vitro experimental analyses reveal that tsRNAs may participate in the regulation of endothelial and inflammatory cell interactions, endothelial cell and vascular smooth muscle cell proliferation and migration, and cardiac metabolism, mitophagy and remodeling, contributing to the pathogenesis of CVD. In addition, altered tsRNAs possess great diagnostic and prognostic potential in CVD. Nevertheless, there are currently no in vivo mechanistic studies using animal models, and the small sizes of reported clinical studies that examined tsRNAs limit their diagnostic and prognostic value. Although of promise, further research is needed to address the utility of tsRNAs in cardiovascular care.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially life-threatening condition, classified as group 4 pulmonary hypertension (PH), caused by stenosis or occlusion of the pulmonary arteries due to unresolved thromboembolic material. The prognosis for untreated CTEPH patients is poor because it leads to elevated pulmonary artery pressure and right heart failure. Early and accurate diagnosis of CTEPH is crucial because it remains the only form of PH that is potentially curable. However, diagnosing CTEPH is often challenging and frequently delayed or misdiagnosed. This review discusses the current role of multimodal imaging in diagnosing CTEPH, guiding clinical decision-making, and monitoring post-treatment outcomes. The characteristic findings, strengths, and limitations of various imaging modalities, such as computed tomography, ventilation-perfusion lung scintigraphy, digital subtraction pulmonary angiography, and magnetic resonance imaging, are evaluated. Additionally, the role of artificial intelligence in improving the diagnosis and treatment outcomes of CTEPH is explored. Optimal patient assessment and therapeutic decision-making should ideally be conducted in specialized centers by a multidisciplinary team, utilizing data from imaging, pulmonary hemodynamics, and patient comorbidities.

Background: Inflammatory components play a prominent role in the pathogenesis of heart failure (HF) and correlate with the progression and severity of the disease. The aim of the present study was to assess the association between the neutrophil-lymphocyte ratio (NLR) and mortality risk in patients with stable HF with reduced ejection fraction (HFrEF).

Methods: A total of 140 patients hospitalized due to a scheduled routine examination without HF exacerbations were included. NLR was calculated as follows: NLR = neutrophil level [G/L]/lymphocyte level [G/L].

Results: The average age in the study sample was 54.1 ± 11.3 years. NLR was significantly associated with co-existing atrial fibrillation and parameters related to nutrition: total cholesterol, triglycerides, low-density lipoproteins, and albumin. During a median follow-up (365 days; IQR 296.5-365), 17 (12.1%) patients died. The log-rank test showed the worst survival rate in the highest NLR tertile. A higher NLR value was an independent predictor of 1-year mortality (HR 1.326, 95% CI: 1.121-1.569, p = 0.0010) after adjustment for natriuretic peptides, comorbidities, and other clinical parameters. It retained its value even after the exclusion of patients with severe kidney dysfunction (eGFR < 30mL/min/1.73m²) and with chronic obstructive pulmonary disease (COPD).

Conclusions: Neutrophil-lymphocyte ratio could be deployed as an auxiliary, no-cost marker of worse 1-year prognosis in stable HFrEF patients.