Cardiology journal最新文献

Background: The importance of bystander cardiopulmonary resuscitation (CPR) during out-of-hospital cardiac arrests is especially important in the context of coronavirus disease 2029 (COVID-19) because it can significantly influence survival outcomes. The objective of this meta-analysis was to examine the primary outcomes of bystander CPR during the pandemic and pre-pandemic periods.

Methods: A search was conducted in the PubMed Central, Scopus, and EMBASE databases, as well as the Cochrane Central Register of Controlled Trials database, up to December 10, 2023. In cases where the value of I² was greater than or equal to 50% or the Q-test indicated that the p-value was less than or equal to 0.05, the studies were considered to be heterogeneous. Sensitivity assessment was performed using the leave-one-out methodology. The study protocol was registered in PROSPERO with the ID number CRD42023494912.

Results: Twenty-five articles were included in this meta-analysis. Pooled analysis showed that bystander CPR frequency during the COVID-19 pandemic was 38.8%, compared to 44.8% for the pre-pandemic period (odds ratio: 1.04; 95% confidence interval: 0.93-1.16; p = 0.48).

Conclusions: The article's conclusions indicate that the COVID-19 pandemic influenced a reduction in bystander CPR compared to the pre-pandemic period, but this difference was not statistically significant. Further research is recommended to understand attitudes, including the fears of witnesses, before performing CPR on patients with suspected or confirmed infectious diseases. The study highlights the importance of bystander intervention in emergency situations and the impact of a pandemic on public health response behaviors.

Thromboembolic diseases have long been a leading cause of morbidity and mortality, necessitating advances in anticoagulant drugs. Heparins, vitamin K inhibitors, and direct oral anticoagulants (DOACs) are well-established drug classes that help prevent thromboembolic complications. While effective, they pose significant risks during long-term therapy, including bleeding, osteoporosis, heparin-induced thrombocytopenia, and the need for frequent monitoring and dose adjustments. Factor XI (FXI) inhibitors represent an innovative approach in anticoagulation therapy, aiming to balance thromboembolic events with the risk of bleeding complications. They include: a) orally administered small molecule inhibitors such as milvexian and asundexian; b) monoclonal antibodies such as abelacimab, osocimab, and xisomab, which specifically bind and inactivate FXI; c) FXI-antisense oligonucleotide (FXI-ASO), which downregulate FXI synthesis at the mRNA level and reduce plasma FXI concentrations. Available data indicate that FXI inhibitors decrease the risk of thromboembolic events and are associated with a lower incidence of major bleeding than current gold standard methods. Hence, FXI inhibitors may become the preferred anticoagulant class, especially for patients with elevated bleeding risk. Their development is an important step in the history of anticoagulant therapy, striving to find a balance between preventing thromboembolism and reducing bleeding risk, ultimately improving patient outcomes. In this context, a discussion on the characteristics of FXI inhibitors, a summary on data regarding the efficacy and safety of FXI inhibitors based on preclinical and clinical studies, and an outline of future perspectives regarding therapeutic strategies of FXI inhibition in venous thrombosis are presented in this study.

Background: Sten graft implantation faces challenges such as deliverability issues, fracture risk, and subsequent restenosis. Recent advancements have introduced thinner coatings for increased flexibility and improved biocompatibility. The aim herein was to assess the safety and performance of a highly flexible cobalt-chromium stent covered with polytetrafluoroethylene (PTFE) in a preclinical model.

Methods: In total 6 PTEF-covered stent grafts 6mm x 38mm cobalt-chromium, (Solaris BXTM, Scitech Produtos Medicos) were implanted compared to 5 controls ( BeGraftTM, Bentley InnoMed GmbH) in the iliac arteries of 11 swine. Stents were evaluated with angiography, high-definition IVUS, and histology for 28 days.

Results: All animals underwent successful implantation with 100% survival at follow-up. At 28 days, there was no statistically significant difference in MLD compared to baseline in both groups (test, 5.2 ± 0.7 mm vs 5.3 ± 0.6 mm, p = 0.8; control, 4.9 ± 0.7 mm vs 5.1 ± 0.5 mm, p = 0.8), indicating no LLL (test, -0.2 ± 0.16 vs control, -0.18 ± 0.16 mm; p = 0.8). IVUS revealed a tendency for the less neointimal area in the test group (3.75 ± 0.9mm² vs 5.69 ± 2.2 mm²; p = 0.08), resulting in a tendency toward higher % AS in the control arm (14.07 ± 3.42% vs 20 ± 7%; p = 0.1). Microscopic evaluation revealed minimal vascular injury (test 0.1 ± 0.3 vs control 0.1 ± 0.1) and complete endothelialization coverage (test, 3.2 ± 0.8 vs control 3.8 ± 0.3) in both groups, with minimal inflammation(test vs. control: per strut 0.02 ± 0.06 vs. 0.14 ± 0.22; neointimal 1.2 ± 0.6 vs 1.1 ± 0.4; medial 0.3 ± 0.4 vs 0.3 ± 0.4).

Conclusion: Solaris BXTM demonstrated highly flexible and biocompatible, with minimal vascular injury, and reduced neointimal hyperplasia compared to the control.

Background: The aim of the study was to analyze the potential relationship between the diuretic response, the clinical profile and the concentrations of selected biochemical markers and to identify a group of patients who will benefit from a new form of therapy combining standard diuretic therapy with the use of a RenalGuard® system.

Methods: This is a retrospective study of 19 patients (mean age 67 ± 10 years, 95% men) hospitalized due to acute decompensated heart failure (ADHF, NYHA class III-IV, BP 125 ± 14/73 ± 16 mmHg, eGFR 58 ± 24) with persistent overhydration despite standard therapy. A targeted comparative analysis of selected clinical and biochemical parameters was performed to determine the parameters associated with a better diuretic response [good diuretic responders (GDR) group].

Results: The good diuretic responders group had significantly lower levels of creatinine (1.23 ± 0.4 vs. 1.69 ± 0.35, p = 0.025) magnesium 0.70 ± 0.14 vs. 0.83 ± 0.09, p = 0.030) and blood urea nitrogen (BUN, 28 ± 11 vs. 39 ± 10, p = 0.045). Additionally, in GDR group a statistically significant greater ability to dilute urine in the 12th and 24th hour of therapy was found.

Conclusions: The results of the study indicate the potential use of the RenalGuard® system in combination with standard intravenous diuretic therapy for controlled dehydration in the treatment of a selected group of patients with ADHF. It is advisable to identify the detailed mechanisms of GDR and characterize this group of patients more precisely.

Background: This study aimed to identify factors associated with the 10-year risk of fatal and non-fatal cardiovascular disease (CVD) events in apparently healthy individuals aged 40-69 years.

Methods: 148 patients without established CVD were divided into low-risk (70 patients) and high-risk (78 patients) groups based on their CVD risk in SCORE2.

Results: High-risk patients presented with higher left atrial volume index (LAVI) (p = 0.003), left ventricular mass index (LVMI) (p < 0.001), and ratio of peak velocity of early diastolic transmitral flow to peak velocity of early diastolic mitral annular motion (E/E') (p < 0.001) but lower oxygen uptake at anaerobic threshold (VO₂AT) (p = 0.02) and maximal oxygen uptake (VO2max) (p = 0.008), compared to their counterparts. High-risk patients also had higher values of high-sensitivity cardiac troponin T (hs-cTnT) (p < 0.001) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) (p<0.001), and lower level of glomerular filtration rate (GFR) (p < 0.001). In a multiple logistic regression model, E/E' > 6.75 cm/s (OR 3.9, 95% CI: 1.5-10.3; p = 0.004) andhs-cTnT > 4.8 pg/ml (OR 6.02, 95% CI: 2.3-15.8; p < 0.001) were independently associated with high and very high CVD risk. SCORE2 (%) correlated positively with metabolic age (R Spearman = 0.79; p < 0.001), hs-cTnT (R = 0.6; p < 0.001), and NT-proBNP (R = 0.5; p < 0.001) and negatively with GFR (R = -0.5; p < 0.001) and VO2max (ml/min/kg) (R = -0.3; p < 0.001).

Conclusions: Elevated E/E' and higher hs-cTnT level independently predict high and very high risk in SCORE2. The increasing 10-year cardiovascular disease risk correlates with higher metabolic age, higher levels of NT-proBNP and hs-cTnT, and lower level of GFR.