Cardiology journal最新文献

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.

Background: The diagnosis of dilated cardiomyopathy (DCM) requires exclusion of obstructive coronary artery disease (CAD). However, co-occurrence of DCM and non-obstructive coronary atherosclerotic plaque is frequent. Our objective was to evaluate the coronary artery dimensions and their relation to the left ventricle mass in DCM patients with excluded coronary atherosclerosis.

Methods: Out of 426 patients with DCM who underwent computed coronary tomography angiography (CCTA), we identified 34 without signs of coronary atherosclerosis and compared them with 193 consecutive patients without DCM and atherosclerosis in CCTA. They were matched one to three by sex, coronary dominance pattern, and body-surface area (BSA). Left ventricle myocardial mass (LVMM) and proximal and middle coronary artery segment dimensions were evaluated with the use of dedicated, commercially available software.

Results: Overall, coronary segment dimensions were not different between groups except for the medial left anterior descending segment and obtuse marginal, which were wider in the DCM group, while the proximal right coronary artery was larger in the non-DCM group. Total coronary artery volume (CAV) and LVMM/CAV ratio were greater in the DCM group (2879 [2535-3508] mm³ vs. 2521 [2120-3115] mm³, p = 0.03) and (0.062 [0.054-0.074] g/mm³ vs. 0.049 [0.039-0.058] mm³, p = 0.0002), respectively. Also, the LVMM/coronary artery ostial area (COA) ratio was larger in patients with DCM (5.4±1.3 g/mm² vs. 3.7 ± 1.1 g/mm², p < 0.0001). The independent positive predictors of a larger LVMM/CAV ratio were DCM and BSA, while age was a negative predictor. LVMM/COA ratio positive predictors were DCM and male sex.

Conclusions: Patients with DCM have altered relationships between LVMM, CAV, and COA.

Background: The diagnosis of acute myocarditis is complex, with cardiac magnetic resonance (CMR) being a recommended diagnostic method. This study aimed to evaluate the real-life use of CMR in the diagnosis of acute myocarditis and to correlate CMR results with the degree of myocardial damage.

Methods: This is a retrospective, observational tertiary single-center study of 90 consecutive patients (F/M:18/72, mean age:39 ± 14 years) hospitalized between 2015-2022 with a clinical diagnosis of acute myocarditis. The study population was divided into two groups: patients who underwent CMR+ and those who did not undergo CMR - In the CMR+ group, various sequences, including T1/T2-weighted imaging, late gadolinium enhancement (LGE), and mapping techniques, were used to assess myocardial inflammation and damage.

Results: CMR was performed in 39 patients (43.3%, F/M:10/29, mean age:41 ± 16 years). In this group, myocardial edema (increased T2 signal intensity) was detected in 29 patients, and LGE (signal intensity 2 standard deviations cabove normal on T1 images) was found in 39 patients. Diagnosis based on Lake Louise Criteria was possible in 29 cases. Edema negatively correlated with TnT levels (r = -0.412, p < 0.05) and positively with the number of LGE segments (r = 0.372, p < 0.05). Significant correlations were found between LVEF and LGE mass (r = -0.360, p < 0.05), and maximal TnT levels (r = -0.38, p < 0.05). CMR+ patients had lower myocardial damage markers and CRP concentrations compared to CMR- patients.

Conclusions: CMR is underused in diagnosing acute myocarditis. Myocardial damage markers correlate with CMR-detected edema and volumetric measures, but not LGE extent. More research is needed to enhance risk assessment and treatment.

Background: The Impella percutaneous mechanical circulatory support device provides improved support in treating patients with high-risk percutaneous coronary interventions (HR-PCI) or in cardiogenic shock. IMPELLA-PL is a multicenter registry developed to share clinical data and experiences using Impella technology in Poland. The retrospective analysis conducted in this study aims to fill the knowledge gap of Impella performance in patients with multivessel coronary artery disease (CAD) and depressed left ventricular ejection fraction (EF) (≤30%) treated with HR-PCI.

Methods: Retrospective data were analyzed from patients presenting with multivessel coronary disease and low EF treated with Impella CP collected from 20 Polish interventional cardiology centers registered with IMPELLA-PL to assess the safety and efficacy in short- and long-term clinical outcomes.

Results: A total of 115 patients with low EF received Impella CP support during HR-PCI. The success rate of Impella supported HR-PCI was high (99.1%) with an average hospital stay of 15.6 ± 10.7 days. The right femoral artery was the most common access (55.7%) followed by the left femoral artery (37.4%). The in-hospital mortality rate was 6.1%, and the all-cause mortality rate at one year was 13.9%.

Conclusions: High-risk PCI with Impella CP periprocedural support was safe and effective in patients with low EF (≤30%). The all-cause mortality rate (6.1% and 13.9%, respectively, for in-hospital and at 12-months) was comparable with other Impella registries.

Background: Our study compared the effect of P2Y12 receptor inhibitors in combination with abciximab on clinical outcomes in patients with acute coronary syndrome (ACS).

Methods: Our study is retrospective, consisting of 852 consecutive ACS patients who presented to our clinic between 2015 and 2021, underwent primary percutaneous coronary intervention (PCI), and received abciximab in addition to dual antiplatelet therapy. The P2Y12 receptor inhibitors were compared in terms of in-hospital and 1-year major adverse cardiac events (MACE), and clinically significant in-hospital and 1-year bleeding complications.

Results: The patients' mean age was 60.4 ± 11 years, and 702 (82.4%) were male. In-hospital MACE, in-hospital mortality, 1-year MACE, and 1-year mortality were significantly higher in the clopidogrel group compared to the ticagrelor group. There was no significant difference in the development of in-hospital and 1-year bleeding between clopidogrel and the more potent P2Y12 receptor inhibitors. According to the BARC score, there was no difference in major bleeding between ticagrelor and clopidogrel (p = 0.641), but minor bleeding was significantly lower in the ticagrelor group (p < 0.001). In logistic regression analysis, the 1-year MACE rate was lower in the potent P2Y12 receptor inhibitors group compared to clopidogrel. At the same time, no association was found with short- and long-term mortality, bleeding, or in-hospital MACE.

Conclusions: In our study, potent P2Y12 receptor inhibitors combined with abciximab decreased 1-year MACE without significantly increasing bleeding in ACS patients undergoing PCI compared to clopidogrel. This study suggests that potent P2Y12 receptor inhibitors can be safely used with abciximab, considering the bleeding risk.