Cardiology journal最新文献

Background: Eustachian valve endocarditis (EVE) is a rare right-sided infective endocarditis (RSIE) manifestation. This condition has scattered and limited clinical characteristics that require collection and systematization. This meta-analysis evaluates the predisposing factors, pathogens, and associated risk profiles in EVE cases.

Methods: The meta-analysis included 68 cases of EVE from 57 reports published between 1986 and 2024 from PubMed, Embase, Scopus, Cochrane, and Web of Science. Data on demographics, clinical characteristics, risk factors, and microbiological findings were extracted and analyzed using descriptive and univariate statistical methods. Pooled prevalence rates from observational studies were calculated using a fixed effects model.

Results: The pooled prevalence of EVE in RSIE among the analyzed cases was 2.54%. Single-valve infections accounted for 70.6% of cases, with the Eustachian valve as the sole affected structure. The most common pathogen was Staphylococcus aureus (60%), predominantly affecting younger intravenous drug users (IVDU) with an odds ratio [OR (odds ratio) = 6.27; 95% CI (confidence interval): 1.62-24.31] in univariate logistic regression analysis. Other predisposing factors, including central venous catheters (CVCs) and cardiac implantable electronic devices (CIED), were not significantly associated with Staphylococcus aureus or other bacterial non-Staphylococcus aureus or fungal infections.

Conclusions: Eustachian valve endocarditis is relatively rare and primarily associated with IVDU and younger age, whereas CVCs and CIEDs are insignificant predictors. Identifying embryonic remnants like the Eustachian valve or Chiari network using echocardiography may facilitate early diagnosis in at-risk populations.

Background: Patients with non-ischemic cardiomyopathy exhibit a range of myocardial fibrosis (MF) patterns on cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) imaging. Data suggests that ring-like MF is associated with worse prognosis. In the present study it was sought to analyze the prevalence of parametric mapping abnormalities in ring-like MF and their prognostic value for arrhythmic events.

Methods: Patients undergoing clinical CMR at 1.5T/3T were evaluated for ring-like MF defined as midwall/subepicardial fibrosis involving ≥ 3 contiguous left ventricular segments. CMR protocol included cine imaging, T1 and T2 mapping, and LGE. Mean native T1, ECV, and T2 values and a number of mid short axis segments with elevated values were calculated. LGE extent was assessed segmentally. Arrhythmic outcomes were defined as appropriate device shock, premature ventricular contractions ≥ 10%, non-sustained/sustained ventricular tachycardia, or ventricular fibrillation.

Results: In total 49 patients (53 ± 17 years, 26.5% female) were analyzed. Many patients had elevated global/segmental mapping values: 45%/76% in native T1, 57%/57% in T2, and 57%/78% in ECV. During median follow-up of 12 months, arrhythmic events occurred in 65% of patients. There was no association between native T1/T2 elevation or number of LGE segments and arrhythmic outcomes. There was a significant association between ECV and arrhythmic outcomes, both septal ECV (p = 0.036) and any segmental ECV elevation (p = 0.03).

Conclusion: T1 and T2 myocardial tissue abnormalities are common in patients with ring-like MF. ECV elevation was associated with arrhythmic events in this cohort. Further studies are needed to establish the diagnostic and prognostic value of parametric mapping in patients with ring-like MF.

Background: This study evaluates the impact of pre-existing comorbidities and in-hospital complications on COVID-19 mortality rates.

Methods: A retrospective single-center study was conducted using electronic health records from 640 COVID-19 patients hospitalized at the University Clinical Centre in Gdansk, Poland, between November 2020 and May 2021. Patients were categorized based on disease severity into stable or ICU wards based on the disease severity. Data on demographics, comorbidities, complications, and treatments were collected and verified. Statistical analyses, including odds ratios (ORs) and confidence intervals (CIs), assessed mortality risk factors supported by python-based processing.

Results: The mean patient age was 67 years (SD ± 15.89), comprising 39% females (n = 250) and 60.94% males (n = 390). Mortality risk was highest in patients aged 65 years and older (OR 3.00; 95% CI, 1.97-4.60). Among the pre-existing comorbidities, chronic kidney disease (OR 3.28; 95% CI, 2.12-5.09), atrial fibrillation (OR 2.43; CI 95%, 1.63-3.61), and heart failure (OR 2.89; 95% CI, 1.91-4.37) were significant predictors of mortality. In hospital complications, such as severe respiratory failure requiring ICU ventilation (OR 23.59; 95% CI, 2.81-197.87), myocardial infarction (OR 25.43; 95% CI, 3.16-204.97), acute kidney injury requiring renal replacement therapy (OR 19.15; 95% CI, 6.49-56.51), sepsis (OR 7.22, 95% CI, 3.77-13.84), stroke, further increased mortality risk.

Conclusions: COVID-19 patients with pre-existing renal and cardiovascular conditions face a higher risk of fatal outcomes. Early diagnosis and intervention targeting these complications are vital to in reducing mortality. Further research is needed to reconcile disparities with existing literature.

Background: The aim of this study was to assess the incidence and clinical significance of depression in patients with cardiac resynchronization therapy with an implantable cardioverter-defibrillator (CRT-D). The study was also to evaluate the impact of shock therapy on depression development and long-term prognosis.

Methods: The prospective study encompassed 396 consecutive heart failure (HF) patients implanted with CRT-D. All patients completed the Beck Depression Inventory (BDI-II) and underwent a psychiatric examination at baseline. 221 patients free of depressive symptoms at baseline were included into the final analysis. The assessment of psychiatric status was routinely repeated every 6 months as well as after the shock delivery. The primary outcome was a composite endpoint of death or hospitalization for HF.

Results: During long-term observation (median 37.1 months) 52 (23.5%) patients suffered from an implantable cardioverter-defibrillator (ICD) shock, whereas 48 (21.8%) subjects developed depression. The incidence of new-onset depression was significantly higher in patients after shock delivery (Shock Group), CRT non-responders and subjects with atrial fibrillation. The risk for a composite endpoint was higher in the Shock Group than subjects without an ICD intervention: 57.7% vs. 25.4% and in patients with new-onset depression compared to the population free of this disorder: 62.5% vs. 24.9% (all p < 0.001). New-onset depression (HR 1.7) and an ICD shock (HR 2.1) were strong independent predictors of poor prognosis.

Conclusions: Depression is a common mental disorder in CRT-D recipients, that adversely affects long-term prognosis. Subjects suffering from ICD shocks and those with HF progression are at higher risk of experiencing depressive symptoms.

Background: Balloon pulmonary angioplasty (BPA) and pulmonary endarterectomy (PEA) are established treatments for chronic thromboembolic pulmonary hypertension (CTEPH). In cases where BPA is ineffective, stent implantation emerges as salvage therapy. However, stent implantation during BPA remains a subject of debate.

Methods: This seven-year case series in Serbia, where PEA is unavailable, examines outcomes in 10 CTEPH patients undergoing BPA with coronary-type stent implantation during BPA. Objectives include assessing the feasibility, safety, and efficacy of this combined approach, identifying optimal patient selection criteria. Criteria for stent placement included persistent unsatisfactory flow post-multiple balloon dilatations. Follow-up assessments were via repeat pulmonary angiography.

Results: Stents were successfully deployed, demonstrating sustained patency in 14 of 15 stents over an average 21.5-month (ranging from 11 up to 82 months) follow-up. Outcomes revealed significant reductions in mean pulmonary artery pressure, improvements in WHO Functional Class, and enhanced 6-minute walking distance. For the first 6 months, patients received daily clopidogrel 75 mg and rivaroxaban 15 mg, without significant bleeding. Dual therapy for pulmonary hypertension was consistently upheld. During the follow-up period, no stent thrombosis, restenosis, or other severe acute or chronic complications were observed; however, in one case, additional balloon stent post-dilatation was required.

Conclusion: Coronary-type stent implantation during BPA for selected CTEPH patients, though not a primary treatment, proved valuable, offering a potential solution when BPA alone falls short. This case series emphasizes the need to refine patient selection criteria for this emerging therapeutic avenue.

Background: The treatment of left main coronary artery disease (LMCAD) in acute coronary syndrome patients is challenging in daily clinical practice. Therefore, the question arises whether the clinical outcomes of acute coronary syndrome (ACS) patients with LM disease vary between centers with and without cardiac surgery on site.

Methods: The study is a retrospective analysis of ACS patient outcomes using data from the PL-ACS registry, which is a Polish archive of ACS patients. The following analysis considered patients with LMCAD (n=4000) who were divided into two groups: those treated in the centers with the cardiac surgery department on site (CS group, n=427) and those without (non-CS group, n=3573).

Results: Patients with ACS in non-CS group more often were not qualified for revascularization than patients in CS group (11.7% in the CS group vs. 19.9% in the non-CS group, p<0.001), however, CABG was more common in non-CS group (18.7% in CS group vs. 25.7% in non-CS group, p<0.001). PCI, including angioplasty of LM, was more common in CS-group than non-CS group (38,6% vs. 30,3%, p<0.001). Among patients with ACS in CS group, major adverse cardiac events (MACE) were observed with greater frequency.

Conclusions: Patients with LM disease admitted to the centers with CS initially had more risk factors for more intensive hospitalization compared to patients in centers without CS on-site. Clinical outcomes and treatment procedures may differ regarding the availability of CS on-site.

Background: Stentys drug-eluting stent (Stentys DES) was proposed to possess potential benefits over balloon-expandable platforms in large bifurcations, mainly distal left main stem (LMS). Several registries demonstrated favourable one-year clinical results of percutaneous coronary intervention (PCI) using Stentys DES for LMS disease. However, long-term follow- up data have been lacking hitherto.

Methods: The study enrolled 175 consecutive patients who underwent PCI with Stentys DES for unprotected LMS and categorized them into acute- and chronic coronary syndrome (ACS/CCS). The primary endpoint was major adverse cardiac and cerebral events (MACCE) composed of cardiac death, myocardial infarction (MI), target lesion revascularization (TLR), and stroke assessed at five years. The secondary endpoints were stent thrombosis (ST), restenosis and target vessel revascularization (TVR).

Results: Clinical follow-up at five years was completed for 124 out of 175 patients (70.9%), encompassing 85 with ACS and 39 with CCS. At five years, MACCE occurred in 55 out of 124 patients (44.4%). Although, there was a higher rate of MACCE (53% vs 28.2%, p = 0.018), MI (27.1% vs 2.6%, p = 0.016) and TLR (20% vs 2.6%, p = 0.036) in ACS vs. CCS patients, the rates of cardiac deaths were similar (27.1% vs. 25.6%, p = 0.77, respectively).

Conclusions: Herein, favourable long-term outcome of LMS PCI with Stentys DES in the CCS setting are shown. In the ACS setting, worse one-year outcome persisted at five years and was partially related to high rate of acute/subacute ST that might be optimized by immediate loading with potent antiplatelet drugs.