European heart journal open最新文献

Aims: Deformation imaging remains underused for cardiovascular risk assessment. As tissue characterization has now been recognized as an additional assessment tool, we sought to investigate the significance of native T1 and extracellular volume (ECV) in an unselected clinical routine population.

Methods and results: The single-centre, prospective cardiovascular magnetic resonance (CMR) registry included patients referred for clinical CMR. Left ventricle global longitudinal strain (GLS) was evaluated in long-axis views. Native T1 and ECV were assessed on septal, basal, or midventricular short-axis positions. Follow-up was conducted for primary (all-cause mortality and heart failure hospitalization) and secondary (all-cause mortality, hospitalized angina, and myocardial infarction) endpoints. The final population consisted of n = 1633 patients who met primary (n = 68) and secondary (n = 90) endpoints during the median follow-up of 395 days. A 10-ms T1 increase was associated with a hazard ratio (HR) of 1.11 [95% confidence interval (CI) 1.07-1.15, P < 0.001] for the primary endpoint independent of ECV (P = 0.738). T1 (HR 1.07, 95% CI 1.03-1.11, P = 0.001) but not ECV (P = 0.674) was an independent predictor for the primary endpoint after correction for common risk factors including age, New York Heart Association class, biomarker NT-proBNP/glomerular filtration rate, and GLS. After dichotomization at the median of 1126 ms, T1 added incremental value for primary endpoint prediction on Kaplan-Meier plots in patients with left ventricular ejection fraction above/below (P = 0.019/0.017) the median of 55% and GLS above/below (P = 0.019/0.041) the median of -16.4%.

Conclusion: Native T1 was found to be an independent risk predictor beyond GLS as well as common clinical risk factors. This may justify the use of non-contrast CMR protocols in selected patients if contrast application is contraindicated.

Aims: Myocardial infarction size is associated with mortality in ST-elevation myocardial infarction (STEMI). With advances in primary percutaneous coronary intervention (PPCI) and medical therapy, whether this relationship has changed over time is unclear.

Methods and results: Patients with STEMI in the UK from 2005 to 2019 were included from the national AMI MINAP registry, with mortality linkage to 2021. Primary outcomes were all-cause mortality at 30 days and 1 year according to infarct size, using Cox regression models. Infarct size was stratified by Tertiles (T1-3) of peak troponin level (T1, smallest; T3, largest), across the early (2005-09), middle (2010-14), and late (2015-19) periods. Subgroup analyses assessed the relationship according to infarct location (anterior vs. non-anterior). A total of 177 214 STEMI patients were included. Adjusted 30-day mortality risk according to infarct size was highest in the early period (aHR: 1.32, 1.21-1.45, P < 0.001), compared to middle (1.12, 1.04-1.20, P = 0.002) and late study periods (1.05, 0.96-1.14, P = 0.299). The relationship between infarct size and 30-day mortality was significant for patients with anterior STEMI in early (1.39, 1.22-1.57, P < 0.001) but not middle or late periods, while remained significant for non-anterior infarction until the late period (early, 1.28, 1.13-1.45, P < 0.001; middle, 1.17, 1.06-1.29, P = 0.002; late, 1.09, 0.96-1.24, P = 0.180).

Conclusion: We observed an independent relationship between infarct size and STEMI mortality, strongest between 2005 and 2009, which reduced over time, becoming non-significant in the 2015-19 period. This association diminished more rapidly for patients with anterior STEMIs. These findings underscore the potential role of contemporary revascularization, systems of care, and guideline-directed medical therapy in reducing STEMI-related mortality.

Aims: Pre-clinical studies point towards an administration time-dependency of anthracycline-induced cancer therapy-related cardiac dysfunction (CTRCD). This retrospective study aimed to investigate the association between time-of-day of AC administration and CTRCD.

Methods and results: Patients from two cardio-oncology outpatient clinics, treated with ACs for any malignancy, were included. Percentage of afternoon AC administration was calculated: cumulative dose administered in the afternoon (12 p.m.-11:59 p.m.)/total cumulative dose. Three groups were defined: morning group ≥ 50% of ACs in the morning (12 a.m.-11:59 a.m.), afternoon group ≥ 50% of ACs in the afternoon, and intermediate group = exactly 50% of ACs in the morning and afternoon. Associations between AC timing and occurrence of CTRCD and heart failure (HF) were assessed using survival analyses. Of 270 included patients, 66 developed CTRCD and 17 developed HF. Compared with the morning group, the afternoon group had a higher risk of developing CTRCD: hazard ratio (HR) 2.88 (95% CI: 1.52-5.44). When considering percentage of ACs administered in the afternoon as a continuous variable, the HR for developing CTRCD was 1.14 (95% CI: 1.04-1.24) for each subsequent 10% of afternoon administration. Results were consistent across sensitivity analyses of age, sex, body mass index, malignancy type, cumulative AC dose, and HFA-ICOS risk score. Congruently, the continuous variable of afternoon AC administration was associated with higher risk of HF: HR = 1.19 (95% CI: 1.01-1.41).

Conclusion: Afternoon administration of ACs is associated with an increased risk of developing CTRCD and HF, suggesting that morning administration may be preferred. Before widespread implementation, these findings should be confirmed in an RCT.

Aims: Chronic myeloid leukemia (CML) patients are at high risk for developing cardiovascular (CV) diseases due to adverse effects of BCR-ABL tyrosine kinase inhibitors.

Objectives: The purpose of this study was to compare patient characteristics and in-hospital mortality between CML patients and non-CML patients, who were hospitalized for ischemic heart disease (IHD).

Methods and results: This study was based on the Japanese Registry of All Cardiac and Vascular Diseases and the Diagnosis Procedure Combination (JROAD-DPC) database. All patients who were first hospitalized for IHD and received percutaneous coronary intervention from April 2012 to March 2021 were extracted. Propensity score matching was used to reduce confounding effects related to differences in patient background. A total of 766 385 patients, in which 371 CML patients were included, were analyzed. CML patients were more likely to be male and less likely to have obesity, hypertension, and dyslipidemia. The number of modifiable CV risk factors (obesity, smoking, hypertension, dyslipidemia, and diabetes mellitus) in CML patients was smaller than in non-CML patients. There was no difference in in-hospital mortality, whether considering all cases or only acute myocardial infarction cases. This was also statistically non-significant after propensity score matching.

Conclusion: CML patients were hospitalized for IHD with fewer CV risk factors than non-CML patients, and in-hospital mortality was comparable between CML and non-CML patients. These findings emphasize the need for more stringent management of modifiable CV risk factors for CML patients.

Earlier clinical trials have investigated the efficacy of auricular stimulation for hypertension, but the overall evidence regarding the effect of non-invasive auricular stimulation on blood pressure (BP) reduction remains unclear. This systematic review summarizes the effects of non-invasive auricular stimulation on cardiovascular haemodynamics. We searched for studies published in English through PubMed, ICHUSHI, and Cochrane Central Library databases and reviewed randomized controlled trials involving adults. Data collection and analysis were performed on the relationships of non-invasive auricular electrical stimulation and acupressure with changes in haemodynamics. A meta-analysis was conducted on the effects of non-invasive auricular stimulation on systolic BP (SBP), diastolic BP (DBP), and heart rate (HR). In the primary analysis, effect sizes were extracted from 18 studies for a total analytic sample of n = 959. Non-invasive auricular stimulation significantly reduced in SBP [weighted mean difference (WMD) = -4.435 mmHg, 95% confidence interval (CI) (-7.037 to -1.832)], DBP [WMD = -2.212 mmHg, 95% CI (-3.734 to -0.690)], and HR [WMD = -3.069 beats/min, 95% CI (-5.389 to -0.749)]. Overall, heterogeneity in each analysis was high, which could be explained by the stimulation duration and baseline values of SBP, DBP, and HR. There were no serious adverse events across all 18 studies. Enhancing vagus nerve activity through non-invasive auricular stimulation leads to clinically safe reductions in BP and HR. Further studies are needed to clarify whether non-invasive auricular stimulation can be used as a viable treatment for hypertension.

Resistance training effectively reduces cardiovascular risk factors (CVRFs). However, the optimal training intensity remains unclear. Firstly, this systematic review investigated the effects of different resistance training intensities on glycated haemoglobin (HbA1c), systolic blood pressure (SBP), low-density lipoprotein (LDL), and waist-to-hip ratio (WHR). Secondly, we aimed to compare the effect of different resistance training intensities with each other. We identified randomized controlled trials (n = 59) investigating progressive (n = 9), low (n = 15), moderate (n = 33), and high intensity (n = 4) resistance training in adults with CVRFs. We used random-effects models to investigate the effects of each intensity on CVRFs compared to non-active controls and meta-regression analyses to investigate differences in effect between training intensities. Meta-analyses showed statistically significant effects of low to moderate certainty. Progressive intensity reduced SBP {-14.70 mm/Hg, 95% confidence interval [CI] (-16.40; -13.00)} and LDL [-0.16 mmol/L, 95% CI (-0.19; -0.13)]. High intensity reduced HbA1c [-0.81%, 95% CI (-1.52; -0.10)], low intensity LDL [-0.10 mmol/L, 95% CI (-0.16; -0.04)], and moderate intensity WHR [-0.02, 95% CI (-0.03; -0.01)] and HbA1c [-0.40%, 95% CI (-0.66; -0.14)]. Meta-regression analyses showed high intensity was significantly more effective in reducing WHR than low intensity. No significant differences were found between resistance training intensities for HbA1c, SBP, and LDL. In one study, high intensity was more effective than low intensity in reducing WHR. However, the limited number of studies investigating high and progressive intensity and the certainty of evidence limits the ability for definitive conclusions. More research is needed for clarification on the effect of different resistance training intensities on multiple CVRFs.

Aims: The association between perioperative antihypertensive drugs and mortality as well as physical function in non-cardiac surgeries remains unclear. We aimed to clarify the association between six antihypertensive classes and postoperative outcomes.

Methods and results: This observational cohort study involved adults undergoing non-cardiac surgeries between 2014 and 2019 using an administrative claims database. We recruited 408 810 patients who continuously used any class of antihypertensive medication both pre- and postoperatively and 2 190 064 non-continuous users aged ≥50 years who underwent five different types of non-cardiac surgeries. The risk for overall death or functional decline, defined as a ≥20% decrease in the Barthel Index score during hospitalization, was determined using multivariable logistic regression models. All-cause deaths or functional decline occurred in 4228 (1.0%) users and 17 978 (0.8%) non-users or 20 625 (5.0%) users and 66 218 (3.0%) non-users, respectively. Among single-class users, angiotensin-converting enzyme inhibitors (ACEis) or angiotensin II receptor blockers (ARBs) showed a multivariable odds ratio (OR) of 0.74 [95% confidence interval (CI) 0.62-0.89 vs. thiazide/thiazide-like diuretics (TH)] for the composite of mortality and functional decline. Among recipients of two medication classes, calcium receptor blockers (CCBs)/ACEi or ARB usage was associated with the lowest risk for composite outcome (OR, 0.86; 95% CI, 0.81-0.91 vs. TH/CCBs). The combinations of the ≥3 classes, including TH/CCB/ACEi or ARB, displayed the lowest odds for the composite outcome. In orthopaedic surgery and gastrointestinal resection, ACEis or ARBs were associated with better survival and physical function.

Conclusion: Perioperative use of ACEis or ARBs is associated with favourable outcomes in non-cardiac surgeries.