European heart journal open最新文献

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.

Graphical Abstract.

Aims: Mortality from cardiogenic shock complicating acute myocardial infarction (AMI-CS) remains high, despite the increasing mechanical circulatory support (MCS) use in clinical practice.

Methods and results: We undertook a systematic review and meta-analysis of trials assessing MCS in adults with AMI-CS. We searched Medline, EMBASE, CENTRAL, Web of Science, and Scopus from inception to May 2024. We evaluated the effect of each intervention on early mortality using a random-effects network meta-analysis of odds ratios (ORs). Safety outcomes included stroke, bleeding, and sepsis. Fourteen trials randomizing 1858 patients were included: intra-aortic balloon pump (IABP) vs. medical therapy (four trials, n = 748 patients), veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) vs. No VA-ECMO (four trials, n = 568 patients), percutaneous ventricular assist device (pVAD) vs. No pVAD (six trials, n = 542 patients). No MCS device showed a significant effect on early mortality vs. initial medical therapy {IABP (OR 0.87, 95% CI 0.66-1.15), VA-ECMO (OR 0.91, 95% CI 0.65-1.27), pVAD (OR 0.80, 95% CI 0.56-1.14), and P (inconsistency) = 0.76}. VA-ECMO and pVAD were associated with increased major bleeding [OR 2.81 (95% CI 1.68-4.71) and OR 5.13 (95% CI 1.87-14.04), respectively]. Higher rates of stroke and sepsis were noted with pVAD. No significant safety concerns were identified with IABP.

Conclusion: The mortality benefit of MCS devices in AMI-CS remains uncertain. Using such devices may be associated with increased risks, including major bleeding, stroke, and sepsis. Current evidence does not support the routine use of MCS devices in the management of AMI-CS.

Aims: The association between inflammation and atrial fibrillation (AF) is evident, but assessing the specific inflammatory pathways involved in the pathogenesis remains complex. This study aimed to identify inflammatory biomarkers associated with paroxysmal (PAF) and persistent (PeAF) AF by evaluating blood samples from the intra- and extracardiac space.

Methods and results: This is an observational, cross-sectional, single-centre study. A total of 92 inflammatory biomarkers were analyzed from blood samples taken from the coronary sinus (CS) and the femoral vein (FV) in 88 patients with AF who had been referred for catheter ablation at the Linköping University Hospital, Sweden. The concentrations of the biomarkers were compared between PAF and PeAF patients in the CS and FV. Significant differences in concentration were found in 36 of 92 biomarkers. Among these, 12 proteins stand out for exhibiting a higher concentration in PeAF patients: Interleukin 6 (IL-6), CUB domain-containing protein 1 (CDCP1), Interleukin 18 receptor 1 (IL-18R1) and cystatin D (CST5) in the FV, β nerve growth factor (β-NGF) and tissue growth factor α (TGF-α) at the CS level, as well as interleukin 18 (IL-18), chemokine ligand 3 (CCL-3) and tumour necrosis factor superfamily 14 (TNFSF-14) in both FV and CS. Moreover, chemokine ligand 25 (CCL-25), chemokine ligand 28 (CCL-28), and artemin (ARTN) were found at a higher concentration in the CS in the overall population.

Conclusion: This study supports the involvement of TNFSF-14, IL-6, and IL-18 in the pathogenesis and maintenance of PeAF. Furthermore, it identifies β-NGF and TGF-α as potential participants in the pathogenesis and/or maintenance of PeAF locally in the atria. Novel inflammatory biomarkers, mainly chemokines, are also identified as possibly involved in the pathophysiology of AF.

Aims: Whether exercise stress testing (ET) for early identification of coronary artery disease (CAD) should be performed for preparticipation screening (PPS) in all master athletes (MAs) or in high-risk athletes only remains debated. We evaluated the prevalence and characteristics of CAD in MAs who underwent coronary computed tomography angiography (CCTA) after a positive preparticipation ET.

Methods and results: According to Italian law and guidelines, all MAs ≥40 years old must undergo annual ET as part of PPS. We retrospectively enrolled MAs without symptoms, baseline ECG abnormalities or history of heart disease referred to CCTA for ST-segment depression (STD) and/or high-risk premature ventricular beats (PVBs) during ET. We evaluated CAD burden, plaque characteristics, and pericoronary fat attenuation index. Athletes with at-risk PVBs also underwent cardiac magnetic resonance (CMR). We enrolled 130 Caucasian MAs (84% males, median age 54 years): 49 (37%) with high-risk PVBs, and 82 (62%) with STD. Coronary artery disease with ≥50% stenosis was identified in 17 (13%) MAs, including 1 with high-risk plaques, without differences according to CCTA indications (P = 0.83). Age ≥ 60 years and dyslipidemia were independent predictors of ≥50% stenosis, and none of the 45 athletes without risk factors had CAD. Only three athletes eventually required coronary revascularization. Among MAs with PVBs, 20/49 (41%) had abnormal CMR and one cathecolaminergic polymorphic ventricular tachycardia.

Conclusion: In a sample of asymptomatic MAs, STD and PVBs during ET were poor predictors for the presence of significant CAD, strongly influenced by the presence of traditional cardiovascular risk factors. However, ET may have a broader diagnostic value by identifying exercise-induced PVBs, enabling the detection of concealed arrhythmogenic conditions.

Aims: This study aims to examine the association between frailty and cardiac structure and function in hospitalized older adults with preserved ejection fraction, using echocardiographic parameters and the Fried frailty index.

Methods and results: A cross-sectional analytical study was conducted in two referral centres. A total of 269 individuals aged 60 years or older were included. The exclusion criteria were conditions that affect ventricular mechanics. Patients were categorized into non-frail, prefrail, and frail groups. Transthoracic echocardiography included 2D imaging, Doppler, and Global Longitudinal Strain (GLS) of the left ventricle. Comparative analysis was considered statistically significant if P < 0.05. Frailty was significantly associated with diastolic dysfunction, with an adjusted odds ratio of 3.49 (95% CI: 1.90-6.39, P < 0.001). After adjusting for potential confounders-including age, hypertension, diabetes mellitus, coronary heart disease, chronic obstructive pulmonary disease, and chronic kidney disease-frailty remained strongly associated with diastolic dysfunction. In addition, frail patients exhibited distinctive cardiac structural changes, including larger atrial volumes and smaller ventricular volumes. Pulmonary artery systolic pressure and tricuspid regurgitation velocity were also significantly elevated in frail individuals, while GLS of the left ventricle did not differ between groups.

Conclusion: Frailty is independently associated with diastolic dysfunction. Even after adjusting for key comorbidities, it remains strongly associated with significant structural and functional cardiac alterations in hospitalized older adults with preserved ejection fraction.

Acidic calcium stores significantly influence basal calcium transient amplitude and β-adrenergic responses in cardiomyocytes. Atrial myocytes contain atrial granules (AGs), small acidic organelles that store and secrete atrial natriuretic peptide (ANP) and are absent in healthy ventricular myocytes. AGs are known to be acidic and calcium-rich, but their number and location relative to other signalling sites remain unexplored. Labelling of acidic organelles in adult guinea pig cardiomyocytes showed the presence of acidic puncta throughout the cytosol. Atrial myocytes exhibited an increased concentration of acidic organelles at the nuclear poles. Live cell fluorescent studies using 4-phenyl-3-butenoic acid (PBA) to inhibit peptidylglycine α-amidating monooxygenase, a crucial component of AGs membranes, effectively eliminated staining at the nuclear poles and most acidic puncta in atrial cells, but not in ventricular cells. Our immunofluorescent labelling also emphasizes the differences in acidic punctae between atrial and ventricular myocytes by showing minimal co-localization between AG-specific ANP and lysosomal-associated membrane protein. Electron microscopy studies on goat atrial fibrillation (AF) and sham control tissue allowed visualization of AGs. Quantitative analysis revealed that AGs were positioned significantly further away from the nearest sarcoplasmic reticulum and were closer to mitochondria in AF compared to sinus rhythm control tissue. We raise the question whether the positioning of AGs is strategic for communication with other calcium-containing organelles.