Progress in cardiovascular diseases最新文献

Background: Consumption of more plant-based foods is gaining popularity, but the role of healthy versus unhealthy plant-based diets in cardiovascular disease (CVD) risk remains inconclusive.

Objectives: We investigated associations of plant-based diet indices (PDIs) with incident CVDs in a prospective cohort study and conducted an updated meta-analysis.

Methods: We included 3507 men and 5345 women of the population-based Rotterdam Study. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for CVD, coronary heart disease (CHD) and stroke per SD increment of an overall PDI, healthy PDI (hPDI) and unhealthy PDI (uPDI), among men and women separately. We combined our findings with previously published effect estimates in an updated meta-analysis.

Results: We documented 2015 CVD cases (1231 CHD and 952 stroke) during 107,290 person-years follow-up. Among men, the PDI and hPDI were associated with a 7 % (HR 0.93, 95 % CI 0.87-0.99) and 8 % (HR 0.92, 95 % CI 0.86-0.98) lower CVD risk. Among women, there was evidence suggesting a U-shaped association of the PDI with stroke (p_{non-linearity} < 0.01). In meta-analyses including up to 43,067 incident CVD cases among 359,740 participants from nine studies, the PDI and hPDI, were associated with a lower CVD riskand the uPDI with a higher CVD risk (pooled HRs [95 % CI], per SD, PDI: 0.94 [0.91-0.97], I² = 50.4 %; hPDI: 0.94 [0.91-0.98], I² = 74.7 %; uPDI: 1.03 [1.01-1.06], I² = 49.0 %).

Conclusions: Our findings support recommendations to consume relatively more healthy plant-based foods for CVD prevention. Potential differences by sex and non-linear associations warrant further investigation.

Aim: We sought the cardiopulmonary exercise testing (CPET) parameter that most accurately reflected therapeutic efficacy in patients with hypertrophic cardiomyopathy (HCM).

Methods: Well-being questionnaire, N-terminal brain natriuretic peptide measurements, echocardiography, and CPET were performed in patients with symptomatic non-obstructive HCM during phase II, randomized, open-label multicentre study, before and after 16 weeks of traditional or sacubitril/valsartan treatment. Patients were followed 36 months after the initial CPET. Primary endpoints were changes in: 1) peak oxygen consumption (VO₂); 2) VO₂ at anaerobic threshold (AT); 3) oxygen pulse; 4) minute ventilation (VE)/carbon-dioxide (CO₂) production slope; 5) VE/VCO₂ at AT (VE/VCO₂_AT); 6) VE/VCO₂ nadir; 7) VE/VCO₂ intercept; and 8) partial end-tidal pressure of carbon-dioxide (P_ETCO₂) change during CPET.

Results: Of 115 screened patients, 61 (52 ± 14 years, 43 % women) were included. Within subject therapy effects were detected only by the VE/VCO₂ intercept and P_ETCO₂ change, whereas the differences between medical regimens were detected by differences in VE/VCO₂ nadir and VE/VCO₂_AT changes after the treatment. The best predictors of the change in well-being were left ventricular outflow tract maximal gradient and VE/VCO₂ intercept (B = 0.41,0.36; SE = 0.16,0.30; CI = 0.14-0.79, 0.15-1.14; p = 0.006,0.016, respectively). Adverse cardiac events were best predicted by the initial VE/VCO₂ nadir.

Conclusion: Ventilatory efficiency parameters outperform peak VO₂ in gauging therapy effects in patients with HCM.

The growing burden of coronary artery disease (CAD) has led to a deeper exploration of the pathophysiologic mechanisms underlying the disease process with the hope of finding novel treatments to reduce CAD morbidity and mortality. Sleep is a normal physiologic phenomenon essential for maintaining homeostasis. Disruption in sleep physiology has been linked to the activation of pro-inflammatory cytokines that may predispose to a greater risk of CAD. Several studies have evaluated the etiologic relationship between sleep deficiency and CAD. In this review, we attempt to highlight the key mechanisms proposed to play a role in the association of sleep with the pathophysiology of CAD, the findings and limitations of the pertinent studies, and possible future direction for evaluating and leveraging the relationship between sleep and CAD to develop new therapeutics.

Objective: To investigate the prospective dose-response association of accelerometer-measured moderate-to-vigorous physical activity (PA;MVPA) with all-cause mortality and cardiovascular disease (CVD) incidence.

Methods: This prospective cohort of 76,074 participants from the UK Biobank study contained one week of individual accelerometer-based PA data collected between June 1, 2013 and December 23, 2015. Using restricted cubic splines to allow for potential non-linearity, we examined dose-response associations of MVPA with all-cause mortality and incident CVD, respectively.

Results: The median follow-up time was 8.0 years (IQR 7.5-8.5). The dose-response association of MVPA with all-cause mortality and CVD showed a similar L-shaped association, with significant risk reductions already from 10 min of MVPA per week for all-cause mortality (hazard ratio [HR], 0.98 [95 % CI,0.98-0.99]) and 15 min per week for CVD incidence (HR, 0.99 [95 % CI,0.98-0.99]). Doing more MVPA was associated with further risk reduction, but beyond around 500 min per week the benefits levelled off at HR's around 0.6 to 0.7. The highest additional benefit of adding more minutes per week for all-cause mortality and CVD incidence were observed between 100 and 250 weekly minutes of MVPA. From this point forward, the mean risk reduction rates decreased and were close to 0 beyond 500 weekly minutes.

Conclusions: Significant, but small, risk reductions in all-cause mortality and CVD incidence can be achieved with as little as 10 and 15 min of MVPA per week, respectively. However, public health organizations should promote the attainment of 250 min of MVPA per week (with 100 min as a possible first target for inactive individuals), as these thresholds are associated with the greatest efficiency. Beyond that, less pronounced risk reductions can be achieved by accumulating additional MVPA, with hardly any additional benefits beyond 500 weekly minutes.

The purpose of this perspective is to provide recommendations on the use of Artificial Intelligence (AI) in health promotion. To arrive at these recommendations, we followed a 6-step process. The first step was to recruit an international authorship team from the Healthy Living for Pandemic Event Protection (HL- PIVOT) network. This enabled us to achieve an international perspective with insights from Canada, Great Britain, Kenya, Italy, and the US. A philosophical inquiry was conducted addressing 5 questions. What should the relationship be between humans and AI in health promotion? How can the public and professionals trust AI? How can we ensure AI is aligned with our values? How can we ensure the ethical use of data by AI? How can we control AI? 4 hypothetical scenarios were also developed to provide perspectives on: i) Artificial 'Versus' Human Intelligence; ii) AI Empowerment in Self-Care; iii) Could AI Improve Patient Provider Relationship; and iii) The Kenyan Cancer Patient at the Height of a Pandemic. Based on the philosophical inquiry and the scenarios 11 recommendations are made by the HL-PIVOT on the use of AI in health promotion. The golden thread running through these recommendations is a human centric approach. The recommendations begin by suggesting that workforce planning should take account of AI. They conclude with the statement that any serious incidents involving an AI in Health Promotion should be reported to the relevant regulatory authority.

Background: Takotsubo Cardiomyopathy (TCM) is a transient heart condition often precipitated by stress and characterized by atypical ventricular ballooning. The interplay between TCM and Adrenal Insufficiency (AI), particularly the influence of catecholamine excess and glucocorticoid deficiency on TCM's pathogenesis in individuals with AI, warrants comprehensive exploration for a better understanding of TCM pathophysiology and establishment of potential therapeutic strategies.

Methods: We conducted an extensive literature search via PubMed and Google Scholar, targeting reports on AI, heart failure, and cardiomyopathy, supplemented by forward and backward citation tracing. We analyzed 46 cases from 45 reports, assessing the clinical presentation and outcomes in the context of AI categorization.

Results: In patients with AI, a glucocorticoid deficit appears to exacerbate the myocardial vulnerability to catecholamine toxicity, precipitating TCM. Most conditions were reversible; however, three pre-1990 cases resulted in irreversible outcomes.

Conclusions: The investigation into the AI and TCM intersection highlights the pathogenic significance of catecholamines in the absence of glucocorticoids. The data consolidates the hypothesis that glucocorticoid scarcity exacerbates the cardiac susceptibility to catecholaminergic toxicity, potentially triggering TCM. The study affirms glucocorticoids' cardioprotective roles and elucidates how catecholamine surges contribute to TCM pathogenesis, suggesting strategic clinical management adjustments for AI patients to reduce TCM incidence.

Angiography-derived fractional flow reserve (FFR) has emerged as a non-invasive technique to assess the functional significance of coronary artery stenoses. The clinical applications of angiography-derived FFR span a wide range of scenarios, including assessing intermediate coronary lesions and guiding revascularization decisions. This review paper aims to provide an overview of angiography-derived FFR, including its principles, clinical applications, and evidence supporting its accuracy and utility. Lastly, the review discusses future directions and ongoing research in the field, including the integration of angiography-derived FFR into routine clinical practice.

Antegrade techniques are the foundation of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Antegrade wiring with the intent to achieve an intraplaque guidewire tracking is not always feasible, and crossing into the extraplaque space with subsequent reentry (antegrade dissection and reentry), might be needed, particularly in more complex occlusions. The present article reviews in detail the antegrade approaches to CTO PCI, focusing on equipment, techniques, and overcoming challenges.

Introduction: Critical limb-threatening ischemia (CLTI) is a severe manifestation of peripheral artery disease (PAD) that can lead to limb amputation and significantly reduce quality of life. In addition to guideline-directed medical therapy (GDMT), endovascular therapy and surgical revascularization are the two revascularization options for CLTI. In recent years, there has been an ongoing debate about the best approach for CLTI patients. The purpose of this meta-analysis is to examine the current evidence and compare the clinical outcomes of endovascular therapy and surgical revascularization for CLTI.

Methods: We conducted a systematic search of electronic databases (PubMed, Embase, Cochrane Library, and Web of Science) for studies comparing the outcomes of endovascular therapy versus surgery in patients with CLTI. The primary outcomes were major adverse limb events (MALE) and major adverse cardiovascular events (MACE), while secondary outcomes included risk of bleeding, wound complications, readmission, unplanned reoperation, acute renal failure, and length of hospital stay. Pooled data was analyzed using the fixed-effect model or the random-effect model in Review Manager 5.3. The Newcastle-Ottawa Scale and Cochrane risk of bias assessment tool were used to assess the bias of included studies.

Results: A total of 16 studies (47,609 patients) were included in this meta-analysis. The overall effect favors surgery over endovascular intervention in terms of MALE [odds ratio (OR) 1.13, 95% CI (1.01-1.28), P = 0.04]. Endovascular therapy is associated with lower MACE rates compared to surgery [OR 0.62, 95% CI (0.51-0.76), P < 0.00001]. Furthermore, the risk of bleeding, wound complications, readmission, unplanned reoperation, acute renal failure as well as the length of hospital stay was lower for endovascular intervention. Finally, there was no statistically significant difference in 30-day mortality between the two groups [OR 0.94, 95% CI 0.79-1.12, P = 0.52; Fig. 3i], and the pooled studies were homogeneous [P = 0.39; I2 = 5%].

Conclusion: Surgery may be the preferred treatment option for CLTI patients, as it is associated with a lower risk of MALE than endovascular therapy. However, endovascular therapy may be associated with a lower risk of MACE and lower rates of bleeding, wound complications, readmission, unplanned reoperation, acute renal failure, and shorter hospital stays. There was no statistically significant difference in 30-day mortality between the two groups. Ultimately, the decision to use endovascular therapy or surgery as the primary treatment strategy should be based on a multi-disciplinary team approach with careful consideration of patient characteristics and anatomy.

Coronary computed tomography angiography (CCTA) has emerged as a pivotal tool in the non-invasive evaluation of coronary artery disease (CAD). Recent advancements in imaging techniques, quantitative plaque assessment methods, assessment of coronary physiology, and perivascular coronary inflammation have propelled CCTA to the forefront of CAD management, enabling precise risk stratification, disease monitoring, and evaluation of treatment response. However, challenges persist, including the need for cardiovascular outcomes data for therapy modifications based on CCTA findings and the lack of standardized quantitative plaque assessment techniques to establish universal guidelines for treatment strategies. This review explores the current utilization of CCTA in clinical practice, highlighting its clinical impact and discussing challenges and opportunities for future development. By addressing these nuances, CCTA holds promise for revolutionizing coronary imaging and improving CAD management in the years to come. Ultimately, the goal is to provide precise risk stratification, optimize medical therapy, and improve cardiovascular outcomes while ensuring cost-effectiveness for healthcare systems.