Cardiology Research最新文献

Background: This secondary analysis of a cross-sectional observational study aimed to evaluate the impact of heart failure (HF) classification on inpatient outcomes and demographic associations.

Methods: Data from the 2019 National Inpatient Sample (NIS) included 259,025 patients older than 18 years with a primary International Classification of Diseases, 10th Revision (ICD-10) diagnosis of HF.

Results: Weighted results for this study showed that HF subtypes were stratified as diastolic (35.63%, n = 92,300), systolic (30.09%, n = 77,931), combined systolic-diastolic (18.74%, n = 48,529), other (11.81%, n = 30,593), end-stage (1.56%, n = 4,030), right (1.18%, n = 3,063), and biventricular (1.00%, n = 2,579). Acuity was categorized as acute on chronic HF (72.68%, n = 188,106), acute HF (10.79%, n = 27,948), chronic HF (1.84%, n = 4,778), and indeterminate (15%, n = 38,193). Demographically, older adults (≥ 75 years), African Americans, and males were found to be more frequently admitted, with age being the most significant factor. Younger patients (< 75 years) were more often diagnosed with non-diastolic HF, while minority groups had higher incidences of systolic and combined HF. Females were more likely to have diastolic HF compared to males. Right, biventricular, and end-stage HF were associated with increased inpatient costs, longer hospital stays, and higher mortality rates. Detailed HF classification reveals significant variations in inpatient outcomes and demographic associations.

Conclusions: Advanced HF subtypes incur higher costs, longer hospital stays, and increased mortality, underscoring the need for improved classification and earlier intervention across diverse populations. Further research is needed to refine HF diagnosis and coding to better understand and manage these conditions.

Background: Concomitant aortic and mitral regurgitation (CAMR) is associated with poorer outcome compared with isolated aortic regurgitation (AR). Current prognostic assessment of AR does not include the magnitude of mitral regurgitation (MR). Cardiac magnetic resonance (CMR) can integrate volumetric data to obtain a novel combined parameter, total regurgitant fraction (TRF), which could have the potential ability to measure the combined effects of AR and MR on left ventricle (LV) overload. The aim of our study was to explore the usefulness of TRF in predicting the future need of aortic valve surgery in patients with CAMR.

Methods and results: Patients with CAMR and prior CMR studies were retrospectively recruited. A total of 45 patients were included, of whom 10 (22%) developed surgery indications. At the median follow-up time point (3.2 years), survival without surgery indication was 95% in the group with TRF < 40% compared to 90% in the group with aortic regurgitant fraction (ARF) < 29%. In contrast, 67% of patients with TRF ≥ 40% developed surgery indications after 3.2 years compared to 55% of patients with ARF ≥ 29%. In the multivariate analysis, the model including binary TRF had the highest hazard ratio of 13.846 (2.822 to 67.939, P = 0.001).

Conclusions: TRF is a promising CMR parameter that could improve the prediction of the need for surgery in patients with CAMR. Further studies with larger populations should be performed to confirm these findings.

Background: Selective sodium glucose transporter-2 inhibitor (SGLT2i) has cardio-renal protective effects via osmotic diuresis and natriuresis, and other pleiotropic effects, such as anti-oxidative, anti-fibrotic, and anti-senescence effects, have been suggested. However, those pleiotropic effects have not yet been fully elucidated in a clinical study.

Methods: We investigated the effects of SGLT2i in patients with heart failure with reduced ejection fraction (HFrEF). Twenty-five HFrEF patients who were initially treated with dapagliflozin from 2021 to 2023 at Fukuoka University Hospital were enrolled and we investigated their baseline characteristics, medications, clinical laboratory examination findings, echocardiography findings, and additional pleiotropic serum markers before administration of dapagliflozin and 6 months later.

Results: The patients were 67.0 ± 13.6 years old, 64.0% were male, and their body mass index was 24.0 ± 4.5 kg/m². Only four patients (16.0%) had diabetes mellitus. With regard to medications, 64.0%, 76.0%, and 60.0% were already taking renin-angiotensin aldosterone system inhibitors, beta-blockers, and mineralocorticoid receptor antagonists, respectively, and these medications did not change significantly for 6 months. After treatment with dapagliflozin for 6 months, serum brain natriuretic peptide, left ventricular ejective function, hemoglobin, and urinary N-acetyl-β-D-glycosaminidase were significantly improved. In addition, high-sensitivity C-reactive protein and oxidative stress markers including myeloperoxidase, matrix metalloproteinase-1, and matrix metalloproteinase-9 significantly improved, while anti-fibrosis and anti-senescence markers did not.

Conclusions: Dapagliflozin had anti-oxidative effects in patients with HFrEF, in addition to cardio-renal protective effects. These anti-oxidative effects could be related to the cardio-renal protective effects of SGLT2i, even in a clinical setting.

Background: Acute myocardial infarction (AMI) remains a leading cause of mortality in the African American population, warranting an examination of regional and demographic trends to inform health policies.

Methods: Utilizing the Centers for Disease Control and Prevention's WONDER death certificate database, we conducted a comprehensive analysis of AMI mortality from 1999 to 2020 in African Americans and overall adults aged 25 and older. Age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated and stratified by year, sex, race, and geographic region. Joinpoint regression facilitated the assessment of mortality trends, revealing average annual percentage changes (AAPCs) with 95% confidence intervals (CIs).

Results: Over the study period (1999 - 2020), there were 3,015,339 total deaths due to AMI in adults aged 25 and older. African Americans had the highest AAMR, at 71.5, followed by Whites, at 63.5, and the lowest among Asians, at 32.6. Overall, AAMR decreased in the African American population from 128.5 in 1999 to 48.5 in 2020, with an AAPC of -5.29 (95% CI: -5.69 to -4.9). AAMR decreased from 109 in 1999 to 37.6 in 2020 in African American females. African American males experienced a decline from 157.8 to 63.4 in AAMR. African American males had a higher overall AAMR (88.6) than females (59.3). Regionally, AAMR was highest in the South (77.6) and lowest in the Northeast (57.6) among African Americans.

Conclusions: While AMI mortality has declined, persistent differences persist in the African American community. African American males experience a higher mortality rate as compared to females. Regional variations, notably the higher AAMR in the Southern region, emphasize the need for targeted health policies to mitigate disparities and enhance healthcare access. These measures may include expanding insurance coverage and improving access to healthcare, education, food, and employment for African Americans.

A plethora of risk factors, such as hypercholesterolemia, smoking, hypertension, and others lead to the progression of coronary atherosclerosis. Vulnerable plaques are formed, and rupture of such plaques results in the development of myocardial infarction. Great progress has been made in the medical community's focus on management of risk factors, with clear improvement in the incidence and outcome of myocardial infarction. However, triggers of plaque rupture, which include significant physical and mental stress, need more attention. In this report, we focused on the effect of emotional stress in triggering various acute cardiac events. Natural disasters such as earthquakes result in significant emotional stress, and have been associated with substantial increases in cardiac death and acute myocardial infarction. This is more pronounced with severe events, particularly if they occur in the early morning hours. Anger and severe emotional stress from various life events, particularly from stressed marital relations or stressful working conditions, will result in markedly increased occurrence of myocardial infarction. This is more pronounced in patients with known coronary artery disease or significant risk factors. Providers need to focus on management of stress during hospitalization for myocardial infarction, as well as in the rehabilitation phase of such events.

Background: Heart failure (HF) is a major cause of global morbidity and mortality. Patients with acute decompensated chronic HF (ad-CHF) usually have more comorbidities, whereas those with de novo acute HF (dn-AHF) may have a more severe clinical presentation. Despite extensive research on HF, comparative data on in-hospital outcomes and mortality between these groups are scarce in Latin American countries. The aim of this study was to evaluate differences in in-hospital complications and mortality among patients hospitalized with either dn-AHF or ad-CHF.

Methods: An ambispective study was conducted at a tertiary hospital in Colombia, including 780 patients hospitalized for acute HF. Patients were classified as dn-AHF or ad-CHF, and sociodemographic, clinical, and in-hospital outcomes were compared using bivariate analysis. A Firth penalized logistic regression model was used to assess the association between dn-AHF and in-hospital mortality.

Results: Of these patients, 39.2% had dn-AHF, and 60.8% had ad-CHF. Median ages were 67 (interquartile range (IQR): 56 - 76) and 66 (IQR: 55 - 79) years, respectively. Both groups had a predominance of reduced left ventricular ejection fraction, with median values of 30% in ad-CHF and 34% in dn-AHF. Ad-CHF patients had more comorbidities, whereas dn-AHF patients showed higher rates of cardiac and non-cardiac complications. Intensive care unit (ICU) admission rates were similar, the need for invasive mechanical ventilation (P < 0.001) and the occurrence of infections (P = 0.049) were significantly more frequent in patients with dn-AHF. In-hospital mortality was higher in dn-AHF than ad-CHF (9.8% vs. 5.5%, P = 0.023). After adjustment, dn-AHF remained independently associated with greater in-hospital mortality (odds ratio (OR): 1.87; 95% confidence interval (CI): 1.07 - 3.31; P = 0.029).

Conclusions: Patients with dn-AHF experienced more in-hospital complications and higher mortality than those with ad-CHF, despite similar ICU admission rates and fewer comorbidities. These results highlight the prognostic importance of dn-AHF and underscore the need for early identification, vigilant monitoring, and phenotype-specific management from admission to improve outcomes, particularly among patients with reduced ejection fraction.

Background: Patent foramen ovale (PFO) may complicate acute pulmonary embolism (PE) by enabling paradoxical embolism, but its clinical impact remains unclear. We evaluated the characteristics, management, and outcomes of patients hospitalized with PE with or without PFO.

Methods: Using the National Inpatient Sample database, adult patients admitted with acute PE between 2016 and 2020 were identified via ICD-10 codes. Patients were grouped based on whether they had concomitant PFO. Clinical characteristics, advanced therapies, and in-hospital outcomes were compared between patients with and without PFO. Multivariable logistic regression analyses were adjusted for demographics and comorbidities, with outcomes reported as adjusted odds ratios (aORs) and 95% confidence intervals (CIs).

Results: We identified 903,230 adult patients hospitalized with acute PE, among whom 4,860 (0.54%) had a PFO. Patients with concomitant PE and PFO were younger (59.4 ± 15.9 vs. 63 ± 16.5 years, P < 0.001) and presented with more severe clinical features, including higher rates of saddle PE (17.7% vs. 9%, P < 0.001) and cor pulmonale (17.9% vs. 8.3%, P < 0.001). They required significantly more frequent interventions, such as catheter-directed thrombolysis (7.4% vs. 3.8%, P < 0.001). After multivariable adjustment, PFO presence was associated with significantly increased odds of stroke (aOR 25.5, 95% CI 19.8 - 32.8; P < 0.001) and peripheral embolism (aOR 13.7, 95% CI 10.5 - 18.0; P < 0.001) but not increased in-hospital mortality (aOR 0.9, 95% CI 0.6 - 1.3; P = 0.702).

Conclusion: In this nationwide study, PFO in patients with acute PE was linked to greater clinical severity and more frequent advanced interventions. Prospective studies are needed to define optimal screening strategies.

Other than the traditional risk factors for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) - detected by means of anamnesis, Holter monitoring, exercise testing, echocardiography and cardiac magnetic resonance imaging - exercise oscillatory ventilation (EOV), detected by cardiopulmonary exercise testing (CPET), has recently been observed in patients with HCM. EOV is considered as one of the most important independent risk factors for morbidity, mortality and SCD in patients with reduced, as well as with preserved ejection fraction. Considering HCM as a prototype of heart failure with preserved ejection fraction, we would like to present a short, specific review concerning EOV as a potential new risk factor for SCD in HCM.

Background: Coronary artery calcium (CAC) scoring is widely used to screen for coronary artery disease (CAD) in asymptomatic individuals. However, it detects calcified plaques and may miss non-calcified or soft plaques. This study compared the diagnostic accuracy of CAC scoring with coronary computed tomography angiography (CCTA) for detecting CAD in asymptomatic individuals with risk factors.

Methods: Eighteen asymptomatic adults with a CAC score of 0 underwent CCTA to evaluate for subclinical CAD. Clinical, biochemical, and lifestyle risk factors were assessed. Diagnostic agreement between CAC and CCTA was analyzed using the Wilcoxon signed rank test.

Results: The cohort had a mean age of 51.4 ± 10.6 years, 88.8% were male, and mean body mass index (BMI) was 27.7 ± 3.6 kg/m². Smoking (70.5%) and family history of CAD (56.25%) were prevalent. Biochemical analyses showed preserved renal function and non-diabetic glycemic profiles. Despite the absence of calcification on CAC, CCTA revealed CAD in 72.2% (13/18) of participants, detecting non-calcified plaques missed by CAC scoring. Elevated cardiac and inflammatory markers, including high-sensitivity cardiac troponin T, apolipoprotein B (apoB), and lipoprotein(a) (Lp(a)), were observed in those with positive CCTA findings. The Wilcoxon signed rank test indicated a significant difference between the modalities (Z = -3.606, P < 0.001).

Conclusions: CCTA detected non-calcified atherosclerosis missed by CAC and demonstrated superior sensitivity for early CAD detection in asymptomatic individuals.

Background: Transcatheter closure of secundum atrial septal defects (ASDs) is a widely accepted intervention in adults with left-to-right shunting and right heart volume overload. However, the time course and magnitude of cardiac remodeling and functional improvement after closure remain incompletely defined. This study evaluated serial echocardiographic changes in right heart structure and hemodynamics following ASD closure.

Methods: In this single-center retrospective cohort, adults who underwent transcatheter secundum ASD closure between January 2020 and December 2023 were included. Echocardiography was performed at baseline, immediately post-procedure, at 3 to 6 months, and at 1 year. Parameters included right atrial (RA) area and volume index (RAVI), right ventricular (RV) dimensions, pulmonary valve velocities, RV systolic pressure (RVSP), mean pulmonary artery pressure (mPAP), tricuspid annular plane systolic excursion (TAPSE), and tricuspid regurgitation (TR) severity. Analyses used Wilcoxon signed-rank tests, Chi-square tests, repeated-measures analysis of variance (ANOVA)/multivariate ANOVA (MANOVA), and mixed-effects models.

Results: Eighty patients were included (mean age: 42.3 ± 15.0 years; 72.5% female). Immediately after closure, significant reductions were observed in TR Vmax (-20.8 cm/s, P = 0.0005), pulmonary valve Vmax (-32.1 cm/s, P < 0.0001), Vmean (-18.6 cm/s, P < 0.0001), velocity time integral (VTI) (-6.9 cm, P < 0.0001), RA area (-2.6 cm², P < 0.0001), RAVI (-7.0 mL/m², P < 0.0001), RVSP (-7.7 mm Hg, P < 0.0001), QP:QS (-0.8, P ≤ 0.0001), and mPAP (-10.0 mm Hg, P = 0.0007). Improvements were sustained at 3 - 6 months (n = 54) and at 1 year (n = 19).

Conclusions: Transcatheter ASD closure in adults results in early and sustained improvements in RA and ventricular remodeling, pulmonary pressures, and TR severity. These findings underscore the role of echocardiography in longitudinal surveillance and support timely intervention in patients with significant shunting (QP:QS > 1.5). Larger multicenter studies with extended follow-up and correlation to clinical outcomes are warranted.