Cardiology Research最新文献

Background: Accurately assessing mortality risk in patients with heart failure with mildly reduced ejection fraction (HFmrEF) after acute myocardial infarction (AMI) remains challenging. This study developed and validated a mortality risk predictive model for such patients.

Methods: In this single-center retrospective study of 873 hospitalized patients with HFmrEF after AMI, 611 patients were included in the training cohort and 262 in the validation cohort. The primary outcome was all-cause mortality over an average 33-month follow-up. Least absolute shrinkage and selection operator (LASSO) regression identified predictive variables for post-discharge mortality, with model performance assessed via receiver operating characteristic (ROC) analysis and decision curve analysis (DCA).

Results: Six mortality risk predictors were identified: age, stroke history, New York Heart Association (NYHA) classification, hemoglobin (Hb) levels, estimated glomerular filtration rate (eGFR), and primary percutaneous coronary intervention (PPCI) implementation. The C-index for training and validation cohorts was 0.795 (95% confidence interval (CI), 0.758-0.832) and 0.741 (95% CI, 0.672-0.81), respectively. Training cohort area under the curve (AUC) metrics for 6-month, 2-year, and 3-year survival were 0.861, 0.805, and 0.815; for the validation cohort, they were 0.722, 0.742, and 0.736.

Conclusions: A validated predictive model assessing mortality risk in HFmrEF patients post-AMI was established. External validation in future studies is recommended.

Background: Acute myocardial infarction (AMI) management has reduced in-hospital mortality, yet heart failure (HF) and atrial fibrillation (AF) remain common long-term complications. Left atrial (LA) function, assessed via speckle-tracking echocardiography (STE), provides sensitive markers of cardiac remodeling. This study aims to investigate the prognostic value of LA deformation parameters and their significance for long-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI), particularly in relation to low triiodothyronine (T3) syndrome.

Methods: A retrospective study enrolled 140 first-onset STEMI patients treated with primary percutaneous coronary intervention. Thyroid hormone concentrations were measured within 24 h of admission, and patients were classified into low T3 (free triiodothyronine (fT3) < 3.2 pmol/L, n = 44) and control groups (n = 96). Echocardiography and STE were performed within 72 h and repeated after 6 months. LA reservoir strain and conduit and contractile strain rate parameters were analyzed. Long-term outcomes, including AF, rehospitalization, HF, major adverse cardiac events (MACEs), and all-cause death, were assessed after 10 years.

Results: Patients with low T3 syndrome were older, with higher inflammatory markers (P = 0.03) and reduced LA conduit strain rates during the acute phase (P = 0.04). After 6 months, LA volume increased significantly in both groups, but more prominently in low T3 patients (P = 0.03). Reduced LA reservoir strain (area under the curve (AUC), 0.721; P = 0.012) and conduit strain rate (AUC, 0.621; P = 0.012) were strong predictors of MACEs and AF, respectively. Logistic regression identified the LA conduit strain rate, LA reservoir strain, LA volume index, and left ventricular ejection fraction as independent predictors of adverse outcomes.

Conclusions: STE-derived LA deformation parameters provide valuable prognostic information in post-STEMI patients. The LA reservoir strain and LA conduit strain rate are significant predictors of MACEs, while LA global longitudinal strain identifies patients at risk of HF. Early STE evaluation can enhance risk stratification and guide management.

Background: A significant association between lower preheparin serum lipoprotein lipase mass (pre-LpL mass) and coronary artery disease (CAD) has been reported in several clinical studies. However, the predictor of a pre-LpL mass as a CAD event in patients with chronic kidney disease (CKD) remains unclear. This prospective study aimed to investigate the clinical significance of a pre-LpL mass as a predictor of primary CAD events in patients with CKD.

Methods: A total of 480 CKD patients who did not develop CAD among outpatients who visited the clinic were enrolled. Using receiver operating characteristic curve analysis for a primary CAD event, participants were divided into two groups (low pre-LpL mass (group L, n = 211) or high pre-LpL mass (group H, n = 269)) by pre-LpL mass, and significance of a pre-LpL mass as a predictor for the primary CAD events was performed.

Results: At baseline, skin autofluorescence, an indicator of advanced glycation end products in vivo, and high-sensitivity C-reactive protein (hs-CRP) concentration, an indicator of inflammation, were significantly higher in group L than in group H. During the median observation period of 107 months, 42 patients experienced a CAD event (group L: n = 31 (14.7%) vs. group H: n = 11 (4.1%)). Group L had a significantly higher incidence of primary CAD events than group H (P < 0.001, log-rank test). Furthermore, patients in group L were at a significantly higher risk of developing a primary CAD event than those in group H based on the multivariate Cox regression analysis (hazard ratio: 2.80; 95% confidence interval, 1.39-5.64; P = 0.003). However, skin autofluorescence and hs-CRP were also significant factors for a primary CAD event.

Conclusions: The prospective study showed that a decrease in pre-LpL mass is a useful predictor of a primary CAD event in patients with CKD. Additionally, background factors such as an increase in advanced glycation end products and inflammation are also an important factor in these patients.

Background: No-reflow phenomenon (NRP) following primary percutaneous coronary intervention (PPCI) remains a critical determinant of adverse outcomes in ST-segment elevation myocardial infarction (STEMI) cases despite successful epicardial recanalization. The core purpose of this study was to establish the value of intracoronary (IC) tirofiban, delivered via the IC route, in mitigating the occurrence of NRP for STEMI cases subsequent to successful vessel reopening.

Methods: This randomized controlled double-blind study enrolled 60 STEMI cases. Following successful PCI, cases with thrombolysis in myocardial infarction (TIMI) flow grade less than 3 were randomized to receive either IC tirofiban (25 ug/kg) or saline 0.9% as placebo, in addition to standard pre-procedural therapy with aspirin, heparin, and ticagrelor. TIMI flow grade and incidence of NRP were evaluated. Additionally, ST-T normalization in electrocardiogram (ECG) was assessed. Bleeding complications and major adverse cardiac events (MACEs) were recorded during hospitalization and at 30-day follow-up.

Results: The tirofiban group demonstrated notably superior coronary flow restoration with 80% achieving TIMI 3 flow versus 46.67% in controls (P = 0.007). NRP occurred in 20% of tirofiban cases compared to 53.33% in controls (P = 0.007). Minor bleeding complications increased in the tirofiban group (26.67% versus 3.33%, P = 0.026), while major bleeding remained absent in both groups. Total in-hospital MACEs were notably reduced with tirofiban treatment compared to controls (3.33% versus 30%, P = 0.012).

Conclusions: In STEMI cases following PPCI, IC tirofiban administration effectively reduces NRP, improves coronary flow restoration, and reduces MACE despite increased minor bleeding risk.

Background: This study evaluated the effectiveness of the estimated glucose disposal rate (eGDR), an indicator of insulin resistance, as a screening tool for cardiovascular disease (CVD) in individuals with obesity.

Methods: A cross-sectional analysis was conducted using data from the US National Health and Nutrition Examination Survey (NHANES) covering the years 1999 to 2018. The study included 20,521 participants with a waist-to-height ratio (WHtR) of 0.6 or higher, indicating obesity. Participants were divided into quartiles based on their eGDR levels: Q1 (> 8 mg/kg/min), Q2 (6 - 8 mg/kg/min), Q3 (4 - 6 mg/kg/min), and Q4 (≤ 4 mg/kg/min). Multivariable logistic regression models, adjusted for various demographic, lifestyle, and metabolic confounders, were used to analyze the relationship between eGDR and CVD. The predictive capability of eGDR was assessed using the area under the receiver operating characteristic curve (AUC), restricted cubic splines (RCS) for capturing non-linear relationships, and stratified subgroup analyses.

Results: CVD prevalence significantly increased with decreasing eGDR levels (Q1: 5.3% vs. Q4: 26.2%). After full adjustment for covariates, multivariable regression confirmed that the lowest eGDR quartile (Q4) was strongly and independently associated with a substantially elevated risk of CVD compared to the highest quartile (adjusted odds ratio (OR) = 6.3; 95% confidence interval (CI): 5.53 - 7.17; P < 0.001). eGDR also demonstrated good predictive performance for specific CVD subtypes, with the highest AUC for heart failure (0.715, 95% CI: 0.699 - 0.730). RCS analysis validated a significant non-linear, inverse dose-response relationship between eGDR and overall CVD risk. Subgroup analyses, stratified by age, sex, and glycemic status, consistently demonstrated a significant association between low eGDR and increased CVD risk across all categories (P < 0.001).

Conclusions: Lower eGDR independently and strongly indicated a heightened risk of CVD in individuals with obesity.

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.