Cardiology Research最新文献

Background: CHA2DS2-VASc score in cardiac amyloidosis (CA) with atrial fibrillation (AF) is believed to underestimate ischemic stroke risk, necessitating a better predictive model.

Methods: Data were obtained from the National Readmission Database (NRD). Outcomes between CA-AF and no-CA-AF were compared using multivariate regression analysis to calculate adjusted odds ratios (aORs). AutoScore, an interpretable machine learning framework, was used to develop a stroke risk prediction model, and its predictive accuracy was evaluated with an area under the curve (AUC) using the receiver operating characteristic analysis.

Results: A total of 11,860,804 (CA-AF 22,687 (0.19%) and no-CA-AF 11,838,117) patients were identified from 2015 to 2019. The adjusted odds of mortality (aOR: 1.41 and 1.29), stroke (aOR: 1.78 and 1.74), non-intracranial hemorrhage (aOR: 2.10 and 1.85), and intracranial hemorrhage (aOR: 14.4 and 4.26) were significantly higher in CA-AF compared with non-CA-AF at both index admission and 30 days, respectively. The CHA2DS2-VASc score had a poor discriminative accuracy for stroke at 30 days in CA-AF (AUC 49%, 95% confidence interval (CI): 47 - 51, P = 0.54). The machine learning autoscore integrative model revealed excellent predictive ability of our newly proposed E-CHADS score (end-stage renal disease (ESRD), congestive heart failure (CHF), hypertension (HTN), cancer, dementia, and diabetes mellitus (DM)) for 30-day risk of ischemic stroke in CA-AF (cutoff of 52 points random forest score) with an AUC of 80% (95% CI: 74 - 86).

Conclusions: CA with AF carries a high risk of ischemic stroke that is not accurately predicted by the CHA2DS2-VASc score. Our proposed model (E-CHADS) identifies three new variables (ESRD, dementia, and cancer) that have higher discriminative accuracy for ischemic stroke in these patients.

Background: Acute myocardial infarction (AMI) is one of the most severe forms of acute coronary syndrome. During myocardial ischemia, cardiac glycogen is metabolized through glycolysis, which becomes the primary source of ATP. The genetic regulation of glycolysis is well established, yet its contribution to AMI pathogenesis remains poorly understood. This study aimed to use bioinformatics approaches to identify glycolysis-related genes (GRGs) associated with AMI, providing a foundation for their potential applications as molecular markers and therapeutic targets.

Methods: GRGs were retrieved from the GeneCards database. Weighted gene co-expression network analysis (WGCNA) was applied to the GSE66360 dataset to identify hub genes, which were validated by the Wilcoxon rank-sum test and the receiver operating characteristic (ROC) curve analysis. Immune cell infiltration and its association with hub gene expression in AMI were further examined using the CIBERSORT algorithm.

Results: Analysis of the GSE66360 dataset identified 695 differentially expressed genes (DEGs). Gene set enrichment analysis (GSEA) indicated that these genes may contribute to AMI pathogenesis by regulating cellular energy metabolism. Intersecting DEGs with GRGs yielded 31 differentially expressed glycolysis-related genes (DEGRGs). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses suggested that DEGRGs may influence AMI development by modulating immune cell function and immune response status. Construction of a protein-protein interaction (PPI) network identified seven hub genes, all of which demonstrated diagnostic performance in GSE66360 based on the ROC analysis. Validation in the independent dataset GSE59867 confirmed two hub genes with diagnostic potential. Immune infiltration analysis further revealed that these two hub genes were significantly associated with multiple types of immune cells.

Conclusion: Two GRGs, S100A8 and CXCL1, were identified as potential biomarkers and therapeutic targets in AMI. Both genes were associated with immune cell infiltration, suggesting that they may contribute to AMI pathogenesis through immunometabolic regulation. Importantly, combined detection of these hub genes may facilitate early risk stratification and prediction of major adverse cardiac events, offering a new direction for AMI diagnosis and prognosis.

Background: Interhospital transfer of ST-elevation myocardial infarction (STEMI) patients can lead to greater access to percutaneous coronary intervention (PCI) and reduce mortality. However, it is unclear how the characteristics of the transferring and receiving hospitals impacts mortality of transferred STEMI patients.

Methods: In this retrospective cohort study, we estimated differences in mortality among STEMI patients undergoing interhospital transfer using Kaplan-Meier survival curves and adjusted hazard ratios derived from Cox proportional hazard models.

Results: We found that partial PCI capability (i.e., retaining some patients while transferring others for PCI) of the transferring hospital and lower quality of the receiving hospital were associated with lower survival.

Conclusions: Interhospital transfers driven by factors other than distance and quality can negatively affect patient outcomes.

Background: Obtaining commissural alignment in transcatheter aortic valve replacement (TAVR) is important for ensuring coronary access and coronary artery filling, reducing the risk of central leaks, and minimizing leaflet stress. The Evolut FX system has the gold markers placed at the neo-commissures and has demonstrated favorable outcomes. We investigated whether evaluating the orientation of the gold markers in a three-cusp coplanar view (3-CV) after Evolut FX implantation was useful for assessing commissural misalignment (CMA).

Methods: Between April 2023 and December 2024, we included 25 patients who underwent transfemoral TAVR using the Evolut FX for symptomatic severe aortic stenosis. All patients underwent multidetector computed tomography (CT) after TAVR. The native-prosthetic gap (NPG) was defined as the distance between the center of the transcatheter heart valve stent frame and the central gold marker in a 3-CV. We evaluated the association between the NPG and CMA, which was derived from the average misalignment deviation on post-TAVR CT.

Results: The median age was 84 years, 36% were male, and 8% had coronary artery disease. The implanting view was the cusp overlap view (COV) in 11 patients, the near-COV in 11 patients, and the left anterior oblique view in three patients. Of the 22 patients implanted using the COV or near-COV, the gold markers were positioned at "2 left-1 right" in 17 patients. The average misalignment deviation was 18.0° (commissural alignment: eight patients, mild CMA: 13 patients, moderate CMA: two patients, and severe CMA: two patients) and the median NPG was 0.11. In cases with commissural alignment and mild CMA, NPG showed a significant positive correlation with the average misalignment deviation (r = 0.68, P < 0.01), whereas in cases with moderate and severe CMA, the relationship was inverse (r = -0.38, P = 0.62). Further, in cases with commissural alignment and mild CMA, a clockwise misalignment occurred when the central marker was positioned closer to the non-coronary cusp side, while a counterclockwise misalignment was observed when positioned closer to the left-coronary cusp side.

Conclusions: Evaluating the orientation of the gold markers in a 3-CV after Evolut FX implantation is useful for assessing CMA.

Background: It has been reported that weight bearing index (WBI) is associated with rehabilitation; however, there are few reports about its association with the length of hospital stay in patients who have undergone cardiac surgery.

Methods: We registered 108 patients who did not have preoperative contraindication of exercise and underwent both cardiac surgery and cardiac rehabilitation from April 2017 to May 2022 at Fukuoka University Hospital. We excluded seven patients whose hospital stays were prolonged due to severe infection or unstable hemodynamics after cardiac surgery. We investigated patient background, laboratory, respiratory, and echocardiographic examinations, physical functions, periprocedural complications, and postoperative outcomes. We divided the patients into two groups according to a cutoff value for walking (0.45 kgf/kg WBI).

Results: The patients' age was 69 (59 - 75) years, the percentage of males was 74.1% (n = 80), and their body mass index (BMI) was 23.4 ± 3.5 kg/m². The low WBI group consisted of 48 patients and the preserved WBI group consisted of 60 ones. The patients in the low WBI group showed a lower percentage of male. With regard to physical functions, grip strength, one-leg standing time, the Short Physical Performance Battery score, 10-m walking speed, walking distance for 2 min both pre- and post-cardiac surgery in the low WBI group were significantly low. After cardiac surgery, the New York Heart Association (NYHA) classification was high, and the strength of exercise tolerance at discharge was low in the low WBI group. There were no significant differences in the progression of cardiac rehabilitation until walking between the groups, but the length of hospital stay in the low WBI group was significantly long. WBI was an independent predictor of the length of hospital stay in a logistic regression analysis.

Conclusions: Preoperative WBI was associated with physical functions, NYHA classification, and length of hospital stay. Preoperative WBI could be a simple marker for detecting postoperative outcomes.

Background: Following transcatheter aortic valve implantation (TAVI), transvalvular mean gradient is known to increase from immediate to 24 h post-procedure. While anesthesia, rapid-pacing, and volume status are blamed, the true etiology is unclear. To our knowledge, no prior studies have evaluated the effects of mitral regurgitation (MR) on the rise in post-TAVI transvalvular mean gradient.

Methods: A single-center, retrospective analysis of patients who underwent TAVI at our institution between 2011 to 2020 was performed (n = 378, males = 206). Patients were divided into two groups, no-to-mild MR (n = 327) and moderate-to-severe MR (n = 51) based on echocardiograms obtained prior to TAVI. Transvalvular gradients were compared between immediate and 24-h post-TAVI echocardiograms.

Results: The average age of no-to-mild MR patients (77 years (interquartile range (IQR): 71 - 84)) was similar to moderate-to-severe MR patients (79 years (IQR: 76 - 85), p=0.13). Both groups had similar procedural blood pressures and peri-procedural medication use. The change in 24-h post-TAVI mean transvalvular gradient was +6 mm Hg (IQR: 3.7 - 9) in the moderate-to-severe MR group and +6 mm Hg (IQR: 3.4 - 9) in the no-to-mild MR group (P = 0.87).

Conclusions: In this study, we evaluated the impact of preexisting MR on changes in transvalvular gradients following TAVI. We observed no statistically significant difference in 24-h post-TAVI gradient changes between patients with moderate-to-severe MR and those with no-to-mild MR. These findings suggest that baseline MR may not be a major determinant of early post-TAVI hemodynamics; however, further prospective studies are needed to confirm this observation.

Background: Patent foramen ovale (PFO) is a common remnant of the embryonic development of the heart with an underestimated potential for morbidity and mortality. This study aimed to investigate the long-term impact of atrial arrhythmia (AA), a common complication after PFO closure, on cardiac function and quality of life (QoL) through a retrospective clinical analysis.

Methods: Patients who underwent percutaneous PFO closure between January 2022 and June 2024 were retrospectively identified. All patients underwent 24-h Holter electrocardiogram (ECG) monitoring prior to the procedure to screen for baseline atrial fibrillation (AF). Cardiac function and QoL were assessed after intervention and at long-term follow-up using echocardiographic parameters and questionnaires (SF-36), respectively.

Results: A total of 215 patients were included in this study. Sinus rhythm was present in all patients at baseline, and 26% developed AA during follow-up after PFO closure. The average follow-up period was 24 ± 7.8 months. Among the 56 patients with post-procedural AA, echocardiographic analysis showed that mitral E/A significantly increased at long-term follow-up compared to the immediate post-interventional period (1.20 ± 0.24 vs. 1.29 ± 0.18, P < 0.05). No statistically significant changes were observed in echocardiographic variables other than mitral E/A. In terms of QoL, only the score for social function improved significantly at long-term follow-up (65.21 ± 6.16 vs. 67.98 ± 7.59, P < 0.05), while no significant differences were found in the other subdomains.

Conclusions: AA, the common complication of PFO closure, has no impact on the long-term cardiac function and QoL of patients.

Background: Dilated cardiomyopathy (DCM) is a major contributing factor for heart failure and cardiac transplantation worldwide. Estimating the prevalence and incidence of DCM is critical for understanding the burden of illness in these patients and improving the landscape of preventative treatments. Previous reviews have shown substantial prevalence and incidence estimates for DCM within key regions such as the United States and several European countries. This review aimed to describe the published evidence on the prevalence and incidence of DCM within the United States, France, Germany, Italy, Spain, and the United Kingdom.

Methods: MEDLINE^® and Embase were searched from database inception to May 9, 2023 for English-language studies reporting the prevalence or incidence of DCM within general populations of adults or children in countries of interest. Manual searches of relevant conferences and bibliographies of previous literature reviews were also conducted.

Results: Of 6,145 identified articles, 10 unique studies were included in the review. Six studies reported prevalence, and five studies reported incidence of DCM in various populations. Prevalence estimates of DCM, including idiopathic and non-idiopathic causes, within adults (≥ 18 years) and/or heterogeneous (all ages) populations ranged from 42.8 to 118.3 per 100,000 persons; idiopathic DCM estimates ranged from 8.3 to 59.2 per 100,000 persons. Prevalence of adolescent (about 11 - 18 years) DCM, including idiopathic and non-idiopathic causes, ranged from 2.6 to 212.8 per 100,000 persons. Annual incidence rates of idiopathic DCM in adult/heterogeneous populations ranged from 6.0 to 7.0 per 100,000 persons. Annual incidence of DCM due to idiopathic/non-idiopathic causes among pediatric populations was reported as 0.6 per 100,000 persons. Reported prevalence and incidence rates by sex showed male preponderance, and estimates were higher in Black persons compared with White and Hispanic persons; higher DCM prevalence estimates were observed in studies utilizing newer DCM definitions using ICD coding compared with older definitions.

Conclusion: This study highlights the varied prevalence and incidence rates of DCM reported across different geographic locations, time periods, sexes, races, and disease definitions. When comparing these rates, it is crucial to consider factors such as data sources, case definitions, case-finding methodologies, and study populations.

Background: This study evaluated the cardioprotective effects of angiotensin receptor-neprilysin inhibitor (ARNI) therapy in patients with heart failure (HF), focusing on blood pressure (BP) and cardiac or renal function.

Methods: A total of 46 patients who started ARNI therapy between December 2020 and March 2023 were included. Blood tests, echocardiography, and assessments of BP and cardiac function including N-terminal pro-brain natriuretic peptide (NT-proBNP) in blood were performed before and 6 months after they started ARNI therapy. The patients were divided into two groups: heart failure with reduced left ventricular (LV) ejection fraction (HFrEF) and non-HFrEF.

Results: Before treatment, the mean NT-proBNP level was 550 pg/mL, LVEF was 45%, and the estimated glomerular filtration rate (eGFR) was 52.7 mL/min/1.73 m² in all patients. After 6 months of ARNI therapy, NT-proBNP levels significantly decreased to 462 pg/mL (P < 0.01), LVEF improved to 52% (P < 0.01), and BP showed a slight reduction, particularly in patients with high baseline BP. eGFR remained stable (P = 0.53). The results showed that ARNI treatment led to a reduction in NT-proBNP and improvements in cardiac function, with more pronounced effects in patients with HFrEF. BP changes correlated with baseline levels, stabilizing at around 125/70 mm Hg, and there were no significant differences in changes in renal function between HFrEF and non-HFrEF patients.

Conclusions: ARNI therapy significantly reduced NT-proBNP levels and improved cardiac function, with mild antihypertensive effects and no major impact on renal function. These results highlight the importance of predicting the degree of BP reduction by BP at baseline before starting ARNI in HF patients.

Although pulmonary arterial hypertension (PAH) usually affects young people with a low burden of cardiovascular comorbidities, epidemiologic changes over time have been providing a codified phenotype of subjects with PAH, characterized by a hemodynamic profile compatible with pure pre-capillary pulmonary hypertension (PH), associated with increased risk factors for left heart disease (LHD). Compared with the younger subjects belonging to the classical PAH phenotype, those with PAH and LHD phenotype share several distinctive features. They include: 1) the older mean age at diagnosis of PAH; 2) peculiar hemodynamic features, characterized by a trend toward lower values of mean pulmonary arterial pressure and pulmonary vascular resistances, and higher values of pulmonary artery wedge pressure; 3) greater clinical deterioration; 4) more impaired exercise capacity; 5) higher mortality risk; 6) weaker response to PAH-targeted treatment; and 7) higher rate of PAH drug discontinuation. Physicians must be aware of such peculiar phenotype of PAH. This is advisable for providing a comprehensive diagnostic workup, in order to reduce the risk of PH misclassification and provide the most appropriate decision-making approach.