Cardiology Research最新文献

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.

Background: This study aimed to explore the effect of radial artery flow hyperperfusion on the successful collection of radial artery blood gas specimens in patients with acute heart failure.

Methods: From February 2023 to December 2024, 548 patients with acute heart failure in the database of the emergency rescue room of our hospital were divided into two groups: non-hyperperfusion group and hyperperfusion group. In the hyperperfusion group, arterial blood gas was collected using the radial artery hyperinfusion method (improving radial artery perfusion by blocking arteries other than the radial artery in the forearm using a customized sphygmomanometer with a double-airbag hollow cuff). The primary endpoint was the success rate of one-time puncture and the success rate of total puncture. Secondary endpoints included puncture frequency of > 3 times, puncture time, pain, puncture site hematoma, puncture site bruise, and patients' satisfaction.

Results: In total, 548 patients were included, including 325 in the non-hyperperfusion group and 223 in the hyperperfusion group. The hyperperfusion group exhibited a significantly higher success rate of one-time puncture (63.4% vs. 83.4%, P< 0.001) and success rate of total puncture (82.5% vs. 94.6%, P < 0.001) compared to the non-hyperperfusion group. Additionally, the hyperperfusion group experienced a significantly reduced number of patients with puncture frequency > 3 times (26.2% vs. 9.9%, P < 0.001) and puncture time (48.59 ± 7.83 s vs. 26.43 ± 6.44 s, P < 0.001). This approach also effectively decreased the risk of puncture site hematoma (2.2% vs. 0.0%, P = 0.045), arm puncture place bruise (5.5% vs. 0.4%, P<0.001), and pain (3.0 (3.0, 4.0) vs. 2.0 (1.0, 2.0), P <0.001) and improved patients' satisfaction after adopting the radial artery hyperinfusion method.

Conclusions: Radial artery hyperperfusion improved the success rate of puncture for radial artery blood specimen collection in patients with acute heart failure, reduced puncture complications, and improved patients' satisfaction.

Background: Remimazolam is a benzodiazepine with sedative, anxiolytic, and amnestic properties similar to those of midazolam. However, its elimination is novel as it undergoes metabolism by tissue esterases with a half-life of 5 - 10 min and a limited context-sensitive half-life, thereby resulting in a rapid dissolution of its clinical effects. Initial clinical work has demonstrated its efficacy for the induction of general anesthesia, as an adjunct to maintenance anesthesia, and for procedural sedation.

Methods: We retrospectively reviewed our experience with the use of remimazolam for sedation during cardioversion in adult patients.

Results: The study cohort included six patients, ranging in age from 22 to 68 years. Intravenous remimazolam was the primary agent for all procedures. All six patients received a single bolus dose of remimazolam while two patients received a continuous infusion after the bolus dose. Two patients received adjunctive agents (fentanyl 100 µg). No clinically significant respiratory or hemodynamic adverse effects were noted in any patient. Adequate amnesia was achieved as none of the six patients recalled the cardioversion.

Conclusion: Our preliminary experience demonstrates that remimazolam may be an effective agent for sedation during cardioversion without significant impact on hemodynamic or respiratory function. In adult patients, a single 5 mg bolus dose of remimazolam provided effective amnesia and sedation for the procedure.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was responsible for the coronavirus disease 2019 (COVID-19) pandemic and generated high morbidity and mortality rates worldwide, as well as several sequelae that persist and need to be evaluated. The aim of this study was to evaluate the association between a history of COVID-19 infection and the occurrence of cardiac arrhythmias in outpatients from a private clinic in Arequipa.

Methods: We conducted a retrospective, analytical, unmatched case-control study in a private cardiology clinic in Arequipa, Peru. A total of 252 adult patients who underwent 24-h Holter monitoring between October and December 2023 were included. Cases were defined as patients with documented cardiac arrhythmias; controls had no arrhythmic findings. The main exposure was a confirmed history of COVID-19. Age, sex, and additional Holter findings were also analyzed. Logistic regression was used to estimate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs), adjusting for age and sex.

Results: Of the total sample, 68 patients were classified as cases and 184 as controls. A history of COVID-19 was more frequent among cases (70.6%) than among controls (50.5%) (P = 0.004). In unadjusted analysis, patients with prior COVID-19 had more than twice the odds of presenting arrhythmias (OR: 2.35; 95% CI: 1.29 - 4.26; P = 0.005). After adjusting for age and sex, the association remained statistically significant (OR: 2.12; 95% CI: 1.10 - 4.11; P = 0.025).

Conclusion: A prior history of COVID-19 was significantly associated with increased odds of cardiac arrhythmias. These findings highlight the importance of structured cardiac evaluation in patients with prior SARS-CoV-2 infection.

Background: Cardiovascular diseases (CVDs) remain the leading cause of global mortality. Different blood pressure subtypes may have varying associations with cardiovascular events, but evidence remains inconclusive in the working population. The objective of the study was to evaluate the incidence and differences between hypertension and prehypertension subtypes in the development of cardiovascular events in an occupational cohort.

Methods: A retrospective cohort study including 12,027 workers monitored over 8 years. The outcome variable was the development of CVD, including myocardial infarction and/or stroke. Hypertension subtypes were classified as normotension (systolic blood pressure (SBP) < 140 mm Hg and diastolic blood pressure (DBP) < 90 mm Hg), isolated systolic hypertension (SBP ≥ 140 mm Hg and DBP < 90 mm Hg), isolated diastolic hypertension (SBP < 140 mm Hg and DBP ≥ 90 mm Hg), and systolic-diastolic hypertension (SBP ≥ 140 mm Hg and DBP ≥ 90 mm Hg). Prehypertension subtypes were defined as isolated systolic prehypertension (SBP 120 - 139 mm Hg and DBP < 80 mm Hg), isolated diastolic prehypertension (SBP < 120 mm Hg and DBP 80 - 89 mm Hg), and systolic-diastolic prehypertension (SBP 120 - 139 mm Hg and DBP 80 - 89 mm Hg). Cox models were used to estimate crude hazard ratios (cHRs) and adjusted hazard ratios (aHRs), controlling for sociodemographic variables and cardiovascular risk factors.

Results: Isolated systolic hypertension (aHR: 6.78, 95% confidence interval (CI): 3.10 - 14.8) and isolated systolic prehypertension (aHR: 3.42, 95% CI: 1.73 - 6.74) showed significant associations with cardiovascular events, even after adjusting for confounding variables. Neither isolated diastolic nor systolic-diastolic prehypertension and hypertension showed significant associations.

Conclusions: While cardiovascular events were infrequent in this occupational cohort, those that occurred showed significant associations with both systolic hypertension and pre-systolic hypertension, suggesting the importance of systolic pressure monitoring in workplace health surveillance.

Background: Currently, limited information is available regarding testosterone in women with heart failure with preserved ejection fraction (HFpEF). This cross-sectional study aimed to elucidate the clinical significance of serum total testosterone concentration (T-T) in Japanese elderly women with pre-HFpEF, a condition that develops before the onset of HF.

Methods: A total of 232 elderly women outpatients with pre-HFpEF (mean age ± standard deviation, 75 ± 7 years) were enrolled. Relationships between T-T and other clinical parameters were investigated. The definition of pre-HFpEF in this study was that patients with left ventricular ejection fraction of 50% or more and E/e' ratio as a marker of left ventricular function greater than 9 on echocardiography had no HF symptoms and no history of HF hospitalization.

Results: There was a significantly negative correlation between T-T and the E/e' ratio (r = -0.24, P < 0.001), and low T-T was significantly related to coronary artery disease. A significant correlation was observed between T-T and biomarkers such as blood brain natriuretic peptide concentration (r = -0.31, P < 0.001), serum high-sensitivity cardiac troponin T concentration (r = -0.33, P < 0.001), and the derivatives-reactive oxygen metabolites test, an oxidative stress marker (r = -0.46, P < 0.001). Furthermore, multiple regression analysis identified that the factors described above were selected as independent variables for T-T as a dependent variable.

Conclusions: This cross-sectional study indicated that low T-T levels reflect unfavorable pathophysiological conditions in Japanese elderly women with pre-HFpEF. To clarify the relevance of T-T as a predictive indicator for the onset of cardiovascular diseases, including HF incidence in elderly women with pre-HFpEF, future prospective studies, including interventional treatments, should be conducted.