Cardiology Research最新文献

Background: India bears a high burden of acute coronary syndrome, with younger patients and a high prevalence of ST-elevation myocardial infarction (STEMI). Spandan is, therefore, an attractive smartphone-based electrocardiogram (ECG) device that could allow for potentially early diagnosis as well as enabling timely intervention which may even save lives in resource-poor settings. The study aimed to assess the performance and diagnostic capability of the Spandan smartphone-based ECG device in decision-making for percutaneous coronary intervention (PCI) by analyzing the initial ST-segment elevation, which was compared to a 12-lead ECG as the gold standard (BPL Cardiart ECG Machine).

Methods: This was an observational cross-sectional study involving 184 eligible participants with chest pain presenting to the local hospital, in Meerut, Uttar Pradesh, India. The study was conducted for the evaluation of the diagnostic appropriateness of the Spandan ECG device for the detection of ST elevation as compared to standard 12-lead ECGs so that the cardiologists could be more easily guided in their decisions relative to PCI. Patients with the onset of chest pain within or after 120 h and ST elevation above 1 mm in two or more leads were enrolled and patients with dementia, bundle branch block, cardiogenic shock, and ECG artifacts were excluded. The analysis included calculating response characteristics and estimating correlation coefficients and confusion matrix to compare both appraisal methods.

Results: The Spandan device performed with good agreement with the gold standard ECG, particularly in the leads II, III, and AVF, with Pearson correlation coefficients close to 1. The ST elevation in the Spandan device showed no statistical difference compared to the 12-lead ECG. The device exhibited a sensitivity of 94% and a positive predictive value of 94% for ST-elevation detection, thus having supportive evidence for possible usefulness for decision-making in PCI.

Conclusions: ECG findings, such as that of the smartphone-based device (Spandan Pro ECG, a single channel autoswitched ECG machine), demonstrated comparable accuracy with the gold standard 12-lead ECG for the diagnosis of ST elevation and helped in making clinical decisions in patients requiring PCI, especially in resource-limited settings.

Background: Right ventricular (RV) diameters and systolic function are strong predictors of outcomes and major adverse cardiovascular events (MACEs) in acute myocardial infarction (AMI). This study evaluated RV parameters via echocardiography in AMI patients and assessed their changes 1 month after discharge.

Methods: A prospective observational study was conducted on 133 consecutive patients with their first AMI. RV diameters and systolic function were evaluated with echocardiography within 24 h after successful percutaneous coronary intervention (PCI) and again 1 month after discharge. MACEs were evaluated during hospitalization and at 1 month post discharge.

Results: Men accounted for 69.92% of the participants, with a mean age of 68 years. Reduced right ventricular free wall longitudinal strain (RVFWSL) and right ventricular four-chamber longitudinal strain (RV4CSL) were observed in 62.4% (mean -18.28±8.77%) and 83.34% (mean -14.78±6.94%) of patients, respectively. Right ventricular longitudinal strain (RVLS) was significantly lower in the ST-elevation myocardial infarction (STEMI) group and Killip III-IV patients. RV basal and mid diameters (RVD1, RVD2) were larger in right coronary artery (RCA) and left main artery (LM) lesions than in left anterior descending artery (LAD) and left circumflex artery (LCx) ones (P < 0.05). RVLS correlated significantly with body mass index (BMI), troponin I, and left ventricular ejection fraction (LVEF). After 1 month, RVFWSL and RV4CSL improved significantly, especially in patients without MACEs, Killip III-IV, and single-vessel lesions.

Conclusions: RV diameters varied with the culprit lesion and remained stable after 1 month. RVLS was significantly reduced in AMI, especially in STEMI and Killip III-IV, correlating with LVEF. After 1 month, RVLS improved faster, particularly in patients without MACEs, Killip III-IV, or single-vessel lesions.

Background: Pulmonary arterial hypertension (PAH) is a chronic disease of the pulmonary blood vessels that can lead to right heart failure, resulting in increased morbidity and mortality if left untreated. While right heart hemodynamics and functional capacity are a well-established predictors of outcome in PAH, emerging evidence suggests that social determinants of health (SDOH) may have a significant impact on patients with PAH, influencing outcomes and survival rates. This study explores the impact of SDOH and their intricate interactions on survival among a Hispanic patient cohort along the US-Mexico border.

Methods: A retrospective analysis was conducted on a single-center cohort of 158 PAH patients (72% female, mean age 58 years) using Cox proportional hazards models and latent class analyses. The primary outcome was mortality during the follow-up period, with secondary analyses examining the impact of individual and combined SDOH on survival.

Results: During a mean follow-up period of 3.8 years (range: 0.2 to 6 years), 37 patients (23.4%) died. Lack of health insurance (hazard ratio (HR) 2.17; 95% confidence interval (CI): 1.05 - 4.49, P = 0.037) and unemployment (HR 2.99; 95% CI: 1.42 - 6.30, P = 0.004) were significantly associated with a higher risk of death within 5 years of follow-up. Latent variable modeling revealed that patients aged ≥ 60 years, who were uninsured, unmarried, and unemployed along with greater PAH severity (measured with cardiac output, mean pulmonary arterial pressure, six-minute walk distance, and World Health Organization Functional Class > 2) had the highest risk of poor outcomes (HR 3.6, 95% CI: 1.9 - 6.8, P < 0.001). Interestingly, the type of insurance did not have a significant impact on survival.

Conclusion: The findings underscore the critical need for improved access to insurance coverage and enhanced social support to promote better health outcomes among this vulnerable Hispanic population. Addressing these SDOH is essential in closing the health disparity gap and improving survival rates in PAH patients.

Background: Acute heart failure (AHF) is a condition commonly affecting elderly patients. Heart failure is classified based on systolic blood pressure (SBP) into hypertensive (SBP ≥ 140 mm Hg), and normotensive (SBP < 140 mm Hg) categories. Differences in the pathophysiological mechanisms associated with each type of AHF may result in varying levels of biomarkers released by the heart during the episode, including N-terminal B-type natriuretic peptide (NT-proBNP), high-sensitivity (hs)-troponin I, and endothelin-1. Currently, there are no studies comparing the levels of cardiac biomarkers between normotensive and hypertensive AHF. Therefore, this study aimed to compare the levels of NT-proBNP, hs-troponin I, and endothelin-1 in patients with hypertensive and normotensive AHF.

Methods: A cross-sectional study was conducted in 104 patients with AHF (40 hypertensive, 64 normotensive) at M. Djamil General Hospital from August 2021 to November 2022. Clinical characteristics, hemodynamic parameters, and cardiac biomarker levels were assessed and compared between groups.

Results: Patients with hypertensive AHF had significantly higher sodium and chloride levels with lower urea levels. Echocardiographic assessment showed higher left ventricular ejection fraction (LVEF) (35.72% vs. 35.25%, P = 0.857), cardiac output (3.0 vs. 2.9 L/min, P = 0.669), and systemic vascular resistance (SVR) (2,276 vs. 2,200, P = 0.693), with lower tricuspid annular plane systolic excursion (TAPSE) (1.7 vs. 1.8 cm, P = 0.717), and estimated right atrial pressure (eRAP) > 8 (87.5% vs. 92.6%, P = 0.517) in normotensive AHF patients compared to hypertensive group, although there was no statistically significant difference between the two groups. The biomarkers test showed higher hs-troponin I levels (281 vs. 72.8 ng/L, P = 0.039) in normotensive AHF than those in hypertensive group. No significant differences were observed in endothelin-1 (12.12 vs. 12.02 pg/L, P = 0.510) and NT-proBNP levels (5,410 vs. 4,712 pg/mL, P = 0.122) between groups.

Conclusions: In patients with normotensive AHF, higher levels of hs-troponin I were observed, with no significant differences in other cardiac biomarkers. A higher proportion of males and a lower prevalence of hypertension as a risk factor were also noted in normotensive AHF, although these differences were not statistically significant.

Marfan syndrome (MFS) is a genetic disorder primarily affecting the connective tissue, with cardiovascular complications as the leading cause of mortality. While mutations in the FBN1 gene are the primary cause, the severity and progression of the disease can vary significantly among individuals. DNA methylation, a key epigenetic regulatory mechanism, has garnered attention in MFS research, particularly regarding methylation changes in the FBN1 locus and their effects on fibrillin-1 expression. Differential methylation and expression of genes related to inflammation (e.g., interleukin (IL)-10, IL-17) and oxidative stress (e.g., PON2, TP53INP1) have been linked to MFS aortic pathology. These alterations likely contribute to disease progression by influencing inflammatory responses, smooth muscle cell apoptosis, and biomechanical properties of the aorta. The transforming growth factor-beta (TGF-β) signaling pathway plays a central role in MFS pathology, with aberrant methylation of related genes potentially elevating active TGF-β levels and exacerbating aortic lesions. Notably, tissue-specific methylation patterns, especially in smooth muscle cells of the aorta, remain poorly understood. A deeper understanding of DNA methylation's role in MFS could pave the way for early interventions and epigenetic-targeted therapies.

Background: This study aimed to investigate the impact of early extubation on stress response and neurodevelopmental outcomes after pediatric cardiac surgery utilizing cardiopulmonary bypass (CPB).

Methods: In this single-center prospective pilot study, we attempted to study the impact of using dexmedetomidine as an adjunct to facilitate early extubation after pediatric cardiac surgery requiring CPB during the first year of life. The study was conducted between May 2014 and January 2020. Perioperative data and stress hormone levels were collected at different points during the perioperative period. In addition, neurodevelopmental outcome measures including cognitive composite score, language (expressive and receptive) and motor (fine and gross) composites were evaluated at five time points including prior to surgery and up to 1 year after the procedure. Two-sample t-tests and Kruskal-Wallis tests were used to compare continuous parametric and non-parametric outcomes, respectively. Fisher's exact or Chi-squared tests were used to compare categorical outcomes.

Results: A total of 30 subjects were included in the final cohort of patients. Of the 30 subjects, 14 patients were randomized to the dexmedetomidine group (dexmedetomidine plus fentanyl) (DEX group) and 16 patients were randomized to the no dexmedetomidine group (fentanyl only) (no DEX group). With few exceptions, both groups demonstrated appropriate blunting of the stress response. There was a significant increase in the ratio of the pro-inflammatory interleukin-10 (IL-10) to the anti-inflammatory interleukin-6 (IL-6) for the no DEX group at the end of the procedure when compared to the DEX group (10 ± 9 vs. 5 ± 4, P = 0.04). When looking at the Bayley cognitive composite score, the DEX group scored better than the no DEX group during the second visit (102 ± 11 vs. 88 ± 17, P = 0.023). By the fifth visit, the two groups scored similarly (94 ± 12 vs. 94 ± 12, P = 0.9 for the no DEX and DEX groups, respectively).

Conclusion: When looking at the neurodevelopmental outcome, both groups had no significant changes in their Bayley scores from baseline with blunting of most stress markers. This study offers possible evidence of the safety of early extubation after pediatric cardiac surgery while maintaining the goal of neuroprotection.

Primary cardiac lymphoma is a rare, often fatal malignancy that can cause disorders of conduction depending on tumor location. We report two cases with sick sinus syndrome and atrial flutter secondary to primary cardiac lymphoma originating from the right atrium. One case required pacemaker implantation in the chronic phase after complete remission of lymphoma, and the other case in the acute phase when cardiac mass occupied the right atrium. Depending on the disease activity of lymphoma including its size, growth rate, and degree of invasion, the clinical course of sinus node dysfunction varies between each patient. In patients with conduction disorders, we suggest that long-term cardiac monitoring is necessary not only at onset but also after complete remission of lymphoma.

Background: The extent of atherosclerosis in healthy men and women was measured using ultrasound in the carotid artery and whether the progression could be predicted using the classic risk factors was investigated. A hypothesis was also formulated as to how microvascular dysfunction and atherosclerosis, on the one hand, and cardiovascular disease and cancer, on the other hand, might be related. To describe the relationship between atherosclerosis and cancer, the classic risk factors and plaque burden were compared.

Methods: From 2009 to 2024, 10,597 subjects (44% women) aged 20 - 65 years without signs of cardiovascular disease were examined using ultrasound of the carotid artery. The sum of all plaque areas (total plaque area (TPA)) and the maximum plaque thickness were measured. Follow-up examinations were carried out on 4,520 subjects (42% women) aged 40 - 65 years. In 2,397 men without cancer or cardiovascular events during follow-up, the classic risk factors and plaque burden were compared between 55 men who had a solid tumor and 188 men who had a cardiovascular event, and whether patients with cancer and a cardiovascular event exhibited different risk profiles was examined.

Results: In the age group of 35 - 65 years, 12% of men and 4.2% of women had advanced atherosclerosis (types III and IVb). In the age group of 40 - 65 years, 2,592 men and 1,928 women were followed up. Low to moderate atherosclerosis was present in 2,052 (79.2%) men and 1,761 (91.3%) women. Advanced atherosclerosis developed in 139 (6.8%) men and 39 (2.2%) women, which could not be predicted by the classical risk factors (P > 0.05). The mean follow-up time was 73 months (6.1 years) for men and 75 months (6.3 years) for women. Patients without cancer or cardiovascular disease have lower risk factors and lower plaque burden compared to men with cancer or cardiovascular events. Patients with cancer have very similar high-risk factors and high plaque burden compared to patients with cardiovascular disease.

Conclusion: By measuring the plaque burden on the carotid artery, a good risk stratification can be achieved in every age group. A follow-up examination every 3 - 5 years is advisable, as a rapid progression of the disease cannot be predicted taking into account the classic risk factors. Early treatment of advanced atherosclerosis improves the prognosis for cardiovascular diseases and possibly also for certain types of cancer. Patients with cancer and cardiovascular events show a similar risk profile and plaque burden.

Background: Heart failure with preserved or mildly reduced ejection fraction (HFpEF/HFmrEF) has differences in therapy and development when compared with HF with reduced EF (HFrEF). We aimed to describe the clinical characteristics and all-cause mortality of patients with HFpEF/HFmrEF compared to those with HFrEF from the Colombian Heart Failure Registry (RECOLFACA).

Methods: RECOLFACA included Colombian adult patients with ambulatory HF recruited from 2017 to 2019. All-cause mortality was our main outcome. We used the Kaplan-Meier method, life table, and Cox proportional hazard models to evaluate the role of the comorbidities on mortality, with a significant P-value of < 0.05. All statistical tests were two-tailed.

Results: We included 2,514 patients, and 1,139 (45.3%) had a diagnosis of HFpEF or HFmrEF. HFpEF/HFmrEF diagnosis was not significantly related to either higher or lower risk of mortality compared to an HFrEF diagnosis; however, the individual risk factors for this outcome varied between the two groups. Health-related quality of life (HRQL) was a common risk factor for both groups.

Conclusion: Although the EF classification was not a significant risk factor for mortality, patients with HFpEF/HFmrEF exhibited a unique profile of risk factors for mortality, the HRQL, highlighting the relevance of an adequate classification of the HF patients.

Background: Intracoronary imaging and physiology guidance of percutaneous coronary intervention (PCI) have shown significant improvements in clinical outcomes. However, comparable data on the use of these modalities in PCI of patients with diabetes are only sparsely available from South Asia. This study investigated the feasibility and clinical outcomes of systematic use of fractional flow reserve (FFR) and optical coherence tomography (OCT) during PCI in patients with diabetes.

Methods: The study enrolled 275 patients (≥ 18 years) from nine centers in India and one from Bangladesh between October 2021 and September 2022. Patients with stable ischemic heart disease, non-ST-elevation myocardial infarction (MI), and unstable angina were included in the study. Angiographically intermediate lesions (diameter stenosis of 40% to 80%) underwent FFR-guided PCI. Lesions with a diameter stenosis of > 80% underwent PCI without FFR evaluation. All PCI procedures were guided by OCT using the MLD-MAX algorithm.

Results: At 12 months, the target lesion failure (TLF) rate, a composite of cardiac death, nonfatal MI, and clinically driven target lesion revascularization, was 3.3%. Among the intermediate lesions, PCI was deferred by 70% after the FFR evaluation. Pre- and post-procedural OCT has led to a strategy change in 49.5% and 33.6%, respectively.

Conclusions: The study revealed a relatively lower rate of events with FFR and OCT guidance compared to historical data from angiography-guided PCI in patients with diabetes. The strategy of combined use of FFR and OCT in PCI may contribute to improved clinical outcomes in patients with diabetes.