Cardiology Research最新文献

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.

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.