Cardiology Research最新文献

Background: Endothelial cell (EC) dysfunction is one of the pathogeneses of pulmonary arterial hypertension (PAH); autophagy is an important conserved mechanism for maintaining cellular homeostasis. However, to date, transcriptional signatures of autophagy-related genes during PAH are not well characterized.

Methods: We analyzed the single-cell RNA sequencing (scRNA-seq) data and revealed the relationship between autophagy and PAH in EC from the perspective of differential expression, transcriptional signature typing, comparative analysis, pseudo-temporal changes of autophagy genes, and high dimensional weighted gene co-expression network analysis (hdWGCNA) networks of autophagy genes. Moreover, we established an in vitro PAH model and verified the expression signatures of candidate autophagy-related genes by western blotting. Student's t-test was used to detect data differences.

Results: Single-cell data showed that ECs had three different subgroups, namely Endo-Nor (normal state), Endo-Mid (transition state), and Endo-PAH (PAH disease group). Functional enrichment analysis of differentially expressed genes between Endo-PAH and Endo-Nor showed that autophagy and phosphatidylinositol 3-kinase (PI3K)-AKT signaling pathways were abnormal. Pseudo-temporal trajectory analysis showed that eight autophagy-related genes were involved in regulating PAH progression. Furthermore, the hdWGCNA network revealed six autophagy-related PAH progression genes. By comprehensively comparing different analysis methods, we identified Ddit4 as an autophagy-related PAH biomarker. Western blot observed that DDIT4 protein was significantly upregulated (P < 0.01) in the PAH model.

Conclusion: This study dissected the expression signature of autophagy genes in PAH at single-cell resolution and identified DDIT4 as a potential biomarker.

Background: Remote ischemic conditioning (RIC) is widely recognized for its cardioprotective effects in the context of ischemic heart disease. Lately, it has been shown that heart conditioning can be utilized as a healthy strategy in the reversion of disease and aging. In this regard, we examine the impact of RIC on patients with cardiac enlargement.

Methods: Forty-four patients with cardiac enlargement were prospectively enrolled and randomly assigned into RIC group (n = 22) and control group (n = 22). RIC protocol is 3-min inflation/deflation of the blood pressure cuff applied in the upper arm to create transient arm ischemia. RIC treatment was performed once a day for 1 year. Left atrial and ventricular dimensions and left ventricular ejection fraction (LVEF) were all assessed in two groups.

Results: RIC was well-tolerated. After 1 year treatment, left atrial and ventricular dimensions were significantly decreased in the RIC group. Moreover, LVEF showed a significant increase, from 46.24% to 56.45% (P < 0.0001).

Conclusion: The research indicates that a year-long healthy regimen of RIC treatment may effectively reverse cardiac enlargement, thereby endorsing the broader implementation of RIC in the daily routines of these patients.

Background: Cardiovascular disease remains a major cause of morbidity and mortality globally. International guidelines recommend aggressive lipid-lowering therapy (LLT) in patients with atherosclerotic cardiovascular disease (ASCVD), targeting a low-density lipoprotein cholesterol (LDL-C) level of < 55 mg/dL and a ≥ 50% reduction from baseline. However, real-world studies continue to show suboptimal LDL-C target achievement. This study aimed to assess the proportion of post-acute coronary syndrome (ACS) patients achieving both LDL-C < 55 mg/dL and a ≥ 50% reduction from baseline at 6 months. A secondary objective was to evaluate target achievement after 1 year and analyze outcomes across different LLT regimens.

Methods: We conducted a retrospective cohort study at a single tertiary center, including patients aged ≥ 18 years who presented with ACS between January 2021 and January 2022, underwent percutaneous coronary intervention (PCI), and had documented LDL-C levels at baseline and at least one follow-up within 12 months. Patients with baseline LDL-C ≤ 55 mg/dL or on ongoing LLT were excluded.

Results: A total of 122 patients were included (mean age 63.5 years; 59.8% had both diabetes and hypertension). At 6 months, only 13/82 patients (15.9%) achieved the primary LDL-C target. The highest achievement was seen in the rosuvastatin + ezetimibe group (30.0%), followed by rosuvastatin (17.9%), atorvastatin + ezetimibe (14.3%), and atorvastatin monotherapy (14.0%). A ≥ 50% LDL-C reduction without meeting the < 55 mg/dL threshold was observed in 24/82 patients (29.3%).

Conclusions: LDL-C target achievement remains low among post-ACS patients despite high-intensity statin use. Combination therapy with rosuvastatin + ezetimibe showed more favorable outcomes, particularly in older adults. These findings underscore the need for structured follow-up, treatment intensification, and broader use of advanced therapies such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors to close the real-world treatment gap.

Guidelines recommend exercise-based cardiac rehabilitation (CR) 2 - 3 times per week. However, this high number of visits per week to outpatient CR can be a burden that lowers patient compliance. Home-based exercise is a key for patients to perform a sufficient volume of exercise. But we sometimes need to be careful in patients who has coronary artery stenosis. Wearable activity trackers would be useful for maintaining an appropriate intensity and sufficient volume of home-based exercise. A 65-year-old male patient who did not have unremarkable past medical history had chest pain and visited our hospital. The primary diagnosis was acute myocardial infarction and the culprit lesion which was 99% stenosis in the posterior descending artery of the left circumflex artery was successfully treated. He was also diagnosed with obesity, hypertension, diabetes mellitus, and dyslipidemia and had residual 75% stenosis in the left anterior descending artery. He was started pharmacotherapy and planned elective percutaneous coronary intervention after 5 months. He was required an exercise-based CR after discharge. Outpatient CR was scheduled for once a week and he needed additional home-based exercise. We used a wearable activity tracker (iAide2-W, TOKAI Corp, Gifu, Japan) to check appropriate intensity of exercise and maintain a sufficient volume for home-based exercise. This device was able to monitor the metabolic equivalent by an acceleration sensor by telemetry. We could check the intensity of exercise at a specialized online site. Thanks to this device, he was able to reduce the body weight and increase the exercise tolerance without any chest pain. The percent predicted oxygen intake per body weight increased from 84% to 95% at the anaerobic threshold and from 68% to 83% at the peak. After 5 months, he treated the residual stenosis successfully. Wearable activity trackers can be used to evaluate biological information in daily life and are expected to be useful for CR.

Background: We sought to compare the long-term outcomes in patients with transthyretin cardiac amyloidosis (CA) compared to those with non-ischemic cardiomyopathy (NICM) from a large healthcare system database.

Methods: Patients with CA or NICM were identified from SSM Healthcare System's data warehouse using ICD codes. Inclusion criteria included at least 6 months of follow-up. Outcomes studied were heart failure hospitalization (HFH), ventricular tachyarrhythmias (VTA), implantable cardiac defibrillator (ICD) and pacemaker (PM) placement. Multivariate logistic analysis and Kaplan-Meier survival curves were constructed.

Results: We identified 231 patients with CA and 462 with NICM, matched for age, race, and gender. CA patients had higher incidence of peripheral vascular disease (48.5% vs. 35.5%) and coronary artery disease (10.4% vs. 6.1%). Mean follow-up was 48.1 ± 33.1 months. CA patients had a higher rate of HFH (57.6% vs. 46.1%) and a lower rate of ICD (1.7% vs. 5.9%). In the multivariate model, CA patients had significantly higher odds for HFH (odds ratio: 1.86; 95% confidence interval: 1.29 - 2.68). Kaplan-Meier survival curves showed a trend toward earlier HFH and later PM or ICD implantation in CA patients.

Conclusions: In this retrospective study from a large healthcare system database, compared to NICM, transthyretin CA patients had significantly higher rates of HFH, similar odds of VTA, and a lower likelihood of receiving an intracardiac device.

Background: Atrial fibrillation (AF) is associated with a high burden of cardiovascular disease, which has been worsened during the coronavirus disease 2019 (COVID-19) pandemic. The purpose of this study was to assess the association between clinical markers, especially interleukin-6 (IL-6) and other inflammatory biomarkers, and the severity of COVID-19 in patients with AF.

Methods: This retrospective cohort study categorized patients based on clinical presentations and laboratory results to investigate the prognostic significance of inflammatory markers in COVID-19 outcomes among those with AF. The study included 100 hospitalized COVID-19 patients aged between 40 to 80 years and was conducted at the Chapidze Hospital in Tbilisi, Georgia. Patients were then grouped by disease severity according to computed tomography (CT) scores, clinical symptoms, respiratory rate and oxygen saturation. Levels of IL-6 were obtained at three time points during hospitalization. A broad range of laboratory tests, including C-reactive protein (CRP), ferritin, and D-dimer, were also conducted.

Results: Patients with AF demonstrated significantly elevated levels of IL-6 (P = 0.024), CRP (P = 0.001), and ferritin (P < 0.001), suggesting a severe inflammatory response. D-dimer levels were also notably higher in the AF group (P < 0.005), indicating an increased risk of thrombotic complications. Oxygen saturation levels were significantly lower (P = 0.004) and CT scores higher in patients with AF. Furthermore, the length of hospitalization was longer among patients with AF (median duration significantly higher, P = 0.032), indicating a more severe disease course.

Conclusions: The proinflammatory markers such as IL-6 are independent predictive markers of COVID-19 severity in AF patients. Overall, it highlights urgent treatment approaches, such as available anti-inflammatory drugs, for COVID-19 patients with arrhythmias. Combining these biomarkers into clinical routines helps us better identify patients at risk and how to treat them.

Five years after the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, there is still a significant number of people who have survived COVID-19 but never fully recovered from the disease. They go through an odyssey of doctor visits and a multitude of diagnostic tests, which ultimately do not provide concrete correlations and answers to the question of how exactly long COVID (LC) affects both physical and mental health, and performance. Often, not even highly technical and highly specialized methods, such as cardiac magnetic resonance imaging (MRI), can provide further explanation. Various research efforts continue to investigate the causes, effects and possible treatments of LC, particularly its impact on cognition and mental health. Patients with LC may experience persistent symptoms, but new symptoms also occur. Based on available studies, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) does not only affect the pulmonary system, but nearly every major system and organ, from the brain and heart to the kidneys and immune system. What mechanisms could explain the persistent symptoms of LC and the inadequate recovery? How valuable is an early internal and neurological examination, particularly in the context of psychotherapy? In this review, we examined which factors could contribute to the persistence of LC symptoms and to what extent mitochondrial impairment by LC can explain the symptoms of LC.

Background: Coronary artery disease (CAD) remains a leading cause of morbidity and mortality. Traditional risk models based on factors like age, hypertension, and lipid levels are limited in individualized prediction, especially for high-risk populations. This study evaluates the independent and combined predictive value of the monocyte-to-lymphocyte ratio (MLR) and triglyceride-glucose (TyG) index for assessing CAD severity.

Methods: In this single-center, retrospective study, 678 patients who underwent coronary angiography (CAG) between January 2022 and June 2024 were included. Eligible patients were aged ≥ 40 years with suspected or confirmed CAD. Clinical data and laboratory values were extracted from electronic records. MLR was calculated as the monocyte-to-lymphocyte ratio, and TyG index was derived from fasting triglycerides and glucose. CAD severity was categorized by SYNTAX scores into no CAD, mild, moderate, and severe CAD. Statistical analyses included Spearman correlation, multivariate logistic regression, and receiver operating characteristic (ROC) curve analysis to assess the diagnostic accuracy of MLR and TyG index.

Results: Of the 678 patients, 67.1% had CAD. Both MLR and TyG index were significantly associated with CAD severity, with MLR showing a stronger correlation with SYNTAX scores. Multivariate analysis confirmed MLR (odds ratio (OR) = 2.15) and TyG index (OR = 1.75) as independent predictors of CAD. The combined MLR-TyG model achieved an area under the curve (AUC) of 0.804, surpassing the predictive value of each marker alone. Subgroup analysis indicated high predictive accuracy in diabetic and hypertensive patients.

Conclusions: MLR and TyG index independently and jointly predict CAD severity, with the combined model enhancing diagnostic accuracy. Reflecting both inflammatory and metabolic dysfunction, this dual-marker approach offers a practical tool for CAD risk stratification, particularly in high-risk populations. Further multicenter studies are needed to validate these findings and examine additional biomarker combinations to refine CAD risk models.

Background: The aim of our study was to evaluate the effects of dapagliflozin on the ventricular arrhythmia burden (VAb) in patients with heart failure with reduced ejection fraction (HFrEF) and an implantable cardioverter defibrillator (ICD), correlating the possible reduction in arrhythmic events and ICD therapies with the basal functional capacity, as well as the remodeling parameters induced by treatment.

Methods: A total of 117 outpatient ICD patients with a known diagnosis of HFrEF who underwent treatment with dapagliflozin were evaluated according to a prospective observational protocol. VAb (including sustained ventricular tachycardia, non-sustained ventricular tachycardia, ventricular fibrillation, and total ventricular events) and specific ICD therapies (anti-tachycardia pacing (ATP) and ICD shocks) were extrapolated from the devices' memory (events per patient per month) by comparing events in the observation period before and after the introduction of dapagliflozin.

Results: The VAb was significantly reduced after dapagliflozin introduction (2.9 ± 1.8 vs. 4.5 ± 2.0, P = 0.01). The burden of appropriate ATPs was significantly reduced (0.57 ± 0.80 vs. 0.65 ± 0.91, P = 0.03), but not for ICD shocks. In patients with a more advanced functional class, a greater reduction in VAb was observed than in patients with a better initial functional capacity (2.2 ± 0.8 vs. 5.5 ± 1.8, P = 0.001 in the New York Heart Association (NYHA) III/IV group; 3.5 ± 2.1 vs. 4.5 ± 2.2, P = 0.02 in the NYHA I/II group). Considering two independent groups according to reverse remodeling (Δleft ventricular ejection fraction (LVEF) > 15%), a significant reduction in VAb was observed only in those patients who presented significant reverse remodeling (2.5 ± 1.1 vs. 5.1 ± 1.6, P = 0.01). A statistically significant interaction between the variation of total ventricular arrhythmias (VTA) and the basal NYHA class (F(1,115) = 142.25, P < 0.0001, partial η² = 0.553), as well as between the variation of VTA and the ΔLVEF (F(1,115) = 107.678, P < 0.0001, partial η² = 0.484) has been demonstrated using a two-way analysis of variance (ANOVA) test.

Conclusions: In ICD outpatients with HFrEF, dapagliflozin treatment produces a reduction in arrhythmic ventricular events. This improvement is more evident in patients who have a worse functional class and thus a more precarious hemodynamic state, and in patients who present with significant ventricular reverse remodeling. Therefore, we can hypothesize that the hemodynamic and structural improvements induced by treatment represent, at least in the short-medium term, some of the principal elements justifying the significant reduction in VAb.

Background: Supraventricular tachycardia (SVT) is common in patients who have undergone a Fontan procedure and is poorly tolerated. SVT recurrence rates after catheter ablations are high. Recent data on the outcomes of SVT ablation and the predictors of recurrence in this population are limited.

Methods: Electronic medical records of patients who had undergone a Fontan procedure and SVT ablation between January 1, 1995, and October 1, 2023, at a tertiary care center were reviewed. Demographic, clinical, and outcome variables over 5 years were compared between patients with and without SVT recurrence.

Results: Twenty-five patients (56% male, mean age 31.5 ± 7.2 years) with a mean age of 6.1 ± 3.6 years at Fontan surgery were included. Ablation success rate was 92%. Recurrence occurred in 12 (48%) patients, of whom 7 (28%) required repeat ablations. Thirteen (59%) patients had a cardiac hospitalization, and one patient died in the 5-year follow-up period. Atypical (71%) and typical (33%) right atrial flutter were the most common SVTs. Higher brain natriuretic peptide (BNP) levels pre- (1,702 vs. 242, P = 0.028) and post-ablation (862 vs. 112, P = 0.017) were associated with recurrence. Atriopulmonary (AP) Fontan type (91% vs. 17%, P = 0.0006), number of radiofrequency (RF) applications (48 vs. 14, P = 0.045), post-ablation cardiovascular (CV) hospitalizations (82% vs. 36% P = 0.030), and post-ablation antiarrhythmic prescriptions (1.8 vs. 1.2, P = 0.0256) were more prevalent in patients with recurrence.

Conclusion: Catheter ablation of SVT in patients with Fontan physiology is associated with a high success rate and a high long-term recurrence rate. Recurrence of SVT is associated with markers of severe heart disease and type of Fontan.