Cardiology Research最新文献

Degenerative aortic valve disease (DAVD) represents the most prevalent valvular ailment among the elderly population, which significantly impacts their physical well-being and potentially poses a lethal risk. Currently, the underlying mechanisms of DAVD remain incompletely understood. While the progression of this disease has traditionally been attributed to degenerative processes associated with aging, numerous recent studies have revealed that heart valve calcification may represent a response of valve tissue to a specific initiating factor, involving the interaction of various genes and signaling pathways. This calcification process is further influenced by a range of factors, including genetic predispositions, environmental exposures, metabolic factors, and hemodynamic considerations. Based on the identification of its biomarkers, potential innovative therapeutic targets are proposed for the treatment of this complex condition. The present article primarily delves into the underlying pathophysiological mechanisms and advancements in diagnostic and therapeutic modalities pertaining to this malady.

Background: Drug-eluting balloons, surface-coated with antiproliferative agents such as sirolimus or paclitaxel, have emerged as an alternative therapeutic option for coronary stenosis. This study evaluated safety and effectiveness of the MOZEC sirolimus-eluting percutaneous transluminal coronary angioplasty (PTCA) balloon dilation catheter (Meril Life Sciences Pvt. Ltd., India) across diverse clinical scenarios in coronary artery stenosis treatment.

Methods: A prospective, single-arm, multicenter, real-world, post-marketing surveillance study evaluated the safety and performance of the MOZEC sirolimus-eluting balloon (SEB) in treating native coronary artery disease in daily clinical practice. Patients were followed for 24 months, with clinical visits or telephonic calls at 1, 6, 12, and 24 months after the index procedure. Safety endpoints included major adverse cardiac events (MACEs), and performance endpoints include change in late lumen loss, clinical success, and device success.

Results: A total of 141 patients were enrolled in the study. The MOZEC SEB was used in 127 (70.17%) de novo lesions, 40 (22.1%) in-stent restenosis lesions, and 14 (7.73%) bifurcations lesions. Over the 24-month follow-up period (n = 134), six cumulative MACEs (4.47%) were observed, comprising two cardiac deaths (1.49%), five myocardial infarctions (3.73%), and four target lesion revascularizations (2.99%). Late lumen loss analysis included 17 patients who underwent additional coronarography at the 6-month follow-up. In-segment and in-device late lumen loss at 6-month follow-up was 0.14 ± 0.37 mm.

Conclusions: The application of MOZEC SEB in various clinical scenarios demonstrated safety and efficacy over long-term follow-up. These findings align with the favorable vessel healing observed during the 6-month imaging follow-up.

Background: The detection of underlying paroxysmal atrial fibrillation (AF) in patients with cryptogenic stroke (CS) can be challenging, and there is great interest in finding predictors of its hidden presence. The recent development of sophisticated software has enhanced the diagnostic and prognostic performance of the 12-lead electrocardiogram (ECG). Our aim was to assess the additional role of a computer-assisted ECG analysis in identifying predictors of AF in patients with CS.

Methods: Sixty-seven patients with ischemic stroke or high-risk transient ischemic attack of unknown etiology were prospectively studied. Their 12-lead digitized ECG was analyzed with dedicated software, quantifying 468 morphological variables. The main clinical, biochemical, and echocardiographic variables were also collected. At discharge, patients were monitored with a wearable Holter for 15 days, and the primary outcome was the detection of AF.

Results: The median age was 80 (interquartile range (IQR): 73 - 84) and AF was detected in 21 patients (31.3%). After preselecting significant ECG variables from the univariate analysis, a multivariate regression including other significant clinical, biochemical and echocardiographic predictors of AF was performed. Among the automatically analyzed ECG parameters, the amplitude of the R wave in V1 (V1_ramp) was significantly associated with the outcome. The best model to predict AF was composed of age, N-terminal B-type natriuretic peptide (NT-proBNP), left atrial reservoir strain (LASr) and V1_ramp. This model showed good discrimination capacity (corrected Somer's D_xy: 0.907, Brier's B: 0.079, area under the curve (AUC): 0.941) and performed better than the same model without the ECG variable (Somer's D_xy: 0.827, Brier's B: 0.119, AUC: 0.896).

Conclusions: The addition of computer-assisted ECG analysis can help stratify the risk of AF in the challenging clinical setting of CS.

Background: This study aims to elucidate the correlation between endothelial function and both cardiac structure and function in patients newly diagnosed with primary (essential) grade 1 hypertension.

Methods: We retrospectively reviewed clinical and echocardiographic data from 109 patients attending a cardiology outpatient clinic from January to December 2022. All subjects underwent comprehensive laboratory tests including lipid profile, glucose, electrolytes, and high-sensitivity C-reactive protein, alongside echocardiography to assess cardiac function. A subset of 34 patients underwent flow-mediated dilation (FMD) testing to evaluate endothelial function, and the results categorized them into normal (FMD ≥ 6%) and reduced (FMD < 6%) endothelial function groups.

Results: The study found no significant differences in baseline demographic or clinical parameters between groups. Age was negatively correlated with FMD values, indicating decreased endothelial function with advancing age. The normal endothelial function group demonstrated better diastolic and systolic parameters and lower right ventricular Tei indices compared to the reduced function group. Additionally, there was a significant negative correlation between the right ventricular Tei index and FMD values.

Conclusions: Endothelial function is associated with right ventricular performance in patients with primary (essential) grade 1 systemic hypertension. Improved endothelial function is associated with better overall cardiac performance. Further studies with age-matched controls are necessary to confirm these findings and determine the independent effects of hypertension on cardiac function.

Background: Blood flow visualization using vector flow mapping (VFM) holds potential as a novel indicator of right ventricular (RV) function.

Methods: This study included 12 patients with atrial septal defect (ASD group, mean (± standard deviation) age: 6.2 ± 1.5 years), six patients with pulmonary hypertension (PH group, mean age: 6.8 ± 2.3 years), and 35 healthy, age-matched children (control group, mean age: 7.3 ± 1.6 years). VFM data were obtained from the parasternal RV short-axis view.

Results: VFM images in the majority of the control group showed a counterclockwise rotating vortex below the tricuspid anterior leaflet and clockwise vortex below the septal leaflet in early diastole. In late diastole, a clockwise vortex flow appeared at the RV apex to the outflow tract. In the ASD and PH groups, the formation of vortical flow below the tricuspid valve was decreased. Late-diastolic vortices also differed from the control group, with counterclockwise or no vortex flow seen in this phase in these groups. Flow energy loss (EL), kinetic energy (KE) and energetic performance index (EPI) were related to RV systolic and diastolic functions. Mean EL over one cardiac cycle (ELcycle) was significantly higher in the PH group than in the control group (P = 0.0471). KE of the RV inflow tract (KE-RVin) and outflow tract (KE-RVout) were significantly lower in the PH group than in the control and ASD groups (P < 0.05 each).

Conclusions: These results suggest that RV vortex formation may be a factor in efficient ejection. EL, KE, and EPI may be applicable to evaluate RV contractility and diastolic function.

Background: The EVEREST trials established the MitraClip as a viable alternative to surgery in treating functional mitral valve regurgitation (FMVR). The MitraClip G4 offers a less invasive way of managing severe FMVR. We sought to compare in-patient mortality and cardiovascular complications in patients with heart failure with reduced ejection fraction (HFrEF) who developed severe FMVR requiring treatment with MitraClip G4 versus annuloplasty. Comparisons of outcomes to previous iterations of the MitraClip were included in the analysis.

Methods: Using the National Inpatient Sample, we included adult patients with FMVR and HFrEF between 2016 and 2020 who underwent percutaneous repair or annuloplasty. MitraClip G4 use was assumed for MitraClip performed in the third quarter of 2019 and afterward. To avoid overlap between the G4 and previous iterations, MitraClip data from 2019 were excluded. Mortality, stroke, and other complications were assessed. Survey-weighted logistic regression was used to adjust for selection bias in the treatment received based on age and comorbidities. The weighted analysis included 19,500 patients receiving either MitraClip G4 or annuloplasty.

Results: The MitraClip group was associated with a decreased risk of in-hospital mortality (odds ratio (OR): 0.38, confidence interval (CI): 0.18 - 0.77), ischemic stroke (OR: 0.29, CI: 0.13 - 0.61), and myocardial infarction (OR: 0.15, CI: 0.08 - 0.28). The MitraClip G4 cohort did not outperform earlier clip versions in reducing complications.

Conclusions: The MitraClip G4 was associated with lower in-hospital mortality and cardiovascular complications than annuloplasty but had outcomes similar to earlier clip versions. Additional studies comparing percutaneous therapies and surgical interventions are necessary to determine optimal treatment strategies for patients with FMVR.

Background: Previous studies have provided evidence of reduced recurrence of atrial fibrillation (AF), all-cause mortality, and heart failure (HF) hospitalizations after catheter ablation (CA) in both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). Aggregate data comparing the efficacy of AF ablation and clinical endpoints in HF with mildly reduced ejection fraction (HFmrEF) to HFrEF and HFpEF are lacking.

Methods: We conducted a systematic review and meta-analysis aimed at determining any differences in AF recurrence rate, all-cause mortality, and HF hospitalizations among patients with HFrEF, HFmrEF, and HFpEF who underwent AF ablation. A systematic search of PubMed/MEDLINE, Embase, and Cochrane Library databases was performed until October 31, 2023.

Results: A total of seven studies comprising 3,795 patients were retained: HFrEF 1,281 (33.8%), HFmrEF 870 (22.9%), and HFpEF 1,644 (43.3%). After median follow-up of 24 months, there was no significant difference in rate of AF recurrence between the three HF categories: HFrEF 40% (30-49%), HFmrEF 35% (28-43%); and HFpEF 35% (25-45%). Only two studies which included outcomes in the three HF categories were identified. Pooled hazard ratio (HR) of all-cause mortality and HF hospitalization combined after ablation or other rhythm control compared to other conservative management were: HFrEF 0.77 (0.63 - 0.94); HFmrEF 0.81 (0.55 - 1.20); and HFpEF 0.74 (0.55 - 1.00).

Conclusions: CA has similar efficacy in the long-term resolution of AF among patients with HFrEF, HFmrEF, and HFpEF. Further studies are needed to provide a robust analysis on the potential impact of CA on all-cause mortality.

The natural progression of bioprosthetic valve degeneration over time requires further interventions for those experiencing symptomatic prosthesis dysfunction. Transcatheter aortic valve replacement (TAVR) emerges as a promising therapeutic option to alleviate symptoms in such patients. The valve-in-valve (ViV) technique eliminates the necessity for repetitive open-heart surgical procedures, offering particular advantages for individuals with higher surgical risks. In this report, we describe the case of a 78-year-old female patient presenting with severe symptomatic aortic restenosis of a biological aortic valve implanted 5 years prior. Given the patient's high surgical risk, a transcatheter ViV implantation was chosen as the treatment approach. Utilizing a balloon-expandable valve, the intervention resulted in the successful implantation of a functional TAVR, resulting in symptom relief and enabling a fast discharge from the hospital.

Background: The advanced glycation end products (AGEs), which can be assessed through skin autofluorescence (SAF), have been linked to chronic kidney disease (CKD), diabetes mellitus (DM), and aging. However, it is unknown how frailty and SAF levels are associated with cardiovascular disease (CVD).

Methods: We enrolled 1,000 consecutive CVD patients who participated in phase II cardiac rehabilitation (CR) and underwent assessment of SAF between November 2015 and September 2017 at Juntendo University Hospital. Of these, 48 patients were excluded as duplicate cases, and a deficiency in SAF data led to the exclusion of an additional 146 patients. The final analysis included 806 patients.

Results: Seventy percent of patients were male, and the mean age was 67.0 ± 12.9 years. In this study, the patients were divided into two groups (high SAF group and low SAF group) based on the median SAF level (2.9 a.u.), which is known as a cutoff value to increase the risk of CVD in previous studies. Compared with the low SAF group (n = 368, 45.7%), the high SAF group (n = 438; 54.3%) was older, and the Kihon Checklist (KCL) total score and prevalence of DM and CKD were significantly higher (all, P < 0.05). Multivariate regression analyses demonstrated that age was the only independent associated factor (P < 0.05) in the low SAF group. Conversely, in the high SAF group, creatinine, hemoglobin A1c (HbA1c) and the sub-total KCL score (1 - 20) were independently associated with SAF levels (all, P < 0.05).

Conclusions: Frailty assessed by KCL is one of the factors significantly correlated with the accumulation of AGEs as well as creatinine, HbA1c and brain natriuretic peptide (BNP) levels in the high SAF group of patients with CVD undergoing phase II CR, who have the higher risk of the onset of CVD and all-cause mortality.

Background: Heart failure (HF) and sepsis are significant causes of disease burden and mortality among the elderly population of the USA. HF causes fluid overload, which complicates the treatment approach when patients develop sepsis necessitating fluid resuscitation. While individual disease states have been studied extensively, the trends in mortality for concurrent sepsis and HF are not well known.

Methods: Mortality trends due to sepsis and HF in individuals aged 65 and older in the USA from 1999 to 2019 were analyzed using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Differences in age-adjusted mortality rate (AAMR) and average annual percent change (AAPC) over the past two decades based on gender, race, region, and place of death were examined.

Results: Between 1999 and 2019, there were a total of 5,887,799 deaths related to HF, 2,584,523 deaths related to sepsis, and 250,115 deaths related to both HF and sepsis. There was also a decrease in AAMR for HF-related (AAPC -0.80%) and sepsis-related (AAPC -0.28) deaths but an increase in combined HF and sepsis-related AAMR (AAPC 1.06%). Men had consistently higher AAMRs compared to women and a greater increase in mortality (AAPC in men 1.53% vs. women 0.56%). African American patients had a higher AAMR than White patients throughout the study period, though the difference narrowed. African Americans saw a decrease in overall HF and sepsis-related AAMR from 48.90 to 40.56 (AAPC -0.83), whereas AAMR for the White population increased from 27.26 to 33.81 (AAPC 1.37). Regionally, the Northeast had the highest AAMR in 1999 (32.32) but decreased to the lowest AAMR by 2019 (30.77). Totally, 203,368 (81.31%) of all deaths related to HF and sepsis were in medical facilities, 18,430 (7.37%) were in home/hospice facilities, and 24,713 (9.88%) in nursing homes.

Conclusions: HF and sepsis-related mortality in the elderly population increased over the past two decades, with men and African Americans at disproportionately higher risk.