Cardiology Research and Practice最新文献

Background: Utilizing the two available prediction models, i.e., the dual antiplatelet therapy (DAPT) score and predicting bleeding complication in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score, we aimed to determine the appropriateness of the DAPT in patients with acute myocardial infarction (AMI) in patients undergoing percutaneous coronary intervention (PCI). Methods: We retrospectively enrolled 235 patients of AMI and for all the patients and thorough information regarding history, risk factors, and medications were collected. Both DAPT and PRECISE-DAPT scores were calculated. The patients were divided by their recommended cutoffs and the appropriateness of the duration of the recommended DAPT was measured based on the observed scores. Bleeding academic research consortium (BARC) classification was used to define the bleeding events. In the patients with DAPT score ≥ 2 and PRESICE-DAPT < 25, the prolonged use of DAPT was recommended. Results: Overall, 235 patients, predominantly male (78.7%), with baseline characteristics exhibiting high rate of smoking (31.1%), diabetes (35.3%), and hypertension (32.8%) were found. The widely prescribed DAPT combination was aspirin with clopidogrel (72.3% at discharge and 46% on current use). Among all the enrolled patients, 163 patients were on DAPT while 71 were on single antiplatelet therapy (SAPT). A significant association between DAPT and PRECISE-DAPT scores was noted in terms of SAPT and DAPT. The appropriateness of DAPT was checked based on the scores, where 81% of the patients with DAPT ≥ 2 and 77.24% with PRECISE-DAPT score < 25 were appropriately prescribed with DAPT. The primary reason for drug interruptions was self-advised. The incidence of bleeding events was observed to be 7.23%, among which 5.1% had Type 1 bleeding according to BARC. Conclusion: Both DAPT and PRECISE-DAPT scores could be used to determine the appropriateness of the recommendations of DAPT in patients with AMI or undergoing PCI.

Background: Atrial fibrillation (AF) is a common morbid arrhythmia that can cause thromboembolic events such as stroke. Despite advancements in diagnostic technologies, a significant number of AF patients may remain undetected and undiagnosed, and these asymptomatic patients possess sufficient risk of cardioembolic stroke. Identifying such patients through appropriate screening techniques and timely initiation of systemic anticoagulation therapy is essential to prevent such life-threatening complications. Objectives: The objectives of this study encompass screening of AF among residents of the Dhulikhel Municipality and identifying its prevalence, along with evaluation of stroke risk and use of antithrombotic therapy in patients confirmed with AF. Methods: All residents of four wards of Dhulikhel Municipality, aged 50 years and above (n = 2048), underwent one-time electrocardiogram (ECG) screening using a portable 12-lead ECG machine. The cardiologist checked the cardiogram, and suspected AF cases were referred to the hospital for further evaluation and appropriate management. They were followed up to find out information on disease confirmation and management. Results: Out of 2048 participants, AF was detected in 16 participants, resulting in an overall prevalence of 0.78% (CI 0.4%-1.3%). The prevalence of AF was highest (2.98%) in population aged 80 years and above. Among individuals with AF, the median age was 71.5 (66.3-79.5) years, 50.0% were male and 75.0% had high stroke risk as indicated by a CHA₂DS₂-VASc score ≥ 2. Among these patients, only 41.66% were treated with oral anticoagulants (OACs), while 58.34% were treated either with single or dual antiplatelet therapy (DAPT). Conclusion: This study provided important insight into the prevalence of AF at the community level. Many AF patients were at high risk of stroke, but the OAC use was less than 50%. Screening of AF needs to be carried out on a larger scale in Nepal for early detection and timely management of the disease.

In the elderly population, coronary heart disease (CHD) often coexists with hypertension. However, excessive blood pressure reduction can paradoxically increase the incidence of adverse events. Understanding the molecular mechanisms underlying hypertension and CHD in aged populations is crucial for developing targeted therapies and improving clinical outcomes. In this study, we constructed myocardial infarction (MI) and transverse aortic constriction (TAC) modelsY in aged mice to simulate the disease states of CHD and hypertension, respectively. Using integrated proteomic and phosphoproteomic analyses, we investigated the molecular signatures associated with MI and TAC in these models. Our aim was to identify key molecules involved in these conditions and to understand their unique and shared characteristics. Through our comprehensive proteomic and phosphoproteomic analysis, we identified a total of 1583 proteins and 232 phosphorylated proteins. We observed significant upregulation of heart disease markers such as Myh7, Xirp2, and Acta1, indicating the successful establishment of the MI and TAC models. The overlapped differentially expressed proteins (DEPs) and differentially phosphorylated proteins (DPPs) in MI and TAC were involved in heart failure-related processes including cardiac muscle contraction and hypertrophic cardiomyopathy, further supporting the validity of the models. Among the DEPs, Ppme1 was upregulated in the TAC model but downregulated in the MI model, while Sec31a and Gm56451 displayed the opposite expression patterns. Among the DPPs, Ablim1 and Atp2a2 were found to be significantly upregulated in the TAC model, whereas their expression was markedly reduced in the MI model. In addition, five other DPPs, including REV_Q3TAY5, Cbx3, PITPNB, Eif4b, and A0A1Y7VP73, were elevated in the MI model but decreased in the TAC model. In conclusion, these findings suggest that MI and TAC not only share certain molecular features but also retain their unique characteristics, providing potential biomarkers and therapeutic targets.

Background: The geriatric nutritional risk index (GNRI) is a valuable tool that may predict the prognosis of elderly patients with heart failure (HF). Malnutrition and low GNRI scores have been associated with a higher risk of hospitalization and mortality. This study aimed to investigate the association between GNRI and 6-month readmission for HF in elderly Chinese patients. Materials and Methods: The study utilized data from hospitalized HF patients by combining electronic medical records from the PhysioNet restricted health data database with external outcome data. In our study, we used the GNRI as the independent variable and assessed its association with the risk of readmission within 6 months. The main analytical methods were multivariable Cox regression, stratified analysis with interaction, threshold effect analysis, and Kaplan-Meier survival curves. Results: This study involved 767 elderly HF patients, 61.3% of whom had malnutrition. In the threshold analysis, HF patients' 6-month readmission risk was significantly reduced with increasing GNRI, with a hazard ratio (HR) and 95% confidence interval (CI) of 0.99 (0.97.1). Malnutrition group was associated with a higher risk of readmission within 6 months for HF patients in analyses that were controlled for confounding factors, with HRs and their 95% CI of 1.17 (0.99, 1.38), 1.18 (1, 1.4), and 1.44 (1.08,1.93), respectively. Subgroup analysis showed that GNRI levels had a consistent impact on outcome events, unaffected by covariates. Conclusions: GNRI was negatively correlated with the outcome event of readmission within 6 months in elderly HF patients. Malnutrition group showed a higher risk of readmission within 6 months.

Background: Data comparing the outcomes of loose versus rigorous validation strategies for pulmonary vein isolation (PVI) in patients with paroxysmal atrial fibrillation (PAF) are limited. We aimed to prospectively assess the effectiveness of loose versus rigorous validation for PVI in patients with PAF with a maintained sinus rhythm. Methods: Patients (n = 117) with PAF were randomized to receive either loose validation (n = 59) or rigorous validation (n = 58) after PVI. The presence of dormant conduction in loose validation was assessed only by adenosine administration followed by isoproterenol infusion. The complete absence of pulmonary vein (PV) potentials in rigorous validation was confirmed by the combination of the Lasso catheter with isoproterenol plus adenosine. Dormant conduction, revealed by validation after PVI, was ablated until all reconnections were eliminated. Results: The procedure time in the rigorous validation group was greater than that in the loose validation group (161.3 ± 52.7 min vs. 142.5 ± 37.6 min, p=0.03, respectively). After successful PVI, the detection of dormant PV reconnections in the rigorous validation group was significantly greater than that in the loose validation group (69.0% vs. 37.3%, p=0.001). However, after reisolation of the sites of dormant PV conduction, the postablation recurrence rates in 1.3 years were similar between the groups (79.2% vs. 83.6%, p=0.67). Conclusion: Rigorous validation can reveal dormant conduction in more than two-thirds of patients with PAF undergoing PVI. However, rigorous validation and additional ablation of the resulting connections do not improve long-term outcomes when a protocol that includes electrophysiological confirmation and pharmacological validation is used.

While percutaneous closure of patent foramen ovale (PFO) and atrial septal defect (ASD) are generally well-tolerated procedures, the development of postprocedure fever has been observed at a higher frequency than reported in the initial device trials. We performed a retrospective analysis of 62 patients who underwent PFO or ASD closure from January 1, 2020, to December 31, 2022, at Mayo Clinic, Arizona. Eight patients out of 62 (12.9%) developed fever following PFO or ASD closure. In each of the fever cases, the Gore Cardioform devices (W.L. Gore and Associates, Flagstaff, AZ) were used. No association was found between clinical characteristics or procedural details and the development of fever. The reactions occurred 24 to 48 hours following device implantation and resolved spontaneously. No evidence of infection was found upon diagnostic evaluation. There was a higher incidence of self-limited atrial fibrillation (AF) in the fever patients (37.5% vs. 18.5%) which was not statistically significant. All patients who developed fever had successful closure with no other subsequent clinical events. We have found a high incidence of fever following PFO or ASD closure using the Gore family of devices that has not been observed in prior years. A unifying etiology or risk factor, such as infection or medication, for the fever could not be identified. Long-term device success was achieved in all fever patients. This small retrospective study suggests that the observed fever is benign and self-limiting but further investigation is warranted to determine its true incidence, mechanism, and prognosis.

Introduction: Despite all the improvements in surgical and anesthetic techniques, this procedure is still associated with pulmonary and cardiovascular complications in the postoperative period, and early rehabilitation, done through the use of cycloergometer, can minimize such complications, besides reducing the length of hospital stay.

Objective: Therefore, the aim of the study was to assess the impact of cardiovascular exercise on lung function, respiratory muscle strength, and functional capacity in elderly patients after heart bypass surgery.

Methods: To this purpose, a randomized and controlled clinical trial was conducted. Research participants were randomized to the cycle ergometer group (CEG) or to the control group (CG). The CG was managed based on the institution's protocol. The CEG also carried out all the activities of the control group, but there was the inclusion of cycle ergometry through a device built by the researchers. Pulmonary function (vital capacity (VC) and peak expiratory flow (PEF)), ventilatory muscle strength (maximum inspiratory pressure (MIP) and maximal expiratory pressure (MEP)), and functional capacity (six-minute walk test) were evaluated before surgery, at ICU, and hospital discharge.

Results: During the research period, 122 patients were evaluated, 61 in each group. The MIP of the cycle ergometry group was higher at discharge from the ICU 95% CI 8 (5.46 to 10.54) and at hospital discharge 95% CI 14 (16.89 to 11.11). MEP was higher in the cycle ergometry group at discharge from the ICU with 95% CI 6 (8.18 to 3.82) and at hospital discharge with 95% CI 9 (11.69 a 6.31). Vital capacity at ICU discharge with 95% CI 6 (7.98 to 4.02) and at hospital discharge with 95% CI 7 (8.98 to 5.02), as well as peak flow at ICU discharge with 95% CI 43 (75.27 to 10.73), showed relevance, being higher in the group that used the cycle ergometer. The CEG showed improvement in functional capacity at the time of hospital discharge with a 95% CI 56 (30.37 to 81.63).

Conclusion: We conclude that application of cycloergometry after CABG decreases the loss of pulmonary function, muscle strength, and functional capacity. This trial is registered with RBR-39yrht6.

Background: Noninvasive assessment of elevated filling pressure in the left ventricle (LV) remains an unresolved problem. Of the many echocardiographic parameters used to evaluate diastolic pressure, the left atrial strain and strain rate (LA S/SR) have shown promise in clinical settings. However, only a few previous studies have evaluated LA S/SR in larger populations.

Methods: A total of 2033 participants from Norwegian (Tromsø 7) and Russian (Know Your Heart) population studies, equally distributed by age and sex, underwent echocardiography, including atrial and ventricular S/SR and NT-proBNP measurements. Of these, 1069 were identified as healthy (without hypertension (HT), atrial fibrillation (AF), or structural cardiac disease) and were used to define the age- and sex-adjusted normal ranges of LA S/SR. Furthermore, the total study population was divided into groups according to ejection fraction (EF) ≥50%, EF <50%, and AF. In each group, uni- and multiple regression and receiver operating characteristic curve analyses were performed to test LA and LV functional parameters as potential indicators of NT-proBNP levels above 250 ng/ml.

Results: The mean LA S/SR values in this study were higher than those in previous large studies, whereas the lower references were comparable. In normal hearts, atrial total strain (ATS) and mitral valve E deceleration time (MV DT) were independent factors indicating elevated NT-proBNP levels, whereas in hearts with reduced EFs, the independent indicators were peak atrial contraction strain (PACS) and LV stroke volume. The areas under the curve for these significant indicators to discriminate elevated NT-proBNP levels were 0.639 (95% confidence interval (CI): 0.577-0.701) for normal EF and 0.805 (CI: 0.675-0.935) for reduced EF.

Conclusion: The results confirm good intrastudy reproducibility, with mean values in the upper range of previous meta-analyses. In the future, automated border-detection algorithms may be able to generate highly reproducible normal values. Furthermore, the study showed atrial S/SR as an additional indicator of elevated NT-proBNP levels in the general population, demonstrating the incremental value of both ATS and PACS in addition to conventional and ventricular strain echocardiography. Thus, the LA S/SR may be regarded as an important addition to the multiparametric approach used for evaluating LV filling.

Background: Heart failure represents the terminal stage of various cardiovascular diseases. This study aims to explore the pharmacological mechanisms underlying the protective effect of Ginsenoside Rg3 against heart failure.

Methods: Potential targets of Ginsenoside Rg3 were identified using SwissTargetPrediction and the Comparative Toxicogenomics Database, while heart failure-related genes were retrieved from the Comparative Toxicogenomics Database, Therapeutic Target Database, DisGeNET, and PharmGKB. Overlapping of Ginsenoside Rg3 targets with heart failure-related genes identified drug-disease interaction genes. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were conducted on the drug-disease interaction genes to elucidate their biological functions. A protein-protein interaction network was constructed using the drug-disease interaction genes, and the hub genes were identified by topological analysis. Additionally, we validate the expression of IL-6 and TNF by real-time PCR.

Results: The intersection of Ginsenoside Rg3 targets and heart failure-related genes yielded 15 drug-disease interaction genes. Enrichment analysis highlighted the involvement of inflammation-related GO terms and KEGG pathways, such as positive regulation of interleukin-8 and -6 production, regulation of immune effector process, cytokine receptor binding, cytokine activity, adipocytokine signaling pathway, and IL-17 signaling pathway, which are implicated in the cardioprotective effect. Topological analysis revealed four hub genes: STAT3, CASP3, TNF, and IL-6. The application of Ginsenoside Rg3 significantly reversed the elevated levels of IL-6 and TNF in the isoproterenol-treated H9c2 cell line.

Conclusions: Our findings suggest that the cardioprotective effect of Ginsenoside Rg3 may be mediated through its anti-inflammation properties. Further research is required to elucidate and validate the detailed cardioprotective mechanisms of Ginsenoside Rg3.