Cardiology Research and Practice最新文献

Background: The length of hospital stay (LOS) is frequently recognized as an indicator of hospital management efficiency and the quality of care. Patients with acute ischemic stroke (AIS) who experience prolonged LOS are at a higher risk of developing complications such as hospital-acquired infections and gastrointestinal bleeding. These complications can adversely affect clinical outcomes, acting as a primary determinant of poor functional outcomes. However, evidence regarding predictors of the LOS after AIS in Ethiopia is lacking. Objective: Therefore, the objective of this study was to assess clinical predictors of the LOS after AIS among patients admitted to Tibebe Ghion and Felege Hiwot Comprehensive Specialized Hospitals. Methods: A retrospective cohort study was conducted among patients diagnosed with AIS and treated at Tibebe Ghion and Felege Hiwot hospitals from November 2018 to November 2021. Multivariate linear regression analysis was employed to explore predictors of LOS. The slope of regression line (β) with its 95% CI is used to declare statistical significance. Results: Of the 278 patients with AIS, 59.7% were male. Stroke-related complications (aspiration pneumonia and urinary tract infections occurred in the hospital in 57 (20.5%), and 12 (4.3%), patients, respectively. The most common neurological deficit observed during hospital admission was limb weakness, affecting 268 patients (96%). The median LOS was 5 days. Among the clinical characteristics, atrial fibrillation (β = 7.337, 95% CI: 1.226, 13.448), Limp weakness (β = 4.831, 95% CI: 2.330, 7.332), aspiration pneumonia (β = 2.089, 95%CI: 1.178, 3.000) and Male sex (β = 1.696, 95% CI: 0.851, 2.542), were significant predictors of LOS. Conclusion: In this study, the presence of AF and stroke-related complications, such as aspirational pneumonia, were found to be significant predictors of LOS. Therefore, implementing efficient prevention strategies targeting potentially modifiable risk factors is essential to mitigate the impact of these factors.

Background: Many patients with coronary heart disease receive percutaneous coronary interventions. These interventions are accompanied by gastrointestinal bleeding that aggravates the disease. The hemoglobin-to-red cell distribution width ratio (HRR) is a novel inflammatory marker. We investigated HRR as a predictor of gastrointestinal bleeding after percutaneous coronary interventions. Methods: Patients (n = 1647) received percutaneous coronary interventions from January 2022 to December 2022 in Longyan First Hospital. The HRR was measured before the interventions. Indicators of patient general condition, biochemical indicators, concomitant diseases, and medication status were collected. Gastrointestinal bleeding within 1 year was assessed. Patients were divided into four groups based on HRR. Kendall's tau-b graded correlation was used to analyze the correlation between hemoglobin (Hb), red blood cell distribution width (RDW), HRR, and gastrointestinal bleeding in peripheral blood after percutaneous coronary intervention. Ordered logistic regression was used for analysis, with gastrointestinal bleeding as the outcome variable and Hb, RDW, and HRR as independent variables. To identify independent risk factors for gastrointestinal bleeding, data were adjusted for age, heart failure, hypertension, diabetes, atrial fibrillation, dyslipidemia, RBC, total cholesterol, triglycerides, LDL-C, creatinine, blood urea nitrogen, and uric acid. Multiple linear regression analysis of HRR, RDW, and Hb predicted gastrointestinal bleeding. Results: Of the 1647 study participants, 20 had gastrointestinal bleeding, 1.2% probability. In the HRR classification, there was a greater probability of gastrointestinal bleeding in the low HRR group after percutaneous coronary intervention. Conclusion: We found a low HRR and a high probability of gastrointestinal bleeding after percutaneous coronary intervention. The HRR could be used as an independent predictor of gastrointestinal bleeding.

Extrinsic heart compression by gastrointestinal (GI) structures is an often underrecognized finding in clinical practice. It is potentially related to unpredictable clinical conditions, ranging from incidental detection in asymptomatic subjects, to deranging and potentially life-threatening clinical manifestations. However, despite its potential clinical relevance, there is still no comprehensive analysis investigating the surrounding causes, clinical findings, and diagnostic imaging work-up for this patient population. A narrative review with an extensive bibliographic search of the literature was performed using PubMed (MEDLINE), Embase, and Cochrane Central Databases up to December 31, 2023. Despite the broad spectrum of GI etiologies, clinical manifestations, and cardiac chamber involvement scenarios, physicians must be aware of such an uncommon condition, in order to provide timely diagnosis through a comprehensive imaging approach, avoid misleading interpretations, and determine the most appropriate decision-making strategy.

Objective: The present study aims to elucidate the significance of immune cell infiltration in Coronavirus disease 2019 (COVID-19) myocarditis and identify potential diagnostic markers for this condition. Myocarditis, an inflammatory cardiac disease, primarily results from viral infections. Although the association between COVID-19 and myocarditis is well-established, the specific mechanism(s) underlying this relationship remain incompletely understood. Methods: The GSE53607 and GSE35182 datasets were obtained from the GEO database, which contains samples from a mouse model for viral myocarditis. Differentially expressed genes (DEGs) and candidate biomarkers were selected using the LASSO regression model and support vector machine recursive feature elimination (SVM-RFE) analysis. Subsequently, the diagnostic potential of these biomarkers was evaluated by calculating the area under the receiver operating characteristic curve (AUC). Further validation of the biomarkers was conducted using the GSE183850 dataset, which consists of samples from patients with COVID-19 myocarditis. In addition, CIBERSORT analysis was employed to estimate the compositional patterns of 22 types of immune cell fractions in merged cohorts. Results: Thirty genes were identified, with a significant proportion of the DEGs being associated with carbohydrate binding, endopeptidase activity, and pathogenic organisms such as Staphylococcus aureus and coronavirus disease. Importantly, gene sets related to the IL6-JAK-STAT3 signaling pathways, inflammatory response, and interferon response exhibited differential activation in viral myocarditis compared to the control group. In addition, in the context of COVID-19 myocarditis patients from the GSE183850 dataset, B2M and C3 were established as diagnostic markers that were subsequently validated (AUC = 0.978 and AUC = 0.956, respectively). Furthermore, analysis of immune cell infiltration revealed correlations between B2M and C3 expression levels and the activation of NK cells, dendritic cells, T cells CD4 memory resting, as well as eosinophils. Conclusion: B2M and C3 have been identified as potential biomarkers for viral myocarditis, providing valuable insights for future investigations into the pathogenesis of COVID-19-associated myocarditis.

Objective: To investigate the relationship between methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism and coronary heart disease (CHD) in the elderly patients living in the coastal area of eastern Zhejiang Province in China. Methods: From September 2021 to May 2022, 163 elderly patients (male ≥ 55 years old, female ≥ 65 years old) admitted to the cardiology department in the Ningbo Lihuili Hospital were collected. Among these patients, 90 patients were diagnosed with CHD (CHD group) and 79 patients did not have CHD (control group). The homocysteine (Hcy) level was measured by the blood biochemical test, and the MTHFR genotype was detected by the PCR fluorescence probe method. Results: Compared with the control group, the CHD group showed a significantly higher distribution frequency of TT genotype (X ² = 5.137, p < 0.05) and a lower frequency of CC genotype (X ² = 6.560, p < 0.05), indicating that elderly people with MTHFR677 TT genotype are more likely to have CHD. In addition, the Hcy level of TT genotype in the CHD group and the control group were both obviously higher than that of CT genotype and CC genotype (p < 0.05). Finally, the univariate and multivariate logistic regression analyses showed that gender, hypertension, diabetes, and MTHFR677 TT genotype were independent risk factors for CHD (p < 0.05). Conclusion: MTHFR C677T mutation is significantly associated with the serum Hcy, and is an important genetic risk for CHD development in the elderly people living in the coastal area of eastern Zhejiang province, China.

Objective: Recurrence of pericardial effusion is possible despite the successful completion of pericardiocentesis and initiation of treatment. Predicting recurrence is important for determining treatment strategies. This study aimed to examine the factors that influence the recurrence of effusion in patients who had undergone pericardiocentesis. Method: A total of 113 patients with the evidence of tamponade or pericardial effusion over 10 mm were included in the study. The mean follow-up period was 49 months. Patients with and without recurrent effusion were divided into two groups. PNI calculation (PNI = 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (mm³) formula was used. Results: Recurrent pericardial effusion was observed in 30 patients during the follow-up period. There was no difference in age, gender, hypertension, LVEF%, hypertension, and appearance of fluid when the two groups were compared. There was a difference in PNI score and presence of malignancy between the two groups (p: 0.031 and 0.042, respectively). Multivariate logistic regression showed that malignancy and PNI score were independent predictors of recurrence in patients undergoing pericardiocentesis (p: 0.015 and p: 0.014, respectively). In the ROC analysis, PNI < 40.75 predicts recurrent pericardial effusion with 75% sensitivity and 58% specificity (AUC: 0.626, 95% CI: 0.509-0.742, and p=0.042). Conclusion: Predictors of recurrence in patients undergoing pericardiocentesis are important for patient follow-up. PNI is a simple and useful score that can be used to predict recurrent pericardial effusion.

This study probes the relationship between serum matrix metalloproteinase-9 (MMP-9) levels, the genetic variant rs17576 in the MMP-9 gene, and the extent of coronary atherosclerosis among Ukrainian patients diagnosed with coronary artery disease (CAD). A cohort of 128 patients was assessed, comprising 25 with angiographically intact (normal) coronary arteries, 40 with acute coronary syndrome (ACS), and 63 with chronic coronary syndrome (CCS). Utilizing clinical, anthropometric, and biochemical analyses, alongside ELISA immunoassays, genotyping, electrocardiography, and coronary angiography, we conducted a comprehensive evaluation. Our findings indicate that MMP-9 levels peaked in ACS patients, particularly those with single and triple-vessel coronary lesions, while the lowest levels were observed in individuals with unaltered coronary arteries. Notably, the glomerular filtration rate (GFR) was highest in patients with angiographically normal coronary arteries, averaging 79.91 ± 27.8 mL/min. In the context of ACS, individuals carrying the GG allele exhibited the highest GFR, whereas AA allele carriers had the lowest. Conversely, in the CCS cohort, GG carriers demonstrated the lowest GFR and heterozygotes the highest, although these differences did not reach statistical significance. A significant disparity in serum MMP-9 levels was observed between ACS patients, CCS patients, and individuals with unimpaired coronary arteries. Moreover, a substantial correlation was established between the degree of coronary artery lesions and GFR in the CCS group, providing a predictive measure for GFR in patients with triple-vessel involvement. However, no significant association was detected between serum MMP-9 levels, the rs17576 genetic variant in the MMP-9 gene, and the number of affected vessels or GFR in both ACS and CCS patients.

Background: Total thoracoscopic mitral valve surgery (TT-MVS) is a minimally invasive technique for mitral regurgitation (MR), but its impact on left ventricular (LV) function and remodeling in patients with reduced LV ejection fraction (LVEF) is unclear. Methods: We retrospectively compared 94 patients who underwent total thoracoscopic mitral valve repair (TT-MVr) or total thoracoscopic mitral valve replacement (TT-MVR) for MR and reduced LVEF at our center from January 1, 2017, to December 31, 2022. We assessed LV functional recovery and remodeling by echocardiography at baseline, 1 week, 3 months, and 6 months after surgery. Results: A total of 43 patients underwent TT-MVr and 51 patients underwent TT-MVR. Both groups had similar early outcomes, hospital mortality, and postoperative complications. The TT-MVr group had higher LVEF and lower left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) than the TT-MVR group at 3 and 6 months after surgery (p < 0.05 for all comparisons). Both groups improved in New York Heart Association (NYHA) functional class from baseline to 6 months after surgery (p < 0.05 for all comparisons). Conclusion: TT-MVr and TT-MVR are feasible and safe for patients with MR and reduced LVEF, but TT-MVr is associated with better LV functional recovery and remodeling within 6 months after surgery. TT-MVr should be preferred over TT-MVR whenever possible in this high-risk population. Further studies are needed to evaluate the long-term outcomes of TT-MVS in this population.

Left ventricular global longitudinal strain (LVGLS) is a highly sensitive echocardiographic biomarker that detects signs of myocardial dysfunction. It has been proven that exercise-based cardiac rehabilitation (CR) improves LV-GLS but whether high-intensity interval training (HIIT) is more efficient than moderate-intensity interval training (MIIT) to improve LV-GLS as cardiac deformation index in cardiovascular patients is debatable. In the current systematic review and meta-analysis, different digital databases including PubMed, Scopus, Web of Science (ISI), and Google Scholar were searched systematically with no time restriction to answer the abovementioned question. Studies were included that reported GLS as the outcome in CVD subjects before and after enrolling in HIIT and/or MITT. A random effects model was used for meta-analysis. Eleven sets of results from nine articles-two of which had two sets of results-were included. The result of the sensitivity test to check the publication bias was not significant either for MIIT (p=0.211) or for HIIT (p=0.238). Our findings showed that GLS was improved significantly after both MIIT (-1.72. [-2.68, -0.77]) and HIIT (-1.86 [-3.01, -0.71]) in CVD patients; however, the effect of HIIT was greater than MIIT. Subgroup analysis results showed that baseline disease and duration of exercises do not influence the effect of training on GLS. More studies are needed to confirm the conclusion.

Background: Quadricuspid aortic valve (QAV) is a rare congenital cardiac anomaly associated with symptomatic aortic regurgitation (AR) or aortic stenosis (AS). Transcatheter aortic valve replacement (TAVR) for QAV remains uncertain. Methods: We retrospectively reviewed prospectively collected data from patients with QAV undergoing TAVR in our center and conducted a systematic literature review for further investigation. Results: Five patients with QAV were treated with TAVR between April 2016 and December 2023. The median age was 67 years (range: 59-86), and the median Society of Thoracic Surgeons score (STS-score) was 3.750% (range: 0.916%-11.823%). Procedural success was achieved in all cases. The median follow-up period was 3 years (from 30 days to 7 years). Four of the patients exhibited no serious complications, while one experienced delayed coronary obstruction. Our systematic review included 31 cases from 21 publications and our center. The median age of patients was 79 years (range: 57-90), including 18 males. The median STS score was 7.835%. Severe AS was present in 64.5% of the patients and severe AR in 41.9%. The most common QAV subtype was type B (48.4%). Technical success was achieved in 100% of the cases, with two cases reporting coronary obstruction and one required a permanent pacemaker implantation. During a median follow-up period of 1 year (from 30 days to 7 years), one case experienced serious complications of delayed coronary obstruction. Conclusion: The TAVR may be an alternative treatment for patients with QAV, preliminarily demonstrating feasible early and long-term results from current experience. However, extra precautions regarding coronary artery obstruction complications are necessary due to the rarity and anatomical complexity of QAV.