Cardiology and Therapy最新文献

Introduction: In pregnancies when congenital heart disease (CHD) is present in siblings, fetal echocardiograms (F-echo) are recommended, regardless if there was a prior level II ultrasound (LII-US) that was normal. The goal of this study was to evaluate if any diagnosis of a critical congenital heart disease (CHD) was missed in a fetus who had a sibling with CHD, when a normal LII-US was documented.

Methods: Retrospective chart review of all F-echo where the indication was sibling with CHD between January 1, 2019 and December 31, 2023 was performed. Fetuses were included if they had a LII-US that was read as normal and had a F-echo. Critical CHD was defined as CHD requiring catheterization or surgical intervention < 1 month of age.

Results: A total of 187 F-echo on fetuses who had a sibling with CHD were evaluated, of which 113 met inclusion criteria. LII-US was performed at 21.1 ± 3.3 weeks gestational age and F-echo was performed at 25.4 ± 3.1 weeks gestational age. No patient with a normal LII-US had a diagnosis of a critical CHD by F-echo (negative predictive value = 100%). Six patients that had a negative LII-US were diagnosed with non-critical CHD or cardiac issues postnatally (negative predictive value = 94.7%). F-echo correctly diagnosed two of the six missed LII-US CHD.

Conclusion: Critical CHD was not missed with a normal LII-US in this at-risk population. F-echo also missed the majority of CHD when a LII-US was read as normal. The cost/benefit of screening F-echo in fetuses with siblings with CHD should be evaluated if a normal LII-US has been performed. Larger studies are needed to determine if these findings remain consistent.

Introduction: Incomplete endothelialization (IDE) of left atrial appendage closure (LAAC) devices increases the risk of device-related thrombosis (DRT) and stroke. Insulin resistance (IR) may contribute to IDE by impairing endothelial function, but its role remains unclear. This study aimed to investigate the association between IR markers and IDE and develop a predictive model for identifying high-risk patients.

Methods: This retrospective observational study included 168 patients with nonvalvular atrial fibrillation (AF) who underwent successful LAAC at Shanghai Ninth People's Hospital between January 2022 and December 2023. IDE was assessed using transesophageal echocardiography (TEE) and cardiac computed tomography angiography (CCTA) at 6 months post-procedure. IR was evaluated using the triglyceride-glucose (TyG) index, triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-c) ratio, and metabolic score for insulin resistance (METs-IR). Logistic regression analysis was performed to identify independent predictors of IDE, and a predictive model was constructed.

Results: Among the 168 patients included in the analysis, 43 (25.5%) exhibited IDE, as determined by TEE or CCTA at 6 months post-procedure. Patients with IDE had a significantly higher body mass index, triglyceride (TG) levels, total TG/high-density lipoprotein ratio, TyG index, METs-IR index, and D-dimer levels, as well as a larger maximum LAA orifice diameter (p < 0.05). Multivariate logistic regression identified D-dimer, METs-IR, and maximum LAA orifice diameter as independent predictors of IDE. The predictive probability model incorporating these factors demonstrated high discriminatory ability (area under the curve 0.800, 95% confidence interval 0.71-0.89, p < 0.0001). The optimal predicted probability cut-off value was 0.284, achieving a sensitivity of 76.2% and a specificity of 85.2%.

Conclusion: IR markers, D-dimer levels, and LAA orifice size are significant predictors of IDE following LAAC. The logistic regression model proposed here provides an effective risk stratification tool for identifying patients at higher risk for IDE, enabling personalized anticoagulation strategies and optimizing post-procedural management. Future research should explore whether metabolic interventions can enhance endothelialization and improve long-term outcomes in patients undergoing LAAC.

This article presents three points of view on lipoprotein(a) [Lp(a)]: that of a patient, his endocrinologist, and a patient association, the Association Nationale des Hypercholestérolémies familiales et Lipoprotéines (a) (ANHET). By sharing his story, the patient reveals the severe impact his high Lp(a) levels had on his health, his daily life, and his family. The endocrinologist explains what Lp(a) is and its role as a risk factor for cardiovascular disease. As an expert in the field, he reviews the recommendations for the screening and management of Lp(a). The vice-president of ANHET describes the association's fight to increase awareness of this risk factor among patients, the medical profession, and even politicians, and to bring about changes in the healthcare system. Given the large number of people concerned, the perspectives of the patient, the physician, and the patient association converge in raising awareness of the negative impact of high levels of Lp(a) on health and the importance of intensifying Lp(a) screening.See the Supplementary Material for a French-language version of this abstract.

Introduction: Tafamidis is approved in many countries for the treatment of patients with transthyretin amyloid cardiomyopathy (ATTR-CM). Approval is largely based on findings from an international phase 3 trial. This post-approval commitment study aimed to evaluate the safety and efficacy of tafamidis in patients with ATTR-CM in China.

Methods: A multicenter, single-arm study in Chinese patients with symptomatic ATTR-CM in China. All patients received once-daily, open-label tafamidis free acid 61 mg for 12 months. Safety reporting was ongoing with efficacy assessments at months 6 and 12, including 6-min walk test distance, New York Heart Association (NYHA) functional classification, National Amyloidosis Centre staging, N-terminal pro-B-type natriuretic peptide and troponin I concentrations, Kansas City Cardiomyopathy Questionnaire Overall Summary score, 5-level EQ-5D index score, EQ visual analog scale, and 12-item Short Form Survey.

Results: Patients (n = 53) were aged 60 (standard deviation [SD]: 12) years, 89% were male, and 94% had variant ATTR-CM (21% had A97S [p.A117S]). At baseline, most (81%) patients had NYHA class II symptoms (6% class I; 13% class III) and National Amyloidosis Centre stage I disease (74%; 21% stage II; 6% stage III). Median treatment exposure was 345 (range, 24‒418) days. Overall, 85% of patients reported treatment-emergent adverse events (TEAEs). The nature and incidence of TEAEs were consistent with the known safety profile of tafamidis. There were no serious or severe treatment-related TEAEs. At 6 and 12 months, there were minimal changes from baseline in all efficacy outcomes with tafamidis, and a high proportion of patients (≥ 44%) showed clinically relevant stability or improvement in each measure.

Conclusions: The safety of tafamidis in Chinese patients with ATTR-CM was consistent with that previously determined. Tafamidis treatment was associated with a stable disease profile over 12 months in a population of patients where most had variant ATTR-CM and mild heart failure symptoms.

Trial registration: NCT04814186.

Cardiogenic shock is the most common cause of mortality in patients with acute myocardial infarction (AMI). Historically, AMI complicated by cardiogenic shock was associated with in-hospital survival of only ~50%. Recent advances in mechanical circulatory support have allowed for improved survival rates compared with only conventional medical treatment. However, the management strategy for AMI-related cardiogenic shock remains largely empirical due to limited high-quality evidence-based studies. In this review, we provide an overview of the four types of left ventricular mechanical circulatory support currently available, review new guideline updates from the American College of Cardiology Foundation/American Heart Association and European Society of Cardiology, and discuss recent and ongoing studies and registries in cardiogenic shock following AMI.

Introduction: Cardiovascular diseases are a leading cause of global mortality, with hypertension as a major risk factor. Low control rates are often attributed to monotherapy, while evidence and clinical guidelines support the effectiveness of combination therapies. This study aimed to evaluate blood pressure changes and the achievement of target levels in patients treated with losartan/chlorthalidone (L/C) compared to losartan/hydrochlorothiazide (L/H).

Methods: A randomized, double-blind, prospective, multicenter clinical trial was conducted. Patients were assigned to one of two treatment groups, starting with a lower dose (50/12.5 mg of losartan/chlorthalidone or losartan/hydrochlorothiazide). Blood pressure was evaluated at 30 days, and patients not meeting therapeutic goals were escalated to a higher dose (100/50 mg of losartan/chlorthalidone or losartan/hydrochlorothiazide) and followed until the study end (60 days).

Results: The study recruited 163 patients (83 for losartan/chlorthalidone [L/C] group and 80 for the losartan/hydrochlorothiazide [L/H] group), with a mean age of 53.1 years. Both treatment groups demonstrated significant reductions in systolic and diastolic blood pressure, with L/C achieving an average reduction in systolic blood pressure (SBP) of - 24.6 mmHg and - 13.3 mmHg for diastolic blood pressure (DBP), while L/H had reductions of - 25.3-mmHg and - 11.5 mmHg, respectively. The L/C group exhibited a higher likelihood of achieving blood pressure goals compared to the L/H. Adverse events were comparable between groups and were mostly mild.

Conclusions: The study showed that both combinations are effective for hypertension, with losartan/chlorthalidone demonstrating greater efficacy in reducing diastolic blood pressure and achieving target levels. Both treatments exhibited similar and favorable safety profiles.

Clinical trials registration: NCT04927299. Registered August 6, 2021- https://clinicaltrials.gov/study/NCT04927299.

Introduction: The V-GOOD study evaluated the effectiveness of trimetazidine modified-release (MR) 80 mg once daily (OD) in patients with chronic coronary syndrome (CCS) who remained symptomatic despite antianginal therapies in routine clinical practice.

Methods: This prospective, observational study involved 1026 adult outpatients with symptomatic CCS from 70 sites in Brazil who were prescribed trimetazidine MR 80 mg OD plus background antianginal treatment. Data on number of angina attacks, short-acting nitrate consumption, prevalence of angina-free patients, severity of angina, patient-reported daily physical activity impairment, treatment adherence, tolerability, and cardiologist and patient satisfaction were collected at baseline (V1), then at 1 month (V2) and 3 months (V3).

Results: Following the addition of trimetazidine MR 80 mg OD, the mean ± standard deviation number of angina attacks per week decreased from 3.1 ± 2.8 at V1 to 1.0 ± 2.1 at V2, and 0.7 ± 1.7 at V3, with concurrent reductions in short-acting nitrate consumption, patient-reported daily physical activity impairment and the proportion of patients with limiting angina (Canadian Cardiovascular Society class III or IV), and increases in the proportion of angina-free patients (all p < 0.001 vs. V1). Most cardiologists rated trimetazidine MR 80 mg OD as satisfactory/very satisfactory (90.7% for effectiveness and 94.8% for tolerability); most patients rated the treatment schedule as convenient/very convenient (97.2%) and satisfactory/very satisfactory (97.1%). Treatment was well tolerated.

Conclusions: These data support the symptomatic benefits and good tolerability associated with adding trimetazidine MR 80 mg OD to other antianginal therapies in patients with persistent symptoms. Graphical abstract available for this article.

Trial registration number: NCT06464276.

Introduction: Real-world data on atrial fibrillation (AF) in the Middle East and North Africa (MENA) region, including Egypt, are sparse. The aim of the FLOW-AF registry was to evaluate the characteristics, treatment patterns, and clinical and economic outcomes of newly diagnosed non-valvular atrial fibrillation (NVAF) patients within the MENA region, including Egypt.

Methods: This multicenter, prospective, observational registry enrolled newly diagnosed patients with NVAF from January 2020 to December 2022 at eight private-sector healthcare centers in Egypt. Data were collected at enrollment (baseline), and then at 6-month and 12-month follow-up. Baseline data included demographics, AF characteristics, medical history, and antithrombotic treatment patterns. Follow-up data included clinical events, healthcare resource utilization, and related costs.

Results: A total of 723 patients were enrolled. Overall, 51.87% were females, and the mean age was 61.9 years. All patients attended the private health sector. The mean (standard deviation) CHA₂DS₂-VASc and HAS-BLED risk scores were 2.37 (1.55) and 1.46 (1.18), respectively. Non-vitamin K antagonist oral anticoagulants (62.52%), vitamin K antagonists (22.28%), and antiplatelet therapy (9.85%) were among the prescribed treatments. Rates of transient ischemic attack and all-cause mortality were 2.64% and 0.83%, respectively; all other outcomes (stroke, bleeding, myocardial infarction, systemic embolism) occurred at a rate of ≤ 0.41%. Antithrombotic medications were the major contributors to per-patient total yearly cost (USD 381.2).

Conclusions: The FLOW-AF study showed that patients with NVAF in Egypt are younger and exhibit lower mean baseline CHA₂DS₂-VASc and HAS-BLED scores compared to Western and other Eastern regions. Additional research, including a broader study population with a longer follow-up, is essential to comprehensively assess the characteristics and outcomes of the NVAF population in Egypt.