Cardiovascular diagnosis and therapy最新文献

Background: Health literacy refers to individual skills to access, process, understand, and use health information to stay healthy. Social support is a multi-faceted construct including of perceived, enacted, and structural support dimensions and negative social reactions. This study explored the mediating effect of health literacy on social support and self-care ability in older patients undergoing percutaneous coronary stent implantation (PCI).

Methods: Between December 2021 and March 2022, a total of 249 older patients who underwent PCI in our hospital were included in this cross-sectional study using the convenience sampling method. The demographic and health history of patients was collected by questionnaire. Exercise of self-care agency scale (ESCA), chronic disease health literacy management scale (HeLMS) and social support rating scale (SSRS) were also analyzed and their correlations were evaluated.

Results: This study indicated that the total scores of health literacy, self-care ability and social support after PCI were 85.96±20.03, 82.82±27.65 and 25.3±4.93, respectively. Correlation analysis showed that health literacy, social support and self-care ability were positively correlated. Both social support (P=0.003) and health literacy (P=0.03) could positively predict self-care ability. Health literacy played a partial mediating role between social support and self-care ability, and the mediating effect was 0.015, accounting for 7.32% of the total effect.

Conclusions: The health literacy and social support are at the high levels, and the self-care ability of PCI patients is at a medium level. The health literacy of older patients after PCI is the ability of social support and self-care ability. Medical staff can enhance the health literacy of patients by improving their level of social support, and then promote their self-care ability.

Background: Bronchial artery embolization (BAE) is a common and important way to manage hemoptysis. This study's purpose was to summarize the efficacy, safety, and related factors of BAE in the treatment of hemoptysis.

Methods: From January 2010 to August 2023, a systematic literature search was conducted in PubMed, EMBASE, Web of Science, and Cochrane Library databases. Original studies with BAE for hemoptysis were included, with no restrictions on language. The outcomes of interest were technical success rate, clinical success rate, recurrence rate, mortality rate, and major complication rate. Pooled proportions with 95% confidence intervals (CIs) were calculated using random-effects models. The Newcastle-Ottawa Scale (NOS) was employed for quality assessment. Factors such as publication year, region, sample size, amount of hemoptysis, etiology, and embolization materials were extracted for subgroup analyses. Additionally, sensitivity analyses and test for publication bias were conducted.

Results: A total of 32 studies, including 6,032 patients, met our inclusion criteria. 27 studies were of high quality, while five of moderate quality. The results indicated the prevalence of technical success was 97.2% (95% CI: 95.1-98.8%) and 93.2% (95% CI: 90.3-95.7%) in clinical success. Hemoptysis recurrence and mortality rates after BAE were 24.8% (95% CI: 20.5-29.4%) and 2.3% (95% CI: 1.1-3.8%), respectively. Moreover, the pooled prevalence of major complication was 0.1% (95% CI: 0.0-0.4%). Subgroup analysis revealed that studies published after 2017 demonstrated a higher technical success rate and a lower recurrence rate. Massive hemoptysis showed a higher technical success rate but a lower clinical success rate. BAE also demonstrated superior efficacy in patients with bronchiectasis. The clinical success rate was significantly higher in patients with benign diseases than those with malignancies. Gelatin sponge (GS) showed poor embolization efficacy. N-butyl-2-cyanoacrylate (NBCA) and coils exhibited reduced recurrence rates, while NBCA displayed an even lower recurrence rate than non-absorbable particles. The study by Ishikawa et al. influenced the stability of the pooled major complication rate, and the sensitivity analysis confirmed the robustness of the remaining results.

Conclusions: BAE is safe and effective in treating different degrees of hemoptysis caused by benign and malignant lesions. Promising clinical efficacy was observed with NBCA as an embolic material for the treatment of hemoptysis. However, further conclusions should be investigated using evidence-based medicine.

Background: The Micra leadless pacemaker (MLP) has been demonstrated to be safe and effective as a substitute for conventional transvenous ventricular pacemakers (TVP). However, its application in the general population is still restricted. The aim of this retrospective study was to assess the safety and efficacy of MLP.

Methods: Clinical data and device parameters were gathered on every patient receiving MLP implantation between 1 January 2019 and 31 December 2023, in the First Affiliated Hospital of Soochow University. The efficacy of MLP on the primary composite endpoint, atrioventricular (AV) synchrony, hospitalization, and post-implantation quality of life was assessed. Safety outcomes included implantation procedural characteristics, acute and chronic complications, and stability of pacing parameters. Meanwhile, we compared pacing parameters, AV synchrony, and improvement of life quality between patients who had been implanted with the MicraTM VR (Medtronic Micra™ MC1VR01) and Micra™ AV (Medtronic Micra™ MC1AVR1). Multivariate linear regression models were used to unearth potential predictors of echocardiography or electrocardiogram (ECG) parameters on pacing parameters.

Results: A total of 94 patients were included, and implantation was successful in all of the cases. A single patient experienced effusion hours after the implantation, indicating a low rate of both acute and chronic complications. In patients with complete AV block (AVB), Micra AV increased AV synchrony from 23.2%±6.3% to 80.8%±5.7%. After 28 days of implantation, the patients' Minnesota Living with Heart Failure Questionnaire (MLHFQ) score decreased from 27.1±18.6 to 20.0±17.6, and none of them required hospital readmission. Left ventricular end-diastolic diameter (LVEDD, 50.0±6.7 cm), left ventricular end-systolic diameter (LVESD, 32.6±3.9 cm), and ECG R wave in lead V5 (RV5, 1.3±0.6 mV) can be employed for the prediction of pacemaker threshold [0.50 (0.38-0.67) mV], sensing voltage (10.1±4.7 mV), and impedance (785.9±226.4 Ohm) correspondingly.

Conclusions: Despite being a small, single-center, retrospective study, our study provided data for assessing the safety and efficacy of MLP. Clinicians and patients can make well-informed therapy decisions by being aware of its benefits and forecasting pacing parameters.

Background: Heart failure (HF) is a clinical syndrome with a high risk. Our previous research showed a regulatory relationship between Sirtuin 1 (SIRT1), peroxisome proliferator-activated receptor α (PPARA) and nuclear receptor co-repressor 1 (NCOR1). This study aimed to investigate the regulatory mechanism of SIRT1/PPARA/NCOR1 axis in HF.

Methods: HF models in vitro were established by doxorubicin (DOX)-induced AC16 and human cardiac microvascular endothelial cell (HCMEC) lines. The contents of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), interleukin-1β (IL-1β), and IL-18 were detected using enzyme-linked immunosorbent assay. Then, we assessed the levels of reactive oxygen species (ROS), malondialdehyde (MDA), superoxide dismutase (SOD) and adenosine triphosphate (ATP). Moreover, the relationship between SIRT1 and PPARA was detected using the co-immunoprecipitation (Co-IP) analysis. The connection between PPARA and NCOR1 was analyzed using chromatin immunoprecipitation (ChIP).

Results: Overexpression of SIRT1 or PPARA could reduce apoptosis in DOX-induced AC16 and HCMEC cells, the levels of IL-1β, IL-18, ANP, BNP, ROS and MDA, while increasing the levels of SOD and ATP. In addition, overexpression of PPARA could increase the viability of DOX-induced cells and the levels of myosin heavy chain 6 (Myh6) and Myh7. Co-IP showed that SIRT1 interacted with PPARA. Silencing PPARA could reverse the effect of SIRT1 overexpression on DOX-induced AC16 and HCMEC cells. ChIP assay demonstrated that PPARA could bind to the promoter region of NCOR1. Silencing NCOR1 could reverse the effect of PPARA overexpression on DOX-induced AC16 and HCMEC cells.

Conclusions: This study revealed that PPARA could mediate SIRT1 to promote NCOR1 expression and thus protect damaged heart cells. The finding provided an important reference for the treatment of HF.

Background: Appropriate levels of physical activity (PhA) provide health benefits to patients with chronic diseases, including patients with pulmonary arterial hypertension (PAH). In this study, we examined the effect of physicians' PhA recommendations on PhA, and the benefits and effectiveness of PhA self-monitoring using a pedometer for PAH patients.

Methods: A prospective clinical trial was performed from 22 April 2021, with consecutive PAH outpatients in stable condition at least three months prior to the study. Each patient was educated about the benefits of PhA in PAH during the initial visit. Patients wore pedometers (Omron HJ-321-E) for 2 weeks. After PhA assessment, the patients were contacted by a physician by phone. Patients who walked <5,000 steps per day (inactive group) were recommended to increase their PhA, and patients who walked ≥5,000 steps per day (active group) were recommended to maintain this level of PhA. Patients wore pedometers for 3 months. The primary endpoint was the number of steps taken after 12 weeks of the study. The secondary endpoints were the 6-minute walk distance (6MWD), quality of life (QoL) (36-Item Short-Form Health Survey), and anxiety and depression levels.

Results: The study included 41 PAH patients aged 45.9±11.9 years, with 32 (78%) of them women. Initially, 18 (44%) patients were in the inactive group (2-week mean: 3,318±1,185 steps/day) while 23 (56%) patients were in the active group (2-week mean: 7,647±1,991 steps/day). The entire study group showed an insignificant decrease in their PhA from 5,203 [interquartile range (IQR), 3,787-7,387] to 4,672 (IQR, 3,821-7,201) steps per day (P=0.57). Patients in the inactive group showed an insignificant increase in their PhA after 12 weeks [increase in the average number of steps per day by 104 (IQR, -244 to 1,007), P=0.52], while patients in the active group showed an insignificant trend towards PhA reduction [change in average daily steps: -815 (IQR, -1,400 to 580), P=0.37]. There were no differences at week 12 in the 6MWD, N-terminal-pro-B-type natriuretic peptide (NT-proBNP) level, QoL, or levels of anxiety and depression, all P values >0.05.

Conclusions: Education, a simple recommendation about PhA, and self-monitoring with a pedometer are insufficient to achieve intervention in PAH patients. Additional methods of motivating and supervising these patients are necessary.

Background: People living with the human immunodeficiency virus (PLWH) are at increased risk of cardiovascular diseases. Right ventricular (RV) function has important prognostic value in cardiac pathology, and advances in imaging modalities, such as transthoracic echocardiography have enabled in-depth RV studies. There is, however, a scarcity of multiparameter RV function studies in PLWH in low- and middle-income settings, such as Nigeria. The aim of this study is to determine the prevalence and predictors of RV dysfunction among adult PLWH in northwest Nigeria.

Methods: This is a retrospective cross-sectional study conducted between February 1, 2023 and August 31, 2023. We consecutively recruited 330 adults [median age 45 years, interquartile range (IQR), 38 to 52 years, 61% female] attending human immunodeficiency virus (HIV) and general outpatient clinics in a tertiary hospital in northwest Nigeria. They included 110 antiretroviral therapy (ART)-experienced PLWH, 110 ART-naïve PLWH, and 110 age- and sex-matched HIV-negative control subjects. All participants had conventional two-dimensional (2D), tissue Doppler (TDI), and speckle tracking (2D-STE) echocardiography to estimate left ventricular (LV) and RV systolic and diastolic function, peak systolic and diastolic myocardial velocities, RV and LV longitudinal strain, and chamber dimensions. All participants also underwent 12-lead electrocardiography. Multiple linear and Firth's logistic regression modeling were performed to assess for independent predictors of RV myocardial performance index (RVMPI) as a continuous and as a dichotomous variable, respectively.

Results: The prevalence of RV dysfunction, as determined by the RVMPI among HIV-positive participants was 14.5% [95% confidence interval (CI): 10.5-19.8%] compared to 0% (95% CI: 0.0-3.4%) for those without HIV. Among participants with HIV, RVMPI was associated with participant age (P<0.001) and left ventricular ejection fraction (LVEF) (P<0.001). Results were similar when RVMPI was dichotomized. The association between RV dysfunction and LVEF was modified by ART status: a 10% decrease in LVEF was associated with an average decrease of 0.08 in RVMPI among participants who were ART-experienced (β=-0.08, P<0.001) but a lesser decrease among those who were ART- naïve (β=-0.03, P=0.14).

Conclusions: This study highlights the complexity of RV dysfunction in PLWH and underscores the importance of LVEF and age as key factors influencing the risk of RV dysfunction in PLWH.

Background: Calcified nodule (CN) is a phenotypic feature of calcified plaques which causes acute coronary syndrome (ACS). Recent studies reported that culprit lesions harboring CN has been shown to increase a risk of repeat revascularization after percutaneous coronary intervention (PCI) with the implantation of newer-generation drug-eluting stent (DES) or debulking device. Mechanistically, a re-protrusion of CN into the lumen has been considered as an important cause associated with repeat revascularization after PCI. These observations suggest the need for additional therapeutic approach to mitigate a risk of repeat revascularization at CN lesions. Here we report a case who received the implantation of one covered stent due to coronary artery perforation after stent implantation at coronary lesion exhibiting CN. This case is unique in terms of preventing restenosis by using covered stent which could physically hinder protrusion of CN through the stent strut.

Case description: A 79-year-old man presented to the emergency department with his prolonged chest pain. Although he had a history of hypertension and adrenal hypertrophy, he was not taking any medication prior to his admission. He was diagnosed as ST-segment elevation myocardial infarction. Emergent coronary angiography revealed one severe stenosis in the middle segment of his right coronary artery (RCA). Primary PCI was performed under the guidance of intravascular ultrasound (IVUS) imaging. IVUS imaging prior to PCI revealed a protruding shape of calcification and its irregular surface at his culprit lesion, suggesting the presence of a CN. Following one DES implantation, coronary artery perforation occurred at the segment receiving DES implantation. We implanted one covered stent for the coronary artery perforation. This procedure resulted in successfully sealing coronary artery perforation. Seven months later, follow-up coronary angiography and optical coherence tomography (OCT) imaging were conducted to evaluate his RCA. Any in-stent restenosis (ISR) was not observed. Furthermore, OCT imaging elucidated a small amount of neointimal proliferation without any re-protruding feature of CN through the segment receiving a covered stent. Of note, he did not experience any clinically-driven target lesion revascularization (TLR) for 2 years after PCI.

Conclusions: Our case indicates the use of covered stent as an effective approach to physically hinder the re-protrusion of calcification tissues into the lumen, potentially mitigating a risk of ISR.

Background: Cardiovascular disease is a primary cause of morbidity and mortality in kidney transplant (KT) candidates. Dobutamine stress echocardiography (DSE) is an effective noninvasive modality for evaluating coronary artery disease with high accuracy. However, long-term data in KT candidates are still lacking. This study aims to assess the prognostic value of DSE in predicting long-term outcomes in KT candidates.

Methods: This study retrospectively included consecutive KT candidates who underwent preoperative DSE between 2007 and 2017 at Siriraj Hospital, Bangkok, Thailand. Normal DSE was characterized by the absence of wall motion abnormalities both at rest and during stress. The primary endpoint was all-cause mortality. Univariable and multivariable analyses were conducted to determine predictors of all-cause mortality, with a P value of <0.05 considered statistically significant.

Results: Among 269 patients (mean age 51 years, 58% male), 34 (12.6%) had abnormal DSE results, and 63 (23%) underwent kidney transplantation after DSE. During a median follow-up period of 7.6 (4.5, 10.1) years, 129 (48%) patients died. Patients with abnormal DSE had a significantly higher mortality rate than those with normal DSE (73.5% vs. 44.2%, P=0.003). Univariable analysis demonstrated that male gender [hazard ratio (HR) 1.50, 95% confidence interval (CI): 1.04-2.16, P=0.03], resting systolic blood pressure (HR 1.006, 95% CI: 1.00-1.01, P=0.04), abnormal DSE (HR 1.95, 95% CI: 1.25-3.05, P=0.003), higher delta wall motion score index (HR 2.57, 95% CI: 1.24-5.35, P=0.01), abnormal stress left ventricular end-systolic volume (HR 2.05, 95% CI: 1.11-3.82, P=0.02), and post-KT status (HR 0.48, 95% CI: 0.30-0.79, P=0.004) were associated with mortality. In the multivariable analysis, male gender and abnormal DSE were independent predictors of mortality [adjusted HR (aHR) 1.65, 95% CI: 1.06-2.20, P=0.02 and aHR 1.88, 95% CI: 1.20-2.93, P=0.006, respectively], while post-KT status emerged as an independent predictor of better outcomes (aHR 0.47, 95% CI: 0.29-0.77, P=0.003).

Conclusions: In KT candidates, preoperative assessment with DSE provides valuable prognostic information for long-term outcomes, particularly regarding all-cause mortality.

Background: The high mortality from ruptured abdominal aortic aneurysm (AAA) is well-documented. However, the perioperative rupture risk is often underestimated. Aortic morphology is a key unresolved factor influencing this risk. This study aims to assess the impact of aortic morphology on the risk of perioperative rupture of AAAs.

Methods: A multicenter retrospective cohort study was conducted among patients undergoing perioperative endovascular aneurysm repair (EVAR) for AAAs between September 2017 and October 2021. All measurements were obtained using dedicated hospital reconstruction software. The primary endpoints were mortality and AAAs rupture. Univariate and multivariate logistic regression were used to analyze the association of risk factors with rupture. Piecewise linear regression was used to analyze the threshold effect of proximal neck angulation on rupture of AAAs. The clinical correlation between proximal aneurysm neck angulation and rupture was retrospectively studied after adjusting for potential confounders.

Results: A total of 160 patients were included. The incidence of AAAs rupture in patients with severe proximal aneurysm neck angulation was significantly higher than in patients without proximal aneurysm neck angulation (15.9% vs. 7.8%, P=0.001). After adjusting for gender, max aneurysm diameter and symptom, severe proximal aneurysm neck angulation was independently associated with AAAs rupture [odds ratio (OR) =8.159, 95% confidence interval (CI): 2.202-30.236; P=0.001]. After adjusting for gender, proximal aneurysm neck angulation and symptom, max aneurysm diameter was independently associated with AAAs rupture (OR =1.093, 95% CI: 1.046-1.143; P<0.001). The female seemed to have severe proximal neck angulation. When the angulation was greater than 41°, the risk of rupture increased linearly.

Conclusions: EVAR remains the preferred surgical approach for managing AAAs, guided by morphological and anatomical considerations. We have established a significant correlation between the extent of proximal neck angulation and the risk of perioperative rupture in aneurysms. Proximal neck angulation differs significantly between genders, with females exhibiting greater angulation than males. Clinicians should meticulously assess proximal neck angulation in patients undergoing EVAR and consider early intervention for those with severe angulation to mitigate the risk of rupture.

Background: A valid pulmonary artery wedge pressure (PAWP) is essential for the hemodynamic characterization of pulmonary hypertension (PH). We prospectively investigated the methodology for obtaining a valid PAWP measurement, while assessing the impact of prespecified factors on its determination.

Methods: In this prospective observational cohort study, we included consecutive patients who underwent right heart catheterization (RHC) using fluoroscopy at the Pulmonary Vascular Disease program at Cleveland Clinic, between February and May 2023. Once a valid PAWP was obtained, we recorded the number of attempts, reason for repeating the determination, pulmonary artery location, depth of the pulmonary artery catheter (PAC) from the introducer hub, and inflation volume of the PAC balloon.

Results: We included 195 patients, age: 57.5±15.7 years, 111 (57%) women, 156 (80%) with PH. The PAWP was 16.4±5.9 mmHg, requiring 1, 2 and ≥3 attempts for a valid measurement in 139 (71%), 39 (20%) and 17 (9%) patients, respectively. PAWP was repeated due to abnormal waveform, incomplete wedge and over wedge. A valid PAWP was obtained in the right pulmonary circulation in 168 (86%) patients, and in the lower third in 134 (69%), middle third in 58 (30%), and upper third of the lung in 3 (2%) patients. The pulmonary artery catheter balloon inflation at valid PAWP was 1.0±0.3 mL, at a distance from the introducer hub of 52.6±5.2 cm. Aspiration of blood in PAW position was obtained in 141 (72%) patients with an arterial oxygenation of 97% (95-99%). The number of measurements for a valid PAWP was directly associated with mean pulmonary artery pressure (mPAP) (r=0.18, P=0.01), PAWP (r=0.22, P=0.002), and pulmonary artery diameter on computed tomography (r=0.16, P=0.04).

Conclusions: A valid PAWP was obtained during the first or second attempt in about 90% of patients that undergo RHC. Advanced interventions such as relocating the PAC to a different place of the same lung or contralateral pulmonary circulation are needed in about 10% of patients.