Acta Cardiologica Sinica最新文献

Background: Intravascular lithotripsy (IVL) is a new endovascular therapy (EVT) for severe femoropopliteal artery calcification. Data from Taiwan are limited.

Methods: Between March 2024 and March 2025, IVL-assisted EVT was performed in six patients (seven limbs, thirteen lesions) with significant femoropopliteal calcification. This study assessed device feasibility, procedural success, vessel patency, clinically driven target-lesion revascularization (CD-TLR), and quality-of-life scores at 12 months using imaging and the EQ-5D-5L.

Results: The average age of the patients was 76 years and they had multiple comorbidities; the baseline ankle-brachial index was 0.61. Most lesions were de novo (77%, mean length 48.5 mm). IVL balloons were deployed at all targets, delivering 153 pulses per lesion. All lesions then underwent specialty balloon treatment, and 77% subsequently received drug-coated balloon angioplasty. EVT reduced stenosis from 81% to 16% and increased lumen area from 2.97 mm²to 26.6 mm². No major complications or bailout stenting occurred. At 12 months, three lesions lost primary patency; one required CD-TLR, and that patient died four months later from intracranial hemorrhage. Quality-of-life scores improved from 0.505 to 0.814.

Conclusions: Early experience with the combined use of IVL, specialty balloons, and drug-coated balloon therapy was encouraging, and this approach may be a promising adjunctive strategy for treating heavily calcified femoropopliteal lesions.

Background: Pulmonary arterial hypertension (PAH) is a progressive disease with variable etiologies and poor prognosis. Long-term outcome data across etiologies remain limited.

Methods: We retrospectively studied 70 patients with PAH confirmed by right heart catheterization at Kaohsiung Chang Gung Memorial Hospital (2005-2023). Baseline characteristics, World Health Organization (WHO) functional class (FC), 6-minute walk distance, hemodynamics, comorbidities, and treatment regimens were collected. Survival was analyzed using the Kaplan-Meier method.

Results: The mean age of the patients was 55 years, and 59% were female. Connective tissue disease (CTD) was the leading etiology (35.7%), followed by idiopathic PAH (24.3%) and congenital heart disease (21.4%). The overall survival rates were 80.9%, 76.6%, and 73.4% at 1, 3, and 5 years, respectively. WHO FC IV at diagnosis was significantly associated with worse survival (p < 0.05). Although patients with CTD-PAH had a numerically lower survival rate compared to other etiologies, the difference did not reach statistical significance. Chronic kidney disease (CKD) and coronary artery disease (CAD) were associated with increased mortality. Combination therapy was associated with numerically higher survival (91.8%, 87.0% and 80.8% at 1, 3 and 5 years, respectively) compared to monotherapy or no therapy, although without statistical significance. Baseline risk stratification using the COMPERA 2.0 four-strata model was significantly associated with survival (p < 0.05).

Conclusions: CTD etiology, advanced FC, and comorbid CKD or CAD were associated with a poor prognosis in our cohort of patients with PAH. Combination therapy may improve long-term outcomes.

Background: This study investigated whether triple combination therapy [dapagliflozin (DAPA) + sacubitril/valsartan (Entresto) + adipose-derived mesenchymal stem cells (ADMSCs)] offered additional benefits on preventing complication syndrome [defined as abdominal aortic aneurysm (AAA) dilatation, muscle layer destruction and inflammation] in rodents with AAA.

Methods: Adult male Sprague-Dawley rats (n = 54) were equally categorized into group 1 (sham control), group 2 (AAA only), group 3 [AAA + DAPA (20 mg/kg/day orally from days 7 to 28 after AAA induction)], group 4 [AAA + Entresto (100 mg/kg/day orally from days 7 to 28 after AAA induction)], group 5 [AAA + ADMSCs (1.0 × 10⁶ cells) by intravenous administration from day 7 after AAA induction for 3 consecutive dosages at 3-day intervals)], and group 6 (AAA + combined DAPA-Entresto-ADMSCs).

Results: The results showed that the AAA diameter at day 28 was smallest in group 1, biggest in group 2, significantly larger in group 4 than in groups 3/5/6, and significantly larger in groups 4/5 than in group 6; however, there was no difference between groups 4 and 5 (all p < 0.0001). Light microscopic findings demonstrated that the AAA intimal thickness (i.e., indicator of intimal hyperplasia)/fibrotic area/number of immune-inflammatory [cluster of differentiation (CD) 3+/CD4+/matrix metalloproteinase [MMP] 2+/MMP9+] cells displayed an identical pattern, whereas the integrity of the laminar structure of AAA medial-muscle layer/number of small vessels exhibited an opposite pattern of AAA diameter among the groups (all p < 0.0001). The protein expressions of inflammation (tumor necrosis factor-alpha/interleukin (IL)-1 beta/IL-6/MMP2/MMP9)/fibrosis (transforming growth factor-beta/mothers against decapentaplegic homolog 3) markers displayed an identical pattern, whereas the protein expressions of tissue inhibitors of metalloproteinases (tissue inhibitor of metalloproteinases-1/tissue inhibitor of metalloproteinases-2) and apoptosis (cleaved-Caspase3/cleaved-poly(ADP-ribose) polymerase) displayed an opposite pattern of AAA diameter among the groups (all p < 0.0001).

Conclusions: The results of the present study support that triple therapy with DAPA + Entresto + ADMSCs could be an innovative therapeutic modality for AAA.

Background: Atrial fibrillation (AF) is a progressive condition that is often undiagnosed until adverse events occur. Traditional risk scores provide limited value for predicting short-term latent AF. Artificial intelligence (AI)-enabled electrocardiogram (ECG) algorithms enable early risk stratification from sinus rhythm ECGs, however their clinical utility remains unvalidated in randomized controlled trials (RCTs).

Objective: To evaluate an AI-ECG-guided strategy for targeted ambulatory Holter monitoring to enhance the early detection of AF or pre-AF atrial findings (PAAFs, defined as premature atrial complexes [PACs] > 500 beats per 24 hours, consecutive short runs of PACs > 20 beats, or non-sustained AF or atrial flutter) compared with usual care.

Design: The LATENT trial is a prospective, open-label, two-arm RCT (NCT06847932) that will recruit 14,726 participants undergoing routine ECGs at a tertiary medical center in Taiwan. Participants will be randomized 1:1 to the intervention group (AI-ECG risk stratification) or control group (usual care). In the intervention group, high-risk individuals identified by the AI-ECG model will be invited to undergo up to 7 days of ambulatory Holter monitoring. In the control group, AI-ECG analysis will be retrospectively applied after study completion to identify those at high risk. The primary endpoint is newly detected AF or PAAFs within 90 days.

Summary: This trial will evaluate the clinical utility of an AI-ECG-guided risk stratification strategy combined with targeted ambulatory Holter monitoring for the early detection of AF or PAAFs in a real-world hospital setting. The findings will inform future strategies for integrating AI-ECG technology to support early AF detection and prevention.

Background: The Osaka Prognostic Score (OPS), derived from C-reactive protein, serum albumin, and total lymphocyte count, reflects systemic inflammation and nutritional status. This study evaluated the prognostic value of the OPS for predicting contrast-induced nephropathy (CIN) and in-hospital all-cause mortality in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI).

Methods: In this retrospective study, 2,769 consecutive STEMI patients treated with pPCI were analyzed. OPS was calculated on admission (range 0-3). Multivariable regression, receiver operating characteristic, and spline analyses were used to evaluate predictors and optimal cutoff values.

Results: CIN occurred in 188 patients (6.8%), and 58 patients (2.1%) died during hospitalization. The mean OPS was significantly higher in patients who developed CIN compared with those who did not (1.86 ± 0.82 vs. 0.73 ± 0.70, p < 0.001). OPS independently predicted CIN (odds ratio: 6.817, 95% confidence interval: 5.157-9.012). For in-hospital mortality, OPS remained an independent predictor across all parsimonious multivariable Cox models, with adjusted hazard ratios ranging from 1.045 to 1.211 (all p < 0.05). An OPS cutoff value of ≥ 1.5 optimally predicted CIN (area under the curve [AUC]: 0.83) and in-hospital mortality (AUC: 0.73). Patients with an OPS of 3 had markedly higher rates of CIN (71.4%) and mortality (15.9%) than those with an OPS of 0 (0.7% and 0.5%, respectively; both p < 0.001). Kaplan-Meier analysis demonstrated a stepwise reduction in in-hospital survival with increasing OPS (log-rank p < 0.001).

Conclusions: The OPS is a simple and effective tool for the early prediction of CIN and in-hospital mortality in STEMI patients undergoing pPCI, and may facilitate early risk stratification and targeted management.

Background: Thoracic mycotic aortic aneurysm with aortoesophageal fistula (TMAA-AEF) is rare and highly lethal. However, limited data are available on imaging evolution and factors precluding transition to definitive surgery.

Methods: This retrospective, single-center case series included all consecutive adults with TMAA-AEF over a 10-year period. AEF was classified using predefined criteria; computed tomography (CT) studies were reviewed by two blinded radiologists with concordance assessed by percentage agreement. A focused review of 19 published studies was performed.

Results: Four patients (three women; median age, 77 years) with severe comorbidities presented with sepsis and upper gastrointestinal hemorrhage. CT demonstrated saccular aneurysms, periaortic inflammation, and loss of the aortoesophageal fat plane in all cases, and periaortic gas and contrast extravasation in three of the four cases. Serial imaging showed rapid progression to pseudoaneurysm and, after thoracic endovascular aortic repair (TEVAR), peri-graft abscess. Three patients underwent emergency TEVAR (median, 8 days); one received supportive care after cardiac arrest. All four died; none reached definitive open reconstruction.

Conclusions: All of the patients in this series died. Failure to achieve staged open reconstruction, driven by advanced sepsis and hemodynamic instability, was the common terminal pathway regardless of TEVAR use. No efficacy conclusion about TEVAR can be drawn from these data. Pre-planned multidisciplinary pathways to definitive surgery are essential in TMAA-AEF.

Background: Hereditary transthyretin amyloid cardiomyopathy (hATTR-CM) is a progressive disease. Emerging evidence supports bone scintigraphy as a noninvasive tool for monitoring treatment response. We aimed to evaluate the long-term impact of eplontersen therapy on technetium-99m pyrophosphate (^99mTc-PYP) single-photon emission computed tomography/computed tomography (SPECT/CT) uptake in patients with hATTR-CM.

Methods: We retrospectively analyzed data from a prospective cohort enrolled in the NEURO-TTRansform trial, including hATTR-CM patients treated with eplontersen. Patients who underwent baseline and at least two post-treatment ^99mTc-PYP SPECT/CT imaging were included. Changes in biomarkers, echocardiographic and ^99mTc-PYP SPECT/CT parameters were assessed.

Results: Five patients met the inclusion criteria. The mean follow-up durations were 22.4 months (first follow-up) and 37.5 months (second follow-up). A significant reduction in the volumetric heart-to-lung ratio was observed from baseline to first follow-up (3.75 ± 0.53 to 2.94 ± 0.38, p = 0.010) and to second follow-up (3.75 ± 0.53 to 2.86 ± 0.39, p = 0.009). A further reduction between the first and second follow-up was also noted (2.94 ± 0.38 to 2.86 ± 0.39, p = 0.025).

Conclusions: Serial ^99mTc-PYP SPECT/CT imaging demonstrated a significant reduction in myocardial tracer uptake over a mean follow-up of 37.5 months in patients with hATTR-CM undergoing eplontersen therapy.

Background: Brugada syndrome (BrS) carries a high risk of ventricular fibrillation (VF) despite protective therapy with implantable cardioverter-defibrillators (ICDs). Catheter ablation targeting epicardial substrate in the right ventricular outflow tract (RVOT) has emerged as a promising adjunctive strategy; however, optimal procedural endpoints remain unclear.

Objective: To present a case series of three BrS patients who underwent high-density (HD) epicardial substrate ablation assisted by electrogram fragmentation mapping, and to review contemporary evidence on Brugada substrate ablation.

Methods: Three symptomatic BrS patients underwent epicardial HD mapping using the EnSite X three-dimensional mapping system and Advisor HD Grid catheter. A dedicated fractionation mapping algorithm was used to identify regions of abnormal electrograms. All spontaneous fractionated or late potentials were ablated until the fragmentation map showed no residual abnormal points.

Results: In our three cases, HD mapping localized clusters of low-voltage, fractionated electrograms in the RVOT epicardium, which were successfully eliminated with epicardial radiofrequency ablation. Complete substrate removal resulted in normalization of the Brugada electrocardiographic pattern in all patients and rendered VF non-inducible. Over 6 months of follow-up, no VF recurrence was noted and no ICD therapies were delivered. No major procedural complications were observed. Post-ablation voltage maps remained patchy (reflecting residual scar tissue); however, the fragmentation maps became uniformly clean, supporting their utility as an objective endpoint.

Conclusions: This case series demonstrates the feasibility of using fragmentation mapping as an intra-procedural guide and endpoint for Brugada ablation in the absence of drug challenge. Fragmentation mapping appeared to reproducibly confirm complete substrate elimination.