Acta cardiologica最新文献

Background: Transcatheter edge-to-edge mitral valve repair (M-TEER) represents a safe treatment modality for patients with high-grade mitral regurgitation (MR). While clinical decision-making concerning the referral of suitable candidates for M-TEER is guided primarily by clinical and echocardiographic parameters, the potential of hemodynamic parameters obtained at the time of screening in predicting treatment outcomes has not been sufficiently investigated.

Methods: All patients who underwent M-TEER and who provided sufficient right heart catheterisation (RHC) data prior to M-TEER were enrolled for analysis. The investigated hemodynamic parameters were analysed descriptively and their associations with survival were estimated by univariable Cox regression analysis and Kaplan-Meier's analysis.

Results: A total of 94 patients were analysed, of whom 92.6% (87/94) had concomitant pulmonary hypertension (PH). Analysis of the hemodynamic profile revealed that 46.8% (44/94) of patients had advanced-stage congestive heart failure with a cardiac index < 2 L/min/m², and 68% (64/94) of patients had a cardiac power index <0.5 W/m². According to the results of the Kaplan-Meier and Cox regression analyses, a systolic pulmonary artery pressure (sPAP) > 60 mmHg and a mean right atrial pressure (RAP) > 20 mmHg were proven to be significant predictors of long-term survival after M-TEER.

Conclusions: Analysis of the hemodynamic profile, specifically the identified predictors, contributes to the improved identification of scenarios associated with a favourable prognosis in patients undergoing M-TEER.

Aims: Recently, a novel metabolic indicator, the Waist-to-Height-Haemoglobin A1c (WHH) index, has been shown to be associated with diabetes risk. This study investigated the association of WHH with the Cardiac Infarction/Injury Score (CIIS) and the risk of subclinical myocardial injury (SC-MI), stratified by hypertension status.

Methods: We conducted a cross-sectional analysis of 5,597 adults aged ≥40 years from the Third National Health and Nutrition Examination Survey who were free of CVD. The WHH index was calculated as waist circumference/height × HbA1c. SC-MI was defined as a CIIS ≥10 on a 12-lead electrocardiogram. Using weighted generalised linear and logistic regression models, we examined the associations of WHH with CIIS and SC-MI. Nonlinear relationships were assessed using restricted cubic spline (RCS) models.

Results: The WHH index was not associated with SC-MI among adults without hypertension (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.73-1.24 per SD increase), but was positively associated among adults with hypertension (OR, 1.37; 95% CI, 1.08-1.72; P_interaction = 0.007). For the CIIS, each 1-SD higher WHH index was positively associated only among those with hypertension (β = 0.81; 95% CI, 0.12 to 1.63; P_interaction = 0.020). RCS analysis confirmed a linear relationship between WHH and SC-MI risk among individuals with hypertension.

Conclusions: These findings demonstrate a significant association between the WHH index and subclinical myocardial injury, particularly among adults with hypertension.

Background: Percutaneous coronary intervention (PCI) has emerged as an established revascularization strategy for selected patients with left main coronary artery (LMCA) disease. However, data regarding outcomes in unselected real-world populations and the impact of intravascular imaging remain limited. We aimed to evaluate clinical outcomes following LMCA PCI according to clinical presentation and to assess the prognostic impact of intravascular imaging guidance.

Methods: We conducted a retrospective single-centre study including consecutive patients undergoing LMCA PCI between 2019 and 2022. Patients were classified as having chronic (CCS) or acute coronary syndrome (ACS). Major adverse cardiac and cerebrovascular events (MACCE) were assessed during follow-up. Kaplan-Meier and Cox regression and stabilised inverse probability of treatment weighting (SIPTW) analyses were performed.

Results: A total of 107 patients were included (19 CCS and 88 ACS; mean age 68.6 ± 11.3 years; 80.4% male). During a mean follow-up of 1121 ± 574 days, ACS patients experienced higher rates of MACCE (40.9% vs. 15.8%; p = 0.039) and all-cause mortality (29.5% vs. 5.3%; p = 0.027) compared with CCS patients. Intravascular imaging-guided PCI was associated with a significantly lower risk of MACCE in multivariable analysis (HR 0.32, 95% CI 0.14-0.75; p = 0.009). In a SIPTW-adjusted analysis, the association remained directionally favourable, although statistical significance was not maintained (HR 0.57, 95% CI 0.26-1.29; p = 0.178).

Conclusions: Clinical presentation significantly influences outcomes after LMCA PCI, with worse long-term prognosis among ACS patients. Intravascular imaging-guided PCI was associated with lower rates of MACCE and remained directionally favourable after weighting analyses, supporting its role in optimising LMCA interventions.

Background: Successive European guideline updates have modified the estimation and categorisation of cardiovascular risk. The transition from the Belgian SCORE calibration to SCORE2 in 2021, followed by revision of SCORE2 thresholds in 2025, may substantially alter clinical interpretation without changes in individual patient characteristics.Methods: Adults aged 40-69 years in primary prevention were retrospectively included from two Belgian centres. Both cohorts were pooled into a single analytical population. Cardiovascular risk was assessed using the HDL-corrected SCORE-Belgium model (2019), SCORE2 (2021), and the updated SCORE2 thresholds (2025), applied to identical baseline data. Low and moderate categories were harmonised. Reclassification was analysed descriptively.Results: Among 413 individuals, 84.3% were classified as low-moderate risk with SCORE-Belgium, 11.6% as high risk, and 4.1% as very high risk. With SCORE2 (2021), 58.8% were categorised as high risk and 7.3% as very high risk. Application of the 2025 thresholds reversed this distribution: 93.5% were classified as low-moderate risk, 6.5% as high risk, and none as very high risk. These variations affected largely the same individuals and occurred despite identical underlying risk estimates.Conclusion: Guideline updates markedly influence cardiovascular risk categorisation in primary prevention. The changes observed are predominantly attributable to the definitions of thresholds, rather than to differences in the underlying risk estimates. Risk categories should, therefore, be interpreted in the context of the specific assessment framework employed. In addition, supplementary methods for refining individual risk remain necessary.

Background: Transcatheter aortic valve implantation (TAVI) is a guideline-recommended treatment for severe aortic stenosis (AS). While the balloon-expandable Edwards Sapien 3 valve has long been the benchmark, the newer Myval valve has emerged as a potential alternative. Comparative data on mid-term survival, specifically one-year all-cause mortality, are lacking but crucial for clinical evaluation.

Methods: This systematic review and meta-analysis synthesised direct comparative evidence on the Myval versus Sapien 3 valves in patients undergoing TAVI, searching PubMed, Embase, and Cochrane Central up to November 2025. The primary outcomes included all-cause mortality within 30 days and 1 year. Secondary outcomes were 30-day safety events and hemodynamic parameters.

Results: Five studies (n = 2771) were included. The pooled analysis indicated no statistical difference in 30-day mortality (RR: 1.05, 95% CI: 0.53-2.07; p = 0.89; I²=0%) or in one-year all-cause mortality (RR: 0.93, 95% CI: 0.64-1.35; p = 0.70; I²=0%). Rates of stroke, major bleeding, pacemaker implantation, and other 30-day complications were also comparable (all p > 0.05). Hemodynamically, the Myval valve was superior at 30 days, with a lower mean gradient (MD: -2.37, 95% CI: -3.45 to -1.30; p < 0.0001) and larger effective orifice area (MD: 0.26, 95% CI: 0.17-0.35; p < 0.00001). Available one-year data from two randomised trials indicated this hemodynamic benefit was sustained.

Conclusion: This updated meta-analysis demonstrates that the newer Myval valve offers comparable early safety and one-year survival to the established Sapien 3 valve, with superior and sustained hemodynamic performance. These findings support its role as a safe and effective alternative in the TAVI landscape.

Background: Contrast-induced nephropathy (CIN) remains an important complication following primary percutaneous coronary intervention (PPCI) in patients with ST-segment elevation myocardial infarction (STEMI). In emergency settings, preventive strategies must be rapid and compatible with timely reperfusion. This study evaluated whether a single preprocedural bolus of high-concentration sodium bicarbonate was associated with a lower incidence of CIN.

Methods: In this prospective randomised study, 110 STEMI patients undergoing PPCI at two tertiary centres were enrolled. All patients received standard care, including isotonic saline hydration. Participants were assigned to saline hydration alone or saline plus a single intravenous bolus of 20 mEq of 8.4% sodium bicarbonate administered 5-10 min before contrast exposure. The primary endpoint was CIN within 48 ± 12 h, defined as an increase in serum creatinine ≥0.5 mg/dL or ≥25% from baseline.

Results: Baseline characteristics were generally comparable, although baseline blood urea nitrogen was higher and estimated glomerular filtration rate lower in the control group. CIN occurred more frequently in controls than in the sodium bicarbonate group (16.4% vs. 1.8%; p = 0.008). Renal function trajectories also favoured sodium bicarbonate. However, sodium bicarbonate did not remain an independent predictor of CIN after multivariable adjustment (OR 0.061, 95% CI 0.003-1.205; p = 0.066).

Conclusions: Sodium bicarbonate administration was associated with a lower unadjusted incidence of CIN. These findings should be considered hypothesis-generating and require confirmation in larger multicentre studies.