Cardiology最新文献

Introduction: Secondary tricuspid regurgitation (STR) is increasingly prevalent in heart failure (HF) patients and independently predicts adverse outcomes. This retrospective study aimed to stratify severe STR patients based on right ventricular fractional area change (RVFAC) and elucidate echocardiographic parameters influencing prognosis.

Method: Overall, 106 hospitalized HF patients with severe STR were analysed post-stabilization using transthoracic echocardiography. Patients were categorized into preserved RVFAC (≥35%, n = 75) and reduced RVFAC (<35%, n = 31) groups. Long-term outcomes were assessed over 60 months for cardiac-related events.

Results: Among 106 patients, those with reduced RVFAC had significantly worse outcomes than those with preserved RVFAC (log-rank test, p = 0.0016). In the preserved RVFAC group, independent predictors of cardiac events included age, prior HF hospitalization, lower TAPSE, higher RV sphericity index, and greater tricuspid tenting height. In the reduced RVFAC group, only TAPSE remained a significant prognostic factor. ROC analyses identified TAPSE ≤13.1 mm (AUC 0.897) and ≤13.9 mm (AUC 0.907) as optimal cutoffs for predicting cardiac events in preserved and reduced RVFAC groups, respectively.

Conclusion: RVFAC serves as an effective prognostic marker in severe STR patients, with additional assessment of TAPSE and morphological parameters enhancing risk stratification. These findings underscore the importance of comprehensive right heart evaluation in managing STR-associated HF, facilitating tailored therapeutic strategies, and improving patient outcomes.

Introduction: We aimed to review the published references regarding cardiac lead perforation subsequent to pacemaker implantation. This study evaluated the risk factors, clinical presentations, and management strategies of patients with perforated cardiac lead after pacemaker implantation.

Methods: A systematic search was performed in PubMed from its inception to September 16, 2024. The search focused on cardiac lead perforation following pacemaker implantation. The quality of the case reports and case series was assessed using Joanna Briggs Institute (JBI) Evidence-Based Health Care Center about different types of research Quality Evaluation Tool.

Results: A total of 120 case reports and 16 case series studies with 153 participants met the inclusion criteria. We found that active bipolar lead appears to be associated with cardiac perforation. Cardiac perforation was symptomatic in 88.8% of patients and asymptomatic in 11.2%. Unremarkable clinical manifestations of delayed lead perforation may range from chest pain, dyspnea, syncope or presyncope, abdominal discomfort, phrenic nerve stimulation to nausea. Imaging findings may not be limited to pericardial effusion but also include pleural effusion, cardiac tamponade, pneumopericardium, and pneumothorax. Surgical intervention was utilized in 47.1% of all included cases for pacemaker lead perforation management.

Conclusion: The incidence of cardiac lead perforation after pacemaker implantation is often underestimated. Our findings highlight the importance of vigilant monitoring for both symptomatic and asymptomatic presentations, particularly in cases involving active bipolar leads. Critically, nearly half of all cases required surgical intervention, underscoring the severity of this complication.

Introduction: Left ventricular (LV) ejection fraction (LVEF) and LV end-diastolic diameter (LVEDd) are well-established predictors of adverse cardiovascular events. However, the possible association with survival in patients with infective endocarditis (IE) treated with aortic valve replacement (AVR) is underexplored. Additionally, it is important to investigate whether sex modifies these associations.

Methods: We retrospectively recruited 170 consecutive patients with IE treated with AVR from three cardiac surgery tertiary hospitals in Scandinavia. Echocardiography was performed both pre- and postoperatively. Baseline characteristics, preoperative blood samples, postoperative complications, echocardiographic, and angiographic data were compared between surviving and deceased patients at both short- (1-year) and long-term (5-year) follow-up.

Results: The mean age in the entire study population was 58.5 ± 15.1 years, and 80.0% were males. The mean LVEF was 54 ± 11% preoperatively, decreasing to 51 ± 11% postoperatively. The mean baseline LVEDd was 5.8 ± 0.9 cm in males and 5.0 ± 0.9 cm in females (p < 0.001), decreasing to 5.2 ± 0.9 cm in males and 4.7 ± 0.6 cm in females after surgery (p = 0.006). At short-term follow-up, reduced postoperative LVEF (<50%) was more common in non-survivors (46.2% vs. 26.2%, p = 0.040), with the strongest association observed in females (71.4% vs. 25.9%, p = 0.025). Similarly, during long-term follow-up, deceased female patients had a higher prevalence of reduced preoperative LVEF (<50%) compared to surviving female patients (30.0% vs. 4.2%, p = 0.033). LVEDd was significantly greater in female non-survivors compared to survivors at both short-term (5.7 ± 1.1 cm vs. 4.9 ± 0.8 cm, p = 0.043) and long-term follow-up (5.5 ± 0.9 cm vs. 4.8 ± 0.8 cm, p = 0.046), an association not observed in male patients.

Conclusion: Our study found that both pre- and postoperative LVEF, as well as preoperative LVEDd, were associated with poorer outcomes in patients with IE undergoing AVR, particularly among female patients. These results highlight the importance of tailored clinical management strategies based on sex-specific risk profiles. Further research is needed to validate these findings and develop interventions to mitigate the observed risks.

Introduction: This study aimed to examine the effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on cardiac structure and cardiorenal function in older adults with hypertension and pre-heart failure.

Methods: A total of 88 patients with hypertension and pre-heart failure who received care at the hospital between August 2022 and August 2024 were enrolled and randomly assigned to either a dapagliflozin group or a conventional treatment group. Changes in N-terminal pro-brain natriuretic peptide (NT-proBNP), troponin I (TnI), estimated glomerular filtration rate (eGFR), interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP), procalcitonin (PCT), left ventricular end-diastolic volume (LVEDV), ejection fraction, left atrial volume index (LAVI), and left ventricular mass index were assessed and compared between the two groups before and after 3 months of treatment.

Results: No significant differences were observed in NT-proBNP, TnI, eGFR, IL-6, and hsCRP levels between the two groups before treatment. Additionally, there were no differences in PCT, TnI, and LVEDV between the groups at 3 months post-treatment. However, IL-6, hsCRP, and eGFR levels were significantly lower in the dapagliflozin group compared to the conventional treatment group at 3 months post-treatment (p < 0.05). Additionally, the LAVI was significantly lower in the dapagliflozin group relative to the conventional treatment group, with the difference being statistically significant (p < 0.05).

Conclusion: These findings indicate that SGLT2i therapy may contribute to early myocardial remodeling and improvement in cardiorenal function in older adults with hypertension and pre-heart failure. Furthermore, prolonged SGLT2i administration appears to exert anti-inflammatory effects.

Instruction: The aim of this study was to examine the causal relationship between blood pressure and digestive tract cancers in European and Asian populations using Mendelian randomization (MR).

Methods: Summary statistics for blood pressure traits and digestive tract cancers were obtained from large-scale genome-wide association studies in European (UK Biobank, FinnGen) and Asian (Biobank Japan, KoGES) cohorts. The inverse variance weighted (IVW) method was the primary analysis, with sensitivity tests including MR-Egger, weighted median, and MR-PRESSO to assess pleiotropy and robustness.

Results: In European populations, no significant causal associations were observed between blood pressure traits and digestive tract cancers (all p > 0.05). In contrast, genetically predicted higher systolic blood pressure (SBP) was linked to increased colorectal cancer (CRC) risk in Asians (OR = 1.436, 95% CI: 1.102-1.869). Sensitivity analyses supported the robustness of this association.

Conclusions: Elevated SBP appears to be a potential causal risk factor for CRC in Asian populations, whereas no such association was observed in Europeans. Nevertheless, the causal links between blood pressure and other digestive tract cancers, as well as the underlying biological mechanisms, remain to be verified. To advance this understanding, further studies are needed to confirm ancestry-specific mechanisms and to clarify the biological pathways underlying these findings.

Introduction: Brain tumors may disrupt cardiac autonomic regulation, leading to arrhythmias that complicate patient management. This review aims to synthesize evidence on the relationship between brain tumor characteristics, treatments, and cardiac arrhythmias.

Methods: A systematic literature search was performed with independent screening and data extraction by two reviewers. Due to heterogeneity in study designs, tumor types, and arrhythmia outcomes, quantitative meta-analysis was not feasible; results were synthesized qualitatively.

Results: Supratentorial tumors, especially in limbic and insular regions, were frequently associated with atrial arrhythmias and ECG abnormalities. High-grade tumors showed diverse arrhythmias, including bradycardia and ventricular events, often linked to tumor progression or seizures. Surgical resection improved arrhythmias but posed perioperative risks, notably with right insular involvement. Chemotherapy effects were variable; radiation-induced arrhythmias were infrequent and dose-dependent. Arrhythmia patterns varied across pre-, peri-, and post-treatment phases, reflecting complex neurocardiac interactions.

Conclusion: Cardiac arrhythmias in brain tumor patients arise from multifactorial mechanisms influenced by tumor biology and treatment effects. Prospective, standardized studies are required to clarify underlying mechanisms and optimize arrhythmia management in neuro-oncology.

Introduction: Early myocardial injury during chemotherapy may precede declines in left ventricular ejection fraction. We assessed the diagnostic accuracy of cardiac troponin I (cTnI) for early detection of cancer therapy-related cardiac dysfunction (CTRCD).

Methods: We conducted a diagnostic test accuracy (DTA) meta-analysis of prospective cohorts measuring cTnI within 3 months after chemotherapy initiation following PRISMA-DTA. Searches were conducted across PubMed, Embase, Cochrane Library, CNKI, and Wanfang databases through August 2025. A bivariate random-effects hierarchical summary receiver operating characteristic (HSROC) model estimated pooled sensitivity and specificity with confidence/prediction regions; risk of bias was appraised using QUADAS-2. Clinical implications were illustrated with Fagan nomograms at prespecified pretest probabilities (10% and 20%).

Results: A total of 5 prospective cohort studies were included. The HSROC summary operating point yielded pooled sensitivity 0.669 (95% CI 0.444-0.836) and specificity 0.839 (95% CI 0.634-0.940). The corresponding positive likelihood ratio was 4.15, and negative was 0.39. At a 10% pretest probability, posttest probabilities were 32% after a positive result and 4% after a negative result; at a 20% pretest probability, they were 51% and 9%, respectively. Leave-one-out analyses indicated stable estimates.

Conclusions: Within the first 3 months of chemotherapy, cTnI shows moderate sensitivity and high specificity for early CTRCD detection. These performance characteristics support cTnI as a confirmatory biomarker to inform risk-stratified surveillance alongside imaging under standardized assay procedures.

Introduction: Guideline-directed medical therapy (GDMT) optimization and effective de-congestion are known to improve outcomes in admitted heart failure (HF) patients, yet their implementation is suboptimal. Using an HF decision aid and point-of-care ultrasound (POCUS) at admission, this resident-led quality improvement (QI) initiative aimed to improve GDMT use and reduce HF readmissions.

Methods: This prospective, single-center QI initiative compared resident-performed POCUS and HF decision-aid use (the QI arm) with routine hospital care in admitted HF patients. Assignment to the QI arm was based on the availability of residents trained to perform POCUS on admission.

Primary outcome: 30-day hospital readmission; secondary outcomes: GDMT utilization using a standard score, adverse outcome occurrence, and 30-day mortality.

Results: The study was terminated early due to funding constraints. We enrolled 103 (42 in the QI arm) out of the planned 254 patients. At discharge, the QI arm had a trend towards improvement in GDMT scores (+21 ± 23% vs. +12 ± 24% in controls, p = 0.106). In particular, a numerically higher proportion of patients in the QI arm were discharged on renin-angiotensin-aldosterone blockers (70.4% vs. 51.4% of controls, p = 0.126). Adverse effect occurrence and 30-day outcomes (readmissions and mortality) were not significantly different between groups. Significantly more people in the QI arm had a transthoracic echocardiogram in the hospital (26 [65.0%] vs. control: 21 [38.9%], p = 0.012).

Conclusion: This study showed that a resident-led QI initiative was feasible and resulted in modest improvement in GDMT use and echocardiography utilization, but without effectively altering 30-day outcomes.

Introduction: Vericiguat has been shown to improve clinical outcomes in patients with heart failure (HF) with reduced ejection fraction in several randomized controlled trials. However, there is limited real-world evidence regarding its effectiveness in clinical practice outside of the controlled research setting.

Methods: Patients hospitalized due to symptomatic HF between January 1 and December 30, 2023, were consecutively enrolled and divided into the vericiguat group and the control group. A total of 207 patients with left ventricular ejection fraction <45% were enrolled.

Results: Patients in the control group had a higher incidence of clinical endpoints than the vericiguat group: cardiac mortality and hospitalization for symptomatic HF during the median follow-up duration of 11.25 months. Patients in the vericiguat group demonstrated a higher event-free survival rate for both cardiac mortality and hospitalization for HF. In the univariable Cox regression analysis, vericiguat was found to be associated with a reduced risk of cardiac mortality (hazard ratio [HR]: 0.299, 95% confidence interval [CI]: 0.104-0.863, p = 0.026) and hospitalization for HF (HR: 0.586, 95% CI: 0.348-0.988, p = 0.045). After propensity score matching for age and sex, we observed that vericiguat's benefit on cardiac mortality was maintained.

Conclusion: This prospective study is the first to report, using real-world data from a Chinese population with ventricular ejection fraction <45%, that vericiguat is associated with a lower incidence of clinical endpoints, including cardiac mortality and hospitalization for HF. These findings align with the results of previous clinical trials.