The latest medical research on Cardiology
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about cardiology gathered by our medical AI research bot.
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Request AccessMagnetic Resonance Myocardial Imaging in Patients With Implantable Cardiac Devices: Challenges, Techniques, and Clinical Applications.
EchocardiographyCardiovascular magnetic resonance imaging (MRI) in patients with cardiac implants, such as pacemakers and defibrillators, has gained importance in ...
Echocardiographic Screening Model for Improved Assessment of Atrial Septal Defect Closure: A Multicenter Retrospective Study.
EchocardiographyAtrial septal defect (ASD) is a prevalent congenital heart condition in adults, which finally leads to pulmonary hypertension and right heart failure if left untreated. Right heart catheterization (RHC), the current gold standard for determining ASD closure feasibility, is invasive. Thus, a noninvasive prescreening tool is urgently needed.
In a multicenter, retrospective study, we assessed 924 ASD patients (2012-2022) to determine their suitability for ASD closure. Using LASSO regression, we identified predictors for a correctable shunt, enabling us to create the ASD model. The ASD model, comprising of estimated pulmonary artery systolic pressure (ePASP), peak velocity through the pulmonary valve (PV), peak E-wave velocity through the tricuspid valve (TVE), and right atrial longitudinal dimension (RA) by echocardiography, was constructed and exhibited favorable discriminative capability with an area under the curve (AUC) of 0.941 (95% CI: 0.920-0.961) in the derivation group. The model also demonstrated good calibration and discriminative abilities in the validation cohort. When juxtaposed with the earlier congenital heart disease (CHD) model, the newly developed ASD model demonstrated superior predictive capabilities for correctable shunt, supported by the net reclassification index (NRI) [0.063 (95% CI: 0.001-0.127, p = 0.047)] and integrated discrimination improvement (IDI) [0.023 (95% CI: 0.011-0.036, p < 0.001)].
In summary, our research advocates the ASD model as a superior tool for screening suitable ASD defect closure candidates.
Three-Dimensional Speckle Tracking Echocardiography Assessment of Right Ventricular Function in Chronic Coronary Syndrome Patients After Percutaneous Coronary Intervention.
EchocardiographyThis study aimed to assess alterations in right ventricular (RV) function following percutaneous coronary intervention (PCI) in patients with chronic coronary syndromes utilizing three-dimensional speckle tracking echocardiography (3D-STE).
A prospective study was conducted involving 136 patients diagnosed with chronic coronary syndromes undergoing PCI, constituting the study group, alongside 110 age- and gender-matched healthy volunteers serving as the control group. Echocardiographic evaluations, including both conventional and three-dimensional assessments, were performed on all study participants at 1-week, 6, and 12 months post-PCI. Parameters such as tricuspid annular plane systolic excursion (TAPSE) were derived from conventional echocardiography, while tricuspid lateral annular systolic velocity (S') was measured via tissue Doppler imaging. 3D-STE was utilized to quantify metrics including right ventricular fractional area change (RVFAC), right ventricular free wall longitudinal strain (RVFWLS), right ventricular global longitudinal strain (RVGLS), right ventricular stroke volume (RVSV), and right ventricular ejection fraction (RVEF).
TAPSE, S', RVFAC, RVFWLS, RVGLS, RVSV, and RVEF exhibited significant increases from 1-week to 6 months post-PCI (p < 0.05). However, from 6 to 12 months post-PCI, RVFAC, RVGLS, RVSV, and RVEF demonstrated no notable changes (p > 0.05). Meanwhile, TAPSE, S', and RVFWLS sustained significant elevations: TAPSE (19.63 ± 3.253% to 22.603 ± 2.885%, p < 0.001); S' (10.57 ± 2.643 to 12.61 ± 2.189 cm/s, p < 0.001); RVFWLS (18.64 ± 2.745% to 19.926 ± 3.291%, p = 0.002). At 12 months post-PCI, S', RVFAC, RVGLS, RVSV, and RVEF remained lower than those of the healthy control group, but the differences were not statistically significant (p > 0.05). However, RVFWLS was significantly lower compared to the healthy control group (19.926 ± 3.291% vs. 22.10 ± 1.994%, p < 0.001).
Following PCI, right ventricular systolic function in patients with chronic coronary syndromes improves significantly over time. However, even at the 12-month post-PCI mark, RVFWLS remains lower than that of the control group. Notably, 3D-STE emerges as a noninvasive method for quantifying right ventricular systolic function post-PCI in chronic coronary syndrome patients.
Challenges posed by climate hazards to cardiovascular health and cardiac intensive care: implications for mitigation and adaptation.
European Heart JournalGlobal warming, driven by increased greenhouse gas emissions, has led to unprecedented extreme weather events, contributing to higher morbidity and...
Comparison of open and hybrid endovascular repair for aortic arch: a multi-Centre study of 1052 adult patients.
Cardiothoracic SurgeryWe aimed to evaluate early and late outcomes by comparing open total arch repair and endovascular arch repair using proximal landing zone analysis in a multicentre cohort.
From 2008 to 2019, patients treated surgically for aortic arch disease at six centres were included, excluding cases with type A aortic dissection, additional aortic root replacement, and extensive aortic aneurysm. In all patients and populations with proximal landing zone 0/1 (N = 144) and 2 (N = 187), early and late outcomes were compared using propensity score matching.
A total of 1052 patients, including 331 (31%) and 721 (69%) undergoing endovascular arch repair and open total arch repair, respectively, were enrolled. After propensity score match (endovascular arch repair, 295, open total arch repair; 566), no significant difference was observed in in-hospital mortality rate (endovascular arch repair, 6.8%, open total arch repair, 6.2%; p = 0.716). Open total arch repair was associated with a lower risk of all-cause death (log-rank test; p = 0.010, hazard ratio 1.41 [95% confidence interval: 1.17-1.71]). The incidence of aorta-related death was higher in endovascular arch repair (Gray test; p = 0.030, hazard ratio; 1.44 [95% confidence interval; 1.20-1.73]). When compared to endovascular arch repair with proximal landing zone 0/1, open total arch repair was associated with lower risks of all-cause death (log-rank test; p < 0.001, hazard ratio; 2.04 [95% confidence interval; 1.43-2.90]) and aorta-related death (Gray's test; p = 0.002, hazard ratio; 1.67 [95% confidence interval; 1.25-2.24]). There was no difference in the risk of all-cause death (log-rank test; p = 0.961, HR; 0.99 [95% confidence interval; 0.67-1.46]) and aorta-related death (Gray's test; p = 0.55, hazard ratio; 1.31 [95% confidence interval; 1.03-1.67]) between endovascular arch repair with proximal landing zone 2 and open total arch repair.
Open total arch repair was considered the first choice based on early and late results; however, endovascular arch repair may be a useful option if the proximal landing zone is limited to zone 2.
Sotatercept: The First FDA-Approved Activin A Receptor IIA Inhibitor Used in the Management of Pulmonary Arterial Hypertension.
Cardiovascular DrugsThis report illustrates the Food and Drug Administration (FDA) approval of first-in-its-class activin A receptor IIA inhibitor, sotatercept (Winrev...
Presence of Apical Aneurysm and Its Impact on Left Ventricular Mechanics and Mechano-Energetic Coupling in Patients With Apical Hypertrophic Cardiomyopathy.
EchocardiographyLeft ventricular (LV) apical aneurysms (ApAn+) occur in 10%-15% of apical hypertrophic cardiomyopathy (ApHCM) patients and confer considerable morbidity. We hypothesized that ApAn+ adversely impact ventricular mechanics and mechano-energetic coupling in ApHCM.
Ninety-eight ApHCM patients were identified, of which nine (9%) had ApAn+ and were compared with 89 (91%) who did not (ApAn-). 2D speckle-tracking echocardiography assessed ventricular mechanics using LV global longitudinal strain (GLS) and torsion, and mechano-energetic coupling as myocardial work indices. Clinical events over follow-up were adjudicated.
Mean age was 64 ± 15 years, 46% were female, and 3% had an HCM family history, with similar clinical risk factors between groups. Of the nine ApAn+ patients, there were six small (<2 cm) and three moderate-sized (2-4 cm) aneurysms. There was no difference in LV ejection fraction (65 ± 15 vs. 67 ± 11%, p = 0.51) or GLS (-9.6 ± 3.3 vs. -11.9 ± 3.9%, p = 0.09) between ApAn+ versus ApAn-. ApAn+ patients had greater myocardial global wasted work (347 ± 112 vs. 221 ± 165 mmHg%, p = 0.03) and lower global work efficiency (GWE, 75 ± 5 vs. 82 ± 8%, p = 0.006). LV GLS (β = -0.67, p < 0.001), ApAn+ (β = -0.15, p = 0.04), and twist rate (β = -0.14, p = 0.04) were independently associated with GWE. At 3.9-year follow-up, cardiovascular mortality (4%) and heart failure hospitalization (14%) events were similar between groups.
ApHCM patients with ApAn+ are characterized by more impaired LV mechano-energetic coupling when compared with ApAn-. ApAn+ is independently associated with worse GWE.
Efficacy of Colchicine for Prevention of Stroke and Adverse Cardiovascular Events: A Meta-analysis of 16 Randomized Controlled Trials.
Cardiovascular DrugsColchicine has been shown to reduce adverse cardiovascular events (ACE) and stroke among patients with coronary artery disease. However, its efficacy with short- and long-term use and risk of stroke has not been well studied, with conflicting results to date.
We sought to evaluate the efficacy of colchicine for the prevention of stroke and other cardiovascular outcomes and to evaluate the effect of short- and long-term use.
We performed a systematic literature search on PubMed, EMBASE, and Clinicaltrial.gov for relevant randomized controlled trials (RCTs) from inception until July 20th, 2024. Odds ratios (ORs) were pooled using a random-effect model, and a p value of < 0.05 was considered statistically significant.
A total of 16 RCTs with 24,967 patients were included (12,538 in colchicine group and 12,429 in the control group) in the analysis. Pooled analysis of primary outcomes showed that risk of incidence of stroke was comparable between colchicine and placebo groups (OR 0.78, 95% confidence interval [CI] 0.59-1.02, p = 0.07). Pooled analysis of secondary outcomes showed that colchicine significantly reduced the risk of incidence of ACE by 33% (OR 0.67, 95% CI 0.54-0.82, p < 0.001), and myocardial infarction by 21% (OR 0.79, 95% CI 0.65-0.95, p = 0.01) compared with placebo. However, the risk of all-cause mortality (OR 0.98, 95% CI 0.79-1.21, p = 0.83) and cardiovascular mortality (OR 0.78, 95% CI 0.56-1.08, p = 0.14) were comparable between both groups of patients.
Colchicine was associated with an overall reduction in the risk of incidence of ACE and MI; however, no such effect was observed with mortality and stroke.
Luminal shape and aortic remodelling after total arch replacement for type A aortic dissection: conventional and frozen elephant trunks.
Cardiothoracic SurgeryThis study was performed to assess postoperative aortic remodelling (AR) after total arch replacement (TAR) for acute type A aortic dissection (AAD) with a frozen elephant trunk (FET) or conventional elephant trunk (cET). Furthermore, the shape of the residual true lumen (TL) was analyzed based on elliptical Fourier analysis (EFA) and evaluated as a predictor of AR.
This study involved patients who underwent TAR with a cET or FET for AAD from December 2006 to January 2023 at five institutions. AR was assessed at the levels of the 4th thoracic vertebra (Th4), Th7, Th10, and above the coeliac trunk. The shape of the residual TL at all four levels was analyzed based on EFA to calculate shape patterns as principal component (PC) values. Inverse probability of treatment weighting (IPTW) was performed for adjustment between the groups.
In total, 180 patients (88 with cET and 92 with FET) were enrolled. The complete AR rate, defined as false lumen remodelling throughout the entire descending thoracic aorta, was significantly higher in the FET than cET group (63.4% vs 32.0%, P = 0.0013). The IPTW-adjusted Fine-Gray regression model revealed that the mean PC2 (hazard ratio, 0.22; P < 0.001) and PC3 (hazard ratio, 0.24; P = 0.009) of the four levels were independent predictors of complete AR.
In AAD repair, the AR rate was significantly higher with use of the FET than cET. The shape patterns of the residual TL can be an important reference for predicting postoperative AR.
Comparison between invasive cardiac output and left ventricular assist device flow parameter.
Cardiothoracic SurgeryEvaluate the correlation between left ventricular assist device flow parameter and invasive cardiac output measurements.
We retrospectively evaluated right heart catheterization examinations performed in left ventricular assist device patients from 2 tertiary medical centers. We evaluated the correlation between cardiac output measurement methods (indirect Fick and thermodilution) and pump flow parameter using linear regression, agreement was graphically displayed using Bland-Altman plot technique. Clinical, echocardiographic, pump and haemodynamic parameters were compared between patients with and without discordance, defined as at least 20% difference between measurements.
The study population consisted of 102 patients (median age 58 [51-64], 86% males, 17 ± 12 months post left ventricular assist device implantation) with a total of 544 measurement compared. Discordance between measurements were present in 102 of 226 (45%) comparisons between indirect Fick and pump flow and in 72 of 161 (48%) between thermodilution and pump flow. A comparison of indirect Fick and left ventricular assist device exhibited a statistical correlation of R = 0.751, and that of thermodilution and left ventricular assist device of R = 0.789. Parameters associated with the presence of discordance between cardiac output measurements included a higher rate of aortic valve opening, lower indirect Fick and higher thermodilution cardiac output. After excluding the lowest tertile of indirect Fick cardiac output values, the correlation between measurements improved (thermodilution: R = 0.879 and indirect Fick: R = 0.843, p < 0.001).
The current left ventricular assist device flow parameter provides an estimation of cardiac output that correlates well with indirect Fick and exhibits the strongest correlation with thermodilution. This correlation was stronger after excluding lower cardiac output values.
Early outcomes of robotic versus video-thoracoscopic anatomical segmentectomy: a propensity score-matched real-world study.
Cardiothoracic SurgeryMinimally invasive anatomic segmentectomy for the resection of pulmonary nodules has significantly increased in the last years. Nevertheless, there is limited evidence on the safety and feasibility of robotic segmentectomy compared to video-assisted thoracic surgery. This study aimed to compare the real-world early outcomes of robotic and video-thoracoscopic in anatomic segmentectomy.
Single centre cohort study including all consecutive patients undergoing segmentectomy by either robotic or video-thoracoscopic from June 2018 to November 2023. Propensity score case matching analysis generated two matched groups undergoing robotic or video-thoracoscopic segmentectomy. Short-term outcomes were analysed and compared between groups.
204 patients (75 robotic and 129 video-thoracoscopic patients) were included. After matching, 146 patients (73 cases in each group) were compared. One 30-day death was observed in the robotic group (P = 1). Two conversions to thoracotomy occurred in the robotic, and none in the video-thoracoscopic group (P = 0.5). Surgical time was longer in the robotic group (P = 0.091). There were no significant differences between robotic and video-thoracoscopic groups in postoperative complications (13.7% vs 15.1%, P = 1), cardiopulmonary complications (6.8% vs 6.8%, P = 1), major complications (4.1% vs 4.1%, P = 1), prolonged air leak (4.1% vs 5.5%, P = 1), arrythmia (1.4% vs 0%, P = 1) and reoperation (2.7% vs 2.7%, P = 1). Median length of stay was 3 days (IQR, 2-3 days) in the robotic group vs 3 days (IQR, 2.5-4 days) in the video-thoracoscopic group (P = 0.212).
Robotic segmentectomy is a safe and feasible alternative to video-thoracoscopy, as no significant differences in early postoperative outcomes were found between the two techniques.
Improvement in patient selection, management, and outcomes in infant heart transplant from 2000 to 2020.
Cardiothoracic SurgeryThe study's primary outcome was to evaluate if post-transplant survival has improved over the last two decades. Secondary outcomes were the infant's waitlist mortality, waitlist time, and identifying factors that affected the infant's survival.
United Network for Organ Sharing (UNOS) database was queried for infants (age ≤ 1) who were listed for heart transplantation between 2000-2020. The years were divided into three eras (Era 1 2000-2006, Era 2 2007-2013, and Era 3 2014-2020). Non-parametric tests, Chi-Squared, Log-Rank test, and Cox-Proportional hazard ratio were used for analysis (alpha = 0.05).
4234 infants were listed for heart transplants between 2000 and 2020. At the time of listing, Infants in era 3 were more likely to be heavier (in kg (p < 0.001) and had better renal function (p < 0.001). Additionally, they were less likely to be on dialysis (p < 0.001), on a ventilator (p < 0.001), and on ECMO (p < 0.001). There has been a significant increase in LVAD use (p < 0.001), though there was no difference in waitlist (0.154) or post-transplant survival (0.51). In all three eras, waitlist survival (p < 0.001) and post-transplant survival (p < 0.001) have improved significantly. CHD and ECMO were associated with worse waitlist survival in all three eras (p < 0.05). Infants are now waiting longer on the waitlist (in days) (33 Era 1 v. 46 Era 2 v. 67 Era 3, p < 0.001).
Infant heart transplant outcomes have improved, but they are now waiting longer on the waitlist. Further improvement in increasing the donor pool, expert consensus on listing strategies, and donor utilization is needed to improve outcomes.