Clinical Research in Cardiology最新文献

{"title":"The impact of myocardial injury on outcomes in TAVI patients.","authors":"Thorald Stolte, Pedro Lopez-Ayala, Jakob Reichl, Anna Pfenniger, Giampiero Allegra, Gregor Leibundgut, Christoph Kaiser, Jasper Boeddinghaus, Felix Mahfoud, Christian Mueller, Thomas Nestelberger","doi":"10.1007/s00392-024-02585-1","DOIUrl":"https://doi.org/10.1007/s00392-024-02585-1","url":null,"abstract":"<p><strong>Background: </strong>Peri-procedural myocardial injury (PPMI) has been commonly reported after transcatheter aortic valve implantation (TAVI) and may have a potential impact on outcomes. The recent update to the Valve Academic Research Consortium (VARC)-3 criteria for PPMI warrants a comparison with the preceding VARC-2 criteria to understand its implications on patient outcomes.</p><p><strong>Aims: </strong>To assess the prognostic significance of PPMI as defined by VARC-3 versus VARC-2 in TAVI patients and evaluate the predictive value of high-sensitivity cardiac troponin T (hs-cTnT) for adverse outcomes within 1 year post-TAVI.</p><p><strong>Methods: </strong>Consecutive patients undergoing TAVI in a tertiary university hospital between December 2011 and June 2023, with hs-cTnT concentrations pre- and post-procedurally, were enrolled. The primary outcome was all-cause mortality at 1 year. Secondary outcomes were major cardiac adverse events (MACE), defined as a composite end point including all-cause mortality, unplanned reintervention, stroke, myocardial infarction, or major bleeding at 30 days and 1 year.</p><p><strong>Results: </strong>Of 653 patients, 535 (82%) had elevated baseline serum hs-cTnT. It was a significant predictor of 1-year mortality and MACE, whereas post-TAVI hs-cTnT concentrations did not predict outcomes (HR: 1.5, p = 0.21 and HR: 0.943, p = 0.54). 367 (56%) of all patients met VARC-2 PPMI criteria, while only 24 (3.7%) met VARC-3 criteria. Patients meeting VARC-3 criteria had significantly more comorbidities and higher 1-year mortality (25% vs. 9%; p = 0.0047). VARC-2 criteria did not predict higher mortality (9% vs. 9%; p = 0.69).</p><p><strong>Conclusions: </strong>Baseline hs-cTnT concentrations strongly predicted 1-year mortality and MACE, while post-procedure levels did not. VARC-3 criteria provided better prognostic discrimination than VARC-2.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142811951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of lipoprotein(a) on aortic valve calcification in patients undergoing transcatheter aortic valve replacement.","authors":"Johanna Bormann, Felix Rudolph, Maximilian Miller, Sara Waezsada, Johannes Kirchner, Sabine Bleiziffer, Kai P Friedrichs, Volker Rudolph, Tanja K Rudolph, Muhammed Gerçek","doi":"10.1007/s00392-024-02587-z","DOIUrl":"10.1007/s00392-024-02587-z","url":null,"abstract":"<p><strong>Background: </strong>Elevated levels of lipoprotein(a) (Lp[a]) have been recognized as substantial risk factors for cardiovascular disease and aortic stenosis (AS). However, the specific role of Lp(a) in promoting aortic valve calcification (AVC) and influencing mortality in elderly, multimorbid patients undergoing transcatheter aortic valve replacement (TAVR) remains unclear and warrants further investigation.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on all consecutive patients who underwent TAVR between August 2019 and June 2020 at our clinic. Patients with missing data or prior aortic valve replacement were excluded. The study cohort was stratified based on an Lp(a) threshold of 60 mg/dl according to guidelines for lipoprotein apheresis in UK and Germany.^1,2 RESULTS: In total, 454 patients were included into the analysis. Mean age was 81 ± 6 years and patients presented with a notable cardiovascular risk profile. Lp(a) values ≥ 60 mg/dl were detected in 102 (22.5%) patients, while 352 (77.5%) had Lp(a) values < 60 mg/dl. The median calcium volume of the total cohort was 894.5 [570.8; 1,382.8] mm². No significant difference was observed between the groups (p = 0.83). Furthermore, Lp(a) did not emerge as a statistically significant predictor of calcium levels before TAVR. Notably, male gender (B = 404.11, p < 0.001) and mean trans-valvular pressure gradient (B = 15.64, p < 0.001) were identified as the strongest coefficients within the robust regression analysis. Log-rank tests indicated no prognostic utility of Lp(a) for 30-day all-cause mortality (p = 0.30) or 40 months long-term all-cause mortality (p = 0.60).</p><p><strong>Conclusion: </strong>Lp(a) might not exert a significant effect on calcification levels or all-cause mortality in patients undergoing TAVR. Despite the study's highly selected population, these results align with current research, supporting the assumption that the influence of Lp(a) may be confined to the early stages of AS and its progression.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraprocedural 3D-vena contracta area predicts survival after transcatheter edge-to-edge repair: results from MITRA-PRO registry.","authors":"Dennis Rottländer, Jörg Hausleiter, Thomas Schmitz, Alexander Bufe, Melchior Seyfarth, Ralph Stephan von Bardeleben, Harald Beucher, Taoufik Ouarrak, Steffen Schneider, Peter Boekstegers","doi":"10.1007/s00392-024-02580-6","DOIUrl":"https://doi.org/10.1007/s00392-024-02580-6","url":null,"abstract":"<p><strong>Background: </strong>The MITRA-PRO registry revealed residual mitral regurgitation (MR) to be an important predictor of survival following transcatheter edge-to-edge repair (TEER). Intraprocedural MR assessment using 3D-Vena Contracta Area (VCA) might be a feasible tool to guide mitral TEER procedures. The study aimed to assess the impact of residual MR assessed by 3D-VCA on 1-year mortality.</p><p><strong>Methods: </strong>823 patients with residual MR quantification using 3D-VCA in the MITRA-PRO registry, were included in this study. 1-year mortality, NYHA classification and major adverse events were assessed 1-year after mitral TEER.</p><p><strong>Results: </strong>Patients with trace residual MR after mitral TEER were allocated to the 3D-VCA < 0.1 cm² group (27.8%), while a 3D-VCA ≥ 0.1 < 0.3 cm² (55.4%) was considered as mild and a 3D-VCA ≥ 0.3 cm² (16.8%) as relevant residual MR. One-year mortality was significantly lower in patients with non-relevant residual MR (3D-VCA < 0.1 cm²: 10.5%; ≥ 0.1 < 0.3 cm²: 16.0%; ≥ 0.3: 24.8%, p = 0.003). An increasing 3D-VCA post mitral TEER was associated with a higher 1-year mortality. At a 3D-VCA of 0.07 cm² mortality increased significantly (1-year mortality 3D-VCA post mitral TEER ≥ 0.07 cm²: 16.5% vs. < 0.07 cm²: 7.8%; p = 0.005) indicating a 3D-VCA of 0.07 cm² to be a cut-off value for survival in daily practice.</p><p><strong>Conclusions: </strong>Residual MR assessed by 3D-VCA after TEER is associated with 1-year mortality. Therefore, 3D-VCA is a valuable echocardiographic tool for intraprocedural MR assessment during mitral TEER and achieving a lower 3D-VCA improve patient survival. (German Clinical Trials Register: DRKS00012288).</p><p><strong>Trial registration number: </strong>DRKS00012288.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Robustness of tricuspid regurgitation reduction at 1 year following edge-to-edge repair for primary tricuspid regurgitation.","authors":"Felix Rudolph, Muhammed Gerçek, Johannes Kirchner, Maria Ivannikova, Kai P Friedrichs, Tanja K Rudolph, Volker Rudolph, Martin Andreas, Anna Bartunek, Philipp E Bartko, Varius Dannenberg","doi":"10.1007/s00392-024-02590-4","DOIUrl":"https://doi.org/10.1007/s00392-024-02590-4","url":null,"abstract":"","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eccentric hypertrophy impairs outcome after TAVR.","authors":"R Thalmann, V Obermeier, Dominik S Westphal, I Diebold, T Trenkwalder, C Pellegrini, G Buglio, H Seoudy, P Hoppmann, C Bradaric, U Schön, E Holinski-Feder, N Lettmann, H Ruge, M Erlebach, C Fuetterer, K L Laugwitz, M Krane, D Frank, C Kupatt","doi":"10.1007/s00392-024-02582-4","DOIUrl":"https://doi.org/10.1007/s00392-024-02582-4","url":null,"abstract":"<p><strong>Background: </strong>Aortic stenosis (AS) induces cardiac remodeling upon chronic left ventricular (LV) pressure overload. Here, we analyzed the clinical outcome of patients undergoing transcatheter aortic valve replacement (TAVR) for symptomatic AS with regard to varying LV hypertrophy patterns. Moreover, we investigated the genetic influence on development of different hypertrophy patterns, measured by polygenic risk scores (PRS).</p><p><strong>Methods: </strong>1703 patients with severe AS undergoing TAVR were categorized according to LV mass index and relative wall thickness in four subgroups: normal geometry (NG, n = 57), concentric remodeling (CR; n = 388), concentric hypertrophy (CH; n = 993) and eccentric hypertrophy (EH; n = 265). Data was analyzed retrospectively with regard to clinical outcome. In a substudy, 520 patients affected by CH (n = 237), EH (n = 139) or CR (n = 164) were analyzed using two PRS that have been previously associated with hypertrophic and dilated cardiomyopathy.</p><p><strong>Results: </strong>1 year after TAVR, for EH, in contrast to the remaining groups (NG, CR, CH), a significant difference in all-cause mortality was observable (mortality 17.4% EH, 14.0% NG, 12.4% CR, 14.0% CH, p = 0.001). This difference was observed up to 4 years (mortality 41.9% EH, 26.9% CH, 28.1% CR, 26.4% NG, p = 0.001). Of note, higher percentiles in a PRS for hypertrophic cardiomyopathy were associated with a reduced likelihood of EH in patients with AS (p = 0.046).</p><p><strong>Conclusions: </strong>The EH group had a statistically significant poorer 1-year and 5-year outcomes than the other groups. PRS might help predict myocardial reactions in patients with aortic stenosis in future.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes with medical therapy, transcatheter repair, or surgery for isolated tricuspid regurgitation: a systematic review and network meta-analysis.","authors":"Tetsuya Saito, Toshiki Kuno, Tadao Aikawa, Hiroki A Ueyama, Polydoros N Kampaktsis, Dhaval Kolte, Naoki Misumida, Hisato Takagi, Yousif Ahmad, Tsuyoshi Kaneko, Alan Zajarias, Azeem Latib","doi":"10.1007/s00392-024-02579-z","DOIUrl":"https://doi.org/10.1007/s00392-024-02579-z","url":null,"abstract":"<p><strong>Background: </strong>Several transcatheter tricuspid valve (TV) repair devices for tricuspid regurgitation (TR) have emerged. However, few studies have compared transcatheter TV repair with medical therapy (MT) alone or isolated TV surgery.</p><p><strong>Methods: </strong>PubMed and EMBASE were searched in February 2024. Studies comparing at least any of the following 2 were included: MT, surgical TV repair, surgical TV replacement, or transcatheter TV repair. The primary outcome was long-term mortality (≧ 1 year). The secondary outcomes were short-term mortality (30-day or in-hospital mortality) and periprocedural complications. We performed a network meta-analysis using a random effects model.</p><p><strong>Results: </strong>A total of 25,831 patients from 22 studies (one randomized trial and 21 observational studies) were included. MT alone was associated with higher long-term mortality compared to surgical TV repair (HR [95% CI] 1.72 [1.34-2.23]), surgical TV replacement (HR [95% CI] 1.49 [1.14-1.96]), and transcatheter TV repair (HR [95% CI] 1.52 [1.30-1.78]). Long-term mortality was comparable between transcatheter and surgical interventions. Transcatheter TV repair had a lower risk of short-term mortality (versus surgical TV repair; RR [95% CI] 0.40 [0.22-0.72], versus surgical TV replacement; RR [95% CI] 0.35 [0.19-0.66]) and lower rates of periprocedural complications, including new pacemaker implantation, renal complications, cardiogenic shock than surgical interventions.</p><p><strong>Conclusions: </strong>MT alone for TR was associated with higher long-term mortality compared to surgical or transcatheter TV interventions. Transcatheter TV repair had better periprocedural outcomes compared to surgical interventions with similar long-term mortality. Despite the possibility of selection bias, transcatheter TV repair appears to be an attractive option for TR treatment.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Angiography-derived physiological patterns of coronary artery disease: implications with post-stenting physiology and long-term clinical outcomes.","authors":"Simone Fezzi, Paolo Alberto Del Sole, Francesco Burzotta, Antonio Maria Leone, Daixin Ding, Dimitrios Terentes-Printzios, Carlo Trani, Luca Bonizzi, Sara Sgreva, Stefano Andreaggi, Jiayue Huang, Gabriele Pesarini, Domenico Tavella, Guy Prado, Andrea Vicerè, Dimitrios Oikonomou, Konstantia Paraskevi Gkini, Domenico Galante, Konstantinos Tsioufis, Charalambos Vlachopoulos, William Wijns, Flavio Ribichini, Shengxian Tu, Roberto Scarsini","doi":"10.1007/s00392-024-02500-8","DOIUrl":"10.1007/s00392-024-02500-8","url":null,"abstract":"<p><strong>Background: </strong>Physiological patterns of coronary artery disease (CAD) have emerged as potential determinants of functional results of percutaneous coronary interventions (PCI) and of vessel-oriented clinical outcomes (VOCE).</p><p><strong>Objectives: </strong>In this study, we evaluated the impact of angiography-derived physiological patterns of CAD on post-PCI functional results and long-term clinical outcomes.</p><p><strong>Methods: </strong>Pre-PCI angiography-derived fractional flow reserve (FFR) virtual pullbacks were quantitatively interpreted and used to determine the physiological patterns of CAD. Suboptimal post-PCI physiology was defined as an angiography-derived FFR value ≤ 0.91. The primary endpoint was the occurrence of VOCE at the longest available follow-up.</p><p><strong>Results: </strong>Six hundred fifteen lesions from 516 patients were stratified into predominantly focal (n = 322, 52.3%) and predominantly diffuse (n = 293, 47.7%). Diffuse pattern of CAD was associated with lower post-PCI angiography-derived FFR values (0.91 ± 0.05 vs. 0.94 ± 0.05; p = 0.001) and larger rate of suboptimal post-PCI physiology (43.0 vs. 22.7%; p = 0.001), as compared to focal CAD. At the median follow-up time of 37 months (33-58), post-PCI suboptimal physiology was related to a higher risk of VOCE (16.2% vs. 7.6%; HR: 2.311; 95% CI 1.410-3.794; p = 0.0009), while no significant difference was noted according to baseline physiological pattern. In diffuse disease, the use of intracoronary imaging was associated with a lower incidence of long-term VOCE (5.1% vs 14.8%; HR: 0.313, 95% CI 0.167-0.614, p = 0.030).</p><p><strong>Conclusions: </strong>Suboptimal post-PCI physiology is observed more often in diffusely diseased arteries and it is associated with higher risk of VOCE at follow-up. The use of intravascular imaging might improve clinical outcomes in the setting of diffuse CAD.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1745-1756"},"PeriodicalIF":3.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11579185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic utility of a multi-biomarker panel in patients with suspected myocardial infarction.","authors":"Betül Toprak, Jessica Weimann, Jonas Lehmacher, Paul M Haller, Tau S Hartikainen, Alina Schock, Mahir Karakas, Thomas Renné, Tanja Zeller, Raphael Twerenbold, Nils A Sörensen, Dirk Westermann, Johannes T Neumann","doi":"10.1007/s00392-023-02345-7","DOIUrl":"10.1007/s00392-023-02345-7","url":null,"abstract":"<p><strong>Background: </strong>The accurate identification of patients with high cardiovascular risk in suspected myocardial infarction (MI) is an unmet clinical need. Therefore, we sought to investigate the prognostic utility of a multi-biomarker panel with 29 different biomarkers in in 748 consecutive patients with symptoms indicative of MI using a machine learning-based approach.</p><p><strong>Methods: </strong>Incident major cardiovascular events (MACE) were documented within 1 year after the index admission. The selection of the best multi-biomarker model was performed using the least absolute shrinkage and selection operator (LASSO). The independent and additive utility of selected biomarkers was compared to a clinical reference model and the Global Registry of Acute Coronary Events (GRACE) Score, respectively. Findings were validated using internal cross-validation.</p><p><strong>Results: </strong>Median age of the study population was 64 years. At 1 year of follow-up, 160 cases of incident MACE were documented. 16 of the investigated 29 biomarkers were significantly associated with 1-year MACE. Three biomarkers including NT-proBNP (HR per SD 1.24), Apolipoprotein A-I (Apo A-I; HR per SD 0.98) and kidney injury molecule-1 (KIM-1; HR per SD 1.06) were identified as independent predictors of 1-year MACE. Although the discriminative ability of the selected multi-biomarker model was rather moderate, the addition of these biomarkers to the clinical reference model and the GRACE score improved model performances markedly (∆C-index 0.047 and 0.04, respectively).</p><p><strong>Conclusion: </strong>NT-proBNP, Apo A-I and KIM-1 emerged as strongest independent predictors of 1-year MACE in patients with suspected MI. Their integration into clinical risk prediction models may improve personalized risk stratification.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1682-1691"},"PeriodicalIF":3.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11579167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138801112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of left ventricular remodeling post-myocardial infarction, determinants, and outcome.","authors":"Damien Logeart, Yoann Taille, Geneviève Derumeaux, Barnabas Gellen, Marc Sirol, Michel Galinier, François Roubille, Jean-Louis Georges, Jean-Noël Trochu, Jean-Marie Launay, Nicolas Vodovar, Christophe Bauters, Eric Vicaut, Jean-Jacques Mercadier","doi":"10.1007/s00392-023-02331-z","DOIUrl":"10.1007/s00392-023-02331-z","url":null,"abstract":"<p><strong>Aim: </strong>Left ventricular remodeling (LVR) after myocardial infarction (MI) can lead to heart failure, arrhythmia, and death. We aim to describe adverse LVR patterns at 6 months post-MI and their relationships with subsequent outcomes and to determine baseline.</p><p><strong>Methods and results: </strong>A multicenter cohort of 410 patients (median age 57 years, 87% male) with reperfused MI and at least 3 akinetic LV segments on admission was analyzed. All patients had transthoracic echocardiography performed 4 days and 6 months post-MI, and 214 also had cardiac magnetic resonance imaging performed on day 4. To predict LVR, machine learning methods were employed in order to handle many variables, some of which may have complex interactions. Six months post-MI, echocardiographic increases in LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), and LV ejection fraction (LVEF) were 14.1% [interquartile range 0.0, 32.0], 5.0% [- 14.0, 25.8], and 8.7% [0.0, 19.4], respectively. At 6 months, ≥ 15% or 20% increases in LVEDV were observed in 49% and 42% of patients, respectively, and 37% had an LVEF < 50%. The rate of death or new-onset HF at the end of 5-year follow-up was 8.8%. Baseline variables associated with adverse LVR were determined best by random forest analysis and included stroke volume, stroke work, necrosis size, LVEDV, LVEF, and LV afterload, the latter assessed by Ea or Ea/Ees. In contrast, baseline clinical and biological characteristics were poorly predictive of LVR. After adjustment for predictive baseline variables, LV dilation > 20% and 6-month LVEF < 50% were significantly associated with the risk of death and/or heart failure: hazard ratio (HR) 2.12 (95% confidence interval (CI) 1.05-4.43; p = 0.04) and HR 2.68 (95% CI 1.20-6.00; p = 0.016) respectively.</p><p><strong>Conclusion: </strong>Despite early reperfusion and cardioprotective therapy, adverse LVR remains frequent after acute MI and is associated with a risk of death and HF. A machine learning approach identified and prioritized early variables that are associated with adverse LVR and which were mainly hemodynamic, combining LV volumes, estimates of systolic function, and afterload.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1670-1681"},"PeriodicalIF":3.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139520154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short- and long-term outcomes of patients with active cancer presenting with an acute coronary syndrome.","authors":"Inbar Nardi Agmon, Ori Rahat, Roy Beigel, Tal Ovdat, Manhal Habib, Oran Tzuman, Limor Ilan Bushari, Ran Kornowski, Katia Orvin","doi":"10.1007/s00392-024-02438-x","DOIUrl":"10.1007/s00392-024-02438-x","url":null,"abstract":"<p><strong>Background: </strong>Management of cancer patients presenting with an acute coronary syndrome (ACS) may be challenging. In this study, we sought to examine whether and how a concomitant diagnosis of active cancer affects patients' management and outcomes following an event of ACS.</p><p><strong>Methods: </strong>We used a retrospective cohort data analysis of patients from the Acute Coronary Syndrome Israeli Survey (ACSIS) carried out between the years 2016-2021 to compare patients with and without a concomitant diagnosis of active cancer.</p><p><strong>Results: </strong>Of 4913 patients who presented with an ACS, 90 (1.8%) patients had a concomitant active cancer. Cancer patients were older, with a higher prevalence of hypertension and chronic renal failure. The rate of ST-elevation myocardial infarction (STEMI) was similar (40%) between both groups. Cancer patients were less likely to undergo coronary angiography during hospitalization; but once it was performed, the rate of percutaneous coronary intervention was similar. The presence of cancer during an ACS was associated with an increased short- and long-term mortality. In a multivariate analysis, the risk for 1-year mortality remained significantly higher in cancer patient (HR 2.72, 95% CI 1.74-4.24, p < 0.001), and was most prominent in patients presenting with STEMI (HR 5.00, 95% CI 2.40-10.39, p < 0.001). Short- and long-term death rates were also higher in cancer patients after a propensity score matching and adjustment for comorbidities other than cancer.</p><p><strong>Conclusion: </strong>Despite significant advances in oncologic and cardiac care, the presence of active cancer in patients with an ACS is still associated with significantly increased risk for 1-year mortality.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1707-1716"},"PeriodicalIF":3.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140173980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}