Frontiers in Cardiovascular Medicine最新文献

{"title":"The expanding role of 16s ribosomal RNA PCR in the management of patients with infective endocarditis undergoing cardiac surgery.","authors":"Natalia Pavone, Federico Cammertoni, Maria Calabrese, Piergiorgio Bruno, Giancarlo Scoppettuolo, Antonella Lombardo, Francesca Giovannenze, Eleonora Taddei, Barbara Fiori, Tiziana D'Inzeo, Gessica Cutrone, Giulia Iannaccone, Niccolò Del Zanna, Massimo Massetti","doi":"10.3389/fcvm.2024.1504197","DOIUrl":"10.3389/fcvm.2024.1504197","url":null,"abstract":"<p><strong>Background: </strong>Aetiological diagnosis and targeted antibiotic therapy are essential to improve the prognosis of patients with infective endocarditis. Molecular tests on blood have been reported to be effective in identifying the causative organism and are recommended when blood cultures are negative. The role of molecular tests on the surgically excised valve is still unclear and needs further investigation.</p><p><strong>Materials and methods: </strong>In this prospective, observational, single center study, we enrolled 100 consecutive patients with native or prosthetic valve endocarditis who underwent cardiac surgery between April 2020 and June 2023. Results of preoperative blood cultures, valve culture, 16s ribosomal RNA and histopathologic analysis of surgical samples were collected in a dedicated database.</p><p><strong>Results: </strong>The mean age of the study population was 60 ± 12.5 years, with a majority of men (73%). Previous cardiac surgery was reported in 31% of patients. Blood culture, valve culture, and 16srRNA were positive in 83%, 47%, and 76% of cases, respectively. The sensitivity of both valve culture and 16srRNA decreased significantly with prolonged preoperative antibiotic therapy. Of note, 16srRNA was the only positive result in 7% of cases, allowing aetiological diagnosis. In 33% of patients, the valve culture test was negative while the molecular test was positive. In these cases, histopathological analysis showed acute inflammation in most cases. In 10%, the molecular test helped in resolving discrepancies between the results of blood and valve cultures.</p><p><strong>Conclusions: </strong>The molecular test showed significantly higher diagnostic sensitivity than valve culture and maintained this efficacy even after 28 days of preoperative antibiotic therapy. In addition to identifying the pathogen in 7% of cases with negative culture results, the molecular test demonstrated utility in other crucial situations. When valve cultures were negative, combining molecular testing and histopathological analysis they allowed the identification of patients who could benefit from prolonged antibiotic therapy. In addition, molecular testing guided the choice of antibiotic treatment when there was a discrepancy between blood culture and valve culture results. Based on these findings, molecular testing should be considered in all patients with infective endocarditis undergoing cardiac surgery. <b>Clinical Trial Registration</b>: ClinicalTrials.gov, identifier (NCT05791357).</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"11 ","pages":"1504197"},"PeriodicalIF":2.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11688630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refining cardiac resynchronization therapy: a comprehensive review on the role of advanced multimodality imaging.","authors":"Flavia-Mihaela Stoiculescu, Diana-Ruxandra Hădăreanu, Călin-Dinu Hădăreanu, Ionuț Donoiu, Cristina Florescu","doi":"10.3389/fcvm.2024.1406899","DOIUrl":"10.3389/fcvm.2024.1406899","url":null,"abstract":"<p><p>Cardiac resynchronization therapy (CRT) offers significant benefits in symptom alleviation, reduction of rehospitalization rates, and overall survival of patients with heart failure (HF) with reduced ejection fraction (rEF). However, despite its proven efficacy, precisely identifying suitable CRT candidates remains a challenge, with a notable proportion of patients experiencing non-response. Accordingly, many attempts have been made to enhance patient selection, and to identify the best imaging parameters to predict the response and survival after CRT implantation. This review article provides a comprehensive overview on the role of multi-modality cardiac imaging in selecting, optimizing, and predicting CRT response and outcomes in HFrEF patients, beginning with an exploration of dyssynchrony types and their impact on HF progression, and an emphasis on the utility of echocardiography in assessing cardiac dyssynchrony. Subsequently, the role of advanced techniques such as speckle tracking and three-dimensional echocardiography, as well as the visual assessment of apical rocking (ApRock) and septal flash (SF) are highlighted. Finally, cardiac magnetic resonance (CMR) scar data, and novel modalities like four-dimensional flow CMR, together with single-photon emission computed tomography offer additional insights, emerging as valuable predictors of CRT response, and potentially refining the identification of suitable CRT candidates.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"11 ","pages":"1406899"},"PeriodicalIF":2.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11688290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mid-term outcomes of atrioventricular valve repair in functional single ventricle patients.","authors":"Yong-Qiang Jin, Qing-Yu Wu, Xiao-Ya Zhang, Li-Xin Fan, En-Rui Zhang, Hui Xue, Ming-Kui Zhang","doi":"10.3389/fcvm.2024.1510143","DOIUrl":"10.3389/fcvm.2024.1510143","url":null,"abstract":"<p><strong>Background: </strong>Surgical treatment of functional single ventricle combined with atrioventricular valve regurgitation remains a clinical challenge. The outcomes of atrioventricular valve repair in patients with single ventricle are limited.</p><p><strong>Methods: </strong>A retrospective study was conducted of all 28 patients with functional single ventricle treated with single-ventricle palliation who underwent atrioventricular valve operation at the First Hospital of Tsinghua University between April 2007 and October 2022.</p><p><strong>Results: </strong>In our cohort, the female/male ratio was 7:21, with an average age of 8.7 ± 6.0 (0.75-26) years. Half of patients (50%) were right-ventricle type for single-ventricle morphology. 18 patients (64.3%) were with a common atrioventricular valve. Twenty-three patients (82.1%) were combined with heterotaxy syndrome. Pre-operatively, twenty-four patients (85.7%) were diagnosed with severe atrioventricular valve regurgitation. AVV was repaired at the Glenn (<i>n</i> = 16, 57.1%), Glenn-Fontan (<i>n</i> = 2, 7.1%) and Fontan (<i>n</i> = 10, 35.7%) stage, respectively. Valve plastic techniques included valve annulus/commissure constriction (<i>n</i> = 24), clefts repair (9 cases), edge-to-edge suturing (13 cases) and common atrioventricular valve separation (4 cases). The early mortality was 3.6% (1/28). All survival patients were observed with improved regurgitation situations. Twenty-two patients (78.5%) were observed with no more than mild regurgitation postoperatively. The mean follow-up time was 5.4 ± 2.9 years (range, 3.08-11.83 years), with late mortality of 11.1% (3/27). All these three cases were observed with a severe regurgitation by echocardiogram in the last follow-up. Besides, reoperation rate of this cohort was 3.6% (1/28).</p><p><strong>Conclusions: </strong>AVV repair could significantly improve AVV function in SV patients combined with severe AVVR, with satisfactory mid-term results. Part of the cohort showed poor prognosis due to repeated AVVR. Regular follow-up by echocardiogram is critically important for these patients.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"11 ","pages":"1510143"},"PeriodicalIF":2.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11688645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Del Nido and histidine-tryptophan-ketoglutarate cardioplegia solutions: an animal study with prolonged ischaemia.","authors":"Alexandro Hoyer, Maja-Theresa Dieterlen, Jagdip Kang, Hanna Oetzel, Karoline Wiesner, Kristin Klaeske, Philipp Kiefer, Susann Oßmann, André Ginther, Martin Kostelka, Suzanne de Waha, Michael A Borger","doi":"10.3389/fcvm.2024.1457770","DOIUrl":"10.3389/fcvm.2024.1457770","url":null,"abstract":"<p><strong>Objective: </strong>Myocardial protection is important for a successful procedure cardiac surgery, and the key element of myocardial protection is cardioplegia. We compared Del Nido cardioplegia (DN) and Bretschneider histidine-tryptophan-ketoglutarate cardioplegia (HTK) regarding cardioprotective effects in a porcine model of prolonged ischaemia.</p><p><strong>Methods: </strong>Landrace pigs weighing 50-60 kg were randomized to receive either DN (<i>n</i> = 9) or HTK (<i>n</i> = 9). All pigs underwent cardiac arrest for 90 min followed by 120 min of reperfusion/convalescence. A detailed set of laboratory, histological and functional parameters was acquired at baseline, during cardiac arrest and following reperfusion/convalescence.</p><p><strong>Results: </strong>Pressure-volume measurements revealed better systolic and diastolic left ventricular performance in DN as compared to HTK (both <i>p</i> < 0.05). Haemoglobin decreased after application of the cardioplegic solution. The decrease was more pronounced in the HTK group than in the DN group (<i>p</i> < 0.01). In contrast to DN, sodium (<i>p</i> < 0.01) and chloride levels (<i>p</i> < 0.05) were significantly decreased in the HTK group after initiation of CPB and remained decreased after reperfusion. The number of animals requiring defibrillations to restore sinus rhythm significantly differed between the groups [HTK: 100% (<i>n</i> = 9/9) vs. DN: 44.4% (<i>n</i> = 4/9), <i>p</i> = 0.03]. Expression of ICAM-1 as a marker of endothelial dysfunction was lower in the DN group compared to the HTK group (<i>p</i> = 0.02). Histological evaluation, oxidative and nitrosative stress, mitochondrial membrane integrity and apoptosis markers were comparable between DN and HTK groups (all <i>p</i> > 0.05).</p><p><strong>Conclusions: </strong>In this porcine model with prolonged ischaemia, DN was superior to HTK in terms of haemoglobin levels, blood electrolytes, spontaneous return of sinus rhythm, left ventricular function, and endothelial injury. Histomorphological parameters indicative of ischaemia/reperfusion injury, oxidative stress and mitochondrial function as well as apoptosis-inducing factors did not differ.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"11 ","pages":"1457770"},"PeriodicalIF":2.8,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11686485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of left atrial function and the relationship between left atrial stiffness index and exercise capacity in hypertension-related heart failure with preserved ejection fraction.","authors":"Qingfeng Zhang, Sijia Wang, Hongmei Zhang, Kai Wang, Wenhua Li, Geqi Ding, Luwei Ye, Chunmei Li, Yan Deng, Yi Wang, Lixue Yin","doi":"10.3389/fcvm.2024.1501004","DOIUrl":"10.3389/fcvm.2024.1501004","url":null,"abstract":"<p><strong>Objective: </strong>The left atrial stiffness index (LASI) holds significance in the atrioventricular coupling function and heart failure progression. To assess left atrial function and evaluate the relationship between LASI and exercise capacity in hypertension-related heart failure with preserved ejection fraction (HT-HFpEF).</p><p><strong>Methods: </strong>The study involved 62 healthy subjects and 163 patients with HT (112 patients in simple HT group and 51 patients in HT-HFpEF group). Each patient performed exercise stress test and standard ultrasonic images were evaluated. A comprehensive evaluation of atrioventricular function, along with investigation into the correlation between these functional parameters and exercise capacity. And further to investigate the feasibility of predicting exercise intolerance using three-dimensional derived left atrial strain index (LASI) (E/e'/LASr and E/e'/LASr-c).</p><p><strong>Results: </strong>Compared to healthy subjects, HT group demonstrated the elevation in left atrial volume accompanied by decrease in strain value (<i>P</i> < 0.05). In HT-HFpEF group, further significant reductions were observed in both longitudinal (LASr) and circumferential strain (LASr-c, LASct-c) (<i>P</i> < 0.05). Univariate regression demonstrated that both E/e'/LASr and E/e'/LASr-c were significantly correlated with metabolic equivalents (METs) (r = -0.462, <i>P</i> < 0.001; r = -0.381, <i>P</i> < 0.001). The E/e'/LASr demonstrates comparable diagnostic efficacy to exercise-E/e' in assessing exercise intolerance in HT-HFpEF patients (AUC: 0.836 vs. 0.867, <i>P</i> = 0.239).</p><p><strong>Conclusion: </strong>Progressive LA remodeling contributes to decreased atrioventricular compliance in HT and HT-HFpEF patients.E/e'/LASr serves as an independent indicator of exercise intolerance in patients with HT-HFpEF.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"11 ","pages":"1501004"},"PeriodicalIF":2.8,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11685112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing Known hypertensive disOrders of pregnancy in woMen of African descent in Canada (AKOMA): protocol for a mixed method study.","authors":"Deborah Baiden, Kara Nerenberg, Edith M Hillan, Maman Joyce Dogba, Monica Parry","doi":"10.3389/fcvm.2024.1471199","DOIUrl":"10.3389/fcvm.2024.1471199","url":null,"abstract":"<p><strong>Background: </strong>Hypertensive disorders of pregnancy (HDP) predispose a woman to maternity-related cardiovascular morbidity and mortality. However, there is limited literature on HDP among women of African descent in Canada.</p><p><strong>Methods and design: </strong>A convergent mixed-method study will be used to investigate the intersection of self-reported HDP risks in women of African descent in Canada with a history of a HDP (quantitative, cross-sectional survey) and explore the perception and experiences of women of African descent living in Canada with a history of a HDP in relation to the intersection of risk factors (critical qualitative inquiry, interviews). Quantitative analysis will use SPSS V. 27.0 and thematic analysis will be conducted using NVivo V. 12. A joint display will be used to combine the quantitative and qualitative results.</p><p><strong>Discussion: </strong>Through the lens of intersectionality, the proposed study aims to provide a comprehensive understanding of the intersection of risks for HDP among women of African descent in Canada with a history of HDP. Furthermore, results could inform future strategies to reduce cardiovascular disease risks.</p><p><strong>Trial registration number: </strong>This is registered in the Open Sciences Framework as follows: https://doi.org/10.17605/OSF.IO/R6CKY.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"11 ","pages":"1471199"},"PeriodicalIF":2.8,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac function in pregnant women with preeclampsia.","authors":"Gülen Yerlikaya-Schatten, Eva Karner, Florian Heinzl, Suriya Prausmüller, Stefan Kastl, Stephanie Springer, Robert Zilberszac","doi":"10.3389/fcvm.2024.1415727","DOIUrl":"10.3389/fcvm.2024.1415727","url":null,"abstract":"<p><strong>Introduction: </strong>Preeclampsia (PE) is thought to be the consequence of impaired placental perfusion leading to placental hypoxia. While it has been demonstrated that PE may be a consequence of maternal cardiovascular maladaptation, the exact role of maternal cardiac function remains to be determined. This study sought to assess cardiac characteristics in pregnant women diagnosed with PE and to determine the possible relationship between PE, maternal cardiac changes/function, and NT-proBNP levels.</p><p><strong>Methods: </strong>This was a retrospective analysis of 65 pregnant women diagnosed with PE who had an echocardiographic examination during pregnancy. Where available, NT-proBNP levels were analyzed. All patients underwent a comprehensive echocardiographic examination based on a standardized examination protocol.</p><p><strong>Results: </strong>Left ventricular size was within the normal range, and there was normal radial left ventricular function. Longitudinal contractility was impaired with a global longitudinal strain of -17.8% (quartiles -20.2 to -15.4). The cardiac index was in the normal range with a median of 3.2 ml/min/m² (quartiles 2.6-4.0). The left atrium was of borderline size in longitudinal diameter [50 (44.8-54.3) mm], but within the normal range in volumetric index [27.3 (22.9-37.3) ml/m²]. Furthermore, mild left ventricular hypertrophy [septal thickness 12 (10-13) mm] and at least borderline elevated filling pressures with an E/e' ratio of 10.6 (8.5-12.9) were found. Maximal tricuspid regurgitation velocity [2.9 (2.5-3.3) m/s] and derived systolic pulmonary pressure [38 (29.5-44.5) mmHg] were borderline elevated. Regarding NT-proBNP levels, an increase in NT-proBNP levels correlated with a decrease in gestational age at delivery (<i>p</i> < 0.0002) and maternal cardiac changes. Obstetric characteristics showed a preterm rate of 71.43%, mostly due to maternal aggravation of PE or because of fetal signs of deprivation based on placental insufficiency. Neonatal deaths occurred in five cases (7.69%).</p><p><strong>Conclusion: </strong>Changes in cardiac function in the context of hypertensive pregnancy diseases can be observed with regard to various echocardiographic parameters. Furthermore, there is a significant association between NT-proBNP levels and a decrease in gestational age at delivery in women with PE, which thus might be useful as a prognostic factor for the management of women with preeclampsia and changes in maternal cardiac function during pregnancy.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"11 ","pages":"1415727"},"PeriodicalIF":2.8,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11685740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in severity of diffuse and focal coronary stenosis between visual and quantitative assessment.","authors":"Xinmao Wang, Chao Song, Heng Liu, Lin Zhou, Letian Zhang","doi":"10.3389/fcvm.2024.1501576","DOIUrl":"10.3389/fcvm.2024.1501576","url":null,"abstract":"<p><strong>Background: </strong>Coronary Artery Disease (CAD) is a leading cause of mortality, with an increasing number of patients affected by coronary artery stenosis each year. Coronary angiography (CAG) is commonly employed as the definitive diagnostic tool for identifying coronary artery stenosis. Physician Visual Assessment (PVA) is often used as the primary method to determine the need for further intervention, but its subjective nature poses challenges. This study sought to evaluate the differences of severity of diffuse and focal coronary stenosis between PVA and Quantitative Coronary Angiography (QCA).</p><p><strong>Methods: </strong>293 patients with coronary artery disease (334 coronary lesions) underwent CAG and fractional flow reserve (FFR). PVA and QCA was used to quantify diameter stenosis (DS). DS ≥50% was defined as obstructive. FFR ≤0.8 was defined as myocardial ischemia.</p><p><strong>Results: </strong>The mean ± SD age of all patients was 66 ± 9 years. ΔDS between PVA and QCA was higher in diffuse lesions (16.45 ± 7.37%) than in focal lesions (14.39 ± 7.83%) (<i>P</i> = 0.04). DS_PVA and DS_QCA had linear negative correlation (r_PVA = -0.3182, r_QCA = -0.4054) with FFR in diffuse, while in focal, DS_PVA and DS_QCA had an even stronger linear negative correlation (r_PVA = -0.4090, r_QCA = -0.4861) with FFR. ROC analysis demonstrated that DS_QCA had better discrimination capability for myocardial ischemia (FFR ≤ 0.80) than DS_PVA in different of length stenosis.</p><p><strong>Conclusions: </strong>PVA was more likely to overestimate diameter stenosis in coronary arteries than QCA, and the severity of diffuse stenosis was more likely to be overestimated than that of focal stenosis.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"11 ","pages":"1501576"},"PeriodicalIF":2.8,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new prediction model for sustained ventricular tachycardia in arrhythmogenic cardiomyopathy.","authors":"Baowei Zhang, Xin Xie, Jinbo Yu, Yizhang Wu, Jian Zhou, Xiaorong Li, Bing Yang","doi":"10.3389/fcvm.2024.1477931","DOIUrl":"10.3389/fcvm.2024.1477931","url":null,"abstract":"<p><strong>Background: </strong>Arrhythmogenic cardiomyopathy (ACM) is an inherited cardiomyopathy characterized by high risks of sustained ventricular tachycardia (sVT) and sudden cardiac death. Identifying patients with high risk of sVT is crucial for the management of ACM.</p><p><strong>Methods: </strong>A total of 147 ACM patients were retrospectively enrolled in the observational study and divided into training and validation groups. The least absolute shrinkage and selection operator (LASSO) regression model was employed to identify factors associated with sVT. Subsequently, a nomogram was constructed based on multivariable logistic regression analysis. The performance of the nomogram was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve and calibration curve. Decision curve analysis was conducted to assess the clinical utility of the nomogram.</p><p><strong>Results: </strong>Seven parameters were incorporated into the nomogram: age, male sex, syncope, heart failure, T wave inversion in precordial leads, left ventricular ejection fraction (LVEF), SDNN level. The AUC of the nomogram to predict the probability of sVT was 0.867 (95% CI, 0.797-0.938) in the training group and 0.815 (95% CI, 0.673-0.958) in the validation group. The calibration curve demonstrated a good consistency between the actual clinical results and the predicted outcomes. Decision curve analysis indicated that the nomogram had higher overall net benefits in predicting sVT.</p><p><strong>Conclusion: </strong>We have developed and internally validated a new prediction model for sVT in ACM. This model could serve as a valuable tool to accurately identify ACM patients with high risk of sVT.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"11 ","pages":"1477931"},"PeriodicalIF":2.8,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of atrial voltage and conduction velocity phenotypes on atrial fibrillation recurrence.","authors":"Pedro Silva Cunha, Sérgio Laranjo, Sofia Monteiro, Guilherme Portugal, Cátia Guerra, António Condeixa Rocha, Mariana Pereira, Rui Cruz Ferreira, Jordi Heijman, Mário Martins Oliveira","doi":"10.3389/fcvm.2024.1427841","DOIUrl":"10.3389/fcvm.2024.1427841","url":null,"abstract":"<p><strong>Introduction: </strong>Low atrial voltage and slow conduction velocity (CV) have been associated with atrial fibrillation (AF); however, their interaction and relative importance as early disease markers remain incompletely understood. We aimed to elucidate the relationship between atrial voltage and CV using high-density electroanatomic (HDE) maps of patients with AF.</p><p><strong>Methods: </strong>HDE maps obtained during sinus rhythm in 52 patients with AF and five healthy controls were analysed. Atrial voltage and CV maps were generated, and their correlations were assessed. Subgroup analyses were performed based on clinically relevant factors such as AF type, CV, and voltage levels. Finally, cluster analysis was conducted to identify distinct phenotypes within the population, reflecting different patterns of conduction and voltage.</p><p><strong>Results: </strong>A moderate positive correlation was found between the mean atrial voltage and CV (<i>r</i> = 0.570). Subgroup analysis revealed differences in voltage (<i>p</i> = 0.0044) but not in global CV (<i>p</i> = 0.42), with no significant differences between AF types. Three distinct phenotypes emerged: normal voltage/normal CV, normal voltage/low CV, and low voltage/low CV, with distinct recurrence rates, suggesting different disease progression paths. Slower atrial CV was identified as a significant predictor of arrhythmia recurrence at 12 and 24 months after AF ablation, surpassing the predictive potential of atrial voltage.</p><p><strong>Conclusion: </strong>Atrial voltage and CV analyses revealed distinct phenotypes. Lower atrial CV emerged as a significant predictor of AF recurrence, exceeding the predictive significance of atrial voltage. These findings emphasise the importance of considering CV and voltage in managing AF and offer potential insights for personalised strategies.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"11 ","pages":"1427841"},"PeriodicalIF":2.8,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}