Journal of Cardiovascular Medicine最新文献

{"title":"Competing stroke mechanisms despite adequate oral anticoagulant therapy: the role of transesophageal echocardiography.","authors":"Matteo Paolucci, Letizia Riva, Luana Gentile, Cristiano Fanciulli, Stefano Forlivesi, Mauro Gentile, Maria Maddalena Viola, Giulia Bugani, Gianni Casella, Andrea Zini","doi":"10.2459/JCM.0000000000001673","DOIUrl":"10.2459/JCM.0000000000001673","url":null,"abstract":"<p><strong>Aims: </strong>Ischemic strokes in patients on oral anticoagulant therapy (OAT) despite optimal adherence pose a therapeutic challenge. We assessed the utility of transesophageal echocardiography (TEE) in identifying potential competing cardiac causes for stroke that occurred despite adequate OAT.</p><p><strong>Methods: </strong>This retrospective observational study included patients admitted for acute ischemic stroke between January 2022 and June 2023 who were on OAT for an established long-term indication. Transthoracic and transesophageal echocardiography, along with assessment of OAT adherence, were conducted. Demographic data, OAT details, and stroke characteristics were analysed to determine the influence of TEE findings on therapeutic decisions.</p><p><strong>Results: </strong>We included 26 patients. TEE identified potential cardiac competing stroke mechanisms in 88% of cases, with valvular thrombi and left atrial or appendage thrombus being predominant. Infective endocarditis, often asymptomatic, was unexpectedly prevalent. TEE significantly influenced therapeutic decisions, especially in cases where transthoracic echocardiography was inconclusive.</p><p><strong>Conclusions: </strong>TEE may be crucial for unravelling the mechanisms of ischemic stroke in patients on adequate OAT, guiding precise therapeutic strategies and potentially reducing the risk of recurrent embolic events. Our findings underscore the limitations of standard echocardiography in detecting cardiac embolic sources and emphasize the importance of tailored decision-making in secondary stroke prevention.</p>","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":" ","pages":"830-835"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pericardial constrictive syndromes: a neglected cause of reversible heart failure.","authors":"Massimo Imazio","doi":"10.2459/JCM.0000000000001679","DOIUrl":"10.2459/JCM.0000000000001679","url":null,"abstract":"","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"25 12","pages":"811-814"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Type B aortic dissection in a patient with aberrant right vertebral artery and Kommerell-like diverticulum.","authors":"Xiong Zhang, Ming Li, Jiehua Li, Quanming Li, Chang Shu","doi":"10.2459/JCM.0000000000001678","DOIUrl":"10.2459/JCM.0000000000001678","url":null,"abstract":"","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":" ","pages":"856-857"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-related differences in demographics, diagnosis and management of patients with chronic coronary syndromes.","authors":"Marco Mojoli, Pier Luigi Temporelli, Daniela Pavan, Maurizio Giuseppe Abrignani, Lucio Gonzini, Donata Lucci, Federico Piscione, Stefano Provasoli, Michele Massimo Gulizia, Domenico Gabrielli, Furio Colivicchi, Fabrizio Oliva, Leonardo De Luca","doi":"10.2459/JCM.0000000000001675","DOIUrl":"10.2459/JCM.0000000000001675","url":null,"abstract":"<p><strong>Aims: </strong>The impact of sex-related factors on current clinical management and outcomes of chronic coronary syndromes (CCS) are unclear.</p><p><strong>Methods: </strong>All patients belonging to the prospective, nationwide START registry were included. Their baseline characteristics, diagnostic workup, revascularization strategy, pharmacological treatment and 1-year clinical outcomes were compared with respect to sex overall and in age tertiles.</p><p><strong>Results: </strong>A total of 5070 consecutive patients were included. Most patients were males (80.1%). As expected, the prevalence of females increased with age. Distribution of risk factors and history of cardiovascular disease were different depending on sex, as well as diagnostic workup, with lower use of exercise stress testing in women (25.1% vs. 36.7%, P < 0.0001). The use of coronary angiography was similar in the two groups. Women had lower rates of multivessel coronary artery disease (CAD) (33.0% vs. 40.6% P < 0.0001) and higher rates of nonobstructive CAD (18.3% vs. 11.3%, P < 0.0001). Rates of myocardial revascularization were similar, but women were more likely to receive percutaneous coronary intervention than men (84.3% vs. 77.8%, P < 0.0001) and less likely to receive surgical/hybrid revascularization (10.0% vs. 15.1%, P < 0.0001). At 12-month follow-up, no differences were observed for the combined endpoint of all-cause mortality, re-hospitalization for myocardial infarction, heart failure, stroke or myocardial revascularization between males and females; however, a significantly worse perceived quality of life was observed in women.</p><p><strong>Conclusions: </strong>In a large nationwide cohort of patients with CCS, clinical outcomes were not different depending on sex. However, several differences in the diagnostic work-up, treatment strategies and quality of life were found between sexes.</p>","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"25 12","pages":"845-853"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left bundle branch pacing for atrio-ventricular block after heart transplant: a safe and effective therapy?","authors":"Raimondo Pittorru, Manuel De Lazzari, Giorgia Ugolini, Gaia Zancanaro, Vincenzo Tarzia, Gino Gerosa, Federico Migliore","doi":"10.2459/JCM.0000000000001677","DOIUrl":"10.2459/JCM.0000000000001677","url":null,"abstract":"","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":" ","pages":"854-855"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impella saves lives in a subset of patients with ST-elevation myocardial infarction and cardiogenic shock.","authors":"Ole Kristian Lerche Helgestad, Christian Hassager, Jacob Eifer Møller","doi":"10.2459/JCM.0000000000001680","DOIUrl":"10.2459/JCM.0000000000001680","url":null,"abstract":"","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"25 12","pages":"815-817"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes and prognostic impact of noninvasive myocardial work indices in patients undergoing transcatheter aortic valve implantation.","authors":"Federica Ilardi, Anna Franzone, Cristina Iapicca, Rachele Manzo, Domenico Angellotti, Dalila Nappa, Domenico S Castiello, Andrea Mariani, Ciro Santoro, Marisa Avvedimento, Attilio Leone, Antonello D'Andrea, Plinio Cirillo, Carmen Spaccarotella, Raffaele Piccolo, Giovanni Esposito","doi":"10.2459/JCM.0000000000001676","DOIUrl":"10.2459/JCM.0000000000001676","url":null,"abstract":"<p><strong>Purpose: </strong>The prognostic significance of noninvasive myocardial work (MW) indices in patients undergoing transcatheter aortic valve implantation (TAVI) has not been adequately examined.</p><p><strong>Methods: </strong>We retrospectively selected 88 consecutive patients (mean age 79.9 ± 6.4 years, 40% males) with severe aortic stenosis scheduled for TAVI enrolled in the EffecTAVI registry. Exclusion criteria were prior valve surgery, atrial fibrillation, and left bundle branch block (LBBB) at baseline. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were measured by echocardiography at baseline and at 30 days. Accuracy of the noninvasive measures was assessed by invasive evaluation of MW.</p><p><strong>Results: </strong>In the overall population, a significant reduction in GWI (2406 ± 567 vs. 2063 ± 515 mmHg% before and after TAVI respectively, P  < 0.001), GCW (2783 ± 616 vs. 2380 ± 495 mmHg%, P  < 0.001) and GWW (238 ± 203 vs. 186 ± 135 mmHg%, P  = 0.015) was observed at 30 days after TAVI. GWE improved only in patients who did not develop left ventricular dyssynchrony due to new-onset LBBB or pacemaker implantation following TAVI. In a multivariable Cox-regression analysis, GWE after TAVI (hazard ratio 0.892, 95% confidence interval 0.81-0.97; P  = 0.011) was the strongest predictor of adverse events (a composite of all-cause death, worsening of dyspnea, or rehospitalization for cardiovascular events) at 1-year follow-up.</p><p><strong>Conclusions: </strong>TAVI results in significant changes in MW indices, including an early decrease in GWI, GCW and GWW, and an improvement in GWE in patients without left ventricle dyssynchrony. A GWE equal or less than 92% at 30 days is indicative of poor clinical outcomes at 1 year.</p>","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":" ","pages":"836-844"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of symptom-to-balloon time in patients with non-ST-segment elevation myocardial infarction and complex lesions.","authors":"Yong Hoon Kim, Ae-Young Her, Seung-Woon Rha, Cheol Ung Choi, Byoung Geol Choi, Su Jin Hyun, Soohyung Park, Dong Oh Kang, Jung Rae Cho, Min-Woong Kim, Ji Young Park, Sang-Ho Park, Myung Ho Jeong","doi":"10.2459/JCM.0000000000001674","DOIUrl":"10.2459/JCM.0000000000001674","url":null,"abstract":"<p><strong>Aims: </strong>Considering the limited data regarding clinical outcomes of patients with non-ST-segment on the ECG elevation myocardial infarction (NSTEMI), this study compared the outcomes of patients undergoing percutaneous coronary intervention with newer-generation drug-eluting stents stratified by the presence/absence of complex lesions and symptom-to-balloon time (SBT; <48 h or ≥48 h).</p><p><strong>Methods: </strong>We enrolled 4373 patients with NSTEMI from the Korea Acute Myocardial Infarction Registry-National Institute of Health dataset and stratified them into the complex group (2106 patients; SBT < 48 h, n  = 1365; SBT ≥48 h, n  = 741) and the noncomplex group (2267 patients; SBT < 48 h, n  = 1573; SBT ≥48 h, n  = 694). The primary outcome was the 3-year all-cause mortality rate. The secondary outcomes were any major adverse cardiac events (MACE), including cardiac death (CD), recurrent myocardial infarction, and stroke.</p><p><strong>Results: </strong>The incidence of all-cause mortality (adjusted hazard ratio, 0.656; P  = 0.009), CD ( P  = 0.037), and MACE ( P  = 0.047) in the complex group and of stroke in the noncomplex group ( P  = 0.020) were significantly lower in patients with SBT < 48 h than in those with SBT ≥48 h. Among patients with SBT < 48 h, the stroke incidence ( P  = 0.019) was higher in the complex group than in the noncomplex group, while among patients with SBT ≥48 h, the MACE incidence ( P  = 0.011) was higher in the former than in the latter.</p><p><strong>Conclusion: </strong>SBT reduction effectively decreased the 3-year mortality in patients with NSTEMI in the complex group compared with the noncomplex group.</p>","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":" ","pages":"818-829"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of direct oral anticoagulants vs. warfarin in left ventricular thrombus in myocardial infarction: systematic review and meta-analysis.","authors":"Tanawat Attachaipanich, Thanaphat Thanyaratsarun, Suthinee Attachaipanich, Pojsakorn Danpanichkul, Kotchakorn Kaewboot","doi":"10.2459/JCM.0000000000001683","DOIUrl":"https://doi.org/10.2459/JCM.0000000000001683","url":null,"abstract":"<p><strong>Aims: </strong>Current recommendations for antithrombotic strategies in left ventricular (LV) thrombus following myocardial infarction (MI) remain uncertain. This study aimed to evaluate the efficacy and safety of direct oral anticoagulants (DOACs) compared to warfarin in LV thrombus following MI.</p><p><strong>Methods: </strong>A systematic search using four databases, including PubMed, Embase, Web of Science, and Cochrane CENTRAL, was conducted from inception to 8 July 2024, without language restrictions. The inclusion criteria were studies that included patients with LV thrombus following MI and compared the efficacy or safety of DOACs and warfarin.</p><p><strong>Results: </strong>There were 11 studies (3 randomized and 8 nonrandomized) included in this meta-analysis, involving 14 927 participants. We used a random-effects model for this meta-analysis. DOACs were associated with higher thrombus resolution than warfarin, with a risk ratio (RR) of 1.07 [95% confidence interval (CI) 1.00-1.15], P = 0.04. Similarly, DOACs were associated with a lower rate of stroke and systemic embolism, with an RR of 0.84 (95% CI 0.78-0.90), P < 0.01. DOACs also marginally reduced the rate of major bleeding compared with warfarin, with an RR of 0.87 (95% CI 0.75-1.00), P = 0.05.</p><p><strong>Conclusions: </strong>DOACs were associated with higher rates of LV thrombus resolution, lower rates of stroke/systemic embolism, and marginally reduced major and bleeding events compared with warfarin in patients with LV thrombus following acute MI. Therefore, DOACs may be a reasonable alternative to warfarin in this setting.</p>","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer survivors and cardiovascular diseases: from preventive strategies to treatment.","authors":"Daniela Di Lisi, Cristina Madaudo, Francesca Macaione, Alfredo Ruggero Galassi, Giuseppina Novo","doi":"10.2459/JCM.0000000000001681","DOIUrl":"https://doi.org/10.2459/JCM.0000000000001681","url":null,"abstract":"<p><p>During the last decades, progress in the treatment of oncological diseases has led to an increase in the survival of cancer patients: cancer survivors (CS). Thus, the incidence of CS has increased enormously, in both adult CS and childhood and adolescent CS. Unfortunately, CS treated with anthracyclines, chest radiotherapy (RT) and other potentially cardiotoxic drugs have a higher risk of cardiovascular (CV) toxicity: heart failure with reduced ejection fraction (HFrEF), valve diseases, coronary artery diseases, vascular diseases and pericardial diseases. In fact, chest irradiation can cause coronary artery diseases that can be latent until at least 10 years after exposure; also, valvular heart diseases can appear after >20 years following irradiation; heart failure may appear later, several years after anticancer drugs or RT. Therefore, it is very important to stratify the CV risk of cancer patients at the end of cardiotoxic drugs, to plan the most appropriate long-term surveillance program, in accordance with 2022 ESC Guidelines on Cardio-Oncology, to prevent late cardiovascular complications. Monitoring of cancer patients must not stop during anticancer treatment but it must continue afterwards, depending on the patient's CV risk. CV toxicity risk should be reassessed 5 years after therapy to organize long-term follow-up. Considering late cardiotoxicity in CS, our review aims to evaluate the incidence of cardiovascular diseases in CS, their mechanisms, surveillance protocols, preventive strategies, diagnosis and treatment.</p>","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}