Exploration of Cardiology最新文献_第2页

Coronary vasospasm testing: escape from the cath lab! 冠状动脉血管痉挛检测：逃离阴道实验室！

Exploration of Cardiology Pub Date : 2024-02-04 DOI: 10.37349/ec.2024.00016

A. Djordjevic Dikic, S. Dedic, N. Boskovic, V. Giga

{"title":"Coronary vasospasm testing: escape from the cath lab!","authors":"A. Djordjevic Dikic, S. Dedic, N. Boskovic, V. Giga","doi":"10.37349/ec.2024.00016","DOIUrl":"https://doi.org/10.37349/ec.2024.00016","url":null,"abstract":"Coronary vasospasm stands as a widely acknowledged and frequent culprit behind chest pain, acute coronary syndrome, and sudden cardiac death, yet it remains a challenging diagnosis. Current guidelines recommend invasive coronary function testing to assess pathophysiology and mechanisms and to define treatment. In reality, this protocol is rarely applied, because it necessitates extended occupation of the cath lab, repetitive administration of nephrotoxic iodine contrast agents, the need for repeated testing on both coronary arteries leading to considerable radiation exposure, and significant direct expenses. The promising perspective for vasospasm testing is a noninvasive approach with advanced echocardiographic techniques, such as transthoracic Doppler echocardiography, with more sensitive indicators of ischemia. Hyperventilation and exercise tests are used for vasospasm directed testing, with assessment of the new parameters: coronary flow velocities and reserve, allowing to see deeper into macro and microvascular pathophysiology. Association between coronary flow, global longitudinal strain and microvascular dysfunction (MVD) and impaired values at hyperemia was previously demonstrated. Reduction in coronary flow velocity (CFV) despite heightened myocardial oxygen consumption and double product during hyperventilation are indicative of coronary vasospasm. Normal coronary angiography finding in patients with documented evidence of ischemia should initiate additional diagnostic testing in order to increase the yield of specific diagnosis in patients with suspected vasospasm, which could help to personalize treatment and prognosis. In order to achieve this, non-invasive provocative stress echocardiography tests should be included in the diagnostic workup. This approach, characterized by its simplicity, feasibility, safety, and efficacy, is currently undergoing extensive testing on a large scale.","PeriodicalId":218206,"journal":{"name":"Exploration of Cardiology","volume":"1 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139866442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Coronary vasospasm testing: escape from the cath lab! 冠状动脉血管痉挛检测：逃离阴道实验室！

Exploration of Cardiology Pub Date : 2024-02-04 DOI: 10.37349/ec.2024.00016

A. Djordjevic Dikic, S. Dedic, N. Boskovic, V. Giga

{"title":"Coronary vasospasm testing: escape from the cath lab!","authors":"A. Djordjevic Dikic, S. Dedic, N. Boskovic, V. Giga","doi":"10.37349/ec.2024.00016","DOIUrl":"https://doi.org/10.37349/ec.2024.00016","url":null,"abstract":"Coronary vasospasm stands as a widely acknowledged and frequent culprit behind chest pain, acute coronary syndrome, and sudden cardiac death, yet it remains a challenging diagnosis. Current guidelines recommend invasive coronary function testing to assess pathophysiology and mechanisms and to define treatment. In reality, this protocol is rarely applied, because it necessitates extended occupation of the cath lab, repetitive administration of nephrotoxic iodine contrast agents, the need for repeated testing on both coronary arteries leading to considerable radiation exposure, and significant direct expenses. The promising perspective for vasospasm testing is a noninvasive approach with advanced echocardiographic techniques, such as transthoracic Doppler echocardiography, with more sensitive indicators of ischemia. Hyperventilation and exercise tests are used for vasospasm directed testing, with assessment of the new parameters: coronary flow velocities and reserve, allowing to see deeper into macro and microvascular pathophysiology. Association between coronary flow, global longitudinal strain and microvascular dysfunction (MVD) and impaired values at hyperemia was previously demonstrated. Reduction in coronary flow velocity (CFV) despite heightened myocardial oxygen consumption and double product during hyperventilation are indicative of coronary vasospasm. Normal coronary angiography finding in patients with documented evidence of ischemia should initiate additional diagnostic testing in order to increase the yield of specific diagnosis in patients with suspected vasospasm, which could help to personalize treatment and prognosis. In order to achieve this, non-invasive provocative stress echocardiography tests should be included in the diagnostic workup. This approach, characterized by its simplicity, feasibility, safety, and efficacy, is currently undergoing extensive testing on a large scale.","PeriodicalId":218206,"journal":{"name":"Exploration of Cardiology","volume":"45 1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139806353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Why and when should be lipoprotein(a) level measured? 为什么要测量脂蛋白（a）水平？

Exploration of Cardiology Pub Date : 2023-12-29 DOI: 10.37349/ec.2023.00015

Miłosz Broncel, M. Broncel

{"title":"Why and when should be lipoprotein(a) level measured?","authors":"Miłosz Broncel, M. Broncel","doi":"10.37349/ec.2023.00015","DOIUrl":"https://doi.org/10.37349/ec.2023.00015","url":null,"abstract":"Lipoprotein(a) [Lp(a)] is composed of a low-density lipoprotein (LDL) and glycoprotein (a)—apo(a). The size and concentration of Lp(a) in serum can vary among individuals and is determined by genetic factors. The environmental factors, diet, and physical activity have a negligible effect on Lp(a) level. Observational, epidemiological, and genetic studies improved that high levels of Lp(a) > 50 mg/dL (> 125 nmol/L) have been associated with an increased risk of myocardial infarction (MI), stroke, and calcific aortic valve stenosis (CAVS). It is recommended to measure Lp(a) at least once in adults to identify individuals with a high cardiovascular risk. This screening is particularly important in certain populations, including: youth with a history of ischemic stroke or a family history of premature atherosclerotic cardiovascular disease (CVD; ASCVD) or high Lp(a), individuals with recurrent cardiovascular events despite optimal hypolipemic treatment and no other identifiable risk factors or patients with familial hypercholesterolemia (FH). Considering Lp(a) levels in the evaluation of cardiovascular risk can provide valuable information for risk stratification and management decisions. However, it’s important to note that the treatments of elevated level of Lp(a) are limited. In recent years, there has been ongoing research and development of new drugs targeting Lp(a): pelacarsen—antisense oligonucleotide (ASO), and olpasiran—a small interfering RNA (siRNA).","PeriodicalId":218206,"journal":{"name":"Exploration of Cardiology","volume":" 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139143054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Viral infections in cardiometabolic risk and disease between old acquaintances and new enemies 老熟人与新敌人之间的病毒感染在心脏代谢风险和疾病中的影响

Exploration of Cardiology Pub Date : 2023-12-27 DOI: 10.37349/ec.2023.00014

C. Vassalle

{"title":"Viral infections in cardiometabolic risk and disease between old acquaintances and new enemies","authors":"C. Vassalle","doi":"10.37349/ec.2023.00014","DOIUrl":"https://doi.org/10.37349/ec.2023.00014","url":null,"abstract":"Atherosclerosis is a chronic disease, characterized by chronic inflammation, endothelial dysfunction, and lipid deposition in the vessel. Although many major, well-identified risk factors for atherosclerosis [e.g., hyperlipidemia, hypertension, type 2 diabetes (T2D), smoking habit, and obesity] explain a lot about the risk, there is a considerable number of patients who develop atherosclerotic damage and undergo adverse events without presenting any of these established modifiable risk factors. This observation has stimulated an urgent need to expand knowledge towards the identification of additional, less established risk factors that may help in the assessment of risk and fill the gap of knowledge in the cardiovascular (CV) setting. Among them, the hypothesis of a possible relationship between viral infectious agents and atherosclerosis has risen since the early 1900s. However, there is still a great deal of debate regarding the onset and progression of CV disease in relation to the roles of the pathogens (as active inducers or bystanders), host genomic counterparts, and environmental triggers, affecting both virus abundance and the composition of viral communities. Accordingly, the aim of this review is to discuss the current state of knowledge on infectious agents in the atherosclerotic process, with particular focus on two environmental-related viruses, as examples of familiar (influenza) and unfamiliar [severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)] disease triggers.","PeriodicalId":218206,"journal":{"name":"Exploration of Cardiology","volume":"38 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139154642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Low-doses ionizing radiation exposure: an emerging causal risk factor for cardiovascular disease 低剂量电离辐射照射：新出现的心血管疾病致病风险因素

Exploration of Cardiology Pub Date : 2023-12-11 DOI: 10.37349/ec.2023.00013

M. Andreassi

引用次数: 0

Alcohol zero: the end, the beginning of the end, or just the end of the beginning? 酒精零:结束，结束的开始，还是只是开始的结束?

Exploration of Cardiology Pub Date : 2023-08-31 DOI: 10.37349/ec.2023.00005

M. Ostojić, V. Djajić, T. Kovacevic-Preradovic, D. Vulic

{"title":"Alcohol zero: the end, the beginning of the end, or just the end of the beginning?","authors":"M. Ostojić, V. Djajić, T. Kovacevic-Preradovic, D. Vulic","doi":"10.37349/ec.2023.00005","DOIUrl":"https://doi.org/10.37349/ec.2023.00005","url":null,"abstract":"Alcohol drinks, especially wine, have been described since 6,000 B.C. For many years in modern medicine, \u0000wine in moderation has been considered healthy for cardiovascular prevention, i.e., recommended by \u0000nutrition committees. Some regional guidelines still recommend one to two standard drinks per day. By the \u0000very recent (January 2023), World Health Organization and Canadian Guidance on alcohol emphasize that \u0000any alcoholic drink is hazardous to the health and the safe amount is zero. The risk starts with every single \u0000drop. It was also nicely summarized in the manuscript “Alcohol-dose question and the weakest link in a \u0000chemical interplay” (Explor Cardiol. 2023;1:15–25. doi: 10.37349/ec.2023.00003) especially from the \u0000standpoint of a researcher in the cardiovascular arena. The newest recommendations are based on \u0000observational studies and their meta-analysis, therefore establishing associations, pointing out that alcohol \u0000may somewhat prevent cardiovascular diseases and diabetes type 2, but with a significant increase in \u0000non-cardiovascular morbidity and mortality, especially cancers. Previous recommendations, therefore, may \u0000be obsolete as they were based on studies where abstainers from alcoholic beverages had inherent higher \u0000risks. The current controversy with conflicting guidelines for alcoholic beverage consumption in the era of \u0000precision medicine may stimulate more fundamental investigations up to genetic ones and find the \u0000cause-effect relations. In the era of precision medicine, it may come closer to discovering the causes of \u0000cancers and many other diseases, enabling predictions of reactions to alcoholic beverages by each person, \u0000not just in the population.","PeriodicalId":218206,"journal":{"name":"Exploration of Cardiology","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115473138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Normal physiologic coronary flow velocity gradient across the left anterior descending artery in healthy asymptomatic subjects 健康无症状受试者左前降支正常生理冠状动脉血流速度梯度

Exploration of Cardiology Pub Date : 2023-08-31 DOI: 10.37349/ec.2023.00006

F. Rigo, V. Spadotto, R. S. Fattore, Pietro Renda, C. Cugini, Maurizio Agnoletto

{"title":"Normal physiologic coronary flow velocity gradient across the left anterior descending artery in healthy asymptomatic subjects","authors":"F. Rigo, V. Spadotto, R. S. Fattore, Pietro Renda, C. Cugini, Maurizio Agnoletto","doi":"10.37349/ec.2023.00006","DOIUrl":"https://doi.org/10.37349/ec.2023.00006","url":null,"abstract":"Aim: Coronary flow velocity (CFV) can be obtained with transthoracic echocardiography (TTE) in the left anterior descending coronary artery (LAD). The physiologic flow velocity gradient across the different segments of LAD has not been established. This study aims to assess the normal values of resting CFV in proximal, mid, and distal LAD.\u0000Methods: In a single center, prospective, observational study design, TTE was attempted on 110 consecutive, asymptomatic middle-aged subjects (age = 55 years, 46% males) with a low likelihood of coronary artery disease (< 5%). Resting CFV in the LAD was assessed with high-end machines, dedicated coronary pre-set, and high-frequency transducers by pulsed-wave Doppler under color-Doppler guidance in the proximal, mid, and distal segments.\u0000Results: The technical success rate for CFV imaging was lowest for the proximal (101/110, 92%), intermediate for mid (106/110, 96%), and highest for the distal segment (108/110, 98%). All 3 segments were interpretable in 101 subjects. CFV was highest in proximal segments (38.6 cm/s ± 3.9 cm/s), intermediate in mid segments (34.3 cm/s ± 6.04 cm/s, P < 0.01 vs. proximal), and lowest in distal segments (28.1 cm/s ± 1.7 cm/s, P < 0.01 vs. proximal and vs. mid).\u0000Conclusions: A resting evaluation of CFV-LAD can be obtained by TTE in the large majority of consecutive subjects referred to the echocardiography laboratory. Feasibility is highest for distal and lowest for proximal-LAD segments. There is a clear physiologic gradient of CFV with decreasing values, of about 10% for each step, going from proximal to mid and distal segments of LAD. When resting CFV is considered, the site of the sampling is important to obtain comparable and physiologically meaningful data.","PeriodicalId":218206,"journal":{"name":"Exploration of Cardiology","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133843537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Left ventricular systolic function and initial exercise capacity—their importance for results of cardiac rehabilitation after acute coronary syndrome 左心室收缩功能和初始运动能力——它们对急性冠脉综合征后心脏康复结果的重要性

Exploration of Cardiology Pub Date : 2023-08-30 DOI: 10.37349/ec.2023.00004

B. Uznańska‐Loch, Ewa Wądołowska, Karina Wierzbowska-Drabik, U. Cieślik-Guerra, J. Kasprzak, M. Kurpesa, T. Rechciński

{"title":"Left ventricular systolic function and initial exercise capacity—their importance for results of cardiac rehabilitation after acute coronary syndrome","authors":"B. Uznańska‐Loch, Ewa Wądołowska, Karina Wierzbowska-Drabik, U. Cieślik-Guerra, J. Kasprzak, M. Kurpesa, T. Rechciński","doi":"10.37349/ec.2023.00004","DOIUrl":"https://doi.org/10.37349/ec.2023.00004","url":null,"abstract":"Aim: The aim of this study was to compare initial and final exercise tolerance and to evaluate the determinants of exercise capacity improvement—after three weeks of inpatient cardiac rehabilitation.\u0000Methods: A cohort of 494 patients after acute coronary syndrome (ACS), treated with primary coronary angioplasty (age 60 years ± 10 years, 27.5% women) was studied retrospectively. Possible correlations between improvement and age, gender, body mass index (BMI), left ventricular ejection fraction (LVEF) and the initial exercise capacity (EXT1) were assessed.\u0000Results: The highest percentage of patients with improvement (43.6%) was in the medium tercile of LVEF (> 42% but ≤ 50%) and was more likely in the medium tercile of initial exercise tolerance [> 5.7 but ≤ 8.4 metabolic equivalent of tasks (METs)]. Receiver-operator characteristic (ROC) curves were developed and the following cut-off values were found: for LVEF > 43% (this value had 69.6% sensitivity in predicting improvement; the chance of improvement was 2.67 higher than in patients with LVEF ≤ 43%); for EXT1 ≤ 8.4 METs (this value had 70.8% sensitivity, the chance of improvement was 1.86 higher than in the other subgroup). No significant relationship between improvement and gender, age or BMI was found.\u0000Conclusions: The combination of LVEF > 43% and EXT1 ≤ 8.4 METs relates to the highest probability of exercise tolerance improvement after cardiac rehabilitation.","PeriodicalId":218206,"journal":{"name":"Exploration of Cardiology","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122658522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Alcohol—dose question and the weakest link in a chemical interplay 酒精剂量的问题和化学相互作用中最薄弱的环节

Exploration of Cardiology Pub Date : 2023-08-18 DOI: 10.37349/ec.2023.00003

P. Hamala, Karina Wierzbowska-Drabik

引用次数: 1

In search of heart barometer—advantage of left atrial dimension over electrocardiographic indices of left ventricular hypertrophy in arterial hypertension 寻找心脏晴雨表-左房维数相对于高血压左室肥厚心电图指标的优势

Exploration of Cardiology Pub Date : 2023-07-14 DOI: 10.37349/ec.2023.00002

Bogusława Nowak, R. Nowakowski, Aleksandra Gapys, T. Rechciński, E. Trzos, M. Kurpesa, P. Lipiec, J. Kasprzak, Karina Wierzbowska-Drabik

{"title":"In search of heart barometer—advantage of left atrial dimension over electrocardiographic indices of left ventricular hypertrophy in arterial hypertension","authors":"Bogusława Nowak, R. Nowakowski, Aleksandra Gapys, T. Rechciński, E. Trzos, M. Kurpesa, P. Lipiec, J. Kasprzak, Karina Wierzbowska-Drabik","doi":"10.37349/ec.2023.00002","DOIUrl":"https://doi.org/10.37349/ec.2023.00002","url":null,"abstract":"Aim: Left ventricular (LV) hypertrophy (LVH) is a common and relevant complication of arterial hypertension (AH) and 12-lead electrocardiogram (ECG) is widely used for its preliminary assessment. The aim of the study was to compare the correlations of four ECG-derived criteria of LVH and left atrial (LA) anteroposterior diameter with LVH assessed by echocardiography and expressed as left ventricular mass (LVM) index (LVMI) in search of the most accurate preliminary indicator of LVH.\u0000Methods: The study included 61 subjects with AH [age (year) 69 ± 10, 17 females] and 27 without AH, (age 40 ± 9, 10 females) evaluated with 12-lead ECG and transthoracic echocardiography (TTE). As the ECG-based criteria of LVH Sokolow-Lyon index (SLI), Cornell voltage (CV), Cornell product (CP), and Romhilt-Estes point score (RES) system were evaluated. The ECG indices and LA diameter were correlated with LVMI and correlations coefficients were compared.\u0000Results: Among ECG-LVH indicators SLI showed the closest correlation with LVMI [rank correlation coefficients (rho) = 0.38, P < 0.0001], followed by CV and CP with rho = 0.33, P = 0.002 and rho = 0.32, P = 0.002, respectively, whereas RES did not correlate significantly with LVMI. The strongest correlation with LVMI was found for the LA diameter with rho = 0.73 and P < 0.0001, showing an even stronger correlation in women—rho = 0.8 (P < 0.0001) vs. rho = 0.65 (P < 0.0001) in men. In the multivariate analysis, the LA was the only independent predictor of the increased LVMI with R2 = 0.52, P < 0.0001.\u0000Conclusions: LA diameter outperformed significantly the ECG indices as far as the correlation with LVMI was concerned and emerged as the only independent predictor of mild and moderate LVH in hypertensive patients. Among the ECG criteria, the strongest correlation was shown for SLI, followed by CV and CP indices.","PeriodicalId":218206,"journal":{"name":"Exploration of Cardiology","volume":"166 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122981523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0