Current Problems in Cardiology最新文献

{"title":"Genotype-phenotype correlations in hypertrophic cardiomyopathy: Insights from an HCM Center of Excellence","authors":"Muddasir Ashraf MD ,&nbsp;M. Fuad Jan MBBS (Hons), MD ,&nbsp;Arshad Jahangir MD ,&nbsp;Stacie Kroboth BS ,&nbsp;Zaid Abood MD ,&nbsp;Sara Walczak BS ,&nbsp;Heather Sanders NP ,&nbsp;A. Jamil Tajik MD","doi":"10.1016/j.cpcardiol.2025.102996","DOIUrl":"10.1016/j.cpcardiol.2025.102996","url":null,"abstract":"<div><h3>Background</h3><div>Owing to the recognition of previously unknown pathogenic gene variants and reclassification of longer-known variants, gene distribution in patients with hypertrophic cardiomyopathy (HCM) is ever-changing. Conflicting data make the role of genotype in risk stratification unclear.</div></div><div><h3>Methods</h3><div>We evaluated genotype distribution and genotype-phenotype correlations in all adult patients with HCM seen at our HCM Center of Excellence from March 31, 2010, to April 30, 2023. We also evaluated a composite outcome, including all-cause mortality, stroke, implantable cardioverter-defibrillator placement, heart failure hospitalization, left ventricular assist device implantation, heart transplantation, septal myectomy, and alcohol septal ablation, based on genotype status. All-cause mortality was separately analyzed.</div></div><div><h3>Results</h3><div>Of 827 patients with HCM, genotyping was completed in 754 (91.2 %). We identified 202 (27 %) genotype-positive (Gen-P), 163 (22 %) variant of unknown significance (VUS), and 389 (51 %) genotype-negative (Gen-N) patients. Mean ages were 47, 57, and 58 years, respectively. The most common gene implicated was <em>MYBPC3</em> (63 %). More patients were on optimal medical treatment after following up with our HCM center. Electrocardiographic, Holter, echocardiographic, and cardiac magnetic resonance imaging characteristics differed based on genotype status. The composite outcome was worse in Gen-P than Gen-N (HR 1.84, <em>p</em>&lt;0.001). Although analysis of all-cause mortality showed survival was different for Gen-P and VUS patients than for Gen-N patients, this difference was not statistically significant.</div></div><div><h3>Conclusion</h3><div><em>MYBPC3</em> was the most common gene implicated. Outcomes were worse in Gen-P patients. Centers of Excellence play an important role in the optimal medical management of patients with HCM.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 4","pages":"Article 102996"},"PeriodicalIF":3.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076091","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":"Utility of lung ultrasound to identify patients at risk of rehospitalization for acute decompensated heart failure","authors":"Juan María Iroulart,&nbsp;Fernando Garagoli,&nbsp;Mariano G. Bergier,&nbsp;Santiago Decotto,&nbsp;Gonzalo Fernández Villar,&nbsp;César Belziti,&nbsp;Emiliano Rossi,&nbsp;Rodolfo Pizarro","doi":"10.1016/j.cpcardiol.2025.103002","DOIUrl":"10.1016/j.cpcardiol.2025.103002","url":null,"abstract":"<div><h3>Introduction</h3><div>Residual congestion at hospital discharge predicts adverse outcomes in acute decompensated heart failure (ADHF). Lung ultrasound (LUS) is a reliable tool for assessing pulmonary congestion. This study aims to evaluate a simplified 4-zone LUS method for identifying heart failure patients at risk after discharge.</div></div><div><h3>Methods</h3><div>This prospective study included adults hospitalized for ADHF without treatable secondary causes. We employed a 4-zone LUS method to quantify B-lines. The primary endpoint was a composite of mortality or rehospitalization within 180 days. We used univariate and multivariate Cox models to evaluate the prognostic value of B-lines. A receiver operating characteristic (ROC) curve identified the optimal B-lines threshold.</div></div><div><h3>Results</h3><div>We included 155 patients (median age: 81 years [IQR 75–85]; 52.9 % male). After the follow-up period, 53 (34.2 %) patients met the primary endpoint. The ROC curve for the number of B-lines at discharge showed an AUC of 0.8, with 7 B-lines identified as the optimal cutoff (sensitivity: 70 %, specificity: 82 %). In univariate analysis, the global B-line count at discharge (HR: 1.33, 95 % CI 1.22-1.45) was significantly associated with the primary endpoint. Using a cutoff of ≥7 B-lines, the association was stronger (HR: 6.92, 95 % CI 3.80-12.60). After multivariable adjustment, ≥7 B-lines at discharge remained significant (HR: 4.41, 95 % CI 1.98-9.81).</div></div><div><h3>Conclusion</h3><div>In our population, the detection of 7 or more B-lines at discharge serves as a reliable marker for identifying patients at risk of mortality or rehospitalization within 180 days.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 4","pages":"Article 103002"},"PeriodicalIF":3.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076040","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":"Transhepatic venous access for catheter ablation of right and left side atrial arrhythmias in adults: challenges and outcomes","authors":"Christian D. Adams MD ,&nbsp;Carlos Andres Tapias MD ,&nbsp;Diego Andres Rodriguez MD, FHRS ,&nbsp;Juan Sebastian Cabrera MD ,&nbsp;Boris Miguel Hernandez MD ,&nbsp;William Fernando Bautista MD, MS ,&nbsp;Luis Carlos Saenz MD","doi":"10.1016/j.cpcardiol.2025.102986","DOIUrl":"10.1016/j.cpcardiol.2025.102986","url":null,"abstract":"<div><h3>Introduction</h3><div>: Electrophysiologic (EP) procedures are typically performed via the femoral venous system, but in some patients, the inferior vena cava (IVC) is unavailable. The hepatic vein has emerged as a viable alternative to femoral access, providing an inferior route that accommodates large sheaths required for better catheter manipulation. Although the percutaneous transhepatic approach has been used successfully in the pediatric population, its use in adults is scarce, with a complication rate of approximately 5 %.</div></div><div><h3>Methods and results</h3><div>: Three patients with limited venous access were referred for ablation between 2018 and 2021. The percutaneous transhepatic access approach provided good support for the EP study, electro-anatomical mapping, and effective radiofrequency ablation of right and left-side arrhythmias. No significant complications were documented, and all patients were discharged within 48 h of the procedure. At follow-up, all patients had excellent arrhythmia control without significant adverse events.</div></div><div><h3>Conclusion</h3><div>: Percutaneous transhepatic access is a feasible and safe alternative to femoral venous access for EP procedures in adult patients with limited venous access.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 4","pages":"Article 102986"},"PeriodicalIF":3.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043277","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":"Emotions & Heart:Exploring the Impact of Negative Emotions on Cardiovascular Health","authors":"Shaun Malik ,&nbsp;Zain S. Ali ,&nbsp;Reem Al-Rawi BHSc ,&nbsp;William Lavercombe MD ,&nbsp;Shyla Gupta BHSc ,&nbsp;Zier Zhou BScH,MSc ,&nbsp;Juan M. Farina MD ,&nbsp;Laura Marcotte MD, FRCPC ,&nbsp;Adrian Baranchuk MD,FACC,FRCPC,FCCS,FSIAC","doi":"10.1016/j.cpcardiol.2025.102989","DOIUrl":"10.1016/j.cpcardiol.2025.102989","url":null,"abstract":"<div><div>Negative emotions can have a significant impact on individuals, which then influences their cardiovascular system. However, the underlying pathophysiological mechanisms and clinical implications of this association remain inadequately defined. A narrative review of pertinent literature was conducted to examine the pathophysiology, clinical manifestations, and treatment related to the interplay between emotions and conditions such as takotsubo cardiomyopathy, atherosclerosis, acute plaque rupture, and cardiac arrhythmias. Negative emotions can instigate a chronic stress response, which in turn heightens sympathetic nervous system activity and increases vulnerability to cardiovascular diseases. This intricate relationship between emotional states and cardiovascular health underscores the necessity for targeted lifestyle interventions and clinical strategies aimed at mitigating the adverse effects of negative emotions.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 3","pages":"Article 102989"},"PeriodicalIF":3.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030246","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 DIAGNOSIS AND TREATMENT OF ASYMPTOMATIC AND SYMPTOMATIC PATIENTS WITH CAROTID ARTERY STENOSIS.","authors":"Robert J Henning, Faha And Brian L Hoh","doi":"10.1016/j.cpcardiol.2025.102992","DOIUrl":"https://doi.org/10.1016/j.cpcardiol.2025.102992","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Carotid artery atherosclerotic stenosis is an important annual cause of stroke in the United States. Moreover, the incidence of carotid artery stenosis is significantly increasing due to the widespread popularity of high fat and high salt diets, sedentary lifestyles, and the increasing age of the population. Of major importance to cardiovascular specialists is the fact that individuals with atherosclerotic carotid artery stenosis can have a prevalence of atherosclerotic coronary artery disease as high as 50 to 75%. Vascular screening for carotid artery stenosis with Doppler ultrasound should be considered for all symptomatic patients with possible carotid stenosis and also considered for asymptomatic patients with (1) symptomatic peripheral arterial disease, coronary artery disease, or atherosclerotic aortic aneurysm or, (2) multiple atherosclerotic risk factors. Carotid artery atherosclerotic plaques that are at high risk for rupture and thrombosis or cerebral embolization are characterized by large lipid cores, intraplaque hemorrhage, thin fibrous caps less than 165 μms that are infiltrated by macrophages and T cells or have surface ulcer(s) or fissures. Carotid artery plaque rupture with cerebral embolism can cause a stroke, TIA, or ipsilateral blindness (amaurosis fugax). Medical treatment based on the recommendations of the American and European Societies for Vascular Surgery for symptomatic patients with carotid stenosis and also asymptomatic patients with high risk carotid stenosis plaques include antiplatelet drugs, antihypertensive drugs for hypertension control and lipid lowering drugs. Management strategies and decisions about carotid revascularization in asymptomatic patients with high risk carotid stenosis should involve a multidisciplinary team and shared decision-making is recommended. The 30 day and five to 10 year outcomes in asymptomatic carotid stenosis patients who have undergone carotid endarterectomy, carotid stenting and/or optimal medical therapy are summarized from the Veterans Administration Cooperative Study, the Asymptomatic Carotid Atherosclerosis Study and the Asymptomatic Carotid Surgery Trials. The current Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2) should help to resolve the debate regarding carotid artery revascularization versus primary medical treatment in asymptomatic patients with &gt;70% carotid artery stenosis. Symptomatic patients who present within 4.5 hours of stroke onset require evaluation for acute pharmacologic intravenous thrombolysis and patients who present with large vessel occlusion within 24 hours of symptom onset should be considered for mechanical thrombectomy to reduce the neurologic deficit. Patients with carotid artery stenosis who present with a history of cerebral infarct in the preceding six months due to cerebral embolism require medical treatment and evaluation by a multidisciplinary team for carotid revascularization in order ","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":" ","pages":"102992"},"PeriodicalIF":3.0,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015793","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":"Comparative lipidomic profiling in adolescents with obesity and adolescents with type 1 diabetes","authors":"Antonio García-Hermoso ,&nbsp;Nidia Huerta-Uribe ,&nbsp;Mikel Izquierdo ,&nbsp;Katherine González-Ruíz ,&nbsp;Jorge Enrique Correa-Bautista ,&nbsp;Robinson Ramírez-Vélez","doi":"10.1016/j.cpcardiol.2025.102991","DOIUrl":"10.1016/j.cpcardiol.2025.102991","url":null,"abstract":"<div><h3>Objective</h3><div>Both adolescents with obesity and those with type 1 diabetes (T1D) exhibit alterations in lipid profiles, but direct comparisons are limited. Comparing lipidomic profiles between obese individuals and those with T1D is crucial for identifying specific metabolic markers, informing tailored interventions, and advancing precision medicine strategies for these distinct populations. The aim of the study was to compare lipidomic profiles between adolescents with obesity and those with T1D, and to analyze associations between metabolites and clinical parameters.</div></div><div><h3>Methods</h3><div>We included 156 adolescents aged 11–18 years (59.6% girls) from the HEPAFIT (<em>n</em>=114, obesity) and Diactive-1 Cohort (<em>n</em>=42, T1D) studies. Clinical measures included anthropometrics, body composition, lipids, liver enzymes, glucose, and HbA1c. Lipidomic analysis of 277 serum/plasma metabolites used UHPLC-MS.</div></div><div><h3>Results</h3><div>Distinct lipid profiles were seen, with higher diglycerides, triglycerides, and certain phosphatidylinositols in the obesity group, while phosphatidylcholines, phosphatidylethanolamines, cholesterol esters, sphingomyelins, and ceramides were elevated in T1D. Triglycerides acyl chain lengths and saturation levels also varied. Multivariate analysis identified seven metabolites –PC(O-18:1/18:1), PC(O-18:1/22:4), PE(O-16:0/18:1), PE(18:2e/22:6), PC(40:1), PC(O-22:1/20:4), and PE(P-18:0/18:1)– significantly associated with clinical parameters.</div></div><div><h3>Conclusions</h3><div>Distinct lipid profiles were observed among adolescents with obesity and T1D in the study, emphasizing the importance of understanding specific metabolite associations with clinical parameters for more precise health management.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 3","pages":"Article 102991"},"PeriodicalIF":3.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015810","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":"National trends in heart failure admissions in Peru: Insights on regional and demographic disparities from 2018 to 2023","authors":"Carlos Diaz-Arocutipa MD ,&nbsp;Rafael Salguero-Bodes MD ,&nbsp;Víctor Juárez MD ,&nbsp;Roberto Martín-Asenjo MD ,&nbsp;German Valenzuela-Rodriguez MD, PhD ,&nbsp;Javier Torres-Valencia MD ,&nbsp;Patricia Ríos-Navarro MD ,&nbsp;Marcos Pariona MD ,&nbsp;Lourdes Vicent MD, PhD","doi":"10.1016/j.cpcardiol.2025.102985","DOIUrl":"10.1016/j.cpcardiol.2025.102985","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure (HF) represents a significant public health challenge, particularly in low- and middle-income countries, where demographic shifts and healthcare disparities influence disease patterns. This study aimed to analyze trends in HF admissions across Peru from 2018 to 2023.</div></div><div><h3>Methods</h3><div>We conducted a secondary data analysis of emergency department morbidity records of patients aged ≥20 years registered in the National Superintendence of Health (SUSALUD) database. HF admissions were identified using ICD-10 codes. Age-adjusted standardized HF admission rates per 100,000 persons were estimated using the direct method. Annual percentage changes with their 95% confidence intervals (CI) were estimated using Poisson regression models.</div></div><div><h3>Results</h3><div>In total, 38,931 HF admissions were recorded, with the majority occurring in patients aged ≥60 years (69.2%), and 51.2% of cases were men. HF admissions showed an overall annual growth rate of 2.78% (95% CI 0.95% - 4.65%), 2.92% (95% CI 1.13% - 4.74%) for men, and 2.57% (95% CI 0.45% - 4.73%) for women. Regional disparities were evident, with the highest rates observed in the Amazon region. HF admissions declined during 2020, followed by a rebound in subsequent years.</div></div><div><h3>Conclusion</h3><div>HF admissions in Peru increased from 2018 to 2023, with notable disparities by sex and region. These findings underscore the need for targeted interventions to address regional and demographic variations in HF burden.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 3","pages":"Article 102985"},"PeriodicalIF":3.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015832","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":"In-hospital outcomes of percutaneous left ventricular assist device recipients in cardiogenic shock hospitalizations with chronic kidney disease: A nationwide analysis","authors":"Akhil Jain MD ,&nbsp;Karnav Modi MBBS ,&nbsp;Ankit Vyas MD ,&nbsp;Maharshi Raval MD ,&nbsp;Argishty Mirzakhanian ,&nbsp;Parth R Nayak MD ,&nbsp;Rupak Desai MBBS ,&nbsp;Venkat Subramaniam MD ,&nbsp;Kiran Garikapati MD ,&nbsp;Rajkumar Doshi MD ,&nbsp;Sourbha S. Dani MD ,&nbsp;William Bennett MD ,&nbsp;Carl J. Lavie MD ,&nbsp;Jose Tafur Soto MD","doi":"10.1016/j.cpcardiol.2025.102993","DOIUrl":"10.1016/j.cpcardiol.2025.102993","url":null,"abstract":"<div><h3>Background</h3><div>There is a lack of data on the role of chronic kidney disease (CKD) in patients who received percutaneous left ventricular assist devices (pLVAD) as mechanical circulatory support (MCS) as an adjunct treatment for cardiogenic shock (CS) management.</div></div><div><h3>Methods</h3><div>Using National Inpatient Sample (2016-19), we extracted CS patients receiving pLVAD and divided them into CKD and non-CKD cohorts. Multivariate regression analysis was used for adjusted odds ratios for outcomes before and after entropy balancing (EB) and predictive margins for the probability of all-cause in-hospital mortality (ACM). ACM was also compared between CS patients who did not receive MCS.</div></div><div><h3>Results</h3><div>In our study, 29,515 patients received pLVAD as the only MCS device in CS, and the prevalence of CKD amongst them was 9.7 %. After EB, ACM did not differ in CS with and without CKD (aOR 1.008, <em>p</em> = 0.953). Higher adjusted incidence rate ratios (IRR) were noted for length of stay (LOS) (aOR 1.68, <em>p</em> &lt; 0.001) and hospitalization cost (aOR 1.365, <em>p</em> = 0.001) in CS with CKD. Mean LOS and hospitalization cost was significantly higher in CKD cohort before and after EB (post-EB: 17.4 days vs. 10.3 days, <em>p</em> &lt; 0.001 and USD 652097 vs. 482359, <em>p</em> = 0.001, respectively). ACM was significantly higher in CS patients who did not receive any MCS if they had CKD (aOR 1.26, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>CKD patients receiving pLVAD for CS had no difference in ACM but had higher resource utilization than those without CKD. pLVAD use was associated with a lower ACM in CKD patients when compared to patients who did not receive any MCS.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 3","pages":"Article 102993"},"PeriodicalIF":3.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015824","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":"Sacubitril-Valsartan in Cancer Therapy-Induced Heart Failure: A Systematic Review and Meta-Analysis of Functional and Hemodynamic Parameters.","authors":"Ramon Hüntermann, Caroline O Fischer-Bacca, Marcel F Alves, Vanio A Livramento Junior, Francisco B Alexandrino, Mariane Y Sato, Rodrigo França Gomes, Franciani R Rocha, Marcelo V Gambetta, Edielle S Melo","doi":"10.1016/j.cpcardiol.2025.102987","DOIUrl":"https://doi.org/10.1016/j.cpcardiol.2025.102987","url":null,"abstract":"<p><strong>Background: </strong>Cancer therapy-induced cardiotoxicity (CTRCD), in the form of heart failure with reduced ejection fraction (HFrEF), is being increasingly recognized. However, the potential benefits of sacubitril/valsartan (S/V) in managing HFrEF secondary to CTRCD remain unclear.</p><p><strong>Objective: </strong>We performed a systematic review and meta-analysis to assess the effectiveness of S/V in preventing cardiotoxicity.</p><p><strong>Methods: </strong>We searched PubMed, Embase, and Cochrane databases for studies evaluating S/V in patients with HFrEF due to CTRCD and reporting the following outcomes: (1) NYHA class; (2) NT-ProBNP and (3) echocardiographic measurements, specifically left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) and E/e' ratio. Statistical analyses were performed using RStudio software. Heterogeneity was assessed using I² statistics.</p><p><strong>Results: </strong>We included 257 patients from six studies. All patients received S/V. The mean patient age was 63 ± 8 years, and 85% of patients had breast cancer. The mean LVEF was 34±7% at baseline. S/V significantly improved NYHA class compared to baseline (MD -0.7; 95% CI -1.2 to -0.3; p<0.01), NT-proBNP (MD -985.1 pg/mL; 95% CI -1231.3 to -739.1; p<0.01), GLS (MD -2.5%; 95% CI -3.6 to -1.4; p<0.01;), and E/e' (MD -1.99; 95% CI 3.7 to -0.1; p=0.03). LVEF (MD 7.3%; 95% CI 5.4 to 9.2; p<0.01) with S/V treatment relative to baseline.</p><p><strong>Conclusion: </strong>In patients with HFrEF due to CTRCD, S/V significantly improved the clinical and echocardiographic parameters of left ventricular systolic and diastolic functions.</p>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":" ","pages":"102987"},"PeriodicalIF":3.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015837","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":"Guideline-directed medical therapy for heart failure: Real-world evidence in one Latin-American center","authors":"Julián Mauricio Jiménez ,&nbsp;Leslie Johana Restrepo ,&nbsp;Manuela Villa ,&nbsp;Sofia Gutiérrez ,&nbsp;Isabella Villarreal ,&nbsp;Johanna Marcela Vanegas ,&nbsp;James Samir Díaz-Betancur","doi":"10.1016/j.cpcardiol.2025.102990","DOIUrl":"10.1016/j.cpcardiol.2025.102990","url":null,"abstract":"<div><h3>Background</h3><div>Despite recommendations from clinical practice guidelines to initiate four drug classes in patients with heart failure (HF) with reduced ejection fraction, information on real-world implementation remains limited. This study evaluated the medications initiated and titrated, the time until the optimal treatment tolerated, pharmacological profiles, patient's adherence, and causes of non-use of guideline directed-medical therapy (GDMT) in a cohort of patients with HF.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted on patients treated in a heart failure program in Colombia. Optimal treatment tolerated was defined as that achieved within 6 months of follow-up. Medication adherence was assessed using the 4-item Morisky-Green scale.</div></div><div><h3>Results</h3><div>A total of 471 patients were included, with a median age of 76 years, 56.9 % male, and a median left ventricular ejection fraction of 35 %. Overall, 43.9 % of patients were on GDMT quadruple therapy, with a median time to optimal tolerated treatment of 57 days (IQR: 1–133). More than 90 % reached target doses with mineralocorticoid receptor antagonists and SGLT2 inhibitors, while less than 50 % achieved it with beta-blockers and renin-angiotensin-aldosterone system inhibitors. Adherence, according to the Morisky-Green scale, was 89.9 % and main causes of non-adherence were lack of social-family support (46.8 %) and forgetting to take medication (44.7 %).</div></div><div><h3>Conclusions</h3><div>In this real-world study of patients with HF, GDMT use rates were higher than those previous national registries. However, the medication doses were lower than those recommended by clinical guidelines. Identifying and quantifying adherence barriers in low- or middle-income countries is essential for implementing recommendations in clinical practice.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 3","pages":"Article 102990"},"PeriodicalIF":3.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015821","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}