Journal of Geriatric Cardiology最新文献

{"title":"Amyloid deposits in prostate biopsy as an opportunity to diagnose early cardiac amyloidosis.","authors":"María Cespón-Fernández, Edgar José Escalona-Canal, Jorge Sánchez-Ramos, Sergio Raposeiras-Roubín, Sámer Abdulkader-Sande, Rafael José Cobas-Paz, Cristina Torreira-Banzas, Emad Abu-Assi, Susana Teijeira-Bautista, Patricia Domínguez-Aristegui, Pablo García-Pavía, María Eugenia Escalona-Canal, Enrique Cespón-Outeda, José Antonio Ortiz-Rey","doi":"10.26599/1671-5411.2025.01.007","DOIUrl":"10.26599/1671-5411.2025.01.007","url":null,"abstract":"<p><strong>Background: </strong>The diagnostic delay of cardiac amyloidosis (CA) is known to be substantially long. A prolonged time from symptoms onset to diagnosis negatively impacts quality of life and life expectancy of the affected patients. We aim to describe the role of the incidental finding of amyloid deposits in prostatic tissue as an early marker of CA.</p><p><strong>Methods: </strong>A systematic cardiological evaluation, comprising ECG, echocardiogram and 99mTc-DPD scintigraphy, was offered to a cohort of 19 patients with incidental prostatic amyloidosis (PA) findings, propectively detected between 2014-2023, to assess cardiac involvement.</p><p><strong>Results: </strong>The median age of the patients was 80.2 years (IQR: 74.9 -82.6 years). Histopathological study revealed amyloid deposits within the walls of small vessels (predominantly small arteries) in 18 patients and mainly in the stroma in the remaining case. All of them were immunohistochemically positive for transthyretin (ATTR) except one patient, with known myeloma, which was unconclusive fo ATTR. Clonal dyscrasia was excluded in the rest of the patients. Thirteen patients (68.4%) underwent all cardiological tests, 4 patients (21.1%) underwent only ECG and echocardiographic evaluation and two patients (10.5%) refused to undergo any cardiological study. Among 13 individuals undergoing the complete evaluation, six patients were eventually diagnosed with CA (46.15%). All of them were asymptomatic from a cardiovascular point of view at the time of the prostate biopsy.</p><p><strong>Conclusion: </strong>The finding of PA should prompt a complete cardiovascular examination, given the significant percentage of patients eventually diagnosed with early-stage CA. Multidisciplinary collaboration among different medical specialists must be encouraged, given the potential clinical impact of CA early diagnosis.</p>","PeriodicalId":51294,"journal":{"name":"Journal of Geriatric Cardiology","volume":"22 1","pages":"169-177"},"PeriodicalIF":1.8,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complexities in Geriatric Cardiology: Clinical Dilemmas and Gaps in Evidence.","authors":"Nikolaos Theodorakis, Christos Hitas, Georgia Vamvakou, Sofia Kalantzi, Aikaterini Spyridaki, Zoi Kollia, Georgios Feretzakis, Maria Nikolaou","doi":"10.26599/1671-5411.2025.01.004","DOIUrl":"10.26599/1671-5411.2025.01.004","url":null,"abstract":"<p><p>Cardiovascular diseases (CVD) are undoubtedly the leading cause of morbidity and mortality in the elderly. Population aging is a global phenomenon. In developed countries, by the year 2050 one in four people will be aged 65+ years. This ongoing growth of the aging population leads to an increasing burden of CVD. The management of CVD in geriatric patients requires specific considerations. Aging is associated with complex pathophysiology due to decreased organ reserve, which is clinically described as frailty. Additionally, the aging population is extremely heterogenous and frequently characterized by a combination of unique features, including atypical disease presentation, multimorbidity, polypharmacy, altered pharmacokinetics, cognitive impairment, renal impairment, dysautonomia, elevated risk of falls, sarcopenia, and frailty. Furthermore, significant gaps in evidence exist largely due to the limited representation of the very elderly, and especially frail patients, in randomized controlled trials. When combined with issues related to life expectancy, goals of care, bioethics, and patients' preferences, these factors pose intricate challenges for healthcare providers. This literature review summarizes selected clinical scenarios that often introduce dilemmas in the management of elderly patients in cardiology practice, emphasizing the intersection of geriatric medicine and cardiology. These include blood pressure management, management of dyslipidemia, anticoagulation in atrial fibrillation, medical and device treatment of heart failure, antiplatelet and interventional management of acute coronary syndromes, and peri-procedural considerations in severe aortic stenosis. The above will provide guidance for clinical practice, as well as implications for health policies and future research in the field of geriatric cardiology.</p>","PeriodicalId":51294,"journal":{"name":"Journal of Geriatric Cardiology","volume":"22 1","pages":"190-209"},"PeriodicalIF":1.8,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Canagliflozin ameliorates ferritinophagy in HFpEF rats.","authors":"Sai Ma, Qing-Juan Zuo, Li-Li He, Guo-Rui Zhang, Ting-Ting Zhang, Zhong-Li Wang, Jian-Long Zhai, Yi-Fang Guo","doi":"10.26599/1671-5411.2025.01.006","DOIUrl":"10.26599/1671-5411.2025.01.006","url":null,"abstract":"<p><strong>Background: </strong>Recent studies have shown that sodium-glucose cotransporters-2 (SGLT2) inhibitors significantly improve major adverse cardiovascular events in heart failure with preserved ejection fraction (HFpEF) patients, but the exact mechanism is unknown. Ferritinophagy is a special form of selective autophagy that participates in ferroptosis. In this study, we aimed to investigate whether ferritinophagy was activated during the occurrence of HFpEF, and whether canagliflozin (CANA) could inhibite ferritinophagy.</p><p><strong>Methods: </strong>We reared Dahl salt-sensitive (DSS) rats on a high-salt diet to construct a hypertensive HFpEF model, and simultaneously administered CANA intervention. Then we detected indicators related to ferritinophagy.</p><p><strong>Results: </strong>The expression of nuclear receptor coactivator 4 (NCOA4), as well as microtubule-associated proteins light chain 3 (LC3), Bcl-2 interacting protein 1 (Beclin-1) and p62, were upregulated in HFpEF rats, accompanied by the downregulation of ferritin heavy chain 1 (FTH1), upregulation of mitochondrial iron transporter sideroflexin1 (SFXN1) and increased reactive oxygen species (ROS) production. Above changes were diminished by CANA.</p><p><strong>Conclusion: </strong>Ferritinophagy is activated in HFpEF rats and then inhibited by CANA, leading to HFpEF benefits. The inhibition of ferritinophagy could provide new prospective targets for the prevention and treatment of HFpEF, and provide new ideas for investigating the mechanism of cardiovascular benefit of SGLT2 inhibitors.</p>","PeriodicalId":51294,"journal":{"name":"Journal of Geriatric Cardiology","volume":"22 1","pages":"178-189"},"PeriodicalIF":1.8,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical impact of drug-coated balloon treatment of coronary artery disease in elderly patients.","authors":"Eun-Seok Shin, Mi Hee Jang, Sunwon Kim, Dong Oh Kang, Ki-Bum Won, Bitna Kim, Ae-Young Her","doi":"10.26599/1671-5411.2025.01.001","DOIUrl":"10.26599/1671-5411.2025.01.001","url":null,"abstract":"<p><strong>Background: </strong>Data on drug-coated balloon (DCB) treatment in elderly patients are limited. This study was to evaluate the efficacy of DCB treatment in percutaneous coronary intervention (PCI) among elderly patients.</p><p><strong>Methods: </strong>A retrospective analysis included 232 patients aged 75 years or older with coronary artery disease who underwent successful PCI using either DCB alone or in combination with drug-eluting stent (DES) based on pre-dilation results (DCB-based PCI). These patients were compared with 1818 elderly patients who underwent second-generation DES implantation (DES-only PCI). The endpoint was major adverse cardiovascular events (MACE) at 2-year follow-up.</p><p><strong>Results: </strong>In the DCB-based PCI, 61.2% of patients received DCB-only treatment. Compared to DES-only PCI, the DCB-based PCI group had fewer stents (0.5 ± 0.7 and 1.7 ± 0.8, <i>P</i> < 0.001), shorter stent lengths (13.3 ± 20.9 mm and 37.4 ± 23.0 mm, <i>P</i> < 0.001), and lower usage of small stents with a diameter of 2.5 mm or less (15.6% and 28.7%, <i>P</i> = 0.010). The DCB-based PCI group exhibited lower rate of MACE (5.5% and 13.1%, <i>P</i> = 0.003), target vessel revascularization (1.1% and 5.6%, <i>P</i> = 0.017) and major bleeding (0.7% and 5.1%, <i>P</i> = 0.009) at 2-year follow-up. The reduced risk in 2-year MACE was consistently observed across various matching procedures, with the most significant reduction noted in target vessel revascularization and major bleeding.</p><p><strong>Conclusion: </strong>The DCB-based PCI reduced stent burden, particularly in the usage of small diameter stents, and was associated with lower risks of MACE, target vessel revascularization, and major bleeding compared to DES-only PCI in elderly patients.</p>","PeriodicalId":51294,"journal":{"name":"Journal of Geriatric Cardiology","volume":"22 1","pages":"150-158"},"PeriodicalIF":1.8,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of optical coherence tomography in clinical management of myocardial infarction with nonobstructive coronary arteries.","authors":"Kenichi Tani, Osamu Kurihara, Akihiro Shirakabe, Nobuaki Kobayashi, Masamichi Takano, Kuniya Asai","doi":"10.26599/1671-5411.2024.12.007","DOIUrl":"10.26599/1671-5411.2024.12.007","url":null,"abstract":"<p><p>Myocardial infarction without angiographic moderate to severe stenosis (> 50%) and any other related diagnosis on clinical presentation is defined as myocardial infarction with nonobstructive coronary arteries (MINOCA). Common causes of MINOCA working diagnosis includes plaque disruption, spontaneous coronary artery dissection, coronary artery spasm, coronary thromboembolism, Takotsubo cardiomyopathy, and myocarditis. Clinical history, assay of myocardial enzymes, electrocardiogram, echocardiography, coronary angiography, and left ventriculography facilitate the initial diagnosis of MINOCA and reveal the underlying causes, while cardiovascular magnetic resonance and optical coherence tomography (OCT) are used to confirm the diagnosis. Although cardiovascular magnetic resonance is the gold standard noninvasive diagnostic tool for MINOCA, its ability to diagnose the cause and mechanism underlying this condition in the coronary arteries is limited because of its image resolution. Observational studies have demonstrated that OCT can be used to determine the underlying cause of MINOCA by investigating the characteristics of the culprit lesions and to predict the prognosis of the patients. In this article, we review the current diagnostic approach for MINOCA focusing on each imaging tool. Furthermore, we reevaluate the role of OCT in the clinical management of MINOCA. Identifying the cause of MINOCA through OCT might help select optimal and effective drug treatments and improve prognosis.</p>","PeriodicalId":51294,"journal":{"name":"Journal of Geriatric Cardiology","volume":"21 12","pages":"1133-1140"},"PeriodicalIF":1.8,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcervical occlusion of atrial septal defect complicating with absence of hepatic segment of inferior vena cava in a patient with dextrocardia.","authors":"Jia-Wang Xiao, Zhong-Chao Wang, Jing-Song Geng, Jian-Ming Wang, Qi-Guang Wang","doi":"10.26599/1671-5411.2024.12.006","DOIUrl":"10.26599/1671-5411.2024.12.006","url":null,"abstract":"","PeriodicalId":51294,"journal":{"name":"Journal of Geriatric Cardiology","volume":"21 12","pages":"1149-1152"},"PeriodicalIF":1.8,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In the early diagnosis of cardiac amyloidosis by point-of-care ultrasound (POCUS) in older patients with heart failure: towards a new standard of care?","authors":"Laura Samaniego-Vega, Ana Ayesta-Lopez, Elena Valle-Calonge, Jesus M De La Hera-Galarza, Jose Gutierrez-Rodriguez, Pablo Solla-Suarez","doi":"10.26599/1671-5411.2024.12.003","DOIUrl":"10.26599/1671-5411.2024.12.003","url":null,"abstract":"","PeriodicalId":51294,"journal":{"name":"Journal of Geriatric Cardiology","volume":"21 12","pages":"1147-1148"},"PeriodicalIF":1.8,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arrhythmogenic left ventricular cardiomyopathy mimicking acute myocardial infarction.","authors":"Cen-Cen Wu, Le-Qun Zhou, Xin-Yu Wang, Ling-Yun Zu, Wei-Xian Xu","doi":"10.26599/1671-5411.2024.12.004","DOIUrl":"10.26599/1671-5411.2024.12.004","url":null,"abstract":"","PeriodicalId":51294,"journal":{"name":"Journal of Geriatric Cardiology","volume":"21 12","pages":"1141-1146"},"PeriodicalIF":1.8,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of hypothalamic microglial activation on ventricular arrhythmias in stress cardiomyopathy.","authors":"Peng-Qi Lin, Quan-Wei Pei, Bin Li, Jie-Mei Yang, Li-Na Zou, De-Zhan Su, Jun-Pei Zhang, Hong-Peng Yin, Mbabazi Nadine, Jun-Jie Yang, Nevzorova Vera A, Khan Musawir Abbas, Zhao-Lei Jiang, Jing-Jie Li, De-Chun Yin","doi":"10.26599/1671-5411.2024.12.002","DOIUrl":"10.26599/1671-5411.2024.12.002","url":null,"abstract":"<p><strong>Background: </strong>Stress cardiomyopathy (SCM) currently has a high incidence in older adults, and the theories regarding its causes include \"catecholamine myocardial toxicity\" and \"sympathetic hyperactivation\". However, the role of the central nervous system in the pathogenesis of SCM remains unknown. We investigated the role of microglia activation in the paraventricular hypothalamic nucleus (PVN) in the development of SCM.</p><p><strong>Methods: </strong>An SCM model was created using male Sprague-Dawley (SD) rats, immobilized for 6 h every day for a week. Electrocardiogram, cardiac electrophysiology, and echocardiography examinations were performed to verify the changes in cardiac structure and function in rats with SCM. RNA sequencing was used to explore the changes in the hypothalamus during SCM. In addition, brain and heart tissues were collected to detect microglial activation and sympathetic activity.</p><p><strong>Results: </strong>The main findings were as follows: (1) immobilization stress successfully induced SCM in SD rats; (2) microglia were significantly activated in the hypothalamus, as evidenced by cytosol thickening, increases in the number of microglial branches, and microglia enriched in the PVN; (3) in SCM, the microglia in the PVN exhibited increased central and peripheral cardiac sympathetic activity and increased the expression of neuroinflammatory factors; and (4) it is possible that inhibiting microglial activation could suppress the sympathetic activity of the central nervous system and heart and increase cardiac electrical stability in SCM rats.</p><p><strong>Conclusions: </strong>SCM was induced in SD rats by immobilization stress, acting through the activation of the hypothalamic microglia. The activated microglia were specifically enriched in the PVN, increasing the activity of the central and peripheral sympathetic nervous systems by regulating the expression of neuro-inflammatory factors, mediating dysfunction of the left ventricle, and increasing the susceptibility to ventricular arrhythmias.</p>","PeriodicalId":51294,"journal":{"name":"Journal of Geriatric Cardiology","volume":"21 12","pages":"1119-1132"},"PeriodicalIF":1.8,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative adverse cardiac events predict post-discharge mortality after fragility hip fracture in elderly patients without cardiovascular disease.","authors":"Seung-Chan Kim, Sook-Jung Kim, Jeong-Eun Yi","doi":"10.26599/1671-5411.2024.12.001","DOIUrl":"10.26599/1671-5411.2024.12.001","url":null,"abstract":"<p><strong>Background: </strong>Perioperative adverse cardiac events (PACEs) in elderly patients with hip fractures are associated with perioperative mortality. We investigated the relationship of PACE with post-discharge mortality and further explored whether it differs between patients with and without cardiovascular disease (CVD).</p><p><strong>Methods: </strong>We retrospectively analyzed data from patients aged ≥ 65 years who underwent fragility hip fracture surgery from September 2016 to December 2021. PACE was defined as a composite of congestive heart failure, cardiogenic shock, myocardial injury after non-cardiac surgery, arrhythmic event, ischemic stroke, or acute pulmonary thromboembolism during hospitalization or within the 30-day postoperative period. Patients with 30-day mortality were excluded. The primary endpoint was all-cause mortality after hospital discharge.</p><p><strong>Results: </strong>Of the 446 patients (133 patients in the CVD group and 313 patients in the non-CVD group), 14.8% experienced PACE, and overall mortality during a median of 15.9 months (interquartile range: 6.6-27.0 months) was 20.9% [CVD (26.3%) <i>vs.</i> non-CVD (18.5%), <i>P</i> = 0.064]. Patients with PACE demonstrated a significantly worse survival rate than those without PACE in both groups (all log-rank <i>P</i> < 0.05). After adjustment for confounders, PACE was an independent predictor of mortality in the overall population [hazard ratio (HR) = 3.01, 95% CI: 1.69-5.35, <i>P</i> < 0.001]. Its prognostic impact was significant in patients without CVD (HR = 2.69, 95% CI: 1.35-5.38, <i>P</i> = 0.005) but not in those with CVD (HR = 1.20, 95% CI: 0.41-3.50, <i>P</i> = 0.735).</p><p><strong>Conclusions: </strong>PACE was associated with increased post-discharge mortality after fragility hip fracture, especially in elderly patients without CVD.</p>","PeriodicalId":51294,"journal":{"name":"Journal of Geriatric Cardiology","volume":"21 12","pages":"1099-1108"},"PeriodicalIF":1.8,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}