Cardiology最新文献

{"title":"The Influence of Renal Function on Safety and Effectiveness of Oral Anticoagulant Treatment Among Frail Elderly Patients with Non- Valvular Atrial Fibrillation and Chronic Kidney Disease.","authors":"Mohammed A Qutub, Alaa S Algazzar, Abdullah K Alassiri, Saud A Albukhari, Abdallah H Bokhary, Alsayed Ali Almarghany, Ahmed AbdElmoez Elsayed, Mohamed M Elbably","doi":"10.1159/000546865","DOIUrl":"https://doi.org/10.1159/000546865","url":null,"abstract":"<p><strong>Background: </strong>The effectiveness and safety of oral anticoagulants (OAC) in patients with chronic kidney disease (CKD) and non-valvular atrial fibrillation (NVAF) in Frail Elderly patients has not been fully established.</p><p><strong>Objectives: </strong>To determine the safety and effectiveness related to OACs in Frail Elderly patients with AF and CKD stage II and III.</p><p><strong>Methods: </strong>Frail Elderly patients ≥65 years with AF and CKD who received OAC from January 2022 to June 2024 were retrospectively identified. Primary endpoints were composite of ischemic stroke and systemic embolism (IS/SE), and composite of intracranial bleeding (ICH) and/or gastrointestinal (GI) bleeding. Secondary endpoints included any bleeding.</p><p><strong>Results: </strong>The study enrolled 365 patients, of whom 141 (38.6%) initiated warfarin therapy and 224 (61.3%) initiated DOACs. CHA2DS2-VASc score was non-significant, (2.6±1.01 vs 2.8±0.89, p value 0.054), for GFR ≥ 60 and GFR < 60 mL/min/1.73m² patients respectively. HAS-BLED score (1.9±0.67 vs 2.3±0.70, p value 0.071) for GFR ≥ 60 and GFR < 60 mL/min/1.73m² patients respectively. While the observed incidence of ICH/GI bleeding was numerically higher in patients with GFR <60 mL/min/1.73m², Cox proportional hazards regression did not demonstrate a statistically significant difference in hazard between the groups. The incidence of composite IS/SE was 8.5% in GFR ≥60 mL/min/1.73m² vs. 8.7% in GFR <60 mL/min/1.73m² (HR 1.02, 95% CI 0.60-1.74, p=0.24). Composite ICH/GI bleeding occurred in 7.1% vs. 9.3% (HR 0.89, 95% CI 0.45-2.72, p=0.41).</p><p><strong>Conclusion: </strong>In this study comparing Frail Elderly patients with NVAF and CKD stage II versus stage III receiving OACs, we observed No significant difference in the risk of IS/SE or ICH/GI bleeding between groups. These findings suggest that within moderate CKD (eGFR 30-89 mL/min), renal function stage may not independently influence OAC-related outcomes when anticoagulation is well-managed. Our results may not generalize to less frail populations or those with advanced CKD. Further prospective studies with larger sample size are needed to provide clearer guidance on the optimal use of OACs in this challenging clinical scenario.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-19"},"PeriodicalIF":1.9,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fixed-dose Combination (Polypill) for Myocardial Infarction Prevention: A Meta-analysis of Randomized Controlled Trials.","authors":"Shenshen Zhang, Xi Chen, Bing Liu, Guangjie Shu, Junyan Li, Huiru Huang, Wenxin Lu, Xiaoshuang Hu, Jia Wang, Ruizhe Hu","doi":"10.1159/000546788","DOIUrl":"https://doi.org/10.1159/000546788","url":null,"abstract":"<p><strong>Aims: </strong>Myocardial infarction (MI) is one of the leading causes of death from cardiovascular diseases (CVD). Despite various drugs and treatments, the outcomes have often been unsatisfactory. The purpose of this meta-analysis aims to analyze the effects of polypill intervention on the incidence of MI and the related risk factors, blood pressure and blood lipids.</p><p><strong>Methods: </strong>We conducted a systematic search of appropriate randomized controlled trials (RCTs) in various databases, utilizing preset search terms. Then, we performed a meta-analysis of individual participant data, including studies that investigated the effectiveness of polypill (a fixed-dose combination drug) as compared to usual care in preventing MI. The primary outcomes are MI, CVD mortality, MACE and all-cause mortality. Secondary outcomes include blood pressure levels (systolic blood pressure (SBP), diastolic blood pressure (DBP)) and serum lipid levels (total cholesterol (TC), low-density lipoprotein cholesterol (LDL) and high-density lipoprotein cholesterol (HDL).</p><p><strong>Results: </strong>A total of 14 trials (N = 59,346) were included, with a mean age of 63.2 ± 10.0 years. The results showed that compared to the usual care group, polypill group was associated with a significant reduction of the incidence of MI (OR = 0.76; 95% CI: 0.59 to 0.99; p = 0.04) and MACE (OR = 0.79; 95%CI: 0.65 to 0.97; p = 0.03). The risk reduction for CVD mortality (OR = 0.85; 95%CI :0.65 to 1.11; p = 0.20) and all-cause mortality (OR = 0.99; 95%CI: 0.95 to 1.03; p = 0.59) did not reach statistical significance contrast with the usual care group. Participants who were in polypill group was observed that the change of SBP level (SMD = -0.13; 95%CI: -0.25 to 0.00; p = 0.04), DBP level (SMD = -0.13; 95%CI: -0.19 to -0.06; p = 0.00) and LDL level (SMD = -0.21; 95%CI: -0.36 to -0.06; p = 0.01) reached statistical significance. However, the change of HDL level (SMD = -0.01; 95%CI: -0.06 to 0.04; p = 0.62) and TC level (SMD = -0.15; 95%CI: -0.32 to 0.01; p = 0.06) did not show remarkable difference.</p><p><strong>Conclusion: </strong>These findings suggested that polypill not only is highly effective for preventing MI and reducing the incidence of MACE, but also can lower blood pressure levels and blood lipid levels.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-19"},"PeriodicalIF":1.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overlooked Trigger of Migraine-Clinical Significance of Small and Medium-Shunt Patent Foramen Ovale.","authors":"Jia-Ning Fan, Ming-Fei Li, Bei-Jian Zhang, Lei Zhang, Wan-Jiao Chen, Da-Wei Lin, Long Cheng, Shi-Qiang Hou, Dan-Dan Chen, Hai-Yan Chen, Yu-Hao Li, Xiao-Chun Zhang, Da-Xin Zhou, Jun-Bo Ge","doi":"10.1159/000546696","DOIUrl":"https://doi.org/10.1159/000546696","url":null,"abstract":"<p><strong>Background: </strong>Patent Foramen Ovale (PFO) is a prevalent congenital heart malformation closely linked with migraine. The effect of PFO size on migraine remains controversial.</p><p><strong>Methods: </strong>This study analyzed migraine patients who underwent PFO closure at our institution from January 2020 through December 2022. Based on transthoracic echocardiography (TTE) findings, the patients were classified into two groups through two distinct classification approaches: method (A) permanent shunt (PS) group or non-PS group, and method (B) large shunt under Valsalva maneuver (LSVM) group or small to moderate shunt under Valsalva maneuver (SMSVM) group. Migraine improvement and adverse events after PFO closure were recorded.</p><p><strong>Results: </strong>A total of 201 migraine patients were included in this study, 110 (54.7%) had PS and 118 (58.7%) had LSVM. The PS and LSVM groups experienced less migraine burden (57.1±64.5 vs. 88.5±96.5 hours, P=0.035; 59.7±67.3 vs. 88.9±96.6 hours, P=0.039). The LSVM group had shorter headache episode durations (11.0±8.2 vs. 14.4±12.3 years, P=0.045). The PS and LSVM groups showed less absolute reduction in migraine burden (33.8±55.2 vs. 71.2±84.9 hours, P=0.032; 33.9±50.5 vs. 76.3±92.8 hours, P=0.008). The LSVM group had a lower rate of alleviation (79.7% vs. 95.2%, P=0.018). Medium to large residual shunt (MLRS) and SMSVM were independent predictors of migraine improvement, and a history of cryptogenic stroke (CS) was a predictor of migraine termination.</p><p><strong>Conclusion: </strong>SMSVM PFO in migraine patients has significant clinical implications and positive intervention outcomes. Both SMSVM and MLRS are associated with migraine relief, and a history of CS is a predictor of migraine termination.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-16"},"PeriodicalIF":1.9,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Decrease in Left Ventricular Size with Age: Impact on Mortality and Cardiovascular Hospitalization.","authors":"Israel Gotsman, Ayelet Shauer, Donna R Zwas, Andre Keren, Offer Amir, David Leibowitz","doi":"10.1159/000546673","DOIUrl":"https://doi.org/10.1159/000546673","url":null,"abstract":"<p><strong>Background: </strong>A small left ventricular (LV) chamber size may reflect adverse cardiac remodeling and have prognostic implications. The prognostic significance of reductions in LV size in hearts with normal baseline LV size remains unclear. This study investigated clinical characteristics and outcomes associated with longitudinal decreases in LV size in this population.</p><p><strong>Methods: </strong>We analyzed echocardiographic data from 6,232 adults with normal baseline left ventricular end-diastolic diameter (LVEDD), with a mean interval of 4.8 years between baseline and follow-up echocardiograms. Participants were categorized by LVEDD change from baseline: No Change (<5 mm), Decreased (≥5 mm), and Increased (≥5 mm).</p><p><strong>Results: </strong>A decrease in LVEDD was observed in 24% of participants (mean change -9±3 mm) and was significantly associated with older age, female sex, decreased volumes, concentric remodeling and diastolic dysfunction. LVEDD increase (13%, 9±4 mm) was associated with higher prevalence of cardiovascular comorbidities and reduced LVEF. Multivariable Cox regression showed decreased LVEDD was independently associated with increased mortality (HR 1.19, 95% CI 1.03-1.37, p=0.02). Sensitivity analysis using annual LVEDD change (>1mm/year) demonstrated a significant association with mortality (HR 1.45, 95% CI 1.26-1.66, p<0.001) and the combined endpoint of death/cardiovascular hospitalization (HR 1.26, 95% CI 1.12-1.41, p<0.001). Restricted cubic spline analysis confirmed a U-shaped relationship between continuous LVEDD change and mortality. Furthermore, increase or decrease in left ventricular end-diastolic volumes were associated with increased mortality and death/cardiovascular hospitalization.</p><p><strong>Conclusions: </strong>A progressive decrease in LVEDD in normal-sized hearts was independently associated with adverse outcomes, highlighting the prognostic importance of declining LV size.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-22"},"PeriodicalIF":1.9,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Changes in Fasting Plasma Glucose Before and After Heart Failure Diagnosis on All-Cause Mortality.","authors":"Boheng Zhang, Xiaokun Liu, Shouling Wu, Jing Yang, Qing Yue, Shuohua Chen, Quanle Han, Wei Wang, Qi Zhang","doi":"10.1159/000546661","DOIUrl":"https://doi.org/10.1159/000546661","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluates the impact of fasting plasma glucose (FPG) changes before and after heart failure (HF) diagnosis on all-cause mortality, offering insights into personalized HF management strategies.</p><p><strong>Methods: </strong>A prospective cohort study based on the Kailuan study included 3533 Patients with HF after excluding those with prior HF, malignancies, or missing FPG data. FPG levels were measured before and after HF diagnosis and categorized into five groups: significant decrease (Q1), mild decrease (Q2), stable (Q3), mild increase (Q4), and significant increase (Q5). The primary endpoint was all-cause mortality, with follow-up until December 31, 2021.</p><p><strong>Results: </strong>Over a mean follow-up of 5.63±3.80 years, 1446 deaths occurred. Kaplan-Meier analysis showed increased mortality with larger FPG changes (P<0.0001). Multivariate Cox regression indicated higher mortality risks in Q1 and Q5 compared to Q3, with hazard ratios of 1.37 (95% CI: 1.12-1.67) and 1.35 (95% CI: 1.12-1.62), respectively.</p><p><strong>Conclusion: </strong>FPG changes before and after HF diagnosis are independent predictors of mortality, with significant changes linked to higher risks, underscoring the need for individualized glucose management in Patients with HF.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-20"},"PeriodicalIF":1.9,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Torsemide in HFrEF: Revisiting the Role of a Potent Loop Diuretic for Enhanced Outcomes and Renal Safety.","authors":"Wei-Chieh Lee, Wen-Shiann Wu","doi":"10.1159/000546106","DOIUrl":"10.1159/000546106","url":null,"abstract":"","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-3"},"PeriodicalIF":1.9,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renaissance of Physical Examination in Hemodynamic Heart Failure Assessment.","authors":"Takahiro Okumura, Hiroaki Hiraiwa, Satoshi Yanagisawa, Toyoaki Murohara","doi":"10.1159/000546543","DOIUrl":"https://doi.org/10.1159/000546543","url":null,"abstract":"","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-8"},"PeriodicalIF":1.9,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Gut-Heart Axis in Heart Failure: Emerging Evidence and Therapeutic Implications.","authors":"Takahiro Okumura, Hiroaki Hiraiwa, Satoshi Yanagisawa, Toyoaki Murohara","doi":"10.1159/000546542","DOIUrl":"https://doi.org/10.1159/000546542","url":null,"abstract":"","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-7"},"PeriodicalIF":1.9,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic Arterial Lactate Values Are Associated with 30-Day Mortality in Patients with Acute Myocardial Infarction and Cardiogenic Shock on Intra-Aortic Balloon Pump Circulatory Support.","authors":"Javier López Pais, Victor Jimenez Ramos, María López Pais, Guillermo Gallego Latorre, Luis Manuel López Barreiro","doi":"10.1159/000545746","DOIUrl":"https://doi.org/10.1159/000545746","url":null,"abstract":"","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-2"},"PeriodicalIF":1.9,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exosomal TIMP4 from myocardial cell relieves heart failure by influencing Th17/Treg Balance.","authors":"Dapeng Wu, Chunfeng Li, Hongjie Li, Lei Yu, Wenting Lin","doi":"10.1159/000545905","DOIUrl":"https://doi.org/10.1159/000545905","url":null,"abstract":"<p><strong>Introduction: </strong>The progression of heart failure (HF) has been independently linked to both tissue inhibitor of metalloproteinase-4 (TIMP4) and the equilibrium between regulatory T (Treg) as well as T helper 17 (Th17) cells. Despite these associations, the interplay between TIMP4 and the Th17/Treg ratio remains poorly understood. Our research sought to elucidate the impact of TIMP4 on HF pathogenesis, with a particular emphasis on its influence on Th17 and Treg lymphocyte populations.</p><p><strong>Methods: </strong>Bioinformatics analysis of the GSE196656 dataset was conducted. An isoprenaline-induced Sprague-Dawley rat model of heart failure was used, with rats divided into groups: HF alone, HF with TIMP4 overexpression, and HF with TIMP4 knockdown. Heart failure in primary myocardial cell cultures was induced using Angiotensin II, and exosomes were collected from the culture medium. ELISA, western blot, TUNEL staining, qRT-PCR, RNA extraction analysis the impact of TIMP4 on heart failure. Additionally, purified naïve CD4+ T cells from rats were used in vitro to investigate TIMP4's influence on Th17 and Treg cell differentiation.</p><p><strong>Results: </strong>Analysis of the GSE196656 dataset revealed significant upregulation of TIMP4 in heart failure. Myocardial exosomal TIMP4 was significantly elevated in the heart failure model. In the experimental rat model, TIMP4 overexpression significantly reduced plasma levels of biomarkers related to heart injury as well as inflammation, enhanced indicators of heart function and suppressed cell death in the heart muscle. Furthermore, TIMP4 overexpression decreased IL-17 levels and the Th17 cell proportion while promoting Treg cell differentiation and increasing IL-10 levels. In vitro studies demonstrated that TIMP4 effectively inhibits the differentiation of Th17 cells and promotes the growth of Treg cells. These effects were observed to vary depending on the dosage.</p><p><strong>Conclusion: </strong>TIMP4 overexpression exerts a protective effect in heart failure by inhibiting myocardial injury, inflammation, and apoptosis, and by regulating immune cell balance. These findings imply that targeting TIMP4 could potentially serve as a therapeutic strategy for heart failure, as it has the ability to regulate immune responses and minimize damage to the myocardium.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-15"},"PeriodicalIF":1.9,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}