Search Results (95)

Introduction: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) caused a global pandemic that emerged in 2019. During this period, a significant disparity in hospitalization and mortality rates emerged, particularly in terms of Ethnicity and sex. Notably, this study aims to examine the influence of sex and Ethnicity on acute coronary syndrome outcomes, specifically during the global SARS-CoV-2 pandemic. Methods: This retrospective observational study analyzed adult patients hospitalized with a primary diagnosis of acute coronary syndrome in the United States in 2020. Primary outcomes included inpatient mortality and the time from admission to percutaneous coronary intervention (PCI). Secondary outcomes encompassed the length of stay and hospital costs. The National Inpatient Sample (NIS) database was utilized to identify and study patients in our test group. Results: A total of 779,895 patients hospitalized with a primary diagnosis of acute coronary syndrome in the year 2020 and 935,975 patients in 2019 were included in this study. Baseline findings revealed that inpatient mortality was significantly higher in 2020 compared to 2019, regardless of sex and Ethnicity (adjusted odds ratio (aOR) 1.20, 95% confidence interval (CI) 1.12–1.23, p-value < 0.001). Concerning primary outcomes, there was no difference in inpatient mortality for hospitalized patients of different sexes between 2019 and 2020 (STEMI: aOR 1.05, 95% CI 0.96–1.14, p-value 0.22; NSTEMI/UA aOR 1.08, 95% CI 0.98–1.19, p-value 0.13). Regarding time to admission for PCI, NSTEMI/UA cases were found to be statistically significant in female patients compared to males (mean difference 0.06 days, 95% CI 0.02–0.10, p-value < 0.01) and African Americans compared to Caucasians (mean difference 0.13 days, 95% CI 0.06–0.19, p < 0.001). In terms of the length of stay, female patients had a shorter length of stay compared to males (mean difference −0.22, 95% CI −0.27 to −0.16, p-value < 0.01). Conclusions: As acute coronary syndrome is an urgent diagnosis, a global pandemic has the potential to exacerbate existing healthcare disparities related to sex and Ethnicity. This study did not reveal any difference in inpatient mortality, aligning with studies conducted prior to the pandemic. However, it highlighted significantly longer treatment times (admission to PCI) for NSTEMI/UA management in female and African American populations. These findings suggest that some disparities may have diminished during the pandemic year, warranting further research to confirm these trends in the years to come. Full article

Objectives: To assess the overall association of lifestyle behaviors with multiple cardiovascular risk factors and mortality. Material and Methods: In the Italian Rural Areas of the Seven Countries Study, involving 1712 middle-aged men (40–59 years) enrolled in 1960, smoking habits, physical activity, dietary habits, marital status, and socioeconomic status (SES) were studied as possible determinants of 15 measurable risk factors (body mass index, tricipital and subscapular skinfold, arm circumference, systolic and diastolic blood pressure, heart rate, double product (systolic blood pressure × heart rate), vital capacity, forced expiratory volume, serum cholesterol, urine protein, urine glucose, corneal arcus and xanthelasma) using canonical correlation (CC). Results: The first CC had a value of 0.54 (R² 0.29, p < 0.0001). The role of marital status was marginal; that of a high SES was contrary to expectations. The strongest behaviors based on standardized CC coefficients were dietary habits and physical activity. The risk factors mostly associated with overall lifestyle behaviors were some anthropometric and cardiovascular measurements. The mean levels of risk factors distributed in tertile classes of the CC variate score of lifestyle behaviors were largely associated in a coherent and graded way with the expected relationship of behaviors versus risk factors. In a large series of Cox models, the CC variate scores were significantly associated with 50-year coronary heart disease (CHD) mortality and much less with stroke and other heart diseases of uncertain etiology. Conclusions: Lifestyle behaviors correlate well with cardiovascular risk factors associated with CHD mortality, and CC is a useful method of analysis to detect long-term impacting characteristics. Full article

Cardiovascular diseases are the most common cause of death worldwide, and they still have dramatic consequences on the patients’ lives. Murine models are often used to study the anatomical and microstructural changes caused by the diseases. Contrast-enhanced microfocus computed tomography (CECT) is a new imaging technique for 3D histology of biological tissues. In this study, we confirmed the nondestructiveness of Hf-WD 1:2 POM-based CECT and cryogenic CECT (cryo-CECT) to image the heart in 3D. The influence of the image quality (i.e., acquisition time and spatial resolution) was assessed for the characterization of the heart structural constituents: heart integrity, the coronary blood vessels and the heart valves. Coronary blood vessels were visualized and segmented in murine hearts, allowing us to distinguish veins from arteries and to visualize the 3D spatial distribution of the right coronary artery and the left main coronary artery. Finally, to demonstrate the added value of 3D imaging, the thickness distribution of the two leaflets in the mitral valve and three cusps in the aortic valve was computed in 3D. This study corroborates the added value of CECT and cryo-CECT compared to classical 2D histology to characterize ex vivo the structural properties of murine hearts and paves the way for the detailed 3D (micro)structural analyses of future cardiovascular disease models obtained in mice and rats. Full article

Chronic heart failure (HF) is the 21st-century cardiovascular epidemic, marked by recurrent hospitalizations and high mortality rates, and represents a considerable burden on Western societies. The complex care demands of HF patients require multidisciplinary approaches, aligning with contemporary guidelines. Accordingly, the Excellence in Heart Failure Program, implemented in Portuguese tertiary hospitals, aims to establish multidisciplinary HF outpatient clinics in Portugal, improving patients’ clinical outcomes. Herein, the results of its pilot project are presented, showing that the implementation of the multidisciplinary clinic resulted in a minimal number of hospitalizations and emergency visits, with only one rehospitalization reported. In addition, patients in the Program experienced significant improvements in ejection fraction (EF) and NT-proBNP levels. Despite the limited power of the sample, these findings underscore the effectiveness of the Program in the management of Portuguese HF patients, particularly in the early discharge period after heart failure, when patients are most vulnerable. Full article

Cardiomyopathies are major causes of heart failure. Chagas disease (CD) is caused by the parasite Trypanosoma cruzi, and it is endemic in Central and South America. Thirty percent of cases evolve into chronic chagas cardiomyopathy (CCC), which has worse prognosis as compared with other cardiomyopathies. In vivo bioenergetic analysis and ex vivo proteomic analysis of myocardial tissues highlighted worse mitochondrial dysfunction in CCC, and previous studies identified nuclear-encoded mitochondrial gene variants segregating with CCC. Here, we assessed the role of the mitochondrial genome through mtDNA copy number variations and mtDNA haplotyping and sequencing from heart or blood tissues of severe, moderate CCC and asymptomatic/indeterminate Chagas disease as well as healthy controls as an attempt to help decipher mitochondrial-intrinsic genetic involvement in Chagas disease development. We have found that the mtDNA copy number was significantly lower in CCC than in heart tissue from healthy individuals, while blood mtDNA content was similar among asymptomatic Chagas disease, moderate, and severe CCC patients. An MtDNA haplogrouping study has indicated that African haplogroups were over represented in the Chagas subject groups in comparison with healthy Brazilian individuals. The European lineage is associated with protection against cardiomyopathy and the macro haplogroup H is associated with increased risk towards CCC. Using mitochondria DNA sequencing, 84 mtDNA-encoded protein sequence pathogenic variants were associated with CCC. Among them, two variants were associated to left ventricular non-compaction and two to hypertrophic cardiomyopathy. The finding that mitochondrial protein-coding SNPs and mitochondrial haplogroups associate with risk of evolving to CCC is consistent with a key role of mitochondrial DNA in the development of chronic chagas disease cardiomyopathy. Full article

The epicardium is a very dynamic cardiac layer with pivotal contributions during cardiogenesis, acting in the postnatal period as an apparently dormant single-cell layer. In mammalian embryos, the epicardium, which originates form the proepicardium, translocates into the pericardial cavity and subsequently rests on the surface of the myocardium. Later, it gives rise to the epicardium-derived cells, which migrate into subepicardial space, invade the developing myocardium, promoting its growth, and contribute to different cell types. Anomalies in the process of epicardial development, the generation of epicardium-derived cells and their signaling mechanisms in different experimental models lead to defective cardiac development, reminiscent of human congenital heart diseases. Furthermore, recent studies have reported that epicardial derivates in adults, i.e., epicardial adipose tissue, are associated with electrophysiological cardiovascular anomalies. Herein, we provide a state-of-the-art review focusing on both congenital and adult heart diseases associated with epicardial development. Full article

Background: Both valvular heart disease (VHD) and atrial fibrillation (AF) frequently coexist. AF is an important cause of arrhythmias with a definitive cardiovascular morbidity. The use of either vitamin K antagonists (VKAs/warfarin) or direct oral anticoagulants (DOACs) (also known as new oral anticoagulants (NOACs)) has been the mainstay for preventing stroke and systemic embolism in patients with VHD and/or AF, and this has been broadly discussed. However, there are limited studies on anticoagulation therapy for patients with valvular atrial fibrillation (VAF). The main aim of this meta-analysis was to evaluate the outcomes (stroke–vascular events and intracranial bleeding) following DOAC and VKA treatment amongst patients with VAF. Methods: We identified clinical trials and observational studies published in the last 10 years. A systematic review and a meta-analysis were performed to evaluate the outcomes of patients with valvular atrial fibrillation following DOAC vs. VKA treatment. Data evaluation was performed using Review Manager 5.4; the endpoints were stroke–vascular events and intracranial bleeding following DOAC and VKA treatment amongst VAF patients. Risk ratios (RR) were evaluated with 95% confidence intervals. Using random effects models, forest plots were obtained. Heterogeneity was assessed by using the I² statistic. Results: Eight studies were included in this metanalysis, and a total of fifteen thousand two hundred and fifteen patients (DOAC (8732) and VKA (6483)) were pooled. We found a significant risk reduction in stroke–vascular events when using DOACs in comparison with using VKAs (pooled RR: 0.76; 95% CI: 0.64–0.90, p = 0.002). A total of 14862 patients (DOAC (8561) and VKA (6301)) were pooled from a total of six studies for intracranial bleeding. We found a significant risk reduction in terms of intracranial bleeding when using DOACs in comparison with using VKAs (pooled RR: 0.43; 95% CI: 0.24–0.77, p ≤ 0.05). Conclusions: When compared to VKAs, DOAC agents were found to have less risk of stroke–vascular events and intracranial bleeding. Further prospective studies are essential to establish the efficacy and safety of DOAC agents in patients with various subtypes of VAF. Full article

Background: Patients with chronic heart failure often experience repeated acute exacerbations leading to high rates of rehospitalization. Therefore, the management of patients to prevent rehospitalization and retain their physical function is important. Brain natriuretic peptide (BNP) and N-terminal-pro BNP are used to estimate the conditions of patients with chronic heart failure, but some hospitals cannot measure these levels in real time. To overcome this, we used bioelectrical impedance analysis as an alternative. Methods and results: Between April 2017 and December 2019, we measured water balance in the outpatient department of Hirose Hospital in three groups: those who had been hospitalized for chronic heart failure (257 patients), those with chronic heart failure who had not been hospitalized (224 patients), and controls with other chronic diseases (275 patients). We found that water balance was significantly correlated to the history of hospitalization, and age was a confounding bias in this correlation, regardless of whether patients have been hospitalized with chronic heart failure. Moreover, patients who have high extracellular water content/total body water content ratios, even in a stable period, are at risk of becoming unstable and experiencing rehospitalization. Conclusion: Water balance monitoring could be a useful indicator to estimate patient condition in real time and predict improvement in chronic heart failure. This easy-to-use indicator may enable timely management of exacerbation of patient condition and reduce hospitalization events. Full article

While still considered a high-risk procedure, cardiac catheterization during the early postoperative period is being performed more frequently in the current era. Limited data are currently available concerning the acute hemodynamic consequences of these procedures. Therefore, the purpose of this study was to evaluate the safety/efficacy of cardiac catheterization performed within thirty days of congenital heart surgery. We completed a retrospective review of all catheterizations within 30 days of congenital heart surgery. Procedures were performed due to failure to progress or hemodynamic deterioration. There were 1873 congenital heart surgeries during the study period. One hundred and three (6.2%) patients with a median age of 124 days underwent catheterization. Sixty-three cases received interventions, and forty patients underwent diagnostic catheterization. Early cardiac catheterization did not show a significant immediate change in the hemodynamics or inotrope score. Survival for patients undergoing diagnostic Cath (81%) did not differ significantly from the intervention group (89%). Although cardiac catheterization was performed on patients at the highest risk for death in the postoperative period, catheter intervention did not increase the risk of death. Those patients undergoing catheter intervention did not seem to experience major adverse events but achieved mild improvement in tissue perfusion. Full article

A mature Caucasian patient, an endurance-trained triathlete (age group), had a routine ECG. The patient was immediately referred to Emergency based on supposed ECG abnormalities indicating a heart attack. This diagnosis was quickly dismissed based on no symptoms, heart rate of 50 BPM, athletic status, excellent health, and no prior cardiovascular problems. The patient had a history of severe white coat hypertension and underwent a further stress test and echocardiogram. The stress test showed exaggerated systolic blood pressures (over 225 mmHg) and high in-clinic basal blood pressures (160/90 mmHg), and the patient was diagnosed as hypertensive with exercise blood pressure close to stroke territory. He was told to stop racing, reduce training, and was prescribed antihypertensive drugs (which he did not take). Subsequent at-home 24 h (values close to 120/80 mmHg) and stress blood pressure measurements reversed that decision when considered in combination with an excellent echocardiogram result. The literature clearly describes endurance-trained athletes with systolic pressures over 225 mmHg Hg as being conditioned with no pathological aspects. Endurance-trained athletes should be examined as special cases in the field of cardiovascular medicine as trained physiological responses often present as cardiac abnormalities, and misdiagnosis can inappropriately change the athlete’s life. Full article

Heart failure (HF) is a syndrome suffered by more than 26 million people worldwide. SGLT2 inhibitors are drugs that have been shown to positively affect the management of HF patients, regardless of their diabetes status. A retrospective observational study was conducted on heart failure patients with reduced ejection fraction (HFrEF) enrolled at the HF clinic, who were on SGLT2 inhibitors. For these patients, baseline and follow-up data were collected and analyzed over time. Changes over time were quantified and statistical analysis was conducted to validate whether the changes were significant. After the screening of all the HF program patients, 24 met the inclusion criteria, with an average age of 68 years. Through the study, it was possible to find a statistically significant difference in the values of NT-ProBNP before and after adding a SGLT2 inhibitor in 14 patients (p = 0.0214). In addition, there was an improvement in the NYHA functional scale of 71% and no significant change in renal function or other laboratory values. Based on the studied parameters and throughout the clinical changes during the follow-up period, it was possible to establish an improvement in HFrEF patients on SGLT2 inhibitors as part of their therapy. Full article