Search Results (1,647)

Background/Objectives: Although differences seem to exist by age in primary cardiovascular prevention with acetylsalicylic acid (ASA), direct comparisons are lacking, as are studies with real-world data. We sought to examine the effectiveness of ASA in reducing cardiovascular diseases and overall mortality in patients at high risk by age subgroups. Methods: We designed a retrospective cohort study using the database of the Catalan primary care system (SIDIAP), Spain, for the period 2006–2020. Included participants were high-cardiovascular-risk individuals without previous vascular disease. We considered people aged 40 to 59 and ≥60 years of age. We assessed the incidences of atherosclerotic cardiovascular disease (ASCVD), all-cause mortality, and ASA adverse effects using Cox proportional hazards modelling, adjusted by the propensity score of ASA treatment. Results: During the study period, 7576 and 30,282 people were aged 40 to 59 and ≥60 years, respectively. The median follow-up was 11.21 (10.71–11.54) years (40 to 59 year-olds) and 11.09 (10.55–11.54) years (≥60 year-olds). The hazard ratio of ASA use for ASCVD in the group aged 40–59 years was 0.64 (0.41–0.99). The number needed to treat in this group was 40 persons and the number that needed to harm for gastrointestinal bleeding (the only adverse effect with significant hazard ratio) was 75 individuals. Conclusions: This direct comparison of real-world age groups at high cardiovascular risk showed no benefit but increased risk in the older population (≥60 years). In the younger subgroup, our observations would support primary prevention with ASA with a consideration of the individual optimal risk–benefit. Full article

Background: Despite improvements in medical therapy, heart failure with reduced ejection fraction (HFrEF) is a major burden on the healthcare system and remains a leading cause of death with a 5-year mortality rate of more than 60%. Novel therapeutic agents such as angiotensin-receptor-neprilysin-inhibitors (ARNIs) lead to significant improvement in clinical outcomes. Optimal therapy monitoring under these novel drugs is crucial for improving the outcome. In this trial, the diagnostic potential of four novel cardiovascular biomarkers—GDF-15, sST2, H-FABP, and suPAR—was evaluated during follow-up in patients with HFrEF. Methods: In this prospective cohort pilot study, 70 patients with HFrEF with ischemic (n = 34) and non-ischemic (n = 36) origin were included. All included patients were on a stable treatment regimen and in a non-decompensated state. The clinical parameters NYHA class, LVEF, MPI/Tei index and ESC Score 2 and the laboratory parameters sST2 (remodeling, inflammation), GDF-15 (remodeling, inflammation), H-FABP (subclinical ischemia and ischemia), suPAR (remodeling, inflammation) and NT-proBNP were assessed before ARNI therapy initiation and at 3 to 6 months at follow-up. Before starting ARNI therapy with sacubitril/valsartan patients had stable and well-established heart failure therapy. Results: There was a sufficient response to therapy with significant improvement in ejection fraction from 29.9% to 38.5% (p < 0.001) and a significant decrease in NT-proBNP from 1402 pg/mL to 572.0 pg/mL (p = 0.003). Interestingly, along with that, a significant increase in sST2 levels from 9602 pg/mL to 12,001 pg/mL (p = 0.039) but no significant change in H-FABP (p = 0.397), GDF-15 (p = 0.382) or suPAR (p = 0.328) were observed. Furthermore, the baseline sST2 level correlated with the risk of cardiovascular events calculated with the ESC Score 2 and the GDF15 level at follow-up correlated with the right ventricular global function, assessed with the MPI/Tei index and this correlation persisted after correction for confounders (r = 0.323, p = 0.039; r = 0.504, p = 0.011). Conclusions: The novel biomarker sST2 but not H-FABP, GDF-15 and suPAR was significantly affected by medical therapy with ARNIs. Monitoring sST2 might offer new opportunities for therapy guidance and disease management. However, these results are hypothesis generating and should be interpreted with caution, given the pilot nature of this study. Full article

Background: Patients presented for complicated redo surgery after previous aortic valve replacement with the indication for aortic root repair due to dilatation or aneurysm. In those cases where the prosthetic aortic valve is in good condition, a valve-sparing procedure might simplify the complicated surgery. The aim of this case series paper is to describe a technique and to show the results of repairing the aortic root without compromising the previously inserted, well-functioning mechanical aortic valve. Methods: Between March 2017 and May 2017, 11 patients underwent re-sternotomy with placement on cardiopulmonary bypass with cardiac arrest and exposure of the aortic root. After the aortotomy, the aortic valve was inspected. Subsequently, the aortic sinuses were resected, sparing the coronary ostia buttons. A prosthetic tube was implanted above the preexisting valve. Finally, the coronary ostia were reattached to the tube, turning this procedure into a complete Bentall. Results: Echocardiography demonstrated fully functional valves and well-implanted aortic prosthesis. All patients were discharged within ten days post-surgery without any adverse events. Conclusions: The delayed two-stage Bentall procedure is a feasible and safe technique that preserves pre-implanted valves and does not cause any distortion of the aortic annulus. Full article

Background: The identification of the left anterior descending (LAD) artery as the culprit vessel in ST-segment elevation myocardial infarction (STEMI) is critical for rapid decision-making and targeted reperfusion. Electrocardiography (ECG) remains a vital diagnostic tool, especially in cases of no prior clinical or imaging data. This study evaluates the accuracy of 12-lead ECG in identifying LAD involvement and occlusion level, while examining the prognostic significance of proximal versus distal LAD lesions in the era of modern reperfusion techniques. Methods: Data from 382 patients with STEMI were analyzed, focusing on the correlation between specific ECG patterns, particularly ST-segment elevation in aVL and aVR, and coronary angiographic findings. The predictive performance of ECG in localizing proximal LAD lesions was assessed through sensitivity, specificity, and predictive values. Clinical outcomes at 30 days and 2.5 years were compared between patients with proximal and distal LAD occlusions. Results: ST-segment elevation ≥ 0.5 mm in aVL or elevation in aVR, when associated with elevation in at least two contiguous precordial leads (V2–V4), demonstrated good sensitivity and predictive value for proximal LAD occlusion. Contrary to earlier studies, no significant difference in short- or long-term clinical outcomes was observed between proximal and distal LAD occlusion groups, possibly reflecting improvements in percutaneous coronary intervention (PCI) techniques and modern pharmacotherapy. Conclusions: The 12-lead ECG remains a valuable tool for identifying LAD as the culprit artery and approximating lesion location. However, in the era of advanced reperfusion therapy, the prognostic value of proximal LAD occlusion may be less pronounced than previously thought. These findings support a nuanced interpretation of ECG in guiding acute management without overestimating the long-term prognostic weight of lesion location alone. Full article

Background/Objectives: Cardiac involvement in systemic sclerosis (SSc) ranges from subclinical to severe. While pulmonary artery hypertension (PAH) is well-documented, the mechanism of left ventricular (LV) ischemia remains unclear. Oxygen-sensitive cardiovascular magnetic resonance (OS-CMR) imaging offers a novel approach to assessing myocardial oxygenation and ischemia. This study evaluated the changes in myocardial deoxygenation in response to stress using LV OS-CMR in SSc patients without known cardiac disease. Methods: We prospectively recruited SSc patients without prior cardiac disease or risk factors, and age- and sex-matched healthy volunteers (HVs). All participants underwent transthoracic echocardiography (TTE) and 3T CMR, including native T1 mapping, rest/stress OS-CMR, stress perfusion, and late gadolinium enhancement (LGE). The primary outcome was a change in the LV OS-CMR signal intensity (SI) after adenosine stress. Results: Thirty-three participants (23 SSc, 10 HV) were enrolled. SSc patients had significantly lower global LV OS-CMR SI compared to HV (13.4 ± 6.5 vs. 19.5 ± 3.6, p = 0.011). OS-CMR SI change ≤ 10% was observed in at least one segment in 20 (87%) SSc patients and globally in 12 (52%). LGE was present in 5 (22%) patients, and 18 (78%) had ≥1 abnormal T1 mapping segment. LV global longitudinal strain (GLS) was reduced in SSc patients compared to the HVs (−19.04 ± 3.86 vs. −21.92 ± 3.72, p = 0.045). All HVs had normal CMR and TTE findings. Conclusions: SSc patients without known cardiovascular disease or PAH demonstrated subclinical LV ischemia with an impaired myocardial oxygenation response to stress. They further demonstrated LV myocardial deformation abnormalities and LV diffuse fibrosis when compared to an age-matched control group. Our findings support the presence of early coronary microvascular dysfunction and LV myocardial fibrosis in this population, which may explain the adverse cardiovascular risk seen in this population, independent of the presence of PAH. Full article

Background: In recent years, multiple transcatheter devices have been developed for tricuspid valve intervention. The aim of this study was to evaluate acute tricuspid annular remodeling following percutaneous leaflet repair using a leaflet approximation device for the reduction of tricuspid regurgitation (TR). Methods: This retrospective cohort study included 26 consecutive patients treated at two centers. Tricuspid annular geometry was assessed using three-dimensional transesophageal echocardiography during the procedure. Results: The mean age of the cohort was 79.3 years, and 88.5% were female. All patients had severe or greater TR pre-procedure, mostly due to annular dilation. The procedure was successful in all cases, with at least a one-grade reduction in TR observed prior to hospital discharge. Significant reductions were observed in the mean septal-lateral diameter (4.09 ± 0.44 cm vs. 3.54 ± 0.53 cm, p < 0.0001), mean major diameter (4.65 ± 0.63 cm vs. 4.28 ± 0.65 cm, p = 0.0002), planimetric area (14.00 ± 2.91 cm² vs. 11.25 ± 2.91 cm², p < 0.0001), and perimeter (13.62 ± 1.43 cm vs. 12.42 ± 1.62 cm, p < 0.0001) of the tricuspid annulus. Conclusions: In this small real-world cohort, transcatheter edge-to-edge repair was found to be both effective and safe. The use of a leaflet approximation device not only reduced TR severity but also led to significant reductions in annular dimensions. To our knowledge, this study provides additional evidence of acute tricuspid annulus remodeling following edge-to-edge repair, which may have significant therapeutic implications. Full article

Background: Diabetes mellitus (DM) is a significant factor affecting prognosis and functional capacity in patients after cardiovascular events. This study aimed to assess the impact of coexisting diabetes on exercise tolerance and hemodynamic parameters in patients qualified for cardiac rehabilitation. Methods: A total of 452 patients (86 women, 366 men; mean age 63.21 ± 7.16 years) who had experienced cardiovascular incidents, including 226 individuals with coexisting DM (DM group) and 226 age- (±1 year) and sex-matched individuals without DM (non-DM group), were included in the analysis. All participants underwent an exercise test using a bicycle ergometer. Clinical data, comorbidities, medication use, left ventricular ejection fraction, and exercise test parameters were evaluated. Results: Patients with DM displayed a higher number of comorbidities (4.29 ± 1.26 vs. 3.19 ± 1.30; p < 0.001), greater medication use (8.71 ± 2.16 vs. 7.83 ± 2.05; p < 0.001), higher body mass (86.93 ± 13.35 kg vs. 80.92 ± 15.25 kg; p < 0.001), and a lower left ventricular ejection fraction (48.78 ± 8.99% vs. 50.01 ± 8.40%; p = 0.002) compared to those in the non-DM group. Diabetic patients also exhibited lower exercise capacity, expressed as peak power per kilogram of body mass (1.05 ± 0.27 W/kg vs. 1.16 ± 0.31 W/kg; p < 0.001). No significant differences were observed regarding absolute peak power or maximum heart rate. Conclusions: In patients after cardiovascular incidents, the presence of diabetes is associated with reduced relative exercise capacity and lower ejection fraction. Full article

Sodium–glucose co-transporter-2 inhibitors (SGLT2is) and GLP-1 receptor agonists (GLP-1 RAs) are now established as cornerstone therapies for patients with type 2 diabetes mellitus (T2DM), given their cardiovascular and renal protective properties. However, their use in patients with peripheral artery disease (PAD) remains controversial due to concerns raised in early trials about potential increases in lower limb complications, particularly amputations. This narrative review examines current evidence on the association between SGLT2is and GLP-1 RAs in PAD-related outcomes, including limb events, amputation risk, and cardiovascular and renal endpoints. Drawing from randomized controlled trials, real-world cohort studies, and systematic reviews, we provide an integrated perspective on the safety and utility of SGLT2is and GLP-1 RAs in individuals with PAD, highlight patient selection considerations, and identify areas for future investigation. Full article

Significant progress has been achieved in the treatment of acute aortic dissection over the past 90 years, following the first surgical intervention. This review pays tribute to the dedication of pioneers and innovators who developed advanced medical devices and therapeutic strategies to address this challenging condition. While navigating uncertainties in treatment optimization, the primary focus of the therapeutic strategies has been to save lives by increasing survival rates during the acute phase and to prevent aorta-related lethal events and late-stage thoracoabdominal aortic replacements. From a neutral standpoint, this review traces over 90 years of progress in treating acute aortic dissection. We hope that as many patients as possible will receive treatment rationally, without over- or under-treatment. Full article

Plaque erosion (PE) is now recognized as a common and clinically significant cause of acute coronary syndromes (ACSs), accounting for up to 40% of cases. Unlike plaque rupture (PR), PE involves superficial endothelial loss over an intact fibrous cap and occurs in a low-inflammatory setting, typically affecting younger patients, women, and smokers with fewer traditional risk factors. The growing recognition of PE has been driven by high-resolution intracoronary imaging, particularly optical coherence tomography (OCT), which enables in vivo differentiation from PR. Identifying PE with OCT has opened the door to personalized treatment strategies, as explored in recent trials evaluating the safety of deferring stent implantation in selected cases in favor of intensive medical therapy. Given its unexpectedly high prevalence, PE is now recognized as a common pathophysiological mechanism in ACS, rather than a rare exception. This growing awareness underscores the importance of its accurate identification through OCT in clinical practice. Early recognition and a deeper understanding of PE are essential steps toward the implementation of precision medicine, allowing clinicians to move beyond “one-size-fits-all” models toward “mechanism-based” therapeutic strategies. This narrative review aims to offer an integrated overview of PE, tracing its epidemiology, elucidating the molecular and pathophysiological mechanisms involved, outlining its clinical presentations, and placing particular emphasis on diagnostic strategies with OCT, while also discussing emerging therapeutic approaches and future directions for personalized cardiovascular care. Full article

Background: Aortic stenosis (AS) is the most common valvular heart disease, associated with poor outcomes if left untreated. Current guidelines recommend that transcatheter aortic valve implantation (TAVI) procedures be performed in hospitals with an on-site cardiac surgery unit due to potential complications requiring surgical intervention. Objective: Based on our experience, we evaluated the feasibility and outcomes of implementing a TAVI program in a cardiology department without an on-site cardiac surgery unit, in collaboration with a remote hospital for surgical backup. Methods: The TAVI program involved pre- and post-procedural evaluations conducted at Meir Medical Center (Kfar Saba, Israel) with a remote surgical team available. The study population included 149 consecutive patients with severe aortic stenosis treated at the Meir valve clinic between November 2019 and December 2023. Procedures were performed by the center’s interventional cardiology team. Results: The mean age of the 149 patients was 80 ± 6 years, and 75 (50%) were female. The average STS score was 4.3, and the EuroSCORE II was 3.1. Among the patients, 68 (45%) were classified as New York Heart Association (NYHA) class III-IV. The valve types used included ACURATE neo2 (57 patients, 38%), Edwards SAPIEN 3 (43 patients, 28%), Evolut-PRO (41 patients, 27%), and Navitor (7 patients, 4%). There were no cases of moderate to severe paravalvular leak and no elevated post-implantation gradients, and there was no need for urgent cardiac surgery. One case of valve embolization was successfully managed percutaneously during the procedure. In-hospital follow-up revealed no deaths and only one major vascular complication. At one-year follow-up, six patients had died, with only one death attributed to cardiac causes. Conclusions: Our findings support the safe and effective performance of transfemoral TAVI in cardiology departments without on-site cardiac surgery, in collaboration with a remote surgical team. Further prospective, multicenter studies are warranted to confirm these results and guide broader clinical implementation of this practice. Full article

Background/Objectives: High-risk percutaneous coronary interventions (HR-PCIs) often require mechanical circulatory support (MCS) to maintain hemodynamic stability. Intra-aortic balloon pump (IABP) and percutaneous left ventricular assist device (PLVAD) are two commonly used MCS devices that differ in their mechanisms. We aimed to evaluate and compare the clinical outcomes associated with IABP and PLVAD use in HR-PCIs without cardiogenic shock. Methods: We conducted a search of PubMed, Scopus, Cochrane, Mendeley, Web of Science, and Embase to identify relevant randomized controlled trials and cohort studies, and we included 13 studies for the systematic review and meta-analysis. The primary goal was to define the difference in early mortality (in-hospital and 30-day mortality), major bleeding, and major adverse cardiovascular event (MACE) components (cardiogenic shock, acute kidney injury (AKI), and stroke/TIA) in IABP and PLVAD. We used a random-effects model with the Mantel–Haenszel statistical method to estimate odds ratios (ORs) and 95% confidence intervals. Results: Among 1 trial and 12 cohort studies (35,554 patients; 30,351 IABP and 5203 PLVAD), HR-PCI with IABP was associated with a higher risk of early mortality (OR = 1.53, 95% CI [1.21, 1.94]) and cardiogenic shock (OR = 2.56, 95% CI [1.98, 3.33]) when compared to PLVAD. No significant differences were found in the rates of arrhythmia, major bleeding, AKI, stroke/TIA, or hospital length of stay. Conclusions: In high-risk PCIs, PLVAD use is associated with lower early mortality and cardiogenic shock risk compared to IABP, with no significant differences in other major outcomes. Full article

Fractional flow reserve (FFR) is a standard physiological index for guiding coronary revascularization, with a threshold of >0.80 typically used to defer intervention. However, due to its distinct anatomical and physiological features, the left anterior descending artery (LAD) often exhibits lower FFR values than non-LAD vessels for lesions of similar angiographic severity. These vessel-specific differences raise concerns about applying a uniform FFR cutoff across all coronary territories. Observational studies indicate that LAD lesions deferred at an FFR of 0.80 may have similar or better outcomes than non-LAD lesions do. LAD lesions also tend to show lower post-percutaneous coronary intervention FFR values, suggesting that vessel specific target thresholds may be more prognostically appropriate. Additionally, some evidence suggests that instantaneous wave-free ratio may offer greater prognostic value than FFR, specifically in LAD lesions, a trend not consistently seen in other arteries. In patients with acute myocardial infarction and multivessel disease, the prognostic relevance of non-culprit lesion FFR may vary by coronary territory, particularly in the LAD. This review outlines the physiological rationale and clinical evidence for vessel-specific interpretation of FFR, with a focus on the LAD, and explores its potential clinical implications and limitations. Full article

Background: TNF receptor 1 (TNF-R1) mediates the proinflammatory and proapoptotic effects of TNF-alpha, with its soluble form predicting incident heart failure (HF). While there is evidence linking TNF pathway activation to cardiac dysfunction, the mechanisms involved remain unclear. This study aimed to investigate the association between TNF-R1, exercise capacity, and cardiac function in asymptomatic patients with hypertensive heart disease (HHD). Methods: We enrolled 80 patients (mean age 55 ± 12 years) with HHD and no clinical symptoms of HF (stages A and B). Echocardiography, including tissue Doppler and left atrial and left ventricular (LV) strain assessment, was performed at rest. Peripheral venous blood samples were collected to measure serum TNF-R1 concentration. Results: The study population was divided into two subsets based on the median exercise capacity (peak VO₂) value. Patients with higher VO₂ had lower serum TNF-R1 concentration and higher early peak mitral annular velocity (e’) and peak atrial longitudinal strain (PALS). After adjusting for other covariates, multivariable regression analysis identified TNF-R1 as an independent determinant of peak VO₂. Mediation analysis revealed that the relationship between TNF-R1 and peak VO₂ was mediated by LV diastolic function (PALS or e’), with a decrease in the beta coefficient after including mediator variables from 0.37 (p < 0.001) to 0.30 (p < 0.006) and 0.31 (p = 0.004), respectively. Conclusions: In patients with HHD, higher TNF-R1 levels are associated with lower exercise capacity, which may be mediated by impaired LV diastolic function. These findings might suggest a role of TNF signalling in early HF development, justifying further studies to evaluate TNF-R1 as a biomarker for risk of HF progression. Full article

Background/Objectives: While aldosterone excess has a detrimental impact on the left ventricle, no data exist concerning right ventricular (RV) function in primary aldosteronism (PA) patients. We aimed to assess RV structure and function in patients with PA using cardiac magnetic resonance imaging. Methods: Thirty PA patients and 30 age- and sex-matched healthy volunteers were studied. All patients underwent cardiac magnetic resonance with the assessment of RV structure and function. Results: Neither the RV mass index (RVMi) nor the RV ejection fraction (RVEF) correlated with the aldosterone levels (p = 0.36 and p = 0.37, respectively). On the contrary, we found a weak positive correlation between the RV end-diastolic volume index (RVEDVi) and aldosterone concentration (rho = 0.5, p = 0.005). Neither the RVEDVi nor the RVEF differed between the PA patients and the control group (p = 0.077 and p = 0.93, respectively). The RVMi was higher in the PA group, at 18.9 (4.9) g/m², versus 13.6 (3.2) g/m² (SD) in the control group (p < 0.0001). The RVEDVi was positively correlated with the duration of hypertension (rho = 0.4, p = 0.03), and the latter was correlated inversely with the RVEF (rho = −0.47, p = 0.009). The RV global longitudinal strain was impaired in PA patients in comparison with the controls (−16.8 (2.5%) versus −19.6 (2.7%), p = 0.0001). Conclusions: The PA patients exhibited larger RVMi values than the controls. The higher the aldosterone levels were, the higher the observed RVEDVi. Additionally, the longer the duration of hypertension, the higher the observed RVEDVi and the lower the noted RVEF. The PA patients exhibited subclinical RV systolic dysfunction, expressed as impaired RV global longitudinal strain. Full article