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Keywords = cardiovascular rehospitalization

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14 pages, 954 KiB  
Article
Left Ventricular Ejection Fraction Predicts Outcomes in Different Subgroups of Patients Undergoing Coronary Angiography
by Henning Johann Steffen, Tobias Schupp, Mohammad Abumayyaleh, Lasse Kuhn, Philipp Steinke, Jonas Dudda, Kathrin Weidner, Jonas Rusnak, Mahboubeh Jannesari, Fabian Siegel, Daniel Duerschmied, Michael Behnes and Ibrahim Akin
J. Clin. Med. 2025, 14(15), 5219; https://doi.org/10.3390/jcm14155219 - 23 Jul 2025
Viewed by 298
Abstract
Objectives: To evaluate the long-term prognostic value of left ventricular ejection fraction (LVEF) in consecutive patients undergoing invasive coronary angiography (CA). Background: LVEF is a key prognostic marker in cardiovascular disease, but its value across different clinical indications for CA remains insufficiently characterized. [...] Read more.
Objectives: To evaluate the long-term prognostic value of left ventricular ejection fraction (LVEF) in consecutive patients undergoing invasive coronary angiography (CA). Background: LVEF is a key prognostic marker in cardiovascular disease, but its value across different clinical indications for CA remains insufficiently characterized. Methods: Consecutive patients undergoing CA between January 2016 and August 2022 were retrospectively included at one institution. Patients were stratified into four LVEF groups: ≥ 55%, 45–54%, 35–44%, and <35%. The primary endpoint was rehospitalization for heart failure (HF) at 36 months. Secondary endpoints were acute myocardial infarction (AMI) and coronary revascularization. Kaplan–Meier and multivariable Cox regression analyses were conducted within the entire study cohort and pre-defined subgroups. Results: A total of 6888 patients were included (median age: 71 years; 65.2% males). LVEF < 35% was associated with a higher comorbidity burden and more extensive coronary artery disease (e.g., three-vessel CAD: 38.6% vs. 20.7%, p < 0.001). Event rates for HF rehospitalization and AMI increased progressively with declining LVEF, while revascularization rates varied across categories. Statistically significant differences across LVEF groups were observed for all three endpoints in unadjusted analyses (log-rank p < 0.001). In multivariable models, LVEF < 35% independently predicted HF rehospitalization (HR = 3.731, p < 0.001) and AMI (HR = 4.184, p < 0.001), but not revascularization (HR = 0.867, p = 0.378). The prognostic association was demonstrated across all subgroups stratified by age, sex, subtype of acute coronary syndrome, and CAD severity. Conclusions: Reduced LVEF is an independent predictor of HF rehospitalization and AMI in patients undergoing coronary angiography, irrespective of its indication, whereas no independent association was observed with coronary revascularization. Full article
(This article belongs to the Section Cardiology)
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12 pages, 1646 KiB  
Systematic Review
Quantitative Flow Ratio-Guided vs. Angiography-Guided Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of One-Year Clinical Outcomes
by Viet Nghi Tran, Amreen Dhindsa, Kuchalambal Agadi, Hoang Nhat Pham, Hong Hieu Truong, Chau Doan Nguyen, Hanad Bashir, Huan Dat Pham, Thanh Vien Truong, Phillip Tran and Thach Nguyen
J. Clin. Med. 2025, 14(14), 5015; https://doi.org/10.3390/jcm14145015 - 15 Jul 2025
Viewed by 332
Abstract
Background: Quantitative Flow Ratio (QFR) is a novel, wire-free, and hyperemia-free physiological assessment for guiding Percutaneous Coronary Intervention (PCI), which may offer advantages over traditional angiography-guided PCI. This systematic review with meta-analysis compares clinical outcomes after one year in patients who underwent QFR-guided [...] Read more.
Background: Quantitative Flow Ratio (QFR) is a novel, wire-free, and hyperemia-free physiological assessment for guiding Percutaneous Coronary Intervention (PCI), which may offer advantages over traditional angiography-guided PCI. This systematic review with meta-analysis compares clinical outcomes after one year in patients who underwent QFR-guided versus angiography-guided PCI. Methods: This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered on 4 November 2024 in PROSPERO (ID: CRD42024609799). A systematic search was performed across multiple databases to identify clinical trials comparing QFR-guided and angiography-guided PCI. Random-effects models were used to assess one-year outcomes of major adverse cardiovascular events (MACEs), revascularization, and rehospitalization, with heterogeneity measured using I2, H2, and Cochran’s Q statistics. Study quality was evaluated using the Cochrane Risk of Bias 2 (RoB 2) tool. Results: Compared to traditional angiography-guided PCI, QFR-guided PCI was associated with numerically lower but statistically non-significant risks of MACEs (risk difference: −0.08, 95% CI: −0.20 to 0.04), revascularization (risk difference: −0.02, 95% CI: −0.08 to 0.03), and rehospitalization (risk difference: −0.02, 95% CI: −0.08 to 0.04) over one year. Substantial heterogeneity was observed for MACEs (I2 = 84.95%, H2 = 6.64) and revascularization (I2 = 94.18%, H2 = 17.18), whereas rehospitalization exhibited low heterogeneity (I2 = 17.17%, H2 = 1.21). The risk of bias was assessed by the RoB 2 tool, which revealed low to some concern risk of bias across key domains. Conclusions: Quantitative Flow Ratio (QFR) has demonstrated comparable one-year clinical outcomes to traditional angiography for PCI guidance, with a trend toward improved results. However, the high heterogeneity among studies and the risk of bias necessitate the need for larger, high-quality trials to validate these findings. Full article
(This article belongs to the Special Issue Interventional Cardiology—Challenges and Solutions)
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13 pages, 1654 KiB  
Article
Effect of Complete Revascularization in STEMI: Ischemia-Driven Rehospitalization and Cardiovascular Mortality
by Miha Sustersic and Matjaz Bunc
J. Clin. Med. 2025, 14(13), 4793; https://doi.org/10.3390/jcm14134793 - 7 Jul 2025
Viewed by 327
Abstract
Background: Patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD) who undergo complete revascularization (CR) have a more favorable prognosis than those who receive incomplete revascularization (IR), as evidenced by recent randomized controlled trials. Despite the absence of a [...] Read more.
Background: Patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD) who undergo complete revascularization (CR) have a more favorable prognosis than those who receive incomplete revascularization (IR), as evidenced by recent randomized controlled trials. Despite the absence of a survival benefit associated with CR in these trials, positive outcomes were ascribed to combined endpoints, such as repeat revascularization, myocardial infarction, or ischemia-driven rehospitalization. In light of the significant burden that rehospitalization from STEMI imposes on healthcare systems, we examined the long-term effects of CR on ischemia-driven rehospitalization and cardiovascular (CV) mortality in STEMI patients with MVD. Methods: In our retrospective study, we included patients with STEMI and MVD who underwent successful primary percutaneous coronary intervention (PCI) at the University Medical Centre Ljubljana between 1 January 2009, and 11 April 2011. The combined endpoint was ischemia-driven rehospitalization and CV mortality, with a minimum follow-up period of six years. Results: We included 235 participants who underwent CR (N = 70) or IR (N = 165) at index hospitalization, with a median follow-up time of 7 years (interquartile range 6.0–8.2). The primary endpoint was significantly higher in the IR group than in the CR group (47.3% vs. 32.9%, log-rank p = 0.025), driven by CV mortality (23.6% vs. 12.9%, log-rank p = 0.047), as there was no difference in ischemia-driven rehospitalization rate (log-rank p = 0.206). Ischemia-driven rehospitalization did not influence CV mortality in the CR group (p = 0.49), while it significantly impacted CV mortality in the IR group (p = 0.03). After adjusting for confounders, there were no differences in CV mortality between CR and IR groups (p = 0.622). Predictors of the combined endpoint included age (p = 0.014), diabetes (p = 0.006), chronic kidney disease (CKD) (p = 0.001), cardiogenic shock at presentation (p = 0.003), chronic total occlusion (CTO) (p = 0.046), and ischemia-driven rehospitalization (p = 0.0001). Significant risk factors for the combined endpoint were cardiogenic shock at presentation (p < 0.001), stage 4 kidney failure (p = 0.001), age over 70 years (p = 0.004), female gender (p = 0.008), and residual SYNTAX I score > 5.5 (p = 0.017). Conclusions: Patients with STEMI and MVD who underwent CR had a lower combined endpoint of ischemia-driven rehospitalizations and CV mortality than IR patients, but after adjustments for confounders, the true determinants of the combined endpoint and risk factors for the combined endpoint were independent of the revascularization method. Full article
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20 pages, 1636 KiB  
Article
The Prognostic Impact of Kidney Dysfunction in Unselected Patients Undergoing Coronary Angiography: In What Subgroups Does Kidney Dysfunction Matter?
by Philipp Steinke, Ibrahim Akin, Lasse Kuhn, Thomas Bertsch, Kathrin Weidner, Mohammad Abumayyaleh, Jonas Dudda, Jonas Rusnak, Mahboubeh Jannesari, Fabian Siegel, Christel Weiß, Daniel Duerschmied, Michael Behnes and Tobias Schupp
J. Clin. Med. 2025, 14(11), 3753; https://doi.org/10.3390/jcm14113753 - 27 May 2025
Viewed by 477
Abstract
Background/Objectives: In recent decades, shifting demographics and advancements in treating cardiovascular disease have altered the types of patients receiving coronary angiography (CA). However, data investigating the impact of kidney dysfunction stratified by the indication for CA are limited. Methods: Consecutive patients [...] Read more.
Background/Objectives: In recent decades, shifting demographics and advancements in treating cardiovascular disease have altered the types of patients receiving coronary angiography (CA). However, data investigating the impact of kidney dysfunction stratified by the indication for CA are limited. Methods: Consecutive patients who underwent invasive CA at one institution between 2016 and 2022 were included in this study. Firstly, the prevalence and extent of coronary artery disease (CAD) in patients with different levels of kidney function was assessed. Secondly, the study examined how impaired kidney function affected long-term outcomes—specifically the risk of rehospitalization for heart failure (HF), acute myocardial infarction (AMI), or the need for coronary revascularization—at 36 months of follow-up. Results: A total of 7624 patients undergoing CA were included with a median estimated glomerular filtration rate (eGFR) of 68.9 mL/min/1.73 m2 (IQR: 50.8–84.3). In total, 63.7% of patients had an eGFR ≥ 60 mL/min/1.73 m2, 29.0% an eGFR of 30–<60 mL/min/1.73 m2, and 7.3% an eGFR of <30 mL/min/1.73 m2. Compared to patients with an eGFR ≥ 60 mL/min/1.73 m2, those with an eGFR 30–<60 mL/min/1.73 m2 and eGFR < 30 mL/min/1.73 m2 had a higher prevalence of CAD (66.8% vs. 72.9% and 80.1%, respectively; p = 0.001) and three-vessel CAD (25.6% vs. 34.5% and 39.5%, respectively; p = 0.001). At 36 months of follow-up, patients with an eGFR 30–<60 mL/min/1.73 m2 and eGFR < 30 mL/min/1.73 m2 suffered from significantly higher risk of HF-associated rehospitalization (HR = 1.937, 95% CI: 1.739–2.157, p = 0.001 and HR = 3.223, 95% CI: 2.743–3.787, p = 0.001, respectively) and AMI compared to patients with an eGFR ≥ 60 mL/min/1.73 m2 (reference group). The significantly higher risk of HF-related rehospitalization remained after multivariable adjustment. Conclusions: Both groups with impaired kidney function demonstrated a markedly higher risk of rehospitalization for HF at 36 months—even after multivariate adjustments. Increased risk of HF-related rehospitalization in patients with an eGFR < 30 mL/min/1.73 m2 was especially evident if they also presented with decompensated HF and LVEF < 35%. In patients with an eGFR 30–<60 mL/min/1.73 m2, presenting with angina pectoris and multivessel disease increased the risk of HF-related rehospitalization. Full article
(This article belongs to the Section Cardiology)
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12 pages, 553 KiB  
Article
Disproportionate vs. Proportionate Secondary Mitral Regurgitation: A Long-Term Pilot Analysis After Mitral Valve Surgery
by Giovanni Alfonso Chiariello, Michele Di Mauro, Emmanuel Villa, Piergiorgio Bruno, Andrea Mazza, Natalia Pavone, Marialisa Nesta, Alberta Marcolini, Rudy Panzera, Andrea Armonia, Gaia De Angelis, Serena D’Avino, Antonio Nenna, Annalisa Pasquini and Massimo Massetti
J. Clin. Med. 2025, 14(10), 3470; https://doi.org/10.3390/jcm14103470 - 15 May 2025
Viewed by 607
Abstract
Objectives: The treatment of secondary mitral regurgitation (MR) is still controversial. In 2019, a new conceptual framework was introduced, distinguishing between patients with a degree of MR “proportionate” to the left ventricular (LV) dilatation and patients in whom the severity of MR is [...] Read more.
Objectives: The treatment of secondary mitral regurgitation (MR) is still controversial. In 2019, a new conceptual framework was introduced, distinguishing between patients with a degree of MR “proportionate” to the left ventricular (LV) dilatation and patients in whom the severity of MR is “disproportionate” to the LV dilatation. The aim of this study was to compare the long-term outcome of patients with disproportionate vs. proportionate secondary MR who underwent mitral valve (MV) surgery. Methods: From January 2012 to June 2022, 96 patients with a preoperative diagnosis of pure secondary MR and LV dysfunction underwent MV surgery. The patients were divided in two groups, disproportionate vs. proportionate MR, according to echocardiographic parameters. A 5.2 (3.5–7.5) years complete clinical and echocardiographic follow-up was performed. Results: In the study period, 61 patients with disproportionate and 35 patients with proportionate MR underwent surgical MV repair or MV replacement. The thirty-day outcome was comparable in the two groups. At long-term follow-up, mortality was 5% in the disproportionate group vs. 11% in the proportionate group (p = 0.2), and cardiovascular mortality was 3% vs. 9%, respectively (0.5). Rehospitalization for heart failure was 6% vs. 20% (p = 0.04), and the rate of patients with New York Heart Association (NYHA) functional class ≥ III was 8% vs. 26%, respectively (p = 0.01). LV volumes were significantly higher in the proportionate group, thus presenting a lower LV ejection fraction (p < 0.001 and p = 0.03, respectively). No cases of recurrent MR have been observed. Conclusions: In this first exploratory analysis, patients with disproportionate secondary MR seem to present a possible benefit in terms of mortality and cardiovascular mortality, although not ones reaching statistical significance. Nevertheless, significant advantages were observed in terms of rehospitalization for heart failure, clinical status and symptoms, LV volumes, and LV function. Among patients referred to cardiac surgery, identifying the subset of patients with functional MR, who may obtain more significant advantages from surgery, seems relevant for patient selection, risk stratification, and to predict long-term outcomes. Full article
(This article belongs to the Special Issue Cardiac Surgery: Clinical Advances)
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18 pages, 1744 KiB  
Review
Influence of Soluble Guanylate Cyclase on Cardiac, Vascular, and Renal Structure and Function: A Physiopathological Insight
by Daniele De Feo, Francesco Massari, Cosimo Campanella, Anna Livrieri, Marco Matteo Ciccone, Pasquale Caldarola, Micaela De Palo and Pietro Scicchitano
Int. J. Mol. Sci. 2025, 26(10), 4550; https://doi.org/10.3390/ijms26104550 - 9 May 2025
Viewed by 930
Abstract
The role of nitric oxide (NO), soluble guanylate cyclase (sGC), and the cyclic guanosine monophosphate (cGMP) pathway in cardiovascular and renal health and disease is a complex issue. The impact of these biochemical pathways on the vascular tree is well established: the activation [...] Read more.
The role of nitric oxide (NO), soluble guanylate cyclase (sGC), and the cyclic guanosine monophosphate (cGMP) pathway in cardiovascular and renal health and disease is a complex issue. The impact of these biochemical pathways on the vascular tree is well established: the activation of sGC by NO promotes vasodilation and modulates vascular tone. Indeed, additional characteristics exist that lead physicians to believe there is a pleiotropic influence of this pathway on the functional activities and structural characteristics of human tissues and cells. Recently, sGC stimulators have demonstrated clinical efficacy in patients with worsening heart failure with reduced ejection fraction, improving cardiovascular death risk, re-hospitalization for HF, and all-cause mortality. These new outcome data have increased interest in understanding the potential pathophysiological mechanisms. The NO-sGC-cGMP axis may influence endothelial function, kidney performance, and cardiac muscle cell activity. The synergy of these actions could explain the positive effects of vericiguat on worsening HF. The aim of this narrative review was to provide a comprehensive insight into the pathophysiological mechanisms of action of NO-sGC-cGMP axis stimulators on cardiac muscle, endothelial cells, and kidneys. Full article
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14 pages, 1982 KiB  
Review
Iron Deficiency as a Factor of Worse Prognosis in Patients with Acute Myocardial Infarction
by Aleksander Misiewicz, Krzysztof Badura, Oliwia Matuszewska-Brycht, Jan Krekora and Jarosław Drożdż
Biomedicines 2025, 13(4), 769; https://doi.org/10.3390/biomedicines13040769 - 21 Mar 2025
Viewed by 977
Abstract
Acute coronary syndromes (ACS) are a leading cause of death and impairment in the adult population. Precise identification and modification of risk factors is crucial for a favorable clinical outcome. In this review, we aim to provide a comprehensive overview of the significance [...] Read more.
Acute coronary syndromes (ACS) are a leading cause of death and impairment in the adult population. Precise identification and modification of risk factors is crucial for a favorable clinical outcome. In this review, we aim to provide a comprehensive overview of the significance of iron deficiency (ID) in patients with ACS, particularly myocardial infarction (MI). The paper evaluates the impact of ID on the prognosis of ACS patients, highlighting its potential influence on myocardial healing, regeneration and cardiovascular events during the follow-up period. The findings suggest that iron deficiency may have a negative impact on the prognosis of patients with MI, resulting in worse quality of life, physical capacity and higher rehospitalization rates in comparison to patients with normal iron status. Iron supplementation in patients with MI could be beneficial and may have an effect on myocardial healing and left ventricular remodeling. Full article
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13 pages, 643 KiB  
Review
Sodium–Glucose Cotransporter-2 Inhibitors After Acute Myocardial Infarction
by Nicia I. Profili, Roberto Castelli, Roberto Manetti, Marta C. Sircana, Michela Pagni, Gemma Lisa Sechi, Antonio Gidaro, Costantino Cossu, Francesco Bella and Alessandro P. Delitala
Biomedicines 2025, 13(3), 720; https://doi.org/10.3390/biomedicines13030720 - 15 Mar 2025
Viewed by 914
Abstract
Sodium–glucose cotransporter-2 inhibitors (SGLT2i) are a specific class of drugs originally developed for treating type 2 diabetes mellitus. Subsequently, studies demonstrated that their action was not limited to glycemic control but could also have positive effects on other specific outcomes, particularly at the [...] Read more.
Sodium–glucose cotransporter-2 inhibitors (SGLT2i) are a specific class of drugs originally developed for treating type 2 diabetes mellitus. Subsequently, studies demonstrated that their action was not limited to glycemic control but could also have positive effects on other specific outcomes, particularly at the cardiovascular level. Indeed, due to their diuretic effect, SGLT2i improve the clinical control of chronic heart failure and reduce the risk of rehospitalization. In addition, other studies reported a protective effect on major cardiovascular events and mortality. More recently, it has been suggested that the prescription of SGLT2i after an acute myocardial infarction may have positive effects due to their possible effect on inflammation, arrhythmias, and ventricular remodeling. Here, we reviewed studies focused on SGLT2i after an acute myocardial infarction in patients treated with percutaneous coronary intervention. Full article
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11 pages, 1276 KiB  
Article
Prognostic Role of Pan-Immune-Inflammatory Value in Patients with Non-ST-Segment Elevation Acute Coronary Syndrome
by Jeong Tae Byoun, Kyeong Ho Yun, Sungho Jo, Donghyeon Joo and Jae Young Cho
J. Cardiovasc. Dev. Dis. 2025, 12(2), 79; https://doi.org/10.3390/jcdd12020079 - 18 Feb 2025
Cited by 2 | Viewed by 728
Abstract
Blood cell-derived indices are potential predictors of clinical outcomes in coronary artery disease. This study assessed the prognostic value of the pan-immune-inflammatory value (PIV) for predicting 1-year major adverse cardiovascular events (MACEs) in patients with non-ST-segment elevation acute coronary syndrome (ACS). A retrospective [...] Read more.
Blood cell-derived indices are potential predictors of clinical outcomes in coronary artery disease. This study assessed the prognostic value of the pan-immune-inflammatory value (PIV) for predicting 1-year major adverse cardiovascular events (MACEs) in patients with non-ST-segment elevation acute coronary syndrome (ACS). A retrospective cohort of 1651 patients receiving percutaneous coronary intervention was analyzed. PIV, calculated from blood cell counts, was categorized with a cut-off value of 256.3 (sensitivity 60.7%, specificity 59.3%) based on receiver operating characteristic curve analysis. MACEs were operationalized as a composite of all-cause mortality, myocardial infarction (MI), stroke, any revascularization, and rehospitalization for heart failure. The incidence of MACEs was 5.0% in patients with low PIV and 9.7% in those with high PIV (log-rank p < 0.001). Multivariate analysis identified age 65 > years, renal dysfunction (eGFR < 60 mL/min/1.73 m2), and high PIV (>256.3) (HR 1.49, 95% CI 1.01–2.22, p = 0.048) as independent predictors of MACEs. Subgroup analyses revealed no statistically significant interaction between MI status or C-reactive protein levels and PIV. PIV was an independent predictor of 1-year MACEs in patients with non-ST-segment elevation ACS. It may serve as a reliable prognostic marker independently of MI or C-reactive protein levels. Full article
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17 pages, 1208 KiB  
Article
Prognostic Role and Determinants of Ascending Aorta Dilatation in Non-Advanced Idiopathic Pulmonary Fibrosis: A Preliminary Observation from a Tertiary University Center
by Andrea Sonaglioni, Antonella Caminati, Greta Behring, Gian Luigi Nicolosi, Gaetana Anna Rispoli, Maurizio Zompatori, Michele Lombardo and Sergio Harari
J. Clin. Med. 2025, 14(4), 1300; https://doi.org/10.3390/jcm14041300 - 15 Feb 2025
Viewed by 782
Abstract
Background: Patients with idiopathic pulmonary fibrosis (IPF) have a high prevalence of cardiovascular (CV) risk factors and an increased CV disease burden. The aim of this study was to investigate the prognostic role of the ascending aorta (AA) diameter in patients with mild-to-moderate [...] Read more.
Background: Patients with idiopathic pulmonary fibrosis (IPF) have a high prevalence of cardiovascular (CV) risk factors and an increased CV disease burden. The aim of this study was to investigate the prognostic role of the ascending aorta (AA) diameter in patients with mild-to-moderate IPF and to identify the main determinants of AA dilatation. Methods: All IPF patients without severe pulmonary hypertension who underwent a multi-instrumental evaluation, comprehensive of high-resolution computed tomography (HRCT) and transthoracic echocardiography (TTE), between September 2017 and November 2023, were retrospectively analyzed. The primary endpoint was the composite of “all-cause mortality or re-hospitalization for all causes”, over a medium-term follow-up. The secondary endpoint was to evaluate the independent predictors of AA dilatation. Additionally, Bland–Altman analysis was used to assess the accuracy and precision of echocardiography-derived AA diameters compared with non-ECG gated HRCT measurements. Results: A total of 105 IPF patients and 102 age-, sex-, and CV risk factor-matched controls without IPF were evaluated retrospectively. Over a follow-up of 3.9 ± 1.9 yrs, 31 patients died and 47 were re-hospitalized. AA/height (HR 1.15, 95% CI 1.06–1.25, p < 0.001) was independently associated with the primary endpoint, whereas unindexed AA (HR 1.01, 95% CI 0.96–1.06, p = 0.83) and AA/BSA (HR 1.00, 95% CI 0.89–1.11, p = 0.39) were not. An AA/height > 20 mm/m showed 100% sensitivity and 63% specificity (AUC = 0.78) for predicting the primary endpoint. C-reactive protein (OR 1.87; 95% CI 1.21–2.89, p = 0.005) and left ventricular mass index (OR 1.13, 95% CI 1.04–1.24, p = 0.006) were independently associated with an AA/height > 20 mm/m in the whole study group. The Bland–Altman analysis revealed a bias of +2.51 mm (with the 95% limits of agreement ranging from −3.62 to 8.65 mm) for AA estimation, suggesting a general overestimation of the AA diameter by TTE in comparison to HRCT. Conclusions: AA dilatation is predictive of poor outcomes in IPF patients without advanced lung disease over a mid-term follow-up. The AA/height assessment may improve the prognostic risk stratification of IPF patients. Full article
(This article belongs to the Special Issue Updates on Interstitial Lung Disease)
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18 pages, 2755 KiB  
Article
Prevalence of Multimorbidity in Lithuania: Insights from National Health Insurance Fund Data
by Dovilė Ramanauskaitė, Roma Puronaitė, Audronė Jakaitienė and Sigita Glaveckaitė
J. Cardiovasc. Dev. Dis. 2025, 12(2), 47; https://doi.org/10.3390/jcdd12020047 - 26 Jan 2025
Viewed by 1208
Abstract
(1) Background: As the burden of multimorbidity is increasing worldwide, little is known about its prevalence in Lithuania. We aimed to estimate the prevalence of chronic conditions and multimorbidity among Lithuanian adults and assess their impact on healthcare utilization. (2) Methods: A retrospective [...] Read more.
(1) Background: As the burden of multimorbidity is increasing worldwide, little is known about its prevalence in Lithuania. We aimed to estimate the prevalence of chronic conditions and multimorbidity among Lithuanian adults and assess their impact on healthcare utilization. (2) Methods: A retrospective analysis of the Lithuanian National Health Insurance Fund database was performed in 2019. Multimorbidity was defined as having two or more chronic conditions. (3) Results: Of the Lithuanian population, 1,193,668 (51.5%) had at least one chronic condition, and 717,386 (31.0%) had multimorbidity. Complex multimorbidity (CM) was present in 670,312 (28.9%) patients, with 85.0% having complex cardiac multimorbidity (CCM) and 15.0% having complex non-cardiac multimorbidity (CNM). Multimorbidity increased with age, from 2% at age 18–24 to 77.5% at age 80 and above, and was more prevalent among women (63.3% vs. 36.7%, p < 0.001). One-third of multimorbid patients were hospitalized at least once per year, with half staying for a week or longer. CCM patients were more likely to be hospitalized, rehospitalized, and have more primary care visits (OR: 2.23, 1.60, 4.24, respectively, all p < 0.001). (4) Conclusions: Multimorbidity in Lithuania increases with age and affects women more. Chronic cardiovascular diseases contribute to a higher prevalence of multimorbidity and a more significant burden on the healthcare system. Full article
(This article belongs to the Section Epidemiology, Lifestyle, and Cardiovascular Health)
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12 pages, 979 KiB  
Article
Mid-Regional Pro-Adrenomedullin Is Associated with Adverse Cardiovascular Outcomes After Cardiac Surgery
by Ulrike Baumer, Niema Kazem, Andreas Hammer, Felix Hofer, Eva Steinacher, Lorenz Koller, Daniel Zimpfer, Martin Andreas, Barbara Steinlechner, Christian Hengstenberg, Alexander Niessner and Patrick Sulzgruber
J. Pers. Med. 2025, 15(2), 47; https://doi.org/10.3390/jpm15020047 - 26 Jan 2025
Viewed by 992
Abstract
Background: In the era of personalized medicine, tools for risk stratification after cardiovascular interventions are crucial to reduce mortality and morbidity, especially in the aging population. Biomarker-based approaches, in particular, have gained significant importance. Mid-regional pro-adrenomedullin (MR-proADM) represents an easily assessable biomarker that [...] Read more.
Background: In the era of personalized medicine, tools for risk stratification after cardiovascular interventions are crucial to reduce mortality and morbidity, especially in the aging population. Biomarker-based approaches, in particular, have gained significant importance. Mid-regional pro-adrenomedullin (MR-proADM) represents an easily assessable biomarker that mirrors cardiac function and fibrosis. Therefore, we aimed to investigate the prognostic potential of MR-proADM in patients undergoing elective cardiac surgery. Methods: Patients undergoing elective cardiac bypass and/or valve surgery were prospectively enrolled between May 2013 and August 2018. The primary endpoint was the composite of hospitalization for heart failure (HHF) or cardiovascular (CV) mortality. Results: In total, 500 patients (146 female [29.2%]; median age 69.8 years (IQR 60.6–75.5 years) were included. Individuals were stratified into risk categories based on their MR-proADM values (Low Risk ≤ 0.63 nmol/L, Intermediate Risk > 0.63 and ≤0.84, High Risk > 0.84). A significant increase in 5-year event rates for HHF/CV mortality in patients in the high-risk category (Low Risk 8.6% vs. High Risk 37.7%, p < 0.001) was observed. MR-pro ADM showed an independent association with HHF/ CV mortality (adjusted HR of 3.43, 95% CI 1.83–6.42; p < 0.001 comparing the High-Risk group to the Low-Risk group). Conclusions: MR-pro ADM was found to be a strong and independent predictor for HHF/CV mortality in patients undergoing elective cardiac surgery. Considering a personalized diagnostic and prognostic work-up, a standardized preoperative evaluation of MR-proADM levels might help to identify patients at risk for major adverse events and early re-hospitalization. Full article
(This article belongs to the Section Disease Biomarker)
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14 pages, 603 KiB  
Article
Sex-Based Differences and Outcomes in Unselected Patients Undergoing Coronary Angiography
by Lasse Kuhn, Tobias Schupp, Philipp Steinke, Kathrin Weidner, Thomas Bertsch, Jonas Rusnak, Mahboubeh Jannesari, Fabian Siegel, Daniel Duerschmied, Michael Behnes and Ibrahim Akin
J. Clin. Med. 2025, 14(1), 224; https://doi.org/10.3390/jcm14010224 - 2 Jan 2025
Cited by 1 | Viewed by 910
Abstract
Background: The study investigates sex-related differences and outcomes in unselected patients undergoing invasive coronary angiography (CA). Sex-based differences with regard to baseline characteristics and management of patients with cardiovascular disease have yet been demonstrated. However, their impact on long-term outcomes in unselected [...] Read more.
Background: The study investigates sex-related differences and outcomes in unselected patients undergoing invasive coronary angiography (CA). Sex-based differences with regard to baseline characteristics and management of patients with cardiovascular disease have yet been demonstrated. However, their impact on long-term outcomes in unselected patients undergoing CA remains unknown. Methods: Consecutive patients undergoing invasive CA from 2016 to 2022 were included at one institution. Prognosis of male and female patients undergoing CA was investigated with regard to the primary endpoint of rehospitalization for heart failure (HF) at 36 months. Secondary endpoints comprised the risk of acute myocardial infarction (AMI) and coronary revascularization at 36 months, as well as in-hospital all-cause mortality. Statistical analyses included Kaplan–Meier analyses, as well as uni- and multivariable Cox proportional regression analyses. Results: From 2016 to 2022, 7691 patients undergoing CA were included (males: 65.1%; females: 34.9%). Males had a higher prevalence of coronary artery disease (CAD) (76.2% vs. 57.4%; p = 0.001), alongside a higher prevalence of 3-vessel CAD compared to females (33.9% vs. 20.3%; p = 0.001). The risk of rehospitalization for HF at 36 months was higher in males compared to females (22.4% vs. 20.3%; p = 0.036; HR = 1.127; 95% CI: 1.014–1.254; p = 0.027), which was no longer observed after multivariable adjustment. Male sex was associated with a higher risk of coronary revascularization (9.6% vs. 5.9%; p = 0.001; HR = 1.659; 95% CI: 1.379–1.997; p = 0.001), which was still evident after multivariable adjustment (HR = 1.650; 95% CI 1.341–2.029; p = 0.001). However, neither the risk of AMI at 36 months (8.1% vs. 6.9%; p = 0.077), nor the risk of in-hospital all-cause mortality (6.9% vs. 6.5%; p = 0.689) differed significantly between the two sexes. Conclusions: In consecutive patients undergoing coronary angiography, male sex was independently associated with an increased risk of coronary revascularization, but not HF-related rehospitalization. Full article
(This article belongs to the Section Cardiology)
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12 pages, 1037 KiB  
Article
Elevated miRNA-499 Levels in Early Phase of Non-ST Elevation Acute Coronary Syndromes Predict Increased Long-Term Risk of Major Adverse Cardiac Events
by Dawid Miśkowiec, Ewa Szymczyk, Paulina Wejner-Mik, Błażej Michalski, Piotr Lipiec, Michał Simiera, Karolina Kupczyńska and Jarosław D. Kasprzak
J. Clin. Med. 2024, 13(24), 7803; https://doi.org/10.3390/jcm13247803 - 20 Dec 2024
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Abstract
Background/Objectives: Available data suggest the diagnostic potential of testing microRNAs (miRs) in myocardial infarction, but their prognostic value remains unclear. To evaluate the prognostic value of circulating miRs (miR-1, miR-21, miR-133a, miR-208 and miR-499) for predicting major adverse cardiac events (MACEs), including [...] Read more.
Background/Objectives: Available data suggest the diagnostic potential of testing microRNAs (miRs) in myocardial infarction, but their prognostic value remains unclear. To evaluate the prognostic value of circulating miRs (miR-1, miR-21, miR-133a, miR-208 and miR-499) for predicting major adverse cardiac events (MACEs), including death, non-fatal myocardial infarction (MI) or cardiovascular rehospitalization, in patients with non-ST segment elevation acute coronary syndromes (NSTE-ACS). Methods: Our prospective, single-center, observational study included patients (pts) with NSTE-ACS admitted <24 h after symptoms onset and pts with confirmed stable coronary artery disease (SCAD) as controls. Relative expression of miRs was calculated, and subjects were categorized according to miRs expression on hospital admission into two groups (≤median and >median). Results: Overall, 103 NSTE-ACS (52 NSTEMI/51 UA) and 47 SCAD pts (median age 66 years, 67% male) were included. During the median 895 (581–1134) days of the follow-up, MACE occurred in 75 (50%) patients: 20 (13%) died, 28 (19%) presented with MI, and 65 (43%) were readmitted due to cardiovascular reasons. Incidence of MI, rehospitalization and MACE was significantly higher in pts with elevated (>median) miR-499 [MI: 34.3% vs. 7.3%; HR = 6.0 (2.8–12.7) for rehospitalization; 53.7% vs. 36.2%, HR = 2.3 (1.4–3.8) for MACE; 62.7% vs. 42%, HR = 2.4 (1.5–3.8)] for hospital readmission. In the Cox proportional hazards regression model, miR-499 expression above the median level [HR = 1.8 (1.1–3.1)], high-sensitivity cardiac troponin T [HR = 1.2 (1.02–1.5)], diabetes [HR = 1.7 (1.1–2.8)] and percutaneous intervention during hospital stay [HR = 2.1 (1.1–3.8)] were identified as independent predictors of MACE in long-term observation, even after adjustment for covariates. Conclusions: Elevated miR-499 level on hospital admission in NSTE-ACS is related to an increased rate of MACE in the 2.5-year follow-up. Full article
(This article belongs to the Special Issue Diagnosis, Monitoring, and Treatment of Myocardial Infarction)
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14 pages, 2649 KiB  
Article
Prognostic Impact of Anemia and Hemoglobin Levels in Unselected Patients Undergoing Coronary Angiography
by Philipp Steinke, Tobias Schupp, Lasse Kuhn, Mohammad Abumayyaleh, Kathrin Weidner, Thomas Bertsch, Alexander Schmitt, Mahboubeh Jannesari, Fabian Siegel, Daniel Duerschmied, Michael Behnes and Ibrahim Akin
J. Clin. Med. 2024, 13(20), 6088; https://doi.org/10.3390/jcm13206088 - 12 Oct 2024
Viewed by 1452
Abstract
Background/Objectives: This study investigates the prevalence and prognostic impact of concomitant anemia in unselected patients undergoing invasive coronary angiography (CA). The spectrum of patients undergoing CA has significantly changed during the past decades, related to ongoing demographic changes and improved treatment strategies [...] Read more.
Background/Objectives: This study investigates the prevalence and prognostic impact of concomitant anemia in unselected patients undergoing invasive coronary angiography (CA). The spectrum of patients undergoing CA has significantly changed during the past decades, related to ongoing demographic changes and improved treatment strategies for patients with cardiovascular disease. Methods: Consecutive patients undergoing invasive CA from 2016 to 2022 were retrospectively included at one institution. Patients with anemia (i.e., hemoglobin < 13.0 g/dL for males and <12.0 g/dL for females) were compared with patients without anemia (i.e., nonanemics). The primary endpoint was rehospitalization for heart failure (HF) at 36 months. Secondary endpoints comprised the risk of rehospitalization for acute myocardial infarction (AMI) and coronary revascularization. Statistical analyses included Kaplan–Meier, multivariable Cox proportional regression analyses, and propensity score matching. Results: From 2016 to 2022, 7645 patients undergoing CA were included with a median hemoglobin level of 13.2 g/dL. Anemics had a higher prevalence of coronary artery disease (CAD) (76.3% vs. 74.8%; p = 0.001), alongside an increased need for percutaneous coronary intervention (PCI) (45.3% vs. 41.5%; p = 0.001). At 36 months, the risk of rehospitalization for HF was higher in anemic patients (27.4% vs. 18.4%; p = 0.001; HR = 1.583; 95% CI 1.432–1.750; p = 0.001), which was still evident after multivariable adjustment (HR = 1.164; 95% CI 1.039–1.304; p = 0.009) and propensity score matching (HR = 1.137; 95% CI 1.006–1.286; p = 0.040). However, neither the risk of AMI (8.4% vs. 7.4%, p = 0.091) nor the risk of coronary revascularization at 36 months (8.0% vs. 8.5%, p = 0.447) was higher in anemic compared with nonanemic patients. Conclusions: In consecutive patients undergoing CA, concomitant anemia was independently associated with an increased risk of rehospitalization for HF, but not AMI or coronary revascularization. Patients with LVEF ≥ 35% and multivessel disease were especially susceptible to anemia-induced HF-related rehospitalization. Full article
(This article belongs to the Special Issue Targeted Diagnosis and Treatment of Coronary Artery Disease)
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