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This study was to investigate the risk factors for recurrence after radiofrequency ablation (RFCA) in patients with persistent atrial fibrillation (PeAF) and analyse its correlation with plasma microribonucleic acid (miRNA) expression based on ultrasound cardiograms. A total of 126 PeAF patients who underwent RFCA were selected as the research subjects (AF group), and 126 healthy subjects matched by gender and age were included as the control (control group). The basic data and biochemical indexes of the included research subjects were collected, and the subjects were followed up for one year after surgery. According to AF recurrence, all research subjects were divided into the recurrence group (45 cases) and the unpredictable group (81 cases). The t-test or Mann-Whitney U Test was adopted to compare B-type natriuretic peptide (BNP), uric acid (UA), glycosylated hemoglobin (HbA<inf>1c</inf>), and other biochemical indicators among patients in recurrence group and unpredictable group. In addition, left atrial diameter (LAD), left atrial volume (LAV), and left atrial ejection fraction (LAEF) were measured in both groups of patients. Logistic regression analysis was performed to identify the primary risk factors for recurrence among patients with PeAF after RFCA. Furthermore, the receiver operating characteristic (ROC) curve was used to compare the area under the curve (AUC) of the identified risk factors. AF duration in the recurrence group was shorter than that in the unpredictable group (P<0.01). The proportion of patients with a CHADS2 score of two or above in the recurrence group was significantly higher than that in the unpredictable group (P<0.05) in addition to UA (P<0.05) and BNP (P<0.001). Similarly, the LAD and LAV in the recurrence group were significantly higher (P<0.01), and LAEF was also found to be superior (P<0.05) in comparison to the unpredictable group. The relative expressions of plasma miRNA-150 and miRNA-133 of the patients in the AF group were remarkably reduced compared with those in the control group (P<0.05), while the relative expressions of miRNA-206, miRNA-21, miRNA-31, miRNA-27b, and miRNA-328 were all significantly increased (P<0.05) in contrast to those in the control group, and the plasma miRNA-21 (P<0.001) and miRNA-27b (P<0.05) expression of the patients in the recurrence group were significantly higher than that in the unpredictable group. AF duration (odds ratio (OR) = 1.182, 95% confidence interval (CI): 1.021~1.357), LAD (OR=2.066, 95% CI: 1.203~4.491), miRNA-21 (OR=1.253, 95% CI: 1.012-1.647), and miRNA-27b (OR=1.186, 95% CI: 1.006-1.391) were all correlated with recurrence among patients with PeAF after RFCA (P<0.05). The AUCs of AF duration, LAD, miRNA-21, and miRNA-27b LAD were found to be 0.654, 0.703, 0.795, and 0.815, respectively. The sensitivity values were 0.687, 0.701, 0.734, and 0.789, while the corresponding specificity values were 0.754, 0.732, 0.825, and 0.866, respectively. After AF duration, LAD and the expressions of miRNA-21 and miRNA-27b were combined as composite indexes, which resulted in an increased AUC (0.879), where the comparison with the AUC of a single index was significantly different (P<0.05). AF duration, LAD, and the expressions of plasma miRNA-21 and miRNA-27b were the independent risk factors for recurrence among PeAF patients after RFCA.
Heart failure with preserved ejection fraction (HFpEF) is a significant public health concern with high morbidity. This study evaluates the prognostic significance of Prognostic Nutritional Index (PNI) and Pan-Immune-Inflammation Value (PIV) in HFpEF, aiming to enhance understanding of its inflammatory and nutritional aspects and identify markers for better diagnosis and risk stratification. This retrospective cohort study included 71 patients diagnosed with HFpEF using the HFA-PEFF algorithm and 81 control subjects without heart failure. The PIV, and PNI indices were calculated. A 6-month follow-up of the HFpEF group was conducted to assess rehospitalization rates. The study found that patients with HFpEF had significantly higher PIV and PNI rates than the control group (P=0.016, P<0.001). A negative correlation (r=-0.328, P<0.001) was observed between the PNI and HFA-PEFF scores. The ROC analysis demonstrated that PIV (AUC: 0.92) had the strongest predictive ability for rehospitalization, followed by Systemic Immune-Inflammatory Index (SII, AUC: 0.87) and PNI (AUC: 0.78), while BMI showed the weakest performance (AUC: 0.59). The multivariate logistic regression analysis demonstrated that both PNI (OR: 0.783, 95% CI: 0.627-0.977, P=0.031) and PIV (OR: 1.012, 95% CI: 1.003-1.021, P=0.008) were significant predictors of rehospitalization in HFpEF patients. PIV and PNI are important parameters that play a predictive role in diagnosing HFpEF and independently predicting rehospitalization. In the multivariate analyses for rehospitalization, that PIV stands out more than SII, and PNI stands out more than BMI, was current and valuable information.
Cardiovascular disease (CVD) remains a leading global health challenge, accounting for 32% of global deaths, with significant disparities in access to care and outcomes, particularly in low- and middle-income countries (LMICs). Despite advancements in prevention, diagnosis, and treatment, unmet needs persist across clinical management, technological integration, and health system barriers. This umbrella review synthesizes evidence on these unmet needs to provide a comprehensive framework for future research and policy interventions. A systematic search was conducted across PubMed, Scopus, Google Scholar, and the Cochrane Library from 2010 to 2023, using keywords such as "unmet needs," "cardiovascular disease," and "health system barriers." Fifty systematic reviews, encompassing 580 studies, were included. Data extraction and quality assessment were performed using the Joanna Briggs Institute checklist, with findings categorized into clinical, technological, socioeconomic, and population-specific domains. The review identified critical gaps in cardiovascular care, including limited access to specialized services, suboptimal adherence to clinical guidelines, and disparities in technological integration, particularly in LMICs. Socioeconomic factors, such as income inequality and gender disparities, significantly impact access to care and outcomes. Technological advancements, including telemedicine, wearable devices, and AI, show promise but face barriers to widespread adoption. Patient education and mental health integration emerged as essential components of comprehensive care models. Precision public policy was highlighted as a key strategy to address these disparities through targeted, data-driven interventions. This review highlights the urgent need for multifaceted strategies to address unmet needs in cardiovascular care. Enhancing access to care, improving guideline adherence, integrating technology, and addressing socioeconomic disparities are critical to reducing the global burden of CVD. Collaborative efforts among policymakers, healthcare providers, and researchers are essential to develop equitable, patient-centered solutions. Precision public policy, tailored to the unique needs of diverse populations, offers a promising pathway to achieving these goals and improving cardiovascular health outcomes worldwide.
Atrial cardiomyopathy (ACM) is increasingly recognized as a key contributor to the development and perpetuation of atrial fibrillation (AF), a prevalent cardiac arrhythmia with significant clinical implications. ACM involves complex structural, electrical, and functional remodeling of the atrial myocardium, driven by various pathological conditions such as hypertension, heart failure, and obesity. Key mechanisms include atrial fibrosis, inflammation, and oxidative stress, which collectively contribute to the pro-arrhythmic and pro-thrombotic state associated with AF. Recent studies highlight the role of epicardial adipose tissue in promoting atrial fibrosis and the importance of genetic predispositions in ACM development. Advanced imaging techniques, including left atrial strain and cardiac magnetic resonance, are emerging as valuable tools for assessing atrial remodeling and guiding therapeutic decisions. Understanding the intricate relationship between ACM and AF may enable earlier identification and targeted interventions, potentially improving outcomes in affected patients. Despite advances, gaps remain in identifying early markers of ACM and developing specific therapeutic strategies. This review focuses on the analysis of ACM as a contributor to AF and its pathophysiological and clinical implications. Future research should focus on refining diagnostic criteria and exploring novel treatment approaches to manage ACM and its associated risks more effectively.
This study examined trends and disparities in USA mortality rates associated with the co-occurrence of coronary artery disease (CAD) and dyslipidemia from 1999-2020. Data were obtained from the multiple cause of death files using CDC WONDER, spanning 1999-2020. ICD-10 codes (I20-I25 for CAD and E78 for dyslipidemia) identified CAD and dyslipidemia-related deaths in adults aged 25 and older. Statistical analyses examined demographic and regional mortality distributions. Joinpoint regression analysis determined trends in age-adjusted mortality rates (AAMR), estimating annual percentage changes (APC). Between 1999 and 2020, 613,969 CAD and dyslipidemia-related deaths occurred in the USA. The AAMR per 100,000 increased from 6.2 in 1999 to 19.0 in 2020. The AAMR rose sharply from 1999-2005 (APC: 10.2; 95% CI: 9.1, 11.3), increased from 2005-2010 (APC: 3.3; 95% CI: 2.6, 5.0), stabilized through 2010-2016 (APC: 0.8; 95% CI: -0.5, 1.4), and increased again from 2016-2019 (APC: 3.0; 95% CI: 1.7, 4.7). Men accounted for 59.8% of deaths, with an AAMR of 18.2, compared to 8.7 for women. Non-Hispanic (NH) American Indian (13.4) and NH white populations (13.3) had the highest AAMRs, followed by NH black or African American (12), Hispanic or Latino (9.8), and NH Asian or Pacific Islanders (9.1). The Midwest had the highest AAMR (14.1), followed by the West (13.8), South (12.2), and Northeast (11.3). Nonmetropolitan areas had higher AAMRs (14.7) compared to metropolitan areas (12.4). Mortality due to concurrent CAD and dyslipidemia is increasing. Targeted interventions are needed to reduce mortality among vulnerable groups.
Heart failure (HF) remains a leading cause of hospitalization globally, exerting significant strain on healthcare systems and impacting patients' quality of life. Seasonal changes in climate and temperature are known to affect HF-related outcomes. This study investigates the seasonal variations in hospitalization outcomes among HF patients in the United States. We conducted a retrospective analysis of the National Inpatient Sample (NIS) database, focusing on patients aged over 18 years with a primary diagnosis of HF from 2018 to 2020, using the ICD-10-CM codes. Our primary outcomes of interest included trends in clinical characteristics, inpatient mortality rates, and length of hospital stay (LOS). In addition, inflation-adjusted healthcare costs for each patient were also analyzed. Statistical analyses included weighted logistic and linear regression, adjusting for patient-level factors (age, sex, race, comorbidities, insurance type, and median household income) and hospital-level factors (bed size, region, and teaching status). Inpatient mortality, length of stay, and inflation-adjusted hospital costs were analyzed. Mortality risk factors were assessed using multivariate models, with costs converted to 2019 dollars using standardized inflation adjustments. We identified 3,820,865 weighted HF hospitalizations, with peak admissions in winter (32.20%), followed by spring (29.73%), autumn (28.68%), and summer (9.39%). The mean patient age was highest in winter (69.5±0.06 years) and lowest in summer (68.7±0.07 years), P<0.001. Comorbidities showed seasonal variations, with hypertension, diabetes, and obesity more prevalent in summer, while acute myocardial infarction was more frequent in winter. White, Hispanic, and Asian/Pacific Islander patients experienced higher winter hospitalizations, whereas Black patients had increased admissions in autumn. Hospitalizations were most common among patients in the lowest income quartile (33.23%). The overall in-hospital mortality rate was 2.28%, highest in winter (2.40%) and lowest in summer (2.11%), P<0.001. The average length of stay (LOS) was 5.24 days (95% CI: 5.20-5.28), increasing from 5.19 days (95% CI: 5.12-5.25) in 2018 to 5.31 days (95% CI: 5.25-5.38) in 2020. Inflation-adjusted costs rose from $57,166 in 2018 to $65,961 in 2020, with significant seasonal differences. Seasonal variations markedly influence HF-related hospitalizations and outcomes, with winter showing the highest hospitalization and mortality rates, especially among White, Hispanic, and Asian/Pacific Islander patients.
Circular RNAs (circRNAs) are implicated in the pathogenesis of acute myocardial infarction (AMI). Current research aims to evaluate the diagnostic and functional value of circFOXP1 in AMI patients. The expression of circFOXP1 was assessed using RT-qPCR, and its diagnostic potential was determined through receiver operating characteristic (ROC) curve. The target gene of circFOXP1 was identified using a luciferase reporter assay. An in vitro hypoxia/reoxygenation (H/R) model was established in AC16 cells, while an AMI model was constructed in C57BL/6 mice. The proliferation and apoptosis of AC16 cells were evaluated using CCK8 and flow cytometry (FCM). The impact of circFOXP1 on inflammation was measured by assessing levels of TNF-α, IL-1β, and IL-6, while the effects of circFOXP1 on oxidative stress were evaluated through measurements of reactive oxygen species (ROS), glutathione (GSH), and lactate dehydrogenase (LDH) levels. circFOXP1 expression was found to be downregulated in AMI patients compared to controls. The ROC curve indicated an area under the curve (AUC) was 0.881 (95%CI=0.847-0.915), with a sensitivity of 0.930 and a specificity of 0.785. Additionally, miR-9-3p was identified as a direct target gene of circFOXP1. High levels of circFOXP1 did not significantly affect f the proliferation of H/R stimulated AC16 cells; however, increased circFOXP1 resulted in significant reduction in cell apoptosis (P<0.001). TNF-α, IL-1β, and IL-6 levels were significantly lower in pcDNA3.1-circFOXP1-transfected cells (P<0.001). ROS concentration and LDH level were markedly reduced in these cells (P<0.01), while GSH level (P<0.001) was significantly elevated. miR-9-3p, as a direct target gene of circFOXP1, was found to reverse the effects of circFOXP1 on H/R AC16 cells and AMI model. circFOXP1 was decreased in AMI patients and may serve as a diagnostic marker for AMI. Overexpression of circFOXP1 was shown to suppress apoptosis, inflammation, and oxidative stress via miR-9-3p in AC16 cells and the AMI model.
Atrial fibrillation (AF) is a prevalent and significant health concern, imposing a substantial economic burden on healthcare systems worldwide. The condition is associated with an increased risk of stroke, heart failure and other comorbidities, contributing to heightened morbidity and mortality rates amongst those affected. Healthcare resource utilization and costs associated with the treatment and management of AF have become a pressing concern, particularly in the context of recurrent episodes. Catheter ablation (CA) has been demonstrated to have positive effects on relieving the economic burden of AF. The aim of this review is to evaluate the economic burden of AF and analyze the cost-efficiency of CA compared to pharmacological treatments, particularly in patients with drug-refractory AF. This narrative review is focused on manuscripts, derived from the NCBI (PubMed) online database, which deal with the economic burden of AF through the analysis of direct and indirect costs and benefits of various therapeutic options, concentrating on CA compared to drug management alone. The economic burden of AF varies widely across healthcare systems, with direct costs ranging from $ 2000 to $ 60,000 per patient per year. The review confirms that CA, despite its higher initial costs ($ 27,000-38,000 per procedure in the USA), provides long-term financial benefits. Across the analyzed studies, CA led to a 20-40% reduction in hospitalization rates, a 15-30% decrease in emergency department visits, and a significant reduction in medication use, particularly in antiarrhythmic drugs and anticoagulants. Cost-utility analyses indicate that CA is cost-effective, with incremental cost-effectiveness ratios (ICER) ranging from $ 6000 to $ 60,000 per quality-adjusted life year (QALY). Furthermore, studies demonstrate a 10-20% improvement in quality-of-life scores for patients undergoing CA compared to those on pharmacological therapy alone. CA is a cost-efficient strategy for managing AF, especially in patients with symptomatic, drug-refractory AF. The procedure provides both long-term economic benefits by reducing healthcare resource utilization and favorable socio-economic effects by improving quality of life. Future studies should continue to explore the broader economic impact of AF management, including indirect costs such as lost productivity and caregiver burden.
The optimal percutaneous coronary intervention (PCI) revascularization strategy in patients presenting with multi-vessel (MV) coronary artery disease (CAD) and acute myocardial infarction (MI) has not been systematically addressed. Accordingly, we performed a frequentist network meta-analysis with the aim of assessing the prognostic impact of different PCI strategies. We conducted an electronic research for studies including angiography-guided and functional-guided complete revascularization in patients with acute MI from 2001 to 30th November 2023. Endpoints of interest were cardiovascular mortality, all-cause mortality, spontaneous MI and any revascularization. Twelve randomized clinical trials involving 11,581 patients fulfilled the inclusion criteria. Functional-guided complete PCI was associated with lower cardiovascular death compared to culprit-only PCI (incidence rate ratio [IRR] 0.61, 95% confidence interval [CI] 0.39-0.96; P=0.033). Both complete functional- and angio-guided PCI reduced the risk of further revascularization compared to culprit-only PCI (IRR 0.37, 95% CI 0.24-0.55, P<0.001, and IRR 0.33, 95% CI 0.20-0.52, P<0.001, respectively). Both complete functional- and angio-guided PCI resulted in a non-significant reduction of spontaneous MI compared to culprit-only PCI strategy (IRR 0.76, 95% CI 0.50-1.15; P=0.20 and IRR 0.72, 95% CI 0.47-1.12; P=0.15, respectively). No significant differences were found regarding other study endpoints and other comparisons. In patients with MI and MV CAD, undergoing successful PCI of IRA, a complete revascularization strategy, regardless of the specific approach, was associated with a lower incidence of repeat revascularization compared with a culprit-only strategy. Complete functional-guided revascularization resulted in lower incidence of cardiovascular death, whereas a complete angio-guided approach did not show the same benefit.
Dyslipidemia remains a central modifiable risk factor for cardiovascular disease, necessitating comprehensive and evolving management strategies. This review provides an updated overview of currently approved and emerging lipid-lowering therapies, focusing on their mechanisms of action, efficacy, and safety profiles. Traditional agents such as statins and bile acid sequestrants continue to play foundational roles, while newer therapies - including PCSK9 inhibitors, bempedoic acid, and RNA-based treatments - have expanded therapeutic options, particularly for high-risk or statin-intolerant patients. Additionally, therapies targeting triglyceride reduction, such as fibrates and omega-3 fatty acids, have demonstrated potential benefits in specific subgroups. Novel strategies such as gene editing, oral PCSK9 inhibitors, HDL-targeted treatments, and gut microbiota modulation represent promising future directions. The review also explores the utility of non-pharmacologic approaches, including lipid apheresis and bariatric surgery, in selected cases. Together, these developments highlight the importance of tailored, multi-targeted approaches to lipid management in the prevention of cardiovascular events. Continued research is essential to refine therapeutic algorithms and optimize patient outcomes.
In the face of numerous studies concerning the technical advances of percutaneous coronary intervention [PCI] and clinical outcomes, only a few studies focus on patients' lived experiences after PCI. This study aims to explore patients' lived experiences after PCI, both in clinical terms and in terms of their perception of their health status, functional capacity, and autonomy at home. A qualitative phenomenological, individual, semi-structured survey was conducted on a sample of 18 patients undergoing PCI. Face-to-face interviews were conducted, interviews had a time duration of 7 to 10 minutes, and all conversations were recorded and transcribed. The study assessed the level of satisfaction, concerning the lived experience, in the pre/post-procedure period and the subsequent follow-up. Patients emphasized the importance of four themes: post-PCI health conditions, activities of daily living, the relationship established with health care providers, and the relationship between patient and family members/caregivers. Patients emphasized the improvement of symptoms, particularly exertional dyspnea, exertional angina, and easy fatigability. As a result, patients reported increased confidence in performing normal daily activities. Patients stressed the importance of establishing a good relationship between patients and healthcare providers. About 72.2% (95% CI 49.1-87.5%) of patients reported that they needed the help of family in the recovery phase. Of this group, 84.6% (95% CI 57.7-95.7%) reported that they never felt like a burden to their loved ones. Post-PCI follow-up is generally characterized by improvement in the patient's functional capacity and autonomy. There are, however, cases in which at least part of the burden of home care falls on family members.
Cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality worldwide, accounting for significant public health and economic burdens. Cardiac rehabilitation (CR) is a comprehensive, multidisciplinary program designed to aid patients in recovering from cardiac events and to prevent further complications. The aim of CR is to improve their quality of life and prognosis. It involves continued prognostic stratification, clinical stabilization, optimization of pharmacological and non-pharmacological therapy, management of comorbidities, treatment of disabilities, reinforcement of secondary prevention interventions, and maintenance of adherence to therapy. The most recent European Society of Cardiology guidelines for the diagnosis and management of atrial fibrillation (AF) emphasize the importance of cardiorespiratory fitness, recommending that patients engage in moderate-intensity exercise and remain physically active to prevent AF incidence or recurrence. Through this symbiotic relationship, CR addresses all aspect of cardiac fitness in AF management. The program's structured exercise regimens are specifically tailored to address the challenges associated with AF, promoting overall cardiovascular health and reducing the risk for cardiac death. CR is also crucial for emotional well-being, offering support and coping mechanisms for the psychological impact of AF, beyond the physical training program. CR programs involve a multidisciplinary approach that is carried out collaboratively by a team of healthcare professionals, including nurses, physiotherapists, psychologists, and dietitians. Moreover, CR in AF patients aims to carry out comprehensive patient support through clinical stabilization and therapy optimization interventions, prescription and implementation of physical activity, educational support on lifestyle risk factors and social-emotional distress, and periodic assessment of outcomes. This narrative review aims to elucidate the role of CR in AF patients, shedding light on the potential benefits and challenges associated with integrating rehabilitation programs into the care of individuals with AF.
Fabry disease (FD) is a rare X-linked lysosomal disorder caused by deficient α-galactosidase A (α-Gal A) activity. This scoping review synthesizes evidence on screening, diagnostic, and follow-up methods for FD. We searched six databases for English and Spanish articles published from 2017 until April 2023. Eligible studies included human research on clinical manifestations and methods for screening, diagnosing, and monitoring FD, such as experimental and quasi-experimental studies, observational research, reviews, and guidelines. We followed PRISMA-ScR guidelines for screening and data extraction. We analyzed data with descriptive statistics and qualitative synthesis. We included 383 studies, with cross-sectional designs being the most common (N:=155, 41%). Most studies were from high-income countries, and 199 (52%) did not report patients' phenotypes. Screening methods often combined clinical presentation, laboratory results, and imaging findings. Specifically, 14 studies (4%) focused on newborn screening. Clinical symptoms were described in 315 studies (82%) and were instrumental in diagnostic investigation. While hallmark manifestations were prevalent, less-recognized symptoms like tinnitus, early stroke, cerebrovascular dolichoectasia, conduction disorders, aortic root dilatation, and parapelvic cysts, were highlighted as important in clinical suspicion. Laboratory, particularly α-Gal A measurement (N.=183, 48%), and genetic sequencing were fundamental to diagnosis confirmation. Follow-up assessments concentrated on cardiovascular, genitourinary, and nervous systems, employing imaging and electrophysiological studies, along with various scales and questionnaires. This review provides a comprehensive overview of screening, diagnostic, and monitoring strategies for FD, offering evidence-based insights to improve the clinical management of FD patients.
Despite the significant improvement in guidewire technology, in-vivo comparison of workhorse guidewires is lacking. This study aims to assess the feasibility of randomized data collection regarding the wiring time and its variability among three guidewires: Sion Blue, Minamo, and Runthrough, and to identify key lesion characteristics for future guidewire research. 45 patients were randomized between February of 2023 and May 2024. Patients undergoing elective percutaneous coronary intervention (PCI) to a bifurcation lesion requiring two guidewires were included. The wiring time was defined from when the tip of the guidewire at the end of the guide catheter until the advancement to the distal target vessel. The mean wiring time was 55.3 seconds for side branch and 95.8 seconds for main branch. The wiring time was similar for both side-branch wiring (Sion Blue 65.9±79.5, Minamo 41.2±33.4, Runthrough 57.6±88, P=0.65) and the main branch wiring (Sion Blue 44.8±38.9, Minamo 123.8±189.4, Runthrough 119.1±183.6, P=0.3). Use of the torque device, guidewire reshaping, or switching to a second guidewire were uncommon. Lesions requiring longer wiring time had severe stenosis (>90%), severe calcification, or tortuosity. The median crossing time was longer when recrossing stent struts, especially during two-stent strategy (>130 seconds). Prospective data collection assessing the difference of wiring time as a clinical endpoint is feasible. Our study results can form a basis for future studies comparing different guidewires.
Multiple valvular heart disease (M-VHD) is a common condition, often involving aortic stenosis (AS) plus a mitral or tricuspid valve disease. We aim to evaluate the evolution and prognostic impact of M-VHD in patients undergoing transcatheter aortic valve implantation (TAVI). A retrospective cohort study was conducted on patients who underwent TAVI in a tertiary care center between January 2016 and December 2022. Echocardiography was performed before and after TAVI. The primary endpoint was the composite of all-cause mortality and cardiovascular hospitalizations during follow-up. A total of 159 patients (88 women; mean [SD] age, 80.8 [7.8] years) with severe AS and M-VHD were identified. Seventy-two (45.3%) had mitral regurgitation, 69 (43.4%) had tricuspid regurgitation, and 18 (11.3%) had mitral stenosis. After TAVI, 77 patients (48.4%) experienced an improvement of the concomitant valve disease, while 82 did not. Female gender (OR:0.25, 95%CI:0.11-0.56, P<0.001), pacemaker implantation (OR:0.37, 95%CI:0.14-0.98, P=0.046) and rheumatic etiology (OR:0.25, 95%CI:0.09-0.74, P=0.012) were negatively associated with improvement. At a median follow-up of 31 months (26-51), patients with no improvement had an increased occurrence of the composite endpoint compared to their counterparties, (P=0.028). On multivariable analysis, NYHA class III/IV (HR:2.04, 95%CI:1.02-4.08, P=0.044) and creatinine (HR:1.43, 95%CI:1.06-1.94, P=0.019) were associated with a higher risk of the endpoint, while the improvement of concomitant valve disease emerged as protective factor (HR:0.46, 95%CI:0.25-0.85, P=0.013). Concomitant valve disease improved in roughly half of M-VHD patients after TAVI. Patients with post-TAVI improvement of the second valve lesion had better clinical outcomes at long-term follow-up.
The burden of cardiovascular disease (CVD) remains a worldwide challenge. CVDs, in particular atherosclerotic CVD, are still an important cause of mortality and morbidity. The increase in life expectancy is a further determining factor in the epidemiology of CVDs in some countries, such as Italy, which increases the urgency of intervening on modifiable risk factors. Among these, hypercholesterolemia is present in a significant percentage of CVD patients. A linear relationship between the risk of acute events and the plasma level of low-density lipoproteins cholesterol (LDL-C) is well known. The reduction of LDL-C levels leads to a decrease in mortality and morbidity. The overall recommendation is to treat hypercholesterolemia intensively and as early as possible. Statins, ezetimibe, bempedoic acid, pro-protein convertase subtilisin/kexin 9 inhibitors (i.e., the monoclonal antibodies alirocumab and evolocumab, or the small interfering RNA inclisiran) are all available for reaching LDL-C targets according to risk profile. While the real-world data confirm the safety of currently recommended LDL-C targets, data on their actual achievement are discouraging, less than half of patients on therapy reach the LDL-C targets recommended by the most recent ESC/EAS Guidelines. The causes of this critical discrepancy are multiple, arising from the various components that characterize the complex relationship between patient and physician within the healthcare system. A call to action is needed. Doctors should be continuously updated on the latest evidence, follow recommendations and engage the patient in the therapeutic process. Regular monitoring of the effects of the prescribed therapy, also through e-health and telemedicine tools, is essential, as well as changing therapy when LDL-C is not adequately controlled. Finally, health systems should align with guidelines and promote good clinical practices, overcoming a silo system, to impact outcomes in terms of overall sustainability.
Transcatheter aortic valve replacement (TAVR) is increasingly performed nowadays, bleeding and vascular complications are not uncommon. Current recommendations for the use of protamine in the post-TAVR setting remain uncertain. This study aimed to evaluate the efficacy and safety of protamine in this setting. A systematic search using four databases, including PubMed, Embase, Web of Science, and Cochrane CENTRAL, was conducted from inception to October 17th, 2024, without language restrictions. The inclusion criteria were studies that compared the efficacy or safety of protamine vs control in post-TAVR patients. There were six studies (two randomized and four non-randomized) included in this meta-analysis, involving 3897 participants. We used a random-effects model for this meta-analysis. Protamine was associated with a lower risk of major bleeding compared to the control group, with an odds ratio (OR) of 0.47 (95% CI 0.30 to 0.74, P<0.01). Additionally, protamine was associated with a lower risk of major vascular complications compared to the control, with an OR of 0.45 (95% CI 0.31 to 0.65, P<0.01). Protamine also reduced the risk of minor bleeding and life-threatening bleeding compared to the control. For the safety outcome, the administration of protamine did not increase the risk of stroke and myocardial infarction. The administration of protamine demonstrated efficacy in reducing bleeding and vascular complications without increasing the risk of thromboembolic complications in the post-TAVR setting.
Previous studies have highlighted the role of inflammatory and nutritional markers in predicting outcomes in cardiovascular diseases. However, to our knowledge, no study has explored the impact of the combination of these two aspects on outcome of patients undergoing transcatheter aortic valve implantation (TAVI). This study aims to assess the predictive value of the pre-procedural platelet-to-lymphocyte ratio (PLR)/albumin ratio on one-year mortality in this population METHODS: This retrospective observational study screened 867 patients who underwent TAVI between December 2018 and September 2023 at our tertiary center, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy. After excluding patients with systemic inflammatory or autoimmune diseases (223), cancer (257), acute or chronic infections (22), and those with missing data (77), the final cohort comprised 288 patients. PLR and albumin levels were calculated from pre-procedural blood samples, and the PLR/albumin ratio was subsequently derived. The prognostic discriminatory capacity and cutoff value of the PLR/albumin ratio were assessed using multivariate Cox regression and ROC analysis, respectively. Individually both PLR and albumin were confirmed as independent predictors of post-TAVI 1-year mortality (odds ratios: 1.01 and 0.83, respectively), but their association with outcome was sensibly increased when considered together as PLR/albumin ratio (odds ratio: 1.33 [95% CI: 1.1-1.6, P=0.007]). In particular, PLR/albumin ratio >4.69 showed the best predictive capacity (AUC 0.69, sensitivity 56.25%, specificity 83.27%) for patients at higher risk of mortality in the first year after TAVI. No other clinical covariate demonstrated such comparable outcome predictive strength. A high PLR/albumin ratio resulted as independent one-year mortality predictor in patients undergoing TAVI procedure. The proposed combination of inflammatory and nutritional markers outperformed the value of single parameters. Its integration into pre-procedural TAVI work-out could be represent a further improvement of individualized risk stratification.
Prolonged dual antiplatelet therapy (DAPT) with ticagrelor 60 mg is recommended in post-myocardial infarction (MI) patients at moderate to high ischemic risk. Beyond physician-led discontinuation, persistence with therapy in real-world settings may be limited due to adverse effects and patient choices. The aim of this study is to assess the real-world incidence of non-compliance with prolonged DAPT and to elucidate reasons for discontinuation. A retrospective observational study was conducted in three high-volume Italian PCI centers, involving patients with prior MI (1-3 years before) prescribed with ticagrelor 60 mg twice daily. Demographic, clinical, and procedural data were collected, with follow-up to determine therapy discontinuation and reasons for it. Among 244 enrolled patients, mean age was 66 years, and 83.6% were male. During follow-up (mean duration: 27.6 months), 10.2% (95% CI: 6.7% to 14.8%) discontinued ticagrelor. Key reasons included voluntary decision (40.0% [21.1% to 61.3%]) and bleeding events (40.0% [21.1% to 61.3%]), with some switching to high-dose regimens post-revascularization. In univariate analysis, ticagrelor discontinuation was significantly associated with female sex, higher BMI, prior PCI or CABG, high bleeding risk, and the absence of multivessel disease or primary PCI. However, in multivariable analysis, only multivessel disease remained independently associated with a lower likelihood of discontinuation (P<0.001). Real-world persistence with prolonged DAPT remains a challenge, often hindered by patient-driven discontinuation and adverse events. Enhanced patient education on therapy benefits and adherence may improve long-term outcomes.