Clinical Research in Cardiology
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A simple score for rapid risk assessment of non-high-risk pulmonary embolism
Clinical Research in Cardiology - - 2013
Dabigatran versus vitamin K antagonists for atrial fibrillation in clinical practice: final outcomes from Phase III of the GLORIA-AF registry
Clinical Research in Cardiology - Tập 111 - Trang 548-559 - 2022
Prospectively collected, routine clinical practice-based data on antithrombotic therapy in non-valvular atrial fibrillation (AF) patients are important for assessing real-world comparative outcomes. The objective was to compare the safety and effectiveness of dabigatran versus vitamin K antagonists (VKAs) in patients with newly diagnosed AF. GLORIA-AF is a large, prospective, global registry program. Consecutive patients with newly diagnosed AF and CHA2DS2-VASc scores ≥ 1 were included and followed for 3 years. To control for differences in patient characteristics, the comparative analysis for dabigatran versus VKA was performed on a propensity score (PS)-matched patient set. Missing data were multiply imputed. Proportional-hazards regression was used to estimate hazard ratios (HRs) for outcomes of interest. Between 2014 and 2016, 21,300 eligible patients were included worldwide: 3839 patients were prescribed dabigatran and 4836 VKA with a median age of 71.0 and 72.0 years, respectively; > 85% in each group had a CHA2DS2-VASc-score ≥ 2. The PS-matched comparative analysis for dabigatran and VKA included on average 3326 pairs of matched initiators. For dabigatran versus VKAs, adjusted HRs (95% confidence intervals) were: stroke 0.89 (0.59–1.34), major bleeding 0.61 (0.42–0.88), all-cause death 0.78 (0.63–0.97), and myocardial infarction 0.89 (0.53–1.48). Further analyses stratified by PS and region provided similar results. Dabigatran was associated with a 39% reduced risk of major bleeding and 22% reduced risk for all-cause death compared with VKA. Stroke and myocardial infarction risks were similar, confirming a more favorable benefit-risk profile for dabigatran compared with VKA in clinical practice. Clinical trial registration
https://www.clinicaltrials.gov
. NCT01468701, NCT01671007.
Validating real-time three-dimensional echocardiography against cardiac magnetic resonance, for the determination of ventricular mass, volume and ejection fraction: a meta-analysisAbstract
Introduction
Methods
Results
Conclusion
Graphical abstract
Clinical Research in Cardiology - - 2024
Real-time three-dimensional echocardiography (RT3DE) is currently being developed to overcome the challenges of two-dimensional echocardiography, as it is a much cheaper alternative to the gold standard imaging method, cardiac magnetic resonance (CMR). The aim of this meta-analysis is to validate RT3DE by comparing it to CMR, to ascertain whether it is a practical imaging method for routine clinical use.
A systematic review and meta-analysis method was used to synthesise the evidence and studies published between 2000 and 2021 were searched using a PRISMA approach. Study outcomes included left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), left ventricular mass (LVM), right ventricular end-systolic volume (RVESV), right ventricular end-diastolic volume (RVEDV) and right ventricular ejection fraction (RVEF). Subgroup analysis included study quality (high, moderate), disease outcomes (disease, healthy and disease), age group (50 years old and under, over 50 years), imaging plane (biplane, multiplane) and publication year (2010 and earlier, after 2010) to determine whether they explained the heterogeneity and significant difference results generated on RT3DE compared to CMR.
The pooled mean differences for were − 5.064 (95% CI − 10.132, 0.004,
This meta-analysis indicates promising results for the use of RT3DE, with limited difference to CMR. Although in some cases, RT3DE appears to underestimate volume, ejection fraction and mass when compared to CMR. Further research is required in terms of imaging method and technology to validate RT3DE for routine clinical use.
Non-invasive predictors for infranodal conduction delay in patients with left bundle branch block after TAVR
Clinical Research in Cardiology - Tập 110 - Trang 1967-1976 - 2021
Left bundle branch block (LBBB) is the most common conduction disorder after transcatheter aortic valve replacement (TAVR) with an increased risk of atrioventricular (AV) block. The aim of the current study was to identify non-invasive predictors for infranodal conduction delay in patients with LBBB. We analyzed consecutive patients undergoing TAVR with pre-existing or new-onset LBBB between August 2014 and August 2020. His ventricular (HV) interval measurement was performed on day 1 after TAVR. Baseline, procedural, as well as surface and intracardiac electrocardiographic parameters were included. Infranodal conduction delay was defined as HV interval > 55 ms. Of 825 patients screened after TAVR, 151 patients (82 ± 6 years, 39% male) with LBBB were included. Among these, infranodal conduction delay was observed in 25%. ΔPR (difference in PR interval after and before TAVR), PR and QRS duration after TAVR were significantly longer in the group with HV prolongation. In a multivariate analysis in patients with sinus rhythm (n = 123), ΔPR (OR per 10 ms increase: 1.52; 95%CI: 1.19–2.01; p = 0.002) was the only independent factor associated with infranodal conduction delay. A change in PR interval by 20 ms yielded a specificity of 83% and a sensitivity of 46%, with a negative predictive value of 84% and a positive predictive value of 45% to predict HV prolongation. Simple analysis of surface ECG and a calculated ΔPR < 20 ms can be used as predictor for the absence of infranodal conduction delay in post-TAVR patients with LBBB.
Effect of frailty on treatment, hospitalisation and death in patients with chronic heart failure
Clinical Research in Cardiology - Tập 110 - Trang 1249-1258 - 2021
Frailty is common in patients with chronic heart failure (CHF) and is associated with poor outcomes. The natural history of frail patients with CHF is unknown. Frailty was assessed using the clinical frailty scale (CFS) in 467 consecutive patients with CHF (67% male, median age 76 years, median NT-proBNP 1156 ng/L) attending a routine follow-up visit. Those with CFS > 4 were classified as frail. We investigated the relation between frailty and treatments, hospitalisation and death in patients with CHF. 206 patients (44%) were frail. Of 291 patients with HF with reduced ejection fraction (HeFREF), those who were frail (N = 117; 40%) were less likely to receive optimal treatment, with many not receiving a renin–angiotensin–aldosterone system inhibitor (frail: 25% vs. non-frail: 4%), a beta-blocker (16% vs. 8%) or a mineralocorticoid receptor antagonist (50% vs 41%). By 1 year, there were 56 deaths and 322 hospitalisations, of which 25 (45%) and 198 (61%), respectively, were due to non-cardiovascular (non-CV) causes. Most deaths (N = 46, 82%) and hospitalisations (N = 215, 67%) occurred in frail patients. Amongst frail patients, 43% of deaths and 64% of hospitalisations were for non-CV causes; 58% of cardiovascular (CV) deaths were due to advancing HF. Among non-frail patients, 50% of deaths and 57% of hospitalisations were for non-CV causes; all CV deaths were due to advancing HF. Frailty in patients with HeFREF is associated with sub-optimal medical treatment. Frail patients are more likely to die or be admitted to hospital, but whether frail or not, many events are non-CV.
Ảnh hưởng của vị trí thiết bị occlusion tai trái đến các yếu tố quyết định tiềm năng của huyết khối liên quan đến thiết bị: một nghiên cứu in silico theo từng bệnh nhân Dịch bởi AI
Clinical Research in Cardiology - - Trang 1-14 - 2023
Huyết khối liên quan đến thiết bị (DRT) sau occlusion tai trái (LAAO) có khả năng liên quan đến các sự kiện bất lợi. Mặc dù các báo cáo lâm sàng gợi ý rằng loại thiết bị và vị trí của nó có ảnh hưởng đến nguy cơ DRT, nhưng cần có các nghiên cứu chuyên sâu về cơ sở cơ chế của nó. Nghiên cứu in silico này nhằm đánh giá tác động của vị trí của thiết bị LAAO không có pacifier (Watchman) và có pacifier (Amulet) đối với các dấu hiệu thay thế của nguy cơ DRT. Các thiết bị LAAO đã được mô hình hóa với hình học chính xác và được cấy ghép ảo vào các vị trí khác nhau trong một tâm nhĩ trái đặc trưng cho bệnh nhân. Sử dụng động lực học chất lỏng tính toán, các giá trị sau đây đã được định lượng: máu còn sót lại, lực cắt trên thành mạch (WSS) và tiềm năng kích hoạt tế bào nội mạc (ECAP). So với vị trí thiết bị gắn vừa với ostium, việc cấy sâu hơn dẫn đến nhiều máu còn sót lại hơn, WSS trung bình thấp hơn và ECAP cao hơn xung quanh thiết bị, đặc biệt trên bề mặt nhĩ của thiết bị và mô xung quanh, cho thấy nguy cơ huyết khối tiềm tàng tăng cao. Đối với thiết bị không có pacifier, định hướng thiết bị lệch trục dẫn đến nhiều máu còn sót lại hơn, ECAP cao hơn và WSS trung bình tương đương với vị trí thiết bị gắn vừa với ostium. Tổng thể, thiết bị có pacifier cho thấy ít máu còn sót lại hơn, WSS trung bình cao hơn và ECAP thấp hơn, so với thiết bị không có pacifier. Trong nghiên cứu in silico này, cả loại thiết bị LAAO và vị trí cấy ghép đều cho thấy ảnh hưởng đến các dấu hiệu tiềm năng của DRT về mặt stasis máu, sự bám dính của tiểu cầu và rối loạn chức năng nội mạc. Kết quả của chúng tôi trình bày một cơ sở cơ chế cho các yếu tố nguy cơ DRT đã được quan sát lâm sàng và mô hình in silico được đề xuất có thể hỗ trợ trong việc tối ưu hóa phát triển thiết bị và các khía cạnh thủ tục.
Cardiospecificity of the 3rd generation cardiac troponin T assay during and after a 216 km ultra-endurance marathon run in Death Valley
Clinical Research in Cardiology - Tập 96 - Trang 359-364 - 2007
The reasons
for the appearance of cardiacspecific
troponin (cTnT) after
strenuous exercise are unclear. The
aim of the present study was to
evaluate the cardiospecificity of the
3rd generation cardiac cTnT assay
during and after an ultra-endurance
race of 216 km at extreme
environmental conditions in Death
Valley. We measured serially cTnT, creatine
kinase (CK), activity and
mass of the isoenzyme MB of CK
(CK-MBact and CK-MBmass), and
myoglobin in 10 well-trained athletes
before, repeatedly during and
after the race. Six of 10
participants finished the race
within a preset time of 60 hours.
Postrace values of biochemical
markers CK, CK-MBact, CKMBmass,
and myoglobin were significantly
increased compared to
baseline (p<0.05). CK-MBact increased
from (median (25th/
75thpercentile) 12 (10/13) U/L to 72
(32/110) U/L, CK-MBmass from 3.9
(2.9/5.6) U/L to 65 (18/80) U/L and
CK increased from median 136 (98/
228) U/L to 3,570 (985/6,884) U/L
respectively. Pre-race myoglobin
was 27 (22/31) µg/l compared to
530 (178/657) µg/l after the run.
One runner developed significant
exercise-induced rhabdomyolysis
with spontaneous recovery. cTnT
values remained below the 99th
percentile reference limit in all
athletes including the runner who
developed significant rhabdomyolysis
(peak CK 27,951 U/L). Strenuous endurance exercise,
even under extreme environmental
conditions, does not
result in structural myocardial
damage in well-trained ultra-endurance
athletes. We found no
crossreactivity between cTnT and
CK, neither in exercise-induced
skeletal muscle trauma nor after
rhabdomyolysis underscoring the
excellent analytical performance of
3rd generation cTnT assay.
Cardiac cystic echinococcosis: a long-term follow-up case report
Clinical Research in Cardiology - - 2012
Prognostic value of sST2 added to BNP in acute heart failure with preserved or reduced ejection fraction
Clinical Research in Cardiology - Tập 104 - Trang 491-499 - 2015
Natriuretic peptides and suppression of tumorigenicity 2 (ST2) represent two different physiopathological pathways. We evaluated the prognostic accuracy and complementarity of B-type natriuretic peptide (BNP) and soluble ST2 (sST2) plasma levels at discharge from a hospital admission for acute heart failure, both in patients with preserved (HFpEF) and depressed (HFrEF) systolic function. We enrolled 195 consecutive patients discharged alive and followed them prospectively for 6 months. The endpoint was all-cause death or hospital readmission for heart failure. Seventy-six patients had HFpEF and 119 had HFrEF, of whom 23 (30.3 %) and 43 (36.1 %) reached the combined endpoint, respectively. In both HFpEF and HFrEF, having the two biomarkers into account added prognostic information, with the highest risk in patients with both biomarkers above the median in their group (approximately 40 % hospitalization-free survival in both groups at 6 months). These associations translated into a significant fourfold increase in risk of the endpoint for one elevated biomarker and sevenfold for both biomarkers elevated in HFrEF, and no association for one elevated biomarker and fivefold increase in risk for both biomarkers elevated in HFpEF. Considering the reclassification of risk added to BNP by measurement of sST2, net reclassification index was 0.31 (p = 0.21) among patients with HFpEF and 0.70 (p < 0.001) among patients with HFrEF. sST2 provides robust prognostic information in acute heart failure with HFrEF, while this pattern was less clear in HFpEF. When sST2 was measured together with BNP, it improved prognostic accuracy in both groups, more clearly in HFrEF.
Cadonilimab plus anlotinib effectively relieve rare cardiac angiosarcoma with multiple metastases: a case report and literature review
Clinical Research in Cardiology - Tập 113 - Trang 358-365 - 2023
Tổng số: 1,943
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