Search Results (1,963)

Patients with heart failure (HF) and their caregivers are a dyad inextricably linked that exert influence on patients’ quality of life (QoL). Purpose: The aim of this study was to explore factors affecting HF patients’ QoL. Factors were: (a) HF patients’ characteristics, (b) anxiety/depression of the dyad (patient–caregiver) and (c) caregivers’ QoL. Material and Methods: In this cross-sectional study, we enrolled 340 patients and 340 caregivers. Data collection was performed by the method of an interview using “The Hospital Anxiety and Depression Scale”, HADS) to assess anxiety and depression (patient–caregiver) as well as the “Minnesota Living with Heart Failure” and the “SF-36 Health Survey (SF-36)” to assess QoL (patient–caregiver, respectively). Results: From the 340 dyads who comprised the sample, 81.3% and 77.5% of patients experienced anxiety and depression, respectively, while 79.3% and 62.2% of caregivers experienced anxiety and depression, respectively. A statistically significant difference between patients and caregivers was only detected for depression (p = 0.001) and not for anxiety (p = 0.567). Patients with scores in HADS that indicate anxiety and depression had a worse QoL (total, physical, and mental). All subscales of the caregiver’s QoL were significantly associated with the patient’s QoL (p < 0.001) apart from the physical functioning scale. The correlation coefficients were all negative, indicating that a better caregiver’s QoL (higher SF36 scores) is associated with a better patient’s QoL (lower Minnesota scores). After controlling for the patient’s characteristics, the anxiety and depression of caregivers did not affect the patient’s QoL (confounding effect) whereas the patient’s anxiety/depression remained significant factors. Patients with anxiety and depression had 5.58 and 6.49 points, respectively, higher QoL score, meaning a worse QoL, compared to those with no anxiety/depression. Conclusions: Evaluating the impact of HF on patients’ QoL and anxiety/depression along with their caregivers permits acknowledgment of this dyadic relationship. Full article

Hypertension is a major public health concern, especially in older adults, and gender differences are a factor in terms of its prevalence. Social connections benefit health, while social isolation is linked to negative outcomes. Prior studies suggest social isolation and connectedness vary by gender, but few have explored this relationship with hypertension. This study examined gender differences in the association between social isolation and hypertension in older adults using data from the National Survey of American Life (1280 adults aged ≥55). Weighted logistic regressions tested gender differences in objective and subjective social isolation and hypertension. Both men and women who were objectively isolated from family and friends, or only friends, were less likely to have hypertension than those not isolated. However, when accounting for subjective isolation, only isolation from family predicted hypertension. Gender moderated this relationship—men isolated from family and friends had a higher likelihood of hypertension, while no such association was found for women. Findings suggest that preventing objective isolation, particularly from family, may help reduce hypertension risk in older adults. This study highlights the need to further investigate social isolation’s impact on health and its underlying mechanisms among older adults in the U.S. Full article

Aortic valve stenosis (AVS) is the most common valvular heart disease that was considered, for a long time, a passive degenerative disease due to physiological aging. More recently, it has been recognized as an active, modifiable disease in which many cellular processes are involved. Nevertheless, since aging remains the major risk factor for AVS, a field of research has focused on the role of early (biological) aging and its dependent pathways in the initiation and progression of AVS. Telomeres are regions at the ends of chromosomes that are critical for maintaining genome stability in eukaryotic cells. Telomeres are the hallmarks and molecular drivers of aging and age-related degenerative pathologies. Clonal hematopoiesis of indeterminate potential (CHIP), a condition caused by somatic mutations of leukemia-associated genes in individuals without hematologic abnormalities or clonal disorders, has been reported to be associated with aging. CHIP represents a new and independent risk factor in cardiovascular diseases, including AVS. Interestingly, evidence suggests a causal link between telomere biology and CHIP in several pathological disorders. In this review, we discussed the current knowledge of telomere biology and CHIP as possible mechanisms of aortic valve degeneration. We speculated on how a better understanding of the complex relationship between telomere and CHIP might provide great potential for an early diagnosis and for developing novel medical therapies to reduce the constant increasing health burden of AVS. Full article

Clinical management of patients with atherosclerotic coronary artery disease (CAD) following acute coronary syndrome includes cardiac rehabilitation. The well-established hallmark of cardiac rehabilitation is structured aerobic exercise training. To date, however, a limited number of studies have directly compared the effects of different doses of exercise on cardiovascular health, leaving uncertainty about the possible differential benefits of different exercise doses for use during cardiac rehabilitation. To address this area of uncertainty, we conducted a literature review and comparative analyses of studies that both compared two or more exercise interventions and assessed pre- and post-intervention peak oxygen consumption ($\dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{P}\mathrm{E}\mathrm{A}\mathrm{K}}$). Results from these analyses suggest that high exercise intensity, even when performed over relatively short duration interventions, appears to yield the most substantial improvements in cardiorespiratory fitness. However, this conclusion is based on the limited number of available studies, underscoring the need for future work examining exercise dose and clinical outcomes in the cardiac rehabilitation setting. Full article

Objectives: We aimed to investigate the association between acute kidney injury (AKI) and the risk for long-term (up to 10 years) all-cause mortality among elderly compared with younger patients following an acute myocardial infarction (AMI). Methods: This study was a retrospective analysis of the Soroka Acute Myocardial Infarction registry and covered the years 2002 to 2017. It included patients diagnosed with an AMI who had a baseline estimated glomerular filtration rate (eGFR) greater than 60 mL/min/1.73 m² and serum creatinine measurements available during hospitalization. The patients were stratified by age: elderly (aged 65 years or older at admission) and younger. In each stratum, two groups were defined based on the presence of an AKI. The survival approach (Kaplan–Meier survival curves, log-rank test and Cox regressions) was utilized to estimate and compare the probability of long-term (up to 10 years) all-cause mortality in each group. Results: Among the 10,511 eligible patients, which consisted of 6132 younger patients (58.3%) and 4379 elderly (41.7%), an AKI occurred in 15.2% of cases, where the elderly patients experienced a higher incidence than the younger patients (20.9% vs. 11.2%, p < 0.001). The presence of an AKI significantly increased the risk of death in both age groups, with the association being stronger among the younger patients (AdjHR = 1.634, 95% CI: 1.363–1.959, p < 0.001) than among the elderly (AdjHR = 1.278, 95% CI: 1.154–1.415, p < 0.001, p-for-interaction = 0.020). Conclusions: An AKI following an AMI was associated with a high risk for long-term all-cause mortality in both age groups, with a stronger association among younger patients. Full article

Endothelial progenitor cells (EPCs) play a crucial role in vascular repair, and their depletion has been involved in coronary artery disease (CAD) severity. This study examines the relationship between circulating EPC levels and CAD complexity, as quantified by the Syntax Score I. A total of 85 patients undergoing coronary angiography were enrolled, with EPCs quantified using flow cytometry. EPC proportion showed a significant inverse relationship with CAD severity, measured by Syntax Score I. Additionally, we investigated EPC levels in patients presenting with acute coronary syndrome (ACS) and found that EPC depletion was more pronounced in this group compared to non-ACS patients (median EPC count: 0.35 vs. 0.61, p = 0.027). These findings suggest that lower EPC levels are indicative of more severe CAD and ACS, reinforcing their potential as biomarkers for cardiovascular risk stratification, monitoring disease advancement, and identifying patients at risk of adverse events. Full article

(1) Background: Peripheral arterial CT angiography (CTA) is an alternative to conventional angiography for diagnosing lower extremity artery disease (LEAD). However, severe arterial calcifications often hinder accurate assessment of arterial stenosis. This study evaluated the diagnostic performance of subtraction CTA with volume position matching compared to conventional CTA, using invasive digital subtraction angiography (DSA) as the gold standard. (2) Methods: Thirty-two patients with LEAD (mean age: 69.6 ± 10.8 years; M/F = 28:4) underwent subtraction CTA and DSA. The arterial tree was divided into 20 segments per patient, excluding segments with a history of bypass surgery. Subtraction was performed separately for each limb using volume position matching. Maximum intensity projections were reconstructed from both conventional and subtraction CTA data. Percent stenosis per arterial segment was measured using calipers and compared with DSA. Segments were classified as stenotic (>50% luminal narrowing) or not, with heavily calcified or stented segments assigned as incorrect. (3) Results: Of 640 segments, 636 were analyzed. Subtraction CTA and conventional CTA left 13 (2.0%) and 160 (25.2%) segments uninterpretable, respectively. Diagnostic accuracies (accuracy, precision, recall, macro F1 score) for subtraction CTA were 0.885, 0.884, 0.936, and 0.909, compared to 0.657, 0.744, 0.675, and 0.708 for conventional CTA. (4) Conclusions: Subtraction CTA with volume position matching is feasible and achieves high diagnostic accuracy in patients with severe calcific sclerosis. Full article

Perioperative management of patients undergoing surgeries of the aortic arch is challenging. This cohort of patients has a high risk of poor neurological outcomes both as a consequence of the disease process as well as the methods employed during surgical management. Many strategies have been put forward to ameliorate these complications; however, maintaining cerebral and spinal cord perfusion and reducing metabolic oxygen demand is the core principle of these strategies. Moderate hypothermia and selective ante-grade perfusion are the most promising methods that provide the best conditions for the competing requirements of both the brain and spinal cord. Intraoperative and postoperative monitoring is essential for early detection and intervention in delayed spinal cord ischaemia and stroke. In this article we aim to discuss the current methods of neuroprotection and spinal cord protection in aortic arch surgery and stenting. Full article

Background: Mesenteric ischemia significantly increases intraoperative mortality in patients with acute aortic dissection (AAD). The arterial diameter affects both blood flow and arterial resistance. There are no data in the literature on changes in arterial diameter in patients with AAD. It has already been demonstrated that changes in arterial diameter can be observed in patients with non-occlusive intestinal ischemia. The aim of this study was to compare the arterial branches of the abdominal aorta in patients with AAD preoperatively and postoperatively. Methods: Preoperative and postoperative contrast-enhanced computed tomography scans of 25 patients who had undergone the frozen elephant trunk procedure for the treatment of AAD were reconstructed and retrospectively analyzed with detailed medical data of the patients. Results: In patients without AAD at the level of the abdominal aorta, statistically significant differences were observed when comparing the diameter of the superior mesenteric artery (p < 0.001) and the renal arteries (p < 0.001) between preoperative and postoperative scans. Occlusion of the inferior mesenteric artery was more common in patients with AAD involving the abdominal aorta. Statistically significant differences in true and false lumen were observed at each level of the abdominal aorta after a successful frozen elephant trunk procedure. Conclusion: Significant changes in visceral artery diameter were observed at the abdominal aortic level in patients both with and without aortic dissection. Chronic or non-occlusive mesenteric ischemia may be associated with a lack of adjustment in arterial diameter. Patients with AAD of the abdominal aorta are more susceptible to occlusion of the inferior mesenteric artery. Full article

(1) Background: The measurement of hemodynamic parameters has proven to be crucial in the treatment of hospitalized heart failure patients, necessitating invasive measurement by right heart catheterization (RHC). The reliability of whole-body impedance cardiography (ICG) among this cohort has not been investigated to date; (2) Methods: The RHC and whole-body ICG examinations measured cardiac output (CO), the cardiac index (CI), total peripheral resistance (TPR), and pulmonary vascular resistance (PVR). To assess the accuracy of the whole-body ICG measurement, bias and precision were calculated as the mean difference and the twofold standard deviation between the average values of measurements; (3) Results: A total of 203 patients were analyzed. No significant bias was observed between the non-invasive CO and CI measurements when compared with the RHC measurements (−0.14 ± 2.56 L/min, p = 0.1; −0.09 ± 1.3 L/min/m², p = 0.06), but a significant bias occurred in the measurement of non-invasive TPR and non-invasive PVR (−1243 ± 3510 dyn × s⁻¹ × cm⁻⁵, p = 0.001; −121 ± 504 dyn × s⁻¹ × cm⁻⁵, p < 0.001); (4) Conclusions: CO and CI can be measured with whole-body ICG among hospitalized CHF patients with acceptable accuracy. The reliability of measuring TPR and PVR should be further investigated. Full article

Background: Advancements in surgical care have made it possible to offer cardiac surgery to an older and frailer patient cohort. Frailty has been recognised as a prognostic indicator that impacts post-operative recovery and patient outcomes. The aim of this study is to identify frailty assessment tools, evaluate the impact of frailty on post-operative outcomes, and explore strategies to optimise care for frail patients undergoing cardiac surgery. Methods: A comprehensive literature search was performed across PubMed, MEDLINE, and SCOPUS to identify articles reporting post-operative outcomes related to frail patients undergoing cardiac surgery. Results: Measurement tools such as gait speed, the Clinical Frailty Scale, Fried frailty phenotype, deficit accumulation frailty index and the Short Physical Performance Battery can be used to assess frailty. Frailty has been reported to increase the risk of post-operative morbidity and mortality. Multiple studies have also reported the association between frailty and an increased length of intensive care unit and hospital stays, as well as an increased risk of post-operative delirium. It is important to perform a comprehensive frailty assessment and implement perioperative optimisation strategies to improve outcomes in this patient population. Pre-operative strategies that can be considered include adequate nutritional support, cardiac prehabilitation, and assessing patients using a multidisciplinary team approach with geriatric involvement. Post-operatively, interventions such as early recognition and treatment of post-operative delirium, nutrition optimisation, early planning for cardiac rehabilitation, and occupational therapy can support patients’ recovery and reintegration into daily activities. Conclusions: The early identification of frail patients during the perioperative period is essential for risk stratification and tailored management strategies to minimise the impact of frailty on outcomes following cardiac surgery. Full article

The Ross procedure introduced a new technique for aortic valve replacement by utilizing a pulmonary autograft to replace the diseased aortic valve. This approach provides a living, dynamic valve substitute capable of growth and adaptation to systemic pressures while addressing the limitations of mechanical valves, which require lifelong anticoagulation, and bioprosthetic valves, which lack durability and growth potential. The Ross procedure offers superior hemodynamic performance and freedom from anticoagulation. While initially popular, utilization declined due to its technical complexity and concerns regarding the potential for the failure of two valves, requiring additional operations. Advances in surgical techniques, such as reinforced autografts, improved myocardial protection, and better homograft preservation, coupled with evidence of favorable long-term outcomes, have renewed interest in the procedure. Preoperative imaging with echocardiography, cardiac magnetic resonance imaging, and computed tomography angiography ensures optimal patient selection and preparation. Intraoperatively, precise autograft harvesting, accurate implantation, and meticulous right ventricular outflow tract reconstruction are critical for success. Blood conservation techniques, such as acute normovolemic hemodilution and retrograde autologous priming, are employed to minimize transfusion-related complications. The anesthesiologist plays a critical role, including meticulous monitoring of myocardial function and hemodynamics, with intraoperative transesophageal echocardiography being essential for assessing valve integrity and ventricular function. Recent studies suggest that the Ross procedure can restore life expectancy in appropriately selected patients, reinforcing its value as a surgical option for managing aortic valve disease. Full article

Transcatheter aortic valve implantation (TAVI) has emerged as a revolutionary therapeutic modality for the management of severe aortic stenosis (AS), particularly in patients who are at high or prohibitive risk for surgical aortic valve replacement (SAVR). Over the past decade, extensive clinical evidence has expanded the indications for TAVI to include intermediate- and low-risk populations, which usually represent a population of younger age, in which the most common complications of TAVI, including paravalvular leak (PVL) and pacemaker implantation, should be avoided. This review focuses on the incidence and predictors of PVL in various types of TAVI implantation, its clinical implication, and the prevention strategies to tackle this complication. Full article

Congestion is a key clinical feature of heart failure (HF), contributing to hospitalizations, disease progression, and poor outcomes. While traditionally considered a hemodynamic issue, congestion is now recognized as a systemic process affecting multiple organs. Renal dysfunction arises from impaired perfusion and sodium retention, leading to maladaptive left ventricular remodeling. Hepatic congestion contributes to cholestatic liver injury, while metabolic disturbances drive anemia, muscle wasting, and systemic inflammation. Additionally, congestion disrupts the intestinal barrier and immune function, exacerbating HF progression. Given its widespread impact, effective congestion management requires a shift from a cardiovascular-centered approach to a comprehensive, multidisciplinary strategy. Targeted decongestive therapy, metabolic and nutritional optimization, and immune modulation are crucial in mitigating congestion-related organ dysfunction. Early recognition and intervention are essential to slow disease progression, preserve functional capacity, and improve survival. Addressing HF congestion through personalized, evidence-based strategies is vital for optimizing long-term care and advancing treatment paradigms. Full article

Pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). While it is known to affect the autonomic nervous system, the relationship between left atrial (LA) remodeling and PVI-mediated neuromodulation remains unclear. We aimed to assess the neuromodulatory effects of PVI using skin sympathetic nerve activity (SKNA). SKNA was recorded one day before and 2–3 days after PVI in 28 paroxysmal AF (PAF) and 33 persistent AF (PerAF) groups. Baseline low frequency to high frequency (LF/HF) ratio was higher in the PAF group (1.23 [interquartile range {IQR}: 0.79–1.76] vs. 0.74 [IQR: 0.49–1.38], p = 0.017). After PVI, the PAF group demonstrated significant reductions in burst amplitude (1.46 [IQR: 1.04–2.84] vs. 1.09 [IQR: 0.78–2.17] μV, p = 0.015) and LF/HF ratio (0.91 [IQR: 0.73–1.52] vs. 0.71 [IQR: 0.48–1.21], p = 0.012), whereas the PerAF group exhibited no such changes. A weak positive correlation was observed between the percentage change in LF/HF ratio and LA volume index in the PAF group (r = 0.572, p = 0.002). PVI significantly decreased SKNA in PAF patients but not in PerAF. LA remodeling may hinder the effectiveness of PVI-mediated neuromodulation. Full article