Hearts, Volume 5, Issue 1 (March 2024) – 12 articles

In the thrombolytic care era, myocardial infarction in cigarette smokers was associated with better six-month outcomes compared to non-smokers. Aims: We tested the hypothesis that in patients with anterior myocardial infarction with ST-segment elevation (STEMI) treated with primary percutaneous coronary intervention (PPCI), cigarette smoking is associated with better coronary artery flow, myocardial perfusion, and left ventricular systolic function. Methods: Ninety-nine patients (sixty-six smokers) with anterior STEMI treated with PPCI were studied. Angiographic coronary artery flow TIMI grades, myocardial blush grades (MBGs) before and after PPCI, ST-segment elevation resolution, maximal troponin I and creatine phosphokinase blood levels, left ventricular echocardiographic systolic function as well as left anterior descending coronary artery (LAD) velocity parameters at admission and at discharge were evaluated. Results: Smokers and non-smokers were treated similarly. In smokers, the age was significantly younger, 54 ± 10, compared to non-smokers, 71.8 ± 10 years, p < 0.05, and had a lower prevalence of women, 13.6% compared to 36.6%. TIMI and MBG before and after PPCI were similar between smokers and non-smokers. Smokers had a lower prevalence of complete ST elevation resolution, 33% compared to 50% in non-smokers. Diastolic LAD velocity and integral were lower in smokers, p < 0.05. Maximal biomarker blood levels as well as LV systolic function at admission and on discharge were similar. Conclusions: Cigarette smokers with anterior STEMI treated with PPCI were younger with a lower prevalence of women and of complete ST elevation resolution and had lower LAD diastolic velocity and integral late after PPCI. However, angiographic parameters and LV systolic function parameters were similar. Full article

Background: This study assesses the temporal responses of cardiovascular function, fibro-inflammation, and glucometabolic profiles in asymptomatic adults with type 2 diabetes, following a low-energy meal replacement plan (MRP) or exercise training. Methods: Secondary analysis of DIASTOLIC: a randomised, open-label, blinded-endpoint trial of 12 weeks MRP (~810 kcal/day) or exercise training. Cardiac magnetic resonance, plasma fibroinflammatory, and metabolic markers were undertaken at baseline, 4, and 12 weeks. Results: Out of 24 participants in the MRP group and 22 in exercise training, 18 and 11 completed all three visits. MRP resulted in early (0–4 weeks) improvement in insulin resistance (HOMA-IR: 10.82 to 4.32), decrease in FABP-4 (4.87 ± 0.19 to 5.15 ± 0.32 mg/L), and improvement in left ventricular remodelling LV mass: volume (0.86 ± 0.14 to 0.78 ± 0.11), all with large effect sizes. MMP8 levels increased moderately at 4–12 weeks. Peak early diastolic strain rate (cPEDSR) initially decreased, then improved. Exercise training led to minor improvements in insulin resistance and MMP-8 levels, with no significant changes in cPEDSR or LV remodelling. Conclusions: MRP resulted in early improvements in insulin resistance, cardiac remodelling, and inflammation, but with an initial decrease in diastolic function, improving by 12 weeks. Exercise training showed minor early benefits in insulin resistance and inflammation, but no significant cardiac changes. Full article

In recent decades, significant advancements in pharmacological, catheter-based, and surgical reperfusion technologies have markedly improved outcomes for individuals undergoing acute myocardial infarction. Despite these remarkable progressions, a segment of patients, particularly those with extensive infarctions or delays in revascularization, remains vulnerable to the onset of mechanical complications associated with myocardial infarction. These complications, spanning mechanical, electrical, ischemic, inflammatory, and thromboembolic events, pose substantial risks of morbidity, mortality, and increased utilization of hospital resources. The management of patients experiencing these complications is intricate, necessitating collaborative efforts among various specialties. Timely identification, accurate diagnosis, hemodynamic stabilization, and decision-making support are crucial for guiding patients and their families in choosing between definitive treatments or palliative care. This review underscores the critical importance of promptly identifying and initiating therapy to reduce prolonged periods of cardiogenic shock and the potential for fatality. By presenting key clinical and diagnostic insights, this review aims to further improve early diagnosis and offer an updated perspective on current management strategies for the diverse range of complications associated with acute myocardial infarction. Full article

Heart failure, a common clinical syndrome caused by functional and structural abnormalities of the heart, affects 64 million people worldwide. Long-term mechanical circulatory support can offer lifesaving treatment for end-stage systolic heart failure patients. However, this treatment is not without complications. This review covers the major complications associated with implantable mechanical circulatory support devices, including strokes, pump thrombosis and gastrointestinal bleeding. These complications were assessed in patients implanted with the following devices: Novacor, HeartMate XVE, CardioWest, Jarvik 2000, HeartMate II, EVAHEART, Incor, VentrAssist, HVAD and HeartMate 3. Complication rates vary among devices and remain despite the introduction of more advanced technology, highlighting the importance of device design and flow patterns. Beyond clinical implications, the cost of complications was explored, highlighting the difference in costs and the need for equitable healthcare, especially with the expected rise in the use of mechanical circulatory support. Future directions include continued improvement through advancements in design and technology to reduce blood stagnation and mitigate high levels of shear stress. Ultimately, these alterations can reduce complications and enhance cost-effectiveness, enhancing both the survival and quality of life for patients receiving mechanical circulatory support. Full article

Artificial intelligence, specifically advanced language models such as ChatGPT, have the potential to revolutionize various aspects of healthcare, medical education, and research. In this review, we evaluate the myriad applications of artificial intelligence in diverse healthcare domains. We discuss its potential role in clinical decision-making, exploring how it can assist physicians by providing rapid, data-driven insights for diagnosis and treatment. We review the benefits of artificial intelligence such as ChatGPT in personalized patient care, particularly in geriatric care, medication management, weight loss and nutrition, and physical activity guidance. We further delve into its potential to enhance medical research, through the analysis of large datasets, and the development of novel methodologies. In the realm of medical education, we investigate the utility of artificial intelligence as an information retrieval tool and personalized learning resource for medical students and professionals. Full article

The benefits of inspiratory muscle training (IMT) have been demonstrated in patients with cardiovascular diseases (CVD); however, the optimal training intensity is not yet fully clarified. The purpose of this study was to review the impact of IMT intensity on respiratory muscle strength, functional and exercise capacity, pulmonary function, and quality of life in patients with CVD. This systematic review was carried out according to PRISMA statement and registered in the PROSPERO database (review protocol: CRD42023442378). Randomized controlled trials were retrieved on 3 July 2023 in the following electronic databases: Web of Science, PubMed, EMBASE, and SCOPUS. Studies were included if they assessed the impact of isolated IMT on CVD patients in comparison with sham, different intensities and/or intervention groups. Eight studies were included for final analysis; IMT consistently led to significantly greater improvements in inspiratory muscle strength compared to control (CON) groups. The intensity of IMT varied in the studies based on different percentages of maximal inspiratory pressure (MIP), ranging from 25% to 60% of MIP. The time of intervention ranged from 4 to 12 weeks. Despite this variability, the studies collectively suggested that IMT is beneficial for enhancing CVD patients’ conditions. However, the optimal intensity range for benefits appeared to vary, and no single intensity emerged as universally superior across all studies. Full article

Germline mutations in Breast cancer susceptibility genes 1 and 2 (BRCA1 and BRCA2) cause breast, ovarian, and other cancers, and the chemotherapeutic drug doxorubicin (Dox) is widely used to treat these cancers. However, Dox use is limited by the latent induction of severe cardiotoxicity known as Dox-induced cardiomyopathy, for which there are no specific treatments currently available. Dox is administered into the systemic circulation, where it readily translocates into sub-cellular compartments and disrupts the integrity of DNA. Accumulating evidence indicates that oxidative stress, DNA damage, inflammation, and apoptosis all play a central role in Dox-induced cardiomyopathy. The BRCA1 and BRCA2 proteins are distinct as they perform crucial yet separate roles in the homologous recombination repair of DNA double-strand breaks, thereby maintaining genomic integrity. Additionally, both BRCA1 and BRCA2 mitigate oxidative stress and apoptosis in both cardiomyocytes and endothelial cells. Accordingly, BRCA1 and BRCA2 are essential regulators of pathways that are central to the development of cardiomyopathy induced by Doxorubicin. Despite extensive investigations, there exists a gap in knowledge about the role of BRCA1 and BRCA2 in Doxorubicin-induced cardiomyopathy. Here, we review the previous findings and associations about the expected role and associated mechanisms of BRCA1 and 2 in Dox-induced cardiomyopathy and future perspectives. Full article

Introduction: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) caused a global pandemic that emerged in 2019. During this period, a significant disparity in hospitalization and mortality rates emerged, particularly in terms of Ethnicity and sex. Notably, this study aims to examine the influence of sex and Ethnicity on acute coronary syndrome outcomes, specifically during the global SARS-CoV-2 pandemic. Methods: This retrospective observational study analyzed adult patients hospitalized with a primary diagnosis of acute coronary syndrome in the United States in 2020. Primary outcomes included inpatient mortality and the time from admission to percutaneous coronary intervention (PCI). Secondary outcomes encompassed the length of stay and hospital costs. The National Inpatient Sample (NIS) database was utilized to identify and study patients in our test group. Results: A total of 779,895 patients hospitalized with a primary diagnosis of acute coronary syndrome in the year 2020 and 935,975 patients in 2019 were included in this study. Baseline findings revealed that inpatient mortality was significantly higher in 2020 compared to 2019, regardless of sex and Ethnicity (adjusted odds ratio (aOR) 1.20, 95% confidence interval (CI) 1.12–1.23, p-value < 0.001). Concerning primary outcomes, there was no difference in inpatient mortality for hospitalized patients of different sexes between 2019 and 2020 (STEMI: aOR 1.05, 95% CI 0.96–1.14, p-value 0.22; NSTEMI/UA aOR 1.08, 95% CI 0.98–1.19, p-value 0.13). Regarding time to admission for PCI, NSTEMI/UA cases were found to be statistically significant in female patients compared to males (mean difference 0.06 days, 95% CI 0.02–0.10, p-value < 0.01) and African Americans compared to Caucasians (mean difference 0.13 days, 95% CI 0.06–0.19, p < 0.001). In terms of the length of stay, female patients had a shorter length of stay compared to males (mean difference −0.22, 95% CI −0.27 to −0.16, p-value < 0.01). Conclusions: As acute coronary syndrome is an urgent diagnosis, a global pandemic has the potential to exacerbate existing healthcare disparities related to sex and Ethnicity. This study did not reveal any difference in inpatient mortality, aligning with studies conducted prior to the pandemic. However, it highlighted significantly longer treatment times (admission to PCI) for NSTEMI/UA management in female and African American populations. These findings suggest that some disparities may have diminished during the pandemic year, warranting further research to confirm these trends in the years to come. Full article

Objectives: To assess the overall association of lifestyle behaviors with multiple cardiovascular risk factors and mortality. Material and Methods: In the Italian Rural Areas of the Seven Countries Study, involving 1712 middle-aged men (40–59 years) enrolled in 1960, smoking habits, physical activity, dietary habits, marital status, and socioeconomic status (SES) were studied as possible determinants of 15 measurable risk factors (body mass index, tricipital and subscapular skinfold, arm circumference, systolic and diastolic blood pressure, heart rate, double product (systolic blood pressure × heart rate), vital capacity, forced expiratory volume, serum cholesterol, urine protein, urine glucose, corneal arcus and xanthelasma) using canonical correlation (CC). Results: The first CC had a value of 0.54 (R² 0.29, p < 0.0001). The role of marital status was marginal; that of a high SES was contrary to expectations. The strongest behaviors based on standardized CC coefficients were dietary habits and physical activity. The risk factors mostly associated with overall lifestyle behaviors were some anthropometric and cardiovascular measurements. The mean levels of risk factors distributed in tertile classes of the CC variate score of lifestyle behaviors were largely associated in a coherent and graded way with the expected relationship of behaviors versus risk factors. In a large series of Cox models, the CC variate scores were significantly associated with 50-year coronary heart disease (CHD) mortality and much less with stroke and other heart diseases of uncertain etiology. Conclusions: Lifestyle behaviors correlate well with cardiovascular risk factors associated with CHD mortality, and CC is a useful method of analysis to detect long-term impacting characteristics. Full article

Cardiovascular diseases are the most common cause of death worldwide, and they still have dramatic consequences on the patients’ lives. Murine models are often used to study the anatomical and microstructural changes caused by the diseases. Contrast-enhanced microfocus computed tomography (CECT) is a new imaging technique for 3D histology of biological tissues. In this study, we confirmed the nondestructiveness of Hf-WD 1:2 POM-based CECT and cryogenic CECT (cryo-CECT) to image the heart in 3D. The influence of the image quality (i.e., acquisition time and spatial resolution) was assessed for the characterization of the heart structural constituents: heart integrity, the coronary blood vessels and the heart valves. Coronary blood vessels were visualized and segmented in murine hearts, allowing us to distinguish veins from arteries and to visualize the 3D spatial distribution of the right coronary artery and the left main coronary artery. Finally, to demonstrate the added value of 3D imaging, the thickness distribution of the two leaflets in the mitral valve and three cusps in the aortic valve was computed in 3D. This study corroborates the added value of CECT and cryo-CECT compared to classical 2D histology to characterize ex vivo the structural properties of murine hearts and paves the way for the detailed 3D (micro)structural analyses of future cardiovascular disease models obtained in mice and rats. Full article

Chronic heart failure (HF) is the 21st-century cardiovascular epidemic, marked by recurrent hospitalizations and high mortality rates, and represents a considerable burden on Western societies. The complex care demands of HF patients require multidisciplinary approaches, aligning with contemporary guidelines. Accordingly, the Excellence in Heart Failure Program, implemented in Portuguese tertiary hospitals, aims to establish multidisciplinary HF outpatient clinics in Portugal, improving patients’ clinical outcomes. Herein, the results of its pilot project are presented, showing that the implementation of the multidisciplinary clinic resulted in a minimal number of hospitalizations and emergency visits, with only one rehospitalization reported. In addition, patients in the Program experienced significant improvements in ejection fraction (EF) and NT-proBNP levels. Despite the limited power of the sample, these findings underscore the effectiveness of the Program in the management of Portuguese HF patients, particularly in the early discharge period after heart failure, when patients are most vulnerable. Full article