Fractional flow reserve (FFR) - a physiological indicator of coronary stenosis significance - has now become a widely used parameter also in the guidance of percutaneous coronary intervention (PCI). Several studies have...Fractional flow reserve (FFR) - a physiological indicator of coronary stenosis significance - has now become a widely used parameter also in the guidance of percutaneous coronary intervention (PCI). Several studies have shown the superiority of FFR compared to visual assessment, contributing to the reduction in clinical endpoints. However, the current approach to FFR assessment requires coronary instrumentation with a dedicated pressure wire and thus increasing invasiveness, cost, and duration of the procedure. Alternative, noninvasive methods of FFR assessment based on computational fluid dynamics are being widely tested; these approaches are generally not fully automated and may sometimes require substantial computational power. Nowadays, one of the most rapidly expanding fields in medicine is the use of artificial intelligence (AI) in therapy optimization, diagnosis, treatment, and risk stratification. AI usage contributes to the development of more sophisticated methods of imaging analysis and allows for the derivation of clinically important parameters in a faster and more accurate way. Over the recent years, AI utility in deriving FFR in a noninvasive manner has been increasingly reported. In this review, we critically summarize current knowledge in the field of AI-derived FFR based on data from computed tomography angiography, invasive angiography, optical coherence tomography, and intravascular ultrasound. Available solutions, possible future directions in optimizing cathlab performance, including the use of mixed reality, as well as current limitations standing behind the wide adoption of these techniques, are overviewed.
BACKGROUND: Myocarditis poses a great diagnostic challenge to clinicians, as the most sensitive diagnostic tools are not easily accessible in many hospitals. Clinical suspicion of myocarditis is based on clinical symptom...BACKGROUND: Myocarditis poses a great diagnostic challenge to clinicians, as the most sensitive diagnostic tools are not easily accessible in many hospitals. Clinical suspicion of myocarditis is based on clinical symptoms and additional tests' abnormalities. The diagnosis should be confirmed by endomyocardial biopsy (EMB) - the gold standard for the diagnosis of myocarditis. The study aimed to assess trends in the use of diagnostic procedures performed in all patients hospitalized with suspected myocarditis in Poland between 2011-2019. METHODS: The nationwide MYO-PL database was derived from the database of the national healthcare insurer and created to identify hospitalization records with a primary diagnosis of myocarditis. We evaluated the use of recommended diagnostic procedures in this group of 19 978 patients within 6 months of the diagnosis of myocarditis. RESULTS: Echocardiography was the most frequently used imaging technique among patients, and the number of patients who underwent this procedure between 2011-2019 rose every year (71.3-86.1%). Use of nuclear medicine procedures remained < 1% regardless of the year. Biomarkers measurements during primary hospitalization were performed in 13.8% (brain natriuretic peptides) and 41.3% (troponins) of patients. Interestingly, EMB was performed in less than 1% of patients. The most sensitive noninvasive test (cardiac magnetic resonance) was performed in 16.4% of patients (7.2-29.2% within 10 years). Most diagnostic tests were less frequently performed in females. CONCLUSIONS: The results highlight that the management of patients with myocarditis could be significantly improved if state-of-the-art diagnostic methods were followed according to guidelines.
BACKGROUND: The aim of this study was to evaluate the diagnostic performance of microRNA-1 in the diagnosis of acute myocardial infarction (AMI). METHODS: PubMed, Embase, Cochrane, Web of science and CNKI databases were...BACKGROUND: The aim of this study was to evaluate the diagnostic performance of microRNA-1 in the diagnosis of acute myocardial infarction (AMI). METHODS: PubMed, Embase, Cochrane, Web of science and CNKI databases were searched by computer to collect English literature evaluating the diagnostic value of microRNA-1 in AMI patients. The retrieval period is from the establishment of the database to September 2023. Two researchers independently screened the literature according to inclusion and exclusion criteria, extracted data, and evaluated the risk of bias in the included studies using QUADAS-2 tools. Stata15.0 software was used for meta-analysis. The combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the summary receiver operator characteristic (SROC) curve were calculated. RESULTS: This study included 11 pieces of literature, which included 894 patients with AMI and600 controls. The main results of meta-analysis were as follows: The pooled sensitivity and specificityof microRNA-1 for the diagnosis of AMI were 78% (95% CI: 0.69-0.85) and 85% (95% CI: 0.76-0.91), respectively, the positive likelihood ratio was 5.1 (95%CI: 3.0-8.6), the negative likelihood ratio was 0.26 (95% CI: 0.17-0.38), the diagnostic odds ratio was 20 (95% CI: 9-47), and the area under the SROC curve (AUC) was 88% (95% CI: 0.85-0.91). CONCLUSIONS: Plasma microRNA-1 has high sensitivity and specificity for early AMI, and has certain diagnostic value, which can help distinguish AMI from patients with other systemic diseases, and can be combined with other biomarkers to diagnose AMI.
BACKGROUND: This study aimed to employ Mendelian randomization (MR) analysis to investigate the causal relationship between sodium-glucose cotransporter 2 (SGLT2) inhibition and atrial fibrillation (AF), as well as asses...BACKGROUND: This study aimed to employ Mendelian randomization (MR) analysis to investigate the causal relationship between sodium-glucose cotransporter 2 (SGLT2) inhibition and atrial fibrillation (AF), as well as assess the potential mediating role of inflammatory proteins in this association. METHODS: A two-sample MR analysis was conducted using summary-level data from the genome-wide association study (GWAS) were used to evaluate the genetic prediction of SGLT2 inhibition and AF. Additionally, a two-step MR approach was applied to explore the causal mediation effects of inflammatory proteins in the SGLT2-AF pathway. RESULTS: Genetically predicted SGLT2 inhibition was associated with a significantly lower risk of AF (odds ratio [OR] 0.51; 95% confidence interval [CI]: 0.27-0.97; p = 0.039). Mendelian randomization analysis further identified FGF-23 (OR 0.88; 95% CI: 0.79, 0.98; p = 0.024) and PD-L1 (OR 0.90; 95% CI: 0.82, 0.96; p = 0.023) as significant mediators, accounting for 21.28% and 17.69% of the total effect, respectively. CONCLUSIONS: These findings provide potential protective role of SGLT2 inhibition against AF, mediated by inflammatory proteins. Further mechanistic and clinical investigations are warranted to elucidate the underlying pathways and therapeutic implications.
Weber J, Kielb J, Saffak S
… +10 more, Glugla S, Chávez-Talavera O, Shahjerdi K, Baensch L, Celik A, Neizel-Wittke M, Kelm M, Zeus T, Polzin A, Dannenberg LK
Sinus rhythm (SR) maintenance strategies after electrical or pharmacological cardioversion in patients with atrial fibrillation (AF) may be only temporarily effective, leading to AF recurrence. Identifying predictors of...Sinus rhythm (SR) maintenance strategies after electrical or pharmacological cardioversion in patients with atrial fibrillation (AF) may be only temporarily effective, leading to AF recurrence. Identifying predictors of AF recurrence after effective electrical cardioversion (ECV) may help personalize treatment, for instance, by affecting modifiable factors of unsuccessful long-term rhythm control. Disseminating information on this topic may benefit individual patients, lower the risk of subsequent procedures and the associated complications, and decrease health care costs. The purpose of this paper was to present the current state of knowledge on the predictors of failed ECV, with a particular focus on the most recent relevant research.
Sawczak F, Krysztofiak H, Kukfisz A
… +8 more, Piszczek M, Szczechla M, Przytarska K, Dudek M, Uchmanowicz I, Tomaszewska M, Straburzyńska-Migaj E, Kałużna-Oleksy M
BACKGROUND: Inflammatory components play a prominent role in the pathogenesis of heart failure (HF) and correlate with the progression and severity of the disease. The aim of the present study was to assess the associati...BACKGROUND: Inflammatory components play a prominent role in the pathogenesis of heart failure (HF) and correlate with the progression and severity of the disease. The aim of the present study was to assess the association between the neutrophil-lymphocyte ratio (NLR) and mortality risk in patients with stable HF with reduced ejection fraction (HFrEF). METHODS: A total of 140 patients hospitalized due to a scheduled routine examination without HF exacerbations were included. NLR was calculated as follows: NLR = neutrophil level [G/L]/lymphocyte level [G/L]. RESULTS: The average age in the study sample was 54.1 ± 11.3 years. NLR was significantly associated with co-existing atrial fibrillation and parameters related to nutrition: total cholesterol, triglycerides, low-density lipoproteins, and albumin. During a median follow-up (365 days; IQR 296.5-365), 17 (12.1%) patients died. The log-rank test showed the worst survival rate in the highest NLR tertile. A higher NLR value was an independent predictor of 1-year mortality (HR 1.326, 95% CI: 1.121-1.569, p = 0.0010) after adjustment for natriuretic peptides, comorbidities, and other clinical parameters. It retained its value even after the exclusion of patients with severe kidney dysfunction (eGFR < 30mL/min/1.73m²) and with chronic obstructive pulmonary disease (COPD). CONCLUSIONS: Neutrophil-lymphocyte ratio could be deployed as an auxiliary, no-cost marker of worse 1-year prognosis in stable HFrEF patients.
BACKGROUND: Patients diagnosed with systemic lupus erythematosus (SLE) or antiphospholipid syndrome (APS) carry a higher risk of atherosclerosis and subsequent major adverse cardiac events; however, the mechanisms of suc...BACKGROUND: Patients diagnosed with systemic lupus erythematosus (SLE) or antiphospholipid syndrome (APS) carry a higher risk of atherosclerosis and subsequent major adverse cardiac events; however, the mechanisms of such complications are still not fully understood. Although patients with SLE or APS are also known to have an increased risk of renal function impairment, there are few data on the correlation of augmentation index normalized to 75 beats per minute (AI@75) or pulse wave velocity (PWV) reflecting arterial remodeling, with laboratory tests indicative of renal function in women diagnosed with SLE or APS. METHODS: This was a prospective, cross-sectional study that enrolled women with a diagnosis of SLE and/or APS. All patients underwent measurement of carotid-femoral PWV (SphygmoCor XCEL, AtCor Medical Ltd) with pulse wave analysis, calculation of AI@75, and laboratory assessment. RESULTS: A total of 60 women with SLE or APS were enrolled in the study. Urea level was found to correlate with AI@75 (rho = 0.362, p = 0.006) and PWV (rho = 0.487, p = 0.006). In separate adjusted (age, body mass index, and blood pressure) models, urea (B = 0.722, 95% CI: 0.407-1.037, p < 0.001), uric acid (4.932, 95% CI: 0.447-9.418, p = 0.03), creatinine (B for 0.1 mg/dL increase = 3.367, 95% CI: 1.112-5.601, p = 0.004), and eGFR (B = -0.318, 95%CI: -0.580- -0.055, p = 0.02) were associated with AI@75. CONCLUSIONS: Urea and uric acid values are associated with increased arterial stiffness measured by non-invasive methods such as PWV and AI@75 in women with SLE or APS with normal or slightly reduced glomerular function.