Prevalence and Predictors of Atherosclerotic Peripheral Arterial Obstructive Disease in Severe Heart Valve Diseases

Prolonged corrected QT interval is associated with cardiac sympathetic nervous function overactivity in patients with severe aortic stenosis: assessment by 123I-metaiodobenzylguanidine myocardial scintigraphy

Prolonged corrected QT interval (QTc) is known to be associated with adverse cardiovascular events in patients with heart failure. The delayed heart-to-mediastinum (H/M) ratio obtained from 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy is a marker of cardiac sympathetic nervous (CSN) activity and has been proposed as a prognostic marker of severe aortic stenosis (AS). However, the association between prolonged QTc and CSN overactivity in patients with AS remains unclear. This study retrospectively analyzed 83 patients with severe AS who underwent electrocardiography, echocardiography, and 123I-MIBG scintigraphy. Prolonged QTc was defined as QTc > 450 and > 470 ms in men and women, respectively. CSN overactivity was defined as delayed H/M ratio < 2.2 and washout rate (WR) > 34%. Prolonged QTc was detected in 14 patients, and these patients had higher left ventricular (LV) mass index and lower LV ejection fraction as compared to those with normal QTc. A significantly higher proportion of patients with prolonged QTc demonstrated CSN overactivity (p = 0.02). In addition, the prolonged QTc group had a lower delayed H/M ratio and higher WR. QTc was inversely correlated with the delayed H/M ratio in men (r =  - 0.53, p = 0.02) and women (r =  - 0.29, p = 0.02). QTc was positively correlated with WR in men (r = 0.55, p = 0.01) and women (r = 0.42, p = 0.001). Multivariate analysis identified age and prolonged QTc as significantly associated with CSN overactivity. Thus, prolonged QTc is associated with CSN overactivity, as assessed using 123I-MIBG scintigraphy in patients with severe AS.

Long-term recurrence of ischemic events in patients with intracranial atherosclerotic stenosis stratified by symptoms and pathogenesis

BACKGROUND

Intracranial atherosclerotic stenosis (ICAS) can cause either transient ischemic attack (TIA) or acute ischemic stroke (AIS). Pathogenesis of ICAS-AIS can be divided into artery-to-artery embolism(A-A), hypoperfusion(HP), and parent-artery atherosclerosis occluding penetrating artery(POPA). However, the prognosis of each type remains uncertain. Our study aimed to investigate potential disparities in the recurrent risk among these four subtypes of symptomatic ICAS.

METHODS

From a prospective, single-center cohort study of acute cerebrovascular diseases from January 2017 to November 2021, we recruited 120 ICAS patients and classified them into four groups based on diffusion weighted imaging. Patients were retrospectively followed up for recurrence in December 2022. The primary outcome was recurrent cerebral vascular events (RCVE) in the same territory.

RESULTS

Among 120 recruited patients, POPA(33%) was the most common subtype, followed by A-A(32%), HP(29%), and TIA(6%). Cumulative recurrent rate was 31.2% with median months of follow-up as 27(20-45.5). There was no significant difference in the risk of RCVE in the same territory among four subgroups within three months. However, when considering the risk after three months, TIA(57%) had the highest risk of RCVE, followed by A-A(26%), while HP(4%) and POPA(8%) had lower risks (P = 0.001). Cox regression model indicated that symptom and pathogenesis was an independent risk factor for RCVE in long-term prognosis (P = 0.022), after adjusting for a history of hypertension and cerebral infarction.

CONCLUSIONS

Distinctive symptoms and pathogenesis of ICAS exhibit varying risks of RCVE in long-term prognosis. The differentiation in recurrent risk may provide valuable insights for guiding secondary prevention strategies.

Simple Phonocardiography with the Ankle-Brachial Index Measurement System as a Tool for Detecting Fourth Heart Sounds of Hypertrophic Cardiomyopathy

Conventional phonocardiography is useful for objective assessment of cardiac auscultation, but its availability is limited. More recently, an ankle-brachial index (ABI) measurement system equipped with simple phonocardiography has become widely used for diagnosing peripheral artery disease, however, whether this simple phonocardiography can be an alternative to conventional phonocardiography remains unclear.This retrospective study consisted of 48 patients with hypertrophic cardiomyopathy (HCM) and 107 controls. The presence of the fourth sound (S4) was assessed by conventional phonocardiography, in addition to apexcardiography and auscultation, in all patients with HCM. S4 was also estimated by the ABI measurement system with the phonocardiographic microphone on the sternum (the standard method) or at the apex (the apex method) in HCM patients and controls.S4 on conventional phonocardiography was detected in 42 of 48 patients (88%) with HCM. Auscultation for the detection of S4 had a sensitivity of 0.78, specificity of 0.57, and accuracy of 0.75. These diagnostic values were generally superior to those of the standard method using the ABI measurement system, whereas the apex method using the ABI measurement system had better diagnostic values, with an excellent specificity of 1.0, sensitivity of 0.77, and accuracy of 0.80. No significant differences were observed in low ABI defined as < 0.9.Simple phonocardiography equipped with the ABI measurement system may be an alternative to conventional phonocardiography for the detection of S4 in patients with HCM when the phonocardiographic microphone is moved from the sternum to the apex.