Clinical trials have demonstrated the efficacy of recombinant human brain natriuretic peptide (rhBNP) in managing acute decompensated heart failure. Moreover, since rhBNP performs roles in hemodynamic regulation, neurohormonal balance, and renal function, rhBNP administration could benefit cardiac surgery patients. We conducted a systematic review and meta-analysis to evaluate the impact of perioperative rhBNP in cardiac surgery patients.
We conducted a comprehensive search of the MEDLINE, Embase, the Cochrane Library, CNKI, and WANFANG databases from January 1, 2007, until December 31, 2023, identifying randomized controlled trials (RCTs) that examined the use of rhBNP during cardiac surgery. We estimated the treatment effects of perioperative rhBNP administration using a random-effects meta-analysis. The primary cardiovascular endpoint was the change in left ventricular ejection fraction (LVEF); meanwhile, renal function was assessed using the 24-hour urine output, changes in estimated glomerular filtration rate (eGFR), and serum creatinine (SCr) levels. Additional parameters included pulmonary artery pressure (PAP), adverse event (AE) incidence, respiratory support duration, ICU length of stay (ICU LOS), hospital length of stay (hospital LOS), and tumor necrosis factor-α (TNF-α) levels.
Our meta-analysis included 38 RCTs encompassing 2280 patients. The use of rhBNP in the perioperative period significantly enhanced LVEF compared to the control group (mean difference = 3.13 (95% CI [1.88, 4.37]; p < 0.00001). Additionally, rhBNP administration was associated with a significant increase in the 24-hour urine volume (mean difference = 401.42, 95% CI [253.06, 549.77]; p < 0.00001) and an improvement in eGFR (mean difference = 13.94, 95% CI [5.57, 22.31]; p = 0.001). Meanwhile, perioperative administration of rhBNP significantly reduced SCr levels (mean difference = –14.55, 95% CI [–22.04, –7.06]; p < 0.0001). In addition, rhBNP significantly decreased PAP, the incidence of AEs, the duration of respiratory support, ICU LOS, hospital LOS, and TNF-α levels.
These findings underscore the potential benefits of rhBNP as a perioperative treatment in patients undergoing cardiac surgery.
The applicability of currently established high-risk inflammatory criteria to East Asian patients is unknown, particularly concerning the hypersensitive C-reactive protein (hs-CRP) cutoff value. In addition, the role of cholesterol and inflammation in determining the prognosis of these patients might shift after the patient accepts lipid-lowering treatments. This study aimed to explore the high-risk hs-CRP cutoff value and compare the prognostic value between inflammation and cholesterol risk in the East Asian population after treatment with percutaneous coronary intervention (PCI).
Post-PCI patients with serial hs-CRP and low-density lipoprotein cholesterol (LDL-C) level measurements were retrospectively enrolled. Major adverse cardiovascular and cerebrovascular events (MACCEs) were defined as a composite of cardiovascular death, non-fatal acute myocardial infarction (AMI), non-fatal stroke, and unplanned coronary revascularization. The association between residual risks and MACCEs was evaluated.
During a median follow-up of 30.4 months, 403 MACCEs occurred among 2373 patients. The high-risk LDL-C and hs-CRP cutoff values in the present study were set at 1.56 mg/L and 1.80 mmol/L, respectively, based on the results of tertile stratification and restricted cubic spline analysis. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of residual cholesterol risk (hs-CRP <1.56 mg/L; LDL-C ≥1.80 mmol/L), residual inflammatory risk (hs-CRP ≥1.56 mg/L; LDL-C <1.80 mmol/L), and residual cholesterol and inflammatory risk (hs-CRP ≥1.56 mg/L; LDL-C ≥1.80 mmol/L) for MACCEs were 1.26 (0.95–1.66), 2.15 (1.57–2.93), and 2.07 (1.55–2.76), respectively. Inflammatory-induced MACCEs were more likely to be associated with the increased risk of non-fatal AMI (HR: 4.48; 95% CI: 2.07–9.73; p < 0.001), while cholesterol-induced MACCEs were more likely to be associated with the increased risk of non-target vessel revascularization (TVR: HR: 1.60; 95% CI: 1.08–2.37; p = 0.019). Persistent high inflammatory risk (baseline and follow-up hs-CRP ≥1.56 mg/L) can be a major determinant of MACCEs (adjusted HR: 2.03; 95% CI: 1.64–2.52; p < 0.001), while persistent high cholesterol risk (baseline and follow-up LDL-C ≥1.80 mmol/L) was not. Serial hs-CRP measurements could produce more predictive values for MACCEs than a single measurement.
Despite statin treatment, residual cholesterol and inflammatory risks persist in post-PCI patients. The high-risk hs-CRP standard may be lower in East Asian patients than their Western counterparts, with a cutoff value of 1.56 mg/L. Inflammation and cholesterol could be major determinants for recurrent cardiovascular events, while hs-CRP seems to be a stronger predictor than LDL-C in post-PCI patients receiving statin therapy.
ChiCTR2100047090, https://www.chictr.org.cn/showproj.html?proj=127821.
Positron emission tomography (PET) imaging with radiotracers can detect amyloid deposits in multiple organs. We conducted a systematic review and meta-analysis to evaluate the diagnostic performance of PET in patients with systemic amyloidosis.
We searched PubMed, Cochrane, Embase, and Web of Science databases using the following keywords: “systemic amyloidosis” and “PET”. Studies evaluating organ involvement in systemic amyloidosis using PET were included. The pooled relative risk (RR) values for each affected organ were calculated. Sensitivity, specificity, positive and negative likelihood ratios (LRs+ and LRs-), and diagnostic odds ratios (DORs) were individually calculated to assess cardiac involvement by PET, and a summary receiver operating characteristic (SROC) curve was generated. The diagnostic performance of PET was compared in separate subgroup analyses based on the type of radiotracer and amyloidosis subtype.
Among 10 studies, the pooled RR values for PET detecting organ involvement in the bone marrow, central nervous system (CNS), heart, lungs, muscles, pancreas, salivary glands, spleen, thyroid, and tongue were statistically significant. In the seven studies on cardiac involvement, the pooled sensitivity and specificity were 0.98 and 0.61, respectively, with an area under the curve (AUC) of 0.8954. Subgroup analysis showed 124I-Evuzamitide had the highest sensitivity (0.98), while 11C-Pittsburgh Compound-B (11C-PIB) had the highest specificity (0.84). PET imaging detected cardiac involvement in light chain amyloidosis (AL) more effectively than in transthyretin amyloidosis (ATTR), with a pooled RR of 0.79 (p = 0.004).
PET imaging has significant clinical value in assessing organ involvement in systemic amyloidosis, particularly for the early detection of cardiac involvement.
To perform a comprehensive assessment of the predictive value of soluble growth stimulator gene 2 protein (sST2) in predicting in-hospital Killip classes II–IV among patients with acute ST-segment elevation myocardial infarction (STEMI). This study aimed to provide more precise prognostic insights for informed clinical decision-making.
A retrospective cohort study was performed. The clinical records of STEMI patients admitted to Tianjin TEDA International Cardiovascular Hospital and who received primary percutaneous coronary intervention (PPCI) within 24 hours of symptom onset from July 2021 to March 2023 were analyzed. Statistical methodologies, including univariate and multivariate analyses, were applied to identify potential risk factors associated with the development of in-hospital Killip classes II–IV and to construct a reliable prediction model.
Among a total of 232 enrolled STEMI patients, 50 experienced Killip classes II–IV during their hospitalisation. Compared to those with Killip class I, the Killip class II-IV patients presented with significantly elevated sST2 concentrations and a higher heart rate (HR) at the first visit. In contrast, the left ventricular ejection fraction (LVEF) and estimated glomerular filtration rate (eGFR) values in these patients were significantly lower. Multivariate logistic regression analysis revealed that an sST2 level >77.3 ng/mL (odds ratio (OR) = 2.813, 95% confidence interval (CI): 1.201–6.586, p = 0.017), a first-visit HR >94 bpm (OR = 7.286, 95% CI: 2.778–19.106, p < 0.001), an LVEF <50% (OR = 3.336, 95% CI: 1.458–7.631, p = 0.004), and an eGFR <84 mL/(min·1.73 m2) (OR = 3.807, 95% CI: 1.556–9.316, p = 0.003) were independent risk factors for the occurrence of in-hospital Killip classes II–IV in STEMI patients treated with PPCI. Receiver operating characteristic (ROC) curve analysis, along with decision curve analysis (DCA), indicated that the combined predictive model integrating sST2, first-visit HR, LVEF, and eGFR exhibited a significantly stronger predictive ability compared to any single parameter.
In STEMI patients undergoing PPCI, the combination of sST2, first-visit HR, LVEF, and eGFR can effectively predict patients with Killip classes II–IV during hospitalisation, which may contribute to early intervention and improved patient outcomes.
To develop a predictive model for cardiac valve calcification (CVC) in rheumatoid arthritis (RA) patients using a novel nomogram approach.
We analyzed data from patients diagnosed with RA at the Department of Rheumatology and Immunology, Nanchong Central Hospital, between January 1, 2020, and October 31, 2023. Data were gathered on patient demographics, disease characteristics, laboratory tests, and imaging findings. Patients were randomly divided into a training set (n = 210) and a validation set (n = 140), in a ratio of 6:4, respectively. Least absolute shrinkage and selection operator (LASSO) regression was employed to identify risk predictors. Meanwhile, both single-factor and multi-factor logistic regression analyses were conducted to ascertain the risk factors associated with cardiac valve calcification. A predictive model was constructed using R software and validated through Bootstrap techniques. The performance of the model was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), calibration curves, and decision curve analysis (DCA).
A total of 350 RA patients were included in the study, of whom 67 (19.1%) were diagnosed with CVC. Multivariate analysis identified several significant risk factors for CVC, including hypertension (odds ratio (OR) = 15.496, 95% confidence interval (CI): 4.373–54.916; p < 0.01), age (OR = 1.118, 95% CI: 1.003–1.246; p = 0.043), disease duration (OR = 1.238, 95% CI: 1.073–1.427; p = 0.003), and elevated erythrocyte sedimentation rate (ESR) (OR = 1.026, 95% CI: 1.006–1.047; p = 0.012). The predictive model demonstrated excellent discriminatory performance, with an AUC of 0.9474 (95% CI: 0.9044–0.9903) in the training set. The model also showed strong internal validity (C-index = 0.947) and maintained robust performance in external validation (AUC = 0.9390; 95% CI: 0.8880–0.9893). Calibration analysis further confirmed the predictive accuracy and reliability of the model.
The developed model can effectively identify RA patients at high risk for CVC. This tool provides a scientific basis for clinical decision-making and has significant potential for enhancing patient management and outcomes.
Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with increased morbidity, mortality, and healthcare expenses. Meanwhile, effective management of AF requires a comprehensive, patient-centered approach that includes risk factor modification, rate and rhythm control strategies, and prevention of thromboembolic events. Multidisciplinary AF clinics have emerged as a model for comprehensive management to improve patient outcomes and reduce healthcare burden. This review discusses the rationale, structure, benefits, challenges, and future directions of multidisciplinary AF clinics, emphasizing their role in optimizing AF management.
The relationship between growth hormone (GH) and changes in cardiac morphology and function in the current study has not been fully elucidated, and this study aimed to assess the effect of hormonal factors on left ventricular structure and function in acromegaly patients using echocardiography.
We retrospectively analyzed the relationships between various echocardiographic parameters in 117 pre-treatment patients with acromegaly and four hormonal variables: GH, GH nadir during the oral glucose tolerance test (OGTT-GH), insulin-like growth factor-1 (IGF-1), and IGF-1/upper limit of normal (IGF-1/ULN) adjusted for age and sex. Patients were categorized into normal and abnormal subgroups based on interventricular septal (IVS) thickening, left atrial (LA) enlargement, and left ventricular (LV) abnormal LV peak flow velocities E and A (E/A ratios). Furthermore, the hormonal levels within these subgroups were compared.
Correlation analysis revealed that IGF-1/ULN was positively associated with IVS thickening and LA enlargement (p = 0.003 and p = 0.001), and negatively associated with an abnormal LV E/A ratio (p < 0.001). Regression analysis identified IGF-1/ULN as a significant risk factor for left heart alterations. Among the four hormonal variables, IGF-1/ULN demonstrated the largest area under the receiver operating characteristic (ROC) curve (AUC), with values of 0.628 for IVS thickening, 0.701 for LA enlargement, and 0.653 for LV abnormal E/A ratio.
IGF-1/ULN is strongly associated with changes in left heart structure and function in acromegaly and serves as a risk factor for these alterations. Thus, monitoring IGF-1/ULN may help predict cardiac changes via echocardiography, suggesting that early clinical management of GH-related levels could prevent early cardiac abnormalities in patients with acromegaly.
Despite recent efforts and improvements in terms of diagnosis and treatment, cardiovascular diseases (CVDs) remain a prime risk factor for mortality globally; thus, elucidating novel mechanisms underlying the development of these diseases remains essential. There have been significant contributions to identifying the classical means of programmed cell death (PCD), such as apoptosis, necroptosis, pyroptosis, and autophagy, in CVDs. In comparison, although the role of cuproptosis in CVDs is relatively unknown, cuproptosis has recently been revealed as a distinct type of copper-induced cell death with a unique molecular signature and regulation compared to conventional forms of PCD. Thus, cuproptosis represents a novel approach for treating CVDs. To investigate such implications in this review, we will systematically study the cellular mechanisms of cuproptosis and its pathophysiological roles in various forms of CVD. Finally, based on such mechanistic knowledge and to bridge mechanistic research with clinical applications, we propose the use of therapeutic strategies such as copper chelation, antioxidant modalities, and ferredoxin 1 (FDX1)/lipoic acid synthetase (LIAS)-based biomarkers.
Mitral valve prolapse (MVP), also known as floppy mitral valve syndrome, systolic click-murmur syndrome, and billowing mitral leaflets, is a developmental anomaly caused when one or two abnormal valve leaflets are displaced into the left atrium below the mitral valve annulus during systole. MVP is observed in 2–3% of patients in the general population and is the leading cause of mitral regurgitation (MR) in developed countries. Overall, MVP is considered a benign developmental anomaly; however, evidence suggests that MVP is associated with sudden cardiac death. Thus, there have been ongoing discussions about the optimal management of this patient group, which includes both pharmacological treatment and surgical interventions. This review aimed to provide an overview of the benign and arrhythmic MVP (AMVP), its diagnostic options, and management possibilities.
There is currently a lack of adequate risk assessment for coronary artery disease in the young and middle-aged population (ages 20–60). This cohort is characterized by limited symptom presentation, low utilization of medical facilities, and challenges in accessing healthcare services. Consequently, these individuals experience difficulties in early disease identification, rendering them susceptible to sudden cardiac death and premature mortality upon the manifestation of symptoms. Data from regular blood and urine tests, as well as questionnaires, are readily available and well-documented across diverse healthcare environments. Hypertension is a notable risk for coronary artery disease within this population. In light of these challenges, we present a risk assessment system for coronary heart disease specifically tailored for young and middle-aged individuals with hypertension, utilizing data derived from blood and urine examinations in conjunction with a brief questionnaire.
The dataset was sourced from the National Health and Nutrition Examination Survey (NHANES) database, covering the years 2005–2019. Following three iterations of feature selection, we identified 26 pertinent features. Subsequently, we developed five predictive models to facilitate large-scale screening for coronary heart disease risk. To enhance the interpretability of our models, we employed SHapley Additive exPlanations (SHAP) to evaluate the individual contributions of each feature.
We included 709 patients diagnosed with coronary artery disease and 6409 healthy individuals in our analysis. The results showed that LightGBM exhibited the highest performance (area under the curve (AUC) of 0.93).
This study has the potential to facilitate the improved screening of patients with coronary artery disease; we have developed a risk assessment system that is freely accessible to the public: https://prediction-of-coronary-heart-disease-htn-young-adults.streamlit.app/.
The body roundness index (BRI) offers a more precise evaluation of body fat and visceral fat levels. However, studies on the relationship between BRI and the risk of cardiovascular disease (CVD) remain limited.
Survival differences across BRI quartiles were estimated using Kaplan-Meier analysis. The association between the BRI and the risk of CVD was examined through Cox proportional hazards and restricted cubic spline (RCS) models. Additional subgroup and sensitivity analyses were also conducted.
This study included 6401 patients (47.43% male), with an incidence of CVD of 17.51%. Kaplan-Meier survival analysis revealed statistically significant differences between groups based on the assigned BRI quartiles. Cox models revealed a strong association between the BRI and CVD risk, while RCS models showed a non-linear link between higher BRIs and increased CVD risk. In certain subgroups, an elevated BRI was closely correlated with an increased incidence of CVD. Notable interactions were found between BRI and gender, age, hypertension, diabetes, alcohol consumption, and smoking status. Sensitivity analysis excluding early CVD cases yielded consistent results.
A significant non-linear association was found between the BRI and CVD risk. The BRI could be a valuable and sensitive marker for identifying individuals at high risk of CVD, with varying predictive value across different population subgroups.
Magnesium deficiency represents a prevalent electrolyte imbalance that notably heightens the risk of adverse cardiovascular incidents among individuals with heart failure. Research indicates that magnesium supplementation can diminish the frequency of negative events linked to hypomagnesemia in heart failure patients, while also enhancing the outcomes for critically ill individuals. Nevertheless, there remains a scarcity of studies investigating the effects of intravenous magnesium supplementation on mortality risk in those suffering from acute heart failure. This study aimed to explore the relationship between the administration of intravenous magnesium sulfate and the overall mortality risk in patients with acute heart failure who are admitted to intensive care units.
This retrospective cohort study employed the Medical Information Mart for Intensive Care IV (MIMIC-IV) database (version 3.1), which encompasses the baseline clinical data of 10,031 patients diagnosed with acute heart failure. Propensity score matching and multivariate Cox regression analysis were utilized to assess the effects of intravenous magnesium sulfate on 28-day all-cause mortality. The evaluation of unmeasured confounding variables was undertaken through E-value calculations, while subgroup analyses were performed to ascertain the robustness of the results.
A total of 10,031 patients participated in the study, with 6240 belonging to the propensity-score matched group, which included 3120 subjects who received intravenous magnesium sulfate and 3120 who did not. The entire cohort consisted of 10,031 individuals, whereas the matched cohort specifically comprised 6240 patients. Within the matched group, the rates of 28-day all-cause mortality were observed to be 13.2% (413/3120) for those administered intravenous magnesium sulfate, compared to 15.8% (493/3120) for the control group. Administration of intravenous magnesium sulfate correlated with a significantly reduced risk of 28-day all-cause mortality (hazard ratio (HR), 0.81; 95% confidence interval (CI), 0.71–0.93; p = 0.004). A sensitivity analysis conducted on the entire cohort corroborated this association (HR, 0.77; 95% CI, 0.69–0.87; p < 0.001). Additional subgroup analyses and E-value assessments reinforced the relevance of these results. Furthermore, intravenous magnesium sulfate was linked to reduced all-cause mortality at both 90 and 365 days.
Intravenous magnesium sulfate appears to decrease all-cause mortality in patients with acute heart failure, while further prospective studies are warranted to validate these results.
Left ventricular diastolic dysfunction (LVDD) can progress to heart failure, a condition associated with diminished quality of life as well as high mortality. Meanwhile, timely diagnosis and effective treatment of LVDD rely on a thorough understanding of the pathogenesis involved in LVDD. Echocardiography and cardiac magnetic resonance are the primary imaging modalities for evaluating left ventricular diastolic function. Several strands of evidence indicate that increased epicardial adipose tissue (EAT) correlates with LVDD in various clinical settings, such as hypertension, coronary artery diseases, diabetes, and obesity. Conversely, therapeutic strategies aimed at reducing EAT may improve the restoration of diastolic function. Some interventions have shown promise in decreasing EAT, including medications (hypoglycemic and hypolipidemic agents), lifestyle modifications (diet and exercise), and bariatric surgery. Notably, these interventions have concurrently been linked to improvements in diastolic parameters. This review compiles recent advancements in the clinical evaluation of LVDD to elucidate the pathophysiological and therapeutic roles of EAT in LVDD.
Acute myocardial infarction (AMI) remains a leading cause of mortality and disability globally. Although percutaneous coronary intervention (PCI) has significantly reduced in-hospital mortality (IHM), the resultant class imbalance complicates accurate risk prediction. While machine learning (ML) demonstrates potential in predicting IHM, there is a lack of models that provide both high accuracy and personalized risk assessment.
This retrospective study was conducted at the First Hospital of Lanzhou University from January 1, 2019, to December 31, 2020. We employed three data processing methods: synthetic minority over-sampling technique (SMOTE), Boruta, and grid search cross-validation (GSCV). Subsequently, six ML algorithms were implemented. Model performance was evaluated using accuracy, sensitivity, precision, F1-score, area under the receiver operating characteristic curve (AUROC), and area under the precision-recall curve (AUPRC).
The study cohort consisted of 1693 patients diagnosed with AMI, of whom 34 (2.0%) experienced IHM following PCI. After employing SMOTE to balance the dataset, 32 independent risk factors were identified using the Boruta feature selection method. Among the evaluated ML models, ensemble algorithms demonstrated superior performance. For instance, the Light Gradient-Boosting Machine (LightGBM) framework achieved a predictive accuracy with an AUROC of 0.93 (95% confidence interval (CI): 0.82–1.00) and an AUPRC of 0.62 (95% CI: 0.17–0.96). Additional performance metrics included an accuracy of 0.988, a precision of 0.625, a sensitivity of 0.625, a specificity of 0.994, and an F1-score of 0.625.
Utilizing SMOTE for class balancing, Boruta for feature selection, GSCV for optimal hyperparameter tuning, and LightGBM for model development achieved strong predictive performance for IHM following AMI. These findings underscore the significance of robust processing and careful algorithm selection.
Studies have demonstrated that patients with non-obstructive coronary artery disease (NOCAD) have an increased risk of myocardial infarction and all-cause mortality, particularly due to coronary microvascular dysfunction (CMD). Moreover, the features of atherosclerotic plaque can affect myocardial blood flow (MBF); however, data on these findings remain limited. Therefore, this study aimed to assess the impact of quantitative coronary computed tomography angiography (CCTA)-derived atherosclerotic plaque features on myocardial perfusion and MBF in NOCAD patients measured using dynamic cadmium–zinc–telluride single-photon emission computed tomography (CZT-SPECT).
Based on the CCTA results, a total of 49 NOCAD patients (stenosis <50%, 29 men, mean age 57.4 ± 9.0 years) were included in the study. In addition to estimating stenosis severity, the plaque volume (mm3) and burden (%) were measured using the coronary bed and separately by structural components (non-calcified, soft-tissue, fibrous, calcified). All patients underwent dynamic CZT-SPECT to assess stress and resting MBF and myocardial flow reserve (MFR).
Based on the MFR values, patients were divided into two groups: Group 1 consisted of patients with reduced MFR (<2.0, n = 20), and Group 2 consisted of those with normal MFR (≥2.0, n = 29). Not all patients had severe myocardial perfusion abnormalities, as determined by standard myocardial perfusion imaging indexes. Analysis of the CCTA data demonstrated that small volumes and burdens of atherosclerotic plaques were characteristic of patients. Stress was significantly correlated with total plaque volume (Spearman's rank correlation coefficient (ρ) = –0.402) and burden (ρ = –0.374), as well as non-calcified plaque volume (ρ = –0.341) and burden (ρ = –0.314). Rest significantly correlated with total plaque volume (ρ = –0.504) and burden (ρ = –0.432), and non-calcified plaque volume (ρ = –0.471) and burden (ρ = –0.433). Meanwhile, MFR and standard indexes of myocardial perfusion impairment did not exhibit significant associations with quantitative CCTA parameters. Multivariate logistic regression analysis revealed that only total plaque volume (odds ratio 1.01; 95% confidence interval 1.005–1.030; p < 0.001) was an independent predictor of reduced stress-related MBF of less than 1.5 mL/min/g.
Total plaque volume, derived from quantitative CCTA data, represents an independent predictor of reduced stress-related MBF of less than 1.5 mL/min/g, as obtained using dynamic CZT-SPECT, even in the absence of obstructive coronary artery disease (CAD).
Immunotherapy has redefined the treatment era for metastatic non-small cell lung cancer (NSCLC); therefore, this study aimed to explore trends in survival and cardiovascular disease (CVD) mortality risk before and after the widespread adoption of immunotherapy.
This research utilized information from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute and the Wide-Ranging Online Data for Epidemiologic Research (CDC-WONDER) database from the Centers for Disease Control and Prevention. The study population comprised patients with metastatic NSCLC from the pre- (2011–2014) and post-immunotherapy (2016–2019) periods. Survival determinants and CVD mortality trends were analyzed using propensity score matching, Kaplan–Meier survival analyses, competing risk models, and accelerated failure time (AFT) models.
A total of 78,028 metastatic NSCLC patients were enrolled in the study, with significant improvements noted in overall survival (OS) and cancer-specific survival (CSS) in the later stages of immunotherapy. The AFT model analysis identified treatment modality, pathological subtype, metastatic site, and some non-medical factors as survival determinants. The interaction analyses revealed that the survival differences among certain subgroups intensified in the post-immunotherapy period. Despite the lack of significant differences in CVD mortality and subgroup composition between the two periods, CVD mortality risk remained high compared with the general U.S. population.
Survival of patients with metastatic NSCLC has improved significantly since the introduction of immunotherapy. However, survival differences between some subpopulations continue to intensify, while CVD mortality risk also remains a key concern.
Hemophilia is an X-linked pathology characterized by a deficiency or lack of certain coagulation factors. This review aims to summarize the present literature describing the abnormalities in myocardial, valvular, and vascular morphology and function associated with hemophilia. While the present findings are limited, recent developments in cardiovascular imaging foreshadow the possibility that future research on the topic will continue to expand.
To rigorously evaluate the methodological quality and predictive performance of risk models for hospital readmission following percutaneous coronary intervention (PCI), as well as identify key predictive factors, and evaluate potential biases along with the clinical suitability of these models.
An extensive search was performed across multiple databases, including PubMed, Web of Science, The Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (VIP), and SinoMed, to identify studies on risk prediction models for hospital readmission following PCI. This search encompassed all available records from the establishment of these databases up to November 1, 2024. The screening procedure was conducted by two independent researchers, who also gathered the relevant data.
A total of 10 studies were incorporated, encompassing 18 models designed to predict readmission. The sample sizes across these models ranged significantly, from those containing as few as 247 participants to samples with as many as 388,078 participants. The reported incidence of readmission varied between 0.70% and 31.44%. Frequently identified predictor variables (occurring in at least four studies) included age, concurrent heart failure, diabetes, chronic lung disease, three-vessel disease, and gender. Nine models provided the area under the receiver operating characteristic (AUROC) curve, with values ranging from 0.660 to 0.899, while calibration metrics were provided in six studies. Internal validation was performed in eight studies, while one study incorporated both an internal and external validation. Eight studies were assessed and found to possess a high risk of bias, largely related to deficiencies in data analysis. The combined AUROC curve for the nine validated models was 0.80 (95% confidence interval (CI): 0.74–0.85), suggesting moderate discrimination ability.
Although existing risk prediction models for hospital readmission following PCI demonstrate a moderate level of predictive discrimination, most of the included studies were found to have a high risk of bias according to the Prediction model Risk Of Bias ASsessment Tool (PROBAST). Therefore, future studies should aim to develop more robust models using larger sample sizes, rigorous methodologies, and multicenter external validation.
CRD42024616342. https://www.crd.york.ac.uk/PROSPERO/view/CRD42024616342.
There is evidence that pacemaker implantation can trigger Takotsubo syndrome (TTS). However, limited information is available on the prognosis of TTS caused by this trigger, so our study aims to elucidate the clinical features, presentation, and prognostic factors associated with this syndrome in this specific situation.
We analyzed a group of patients with TTS triggered by pacemaker implantation (n = 41), including consecutive cases from the multicenter registry on takotsubo syndrome (RETAKO) and patients identified through a systematic literature search, and compared them to the general RETAKO cohort (n = 1559). We performed a 1:3 propensity score matching (PSM) based on dyslipidemia, diabetes mellitus, smoker/ex-smoker status, syncope, angina, vagal symptoms, and physical/mixed trigger, generating two balanced groups.
Compared to other triggers, TTS associated with pacemaker implantation was linked to a longer corrected QT interval (551.2 ms vs. 502.5 ms, p = 0.005), lower left ventricular ejection fraction (34.8% vs. 47.3%, p < 0.001), a higher proportion of acute kidney injury (29.3% vs. 11.0%, p = 0.001), and an increased rate of cardiogenic shock (20.6% vs. 8.8%, p = 0.029). However, there were no differences in all-cause mortality (12.2% vs. 13.1%, p = 0.858) or TTS recurrence (0.0% vs. 3.9%, p = 0.639). After PSM, the previously observed differences were no longer present, with no significant differences in death or recurrences.
TTS following pacemaker implantation predominantly presents with greater rates of cardiogenic shock and acute kidney injury, without differences in all-cause mortality or TTS recurrence. After PSM, no differences were found regarding cardiovascular outcomes, suggesting that the physical nature of the trigger could account for the initial differences observed.
Heart failure (HF) is a major public health concern due to the associated high morbidity, mortality, and growing economic burden. Thus, early prevention and identification of modifiable risk factors are crucial to reducing the prevalence of HF. The American Heart Association has recently introduced the Life's Essential 8 (LE8) metrics, which offer a comprehensive framework for assessing cardiovascular health. This research aims to investigate the association between the LE8 metrics and the prevalence of HF among the American population, exploring whether the LE8 metrics are associated with HF prevalence and can contribute to the risk stratification of HF in public health settings.
The present cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) 2007–2020, including participants aged ≥20 years with complete data on HF and the LE8 metrics. Multiple logistic regression analysis was conducted to evaluate the relationship between LE8 and the prevalence of HF. Subgroup analyses combined with interaction tests were utilized to investigate potentially affecting factors. Furthermore, the dose-response association was analyzed using smooth curve fitting, while the receiver operating characteristic (ROC) curve was employed to examine the predictive performance of the LE8 metrics in HF patients.
A dose-response reverse linear association was identified between the LE8 scores and HF prevalence within the American population. When comparing the group with the lowest LE8 score to that with the highest score, the latter exhibited a 70% decrease regarding HF prevalence (odds ratio (OR) = 0.30; 95% confidence interval (CI), 0.22–0.43; p < 0.01) in the fully adjusted model. Moreover, variables including physical activity, nicotine exposure, sleep health, body mass index (BMI), and plasma glucose were identified as independently associated with the prevalence of HF.
Higher LE8 scores were associated with a lower prevalence of HF, suggesting that the LE8 metrics may be a useful tool for identifying at-risk individuals in population health.
Combined valve and coronary surgery is technically complex, and the prognosis for such patients remains poor. This study aimed to analyze the short-term prognostic effects of histidine–tryptophan–ketoglutarate (HTK) cardioplegia versus 1:4 cold blood (CB) cardioplegia in patients requiring combined valve and coronary surgery.
This retrospective cohort study categorized patients undergoing valve surgery combined with coronary artery bypass grafting (CABG) into two groups: the HTK group (n = 504) and the CB group (n = 188), based on the type of cardioplegia used. Propensity score matching (PSM) was employed to adjust for baseline differences between the groups. The primary endpoints included operative mortality, postoperative myocardial infarction (PMI), postoperative acute kidney injury (AKI), and postoperative atrial fibrillation (POAF). Secondary endpoints included stroke incidence, ventilation time, aortic cross-clamp time, and intensive care unit (ICU) length of stay (LOS).
After PSM, patients with HTK experienced significantly lower rates of AKI and POAF (p < 0.05). Troponin I (TnI) and creatine kinase-MB (CK-MB) measurements at 48 and 72 hours postoperatively were lower in the HTK group compared with the CB group (p < 0.05). However, no significant difference in PMI incidence was detected (p = 0.368). Additionally, the HTK group demonstrated shorter mechanical ventilation times (p = 0.01) and ICU stays (p = 0.009).
HTK cardioplegia reduced postoperative ventilation time, ICU LOS, and the incidence of AKI and POAF compared with CB cardioplegia in patients undergoing valve surgery combined with CABG. HTK cardioplegia is effective, safe, and superior to CB cardioplegia in improving short-term outcomes in these patients.
Infective endocarditis (IE) is an inflammatory disease caused by the infection of the endocardium or heart valves by pathogenic microorganisms. It is characterized by diagnostic challenges, difficult treatment, and high mortality. Multimodal imaging techniques, including echocardiography, computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine imaging, play a crucial role in the diagnosis of IE. Echocardiography is the first-line imaging modality for suspected IE. Cardiac CT, with its excellent spatial resolution and three-dimensional (3D) reconstruction capabilities, is helpful in detecting paravalvular abscesses, fistulas, and pseudoaneurysms. MRI has advantages in identifying neurological complications and assessing myocardial involvement. Nuclear imaging demonstrates high specificity in detecting prosthetic valve IE and device-related infections. These imaging techniques are important in detecting perivalvular complications, evaluating local and distant spread of infection, and guiding therapeutic interventions, thereby enhancing the diagnostic and therapeutic management of IE.
Long-term right ventricular outflow tract dysfunction can lead to right and left heart failure. Nonetheless, current data on the clinical characteristics of the right ventricular outflow tract obstruction (RVOTO) in China remain limited. This study analyzed the evolving trends in the observed proportion, etiology, spectrum, and interventions for RVOTO over the past 18 years from a single-center echocardiographic database.
A total of 10,234 RVOTO cases (17,451 records from 2003 to 2020) were included in the transthoracic echocardiography database in China. The RVOTO cases were divided into eight groups according to the different obstruction sites and disease types. Subsequently, RVOTO was categorized into three types: congenital, iatrogenic, and neither congenital nor iatrogenic. Moreover, congenital RVOTO was further classified into simple and complex congenital RVOTO. Next, we calculated the proportion of RVOTO patients who had received interventions. We analyzed the proportions of different types of RVOTO and the variation tendency.
During 2003–2008, 2009–2014, and 2015–2020, the observed proportion of RVOTO cases in the total echocardiographic cases decreased (3.2%, 2.1% and 1.8%, respectively; p < 0.001); the proportion of RVOTO with a congenital etiology also reduced, though as the dominant cause; meanwhile, the proportion of simple congenital RVOTO increased (48.5%, 52.4% and 67.3%, respectively; p < 0.001). As the two most common types of RVOTO, the proportion and number of valvular pulmonary stenosis (PS) increased, while the proportion of Fallot cases decreased. The number of RVOTO cases receiving surgical or transcatheter intervention and experiencing intervention-related severe pulmonary regurgitation (PR) or residual peripheral PS increased, although with a low probability of reoperation.
The clinical characteristics of RVOTO have undergone significant changes in China over the past two decades. After the RVOTO intervention, the increasing number of cases with severe PR or residual peripheral PS and a low possibility of reoperation signifies a future necessity for transcatheter pulmonary intervention.
Coronary computed tomography angiography (CCTA)-derived fractional flow reserve (CT-FFR) represents a significant technical advancement in the non-invasive evaluation of coronary artery disease, propelling CCTA into a new era of functional assessment. This review offers a comprehensive perspective on CT-FFR technology and its applications, encompassing technical refinements, diagnostic performance, indications, and other advantages. Furthermore, the implications of China-developed CT-FFR on the community and in different markets are discussed.
Homozygous familial hypercholesterolemia (HoFH) is a rare inherited metabolic disorder. Meanwhile, HoFH is characterized by extremely high plasma levels of low-density lipoprotein cholesterol (LDL-C) from birth, alongside xanthomas and premature atherosclerotic cardiovascular diseases (ASCVDs). Traditional drugs such as statins have difficulty maintaining serum lipids at an ideal level. Here, we report the case of a 12-year-old child with HoFH who underwent liver transplantation. The goal of lipid reduction could not be achieved in this patient by any other means, and the patient had also experienced mild cardiovascular damage. During the 5-year post-transplant follow-up, the serum lipids were controlled in the patient, while the progression of atherosclerotic plaques was detected without the use of any lipid-lowering drugs. Additionally, we review the progress of current treatments for HoFH and discuss new lipid-lowering medications, as well as the challenges associated with liver transplantation.
Assessment of the influence of the five central cardiac rehabilitation (CR) prescriptions on heart function and cardiovascular complications in individuals with coronary artery disease following percutaneous coronary intervention (PCI).
This systematic review and meta-analysis was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic search of PubMed, Web of Science, Ovid full-text journals database, Embase, CINAHL, Cochrane Library, MEDLINE, CNKI, VIP, SinoMed, and Wanfang data resources, was performed in November 2024. Studies that met the following criteria were included: (i) Population (P): adult individuals (18 years or older) with a confirmed diagnosis of ischemic heart disease using the clinical gold standard “coronary angiography” and undergoing first-time PCI; (ii) Intervention (I): five core cardiac rehabilitation prescriptions; (iii) Control (C): routine rehabilitation guidance/traditional rehabilitation guidance; (iv) Outcomes (O): left ventricular ejection fraction (LVEF)/left ventricular end-diastolic diameter (LVEDD)/six-minute walk distance (6MWD)/Major Adverse Cardiovascular Events (MACE); (v) Study design (S): randomized controlled trials.
This systematic review and meta-analysis of 16 randomized controlled trials (involving 1808 patients) demonstrates that comprehensive Cardiac Rehabilitation (CCR), integrating exercise training, nutritional counseling, smoking cessation support, psychological intervention, and medication management, yields two key benefits for coronary heart disease (CHD) patients following first-time PCI: (1) significant enhancement of cardiac function evidenced by improved LVEF (standardized mean difference (SMD) = 0.56, 95% confidence interval (CI): 0.33 to 0.79), reduced LVEDD (SMD = –0.67, 95% CI: –0.97 to –0.36), and increased exercise capacity (SMD = 0.82, 95% CI: 0.48 to 1.15); (2) substantial reduction in MACE (odds ratios (OR) = 0.15, 95% CI: 0.09 to 0.24).
Patients who have undergone first-time PCI for CHD may experience significant advantages from the combined intervention of five CR strategies. Along with adherence to medical therapy and the evolution of medical models, strengthening multidisciplinary cooperation is crucial for optimizing clinical outcomes in patients following coronary interventional procedures.
CRD42024565139, URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024565139.
Regulatory T cells (Tregs) play pivotal roles in immune homeostasis; however, the association between Tregs and the pathogenesis of coronary heart disease (CHD) remains unclear. Thus, this study aimed to investigate the relationships among Tregs, glucagon-like peptide-1 receptor (GLP-1R) expression, and CHD risk, with a focus on the severity of coronary artery stenosis and inflammatory cytokine dynamics.
A total of 130 CHD patients (stratified by the Gensini score into low-/high-risk stenosis subgroups) and 70 non-CHD controls were enrolled in this case–control study. Peripheral blood Tregs (CD4+CD25+FoxP3+) and GLP-1R+ Tregs were quantified via flow cytometry. Plasma cytokines interleukin-2 (IL-2), interleukin-4 (IL-4), interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-35 (IL-35), and tumor necrosis factor-alpha (TNF-α) were measured. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were employed to evaluate the associations between Treg subsets and clinical outcomes; meanwhile, the Spearman correlation was used to assess the relationships between cytokines.
CHD patients presented with significantly lower proportions of total Tregs (p < 0.001) and GLP-1R+ Tregs (p = 0.013) compared to controls, with further reductions in the high-risk stenosis subgroups. Multivariate analysis identified both Tregs (CHD: odds ratio (OR) = 0.752; p < 0.001; stenosis: OR = 0.760; p = 0.021) and GLP-1R+ Tregs (CHD: OR = 0.859; p = 0.013; stenosis: OR = 0.840; p = 0.040) as independent predictors. The ROC analysis demonstrated diagnostic utility for Tregs (CHD: area under the curve (AUC) = 0.663; stenosis: AUC = 0.635) and GLP-1R+ Tregs (CHD: AUC = 0.600; stenosis: AUC = 0.619). The GLP-1R+ Treg proportion was positively correlated with anti-inflammatory IL-35 (r = 0.185, p = 0.016) and inversely correlated with IL-4 (r = –0.150, p = 0.047).
Reduced Treg frequency and impaired GLP-1R expression on Tregs are independently associated with CHD susceptibility and stenosis progression, potentially mediated by dysregulation of inflammatory cytokines. The GLP-1R pathway in Tregs represents a novel immunomodulatory target for therapeutic intervention in CHD.
Transcatheter aortic valve replacements (TAVRs) have become the predominant solution for treating patients with severe aortic valve stenosis. Meanwhile, procedural coronary obstructions and/or occlusions post-TAVR have subsequently become greater concerns as the use of TAVR increases in younger populations. Therefore, this preclinical study aimed to develop methodologies to assess coronary perfusion following a TAVR in both reanimated swine hearts and preserved human specimens perfused in a pulsatile system.
This study employed Visible Heart® methodologies to functionally reanimate seven swine hearts. Endoscopic video cameras were used to enable direct visualization of the aortic root throughout these experimental procedures. Pressure wires were placed in the desired coronary arteries, and measurements were collected both before and after the TAVR. Subsequently, these reanimated hearts were scanned using micro-computed tomography (micro-CT), and the valve placements were assessed at resolutions >20 microns. Similar methodologies were utilized to study 13 perfusion-fixed human hearts, using a pulsatile pump, their valves were made functional, and the coronaries were perfused.
Pressure measurements from the left anterior descending arteries (LADs) were normalized to the recorded aortic pressures and the percentage difference from the pre- and post-TAVR and were correlated to the following features: commissural alignments (p = 0.274), valve implant depths (p = 0.546), left coronary sinus height (p = 0.127), left coronary ostium heights (p = 0.012), and estimated leaflet to ostium distance (ELOD) (p = 0.001).
These studies suggest that there may be stronger correlations between the ELOD and coronary perfusion post-TAVR than pre-procedural measurements of left coronary ostium heights. Left sinus heights, commissural alignments, and implant depths did not correlate significantly relative to coronary perfusions post-TAVR. These results could be further explored in various clinical studies and potentially used to provide additional insights into TAVR procedures across different patient anatomies, informing innovations in device design.
Heart failure (HF) is a heterogeneous clinical syndrome, the prevalence of which is increasing among younger adults, promoting global concern due to its significant morbidity and mortality. Therefore, predicting the occurrence of HF using risk-related biomarkers is essential for screening and prevention. Retinol-binding protein 4 (RBP4) is a 21 kDa secreted factor produced by the liver and adipose tissue. Elevated serum RBP4 levels are consistently observed in HF patients and are associated with different New York Heart Association (NYHA) class and left ventricular dysfunction. In addition to its role in retinol transport, emerging evidence suggests that RBP4 contributes to the pathogenesis of HF by inducing insulin resistance, triggering chronic inflammation, and directly injuring cardiomyocytes. Studies have found that RBP4 is a potential diagnostic biomarker for HF; however, its clinical relevance is limited due to a paucity of clinical studies and basic science research. This article reviews the current clinical and experimental evidence regarding the pathophysiological effects of RBP4 related to its role in the progression of HF.
Functional impairment is a hallmark of heart failure (HF) and a strong prognostic factor. Cardiopulmonary exercise testing (CPET) provides a robust and objective assessment of exercise capacity; however, the impact of new pharmacotherapies on CPET parameters remains largely uncharacterized systematically. This review examines the influence of contemporary HF therapies on functional capacity, with particular focus on CPET-derived metrics, such as peak oxygen uptake (VO2 peak), ventilatory efficiency (VE/VCO2 slope), and oxygen uptake efficiency slope (OUES). A critical synthesis of randomized trials, observational studies, and meta-analyses was performed to assess the effects of both conventional (angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, mineralocorticoid receptor antagonists (MRAs)) and novel agents (angiotensin receptor neprilysin inhibitor (ARNIs), sodium–glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP)-1 receptor agonists, vericiguat, finerenone) on CPET outcomes. Conventional therapies provide modest improvements in CPET indices, whereas sacubitril/valsartan and SGLT2 inhibitors show more consistent and clinically meaningful benefits across different HF phenotypes. Vericiguat provided preliminary promise in improving VO2 peak and ventilatory parameters. Meanwhile, evidence for GLP-1 receptor agonists and finerenone remains limited or inconclusive. Heterogeneity across studies, in terms of the timing of CPET follow-up and baseline functional status, emerged as important modulators of the observed outcomes. Novel HF therapies can potentially improve exercise capacity beyond symptomatic relief, supporting a shift toward CPET-based endpoints in HF clinical trials. Personalized CPET monitoring may optimize therapeutic strategies and better reflect meaningful functional gains in HF populations.
Despite advancements in treatment, coronary artery disease (CAD) remains a significant global health concern. Although lipoprotein(a) [Lp(a)] is recognized as a crucial cardiovascular risk factor associated with increased risk, the prognostic value of using Lp(a) levels in patients with acute coronary syndrome (ACS) who have undergone percutaneous coronary intervention (PCI) remains debatable. This review aimed to investigate the association between Lp(a) levels and recurrent ischemic events in patients with ACS undergoing PCI.
This systematic review included studies with individuals aged ≥18 years diagnosed with ACS who underwent PCI and had Lp(a) measurements. The included studies were sourced from the PubMed database, with a focus on articles published between January 2020 and January 2025. Keywords related to Lp(a) and cardiovascular diseases were used in the search. Data extraction involved a review of titles and abstracts followed by quality assessment using the QUADAS-2 tool.
The final analysis included 10 studies with a combined population of 20,896 patients from diverse regions, including Japan, India, Egypt, China, and South Korea. Key findings indicate that elevated Lp(a) levels are significantly associated with adverse cardiovascular outcomes, including myocardial infarction and mortality, both in hospital and during long-term follow-up.
This review highlights Lp(a) as a critical biomarker for predicting recurrent cardiovascular events in ACS patients post-PCI. The consistent correlation between elevated Lp(a) levels and adverse outcomes underscores the necessity of routine monitoring and targeted management of Lp(a) to mitigate residual cardiovascular risk.
Hypertrophic cardiomyopathy (HCM) is a multifaceted genetic disorder characterized by left ventricular hypertrophy (LVH) in the absence of alternative causes, with an estimated prevalence ranging from 1 in 200 to 1 in 500 individuals. Since HCM was first characterized in 1869, a plethora of pathogenic mutations have been identified, while ongoing research continues to elucidate the various pathophysiological mechanisms present in individuals with HCM. Comprehensive physical examination findings and multimodality imaging techniques have become crucial for accurately diagnosing and risk stratifying HCM patients. Meanwhile, recent advancements in research have contributed to a more refined definition and heightened recognition of HCM, prompting further investigations into targeted therapeutic strategies. This evolution in understanding provides alternative treatment options for patients, moving beyond traditional approaches such as myectomy or septal ablation. This review aims to systematically explore the genetic and pathophysiological underpinnings of HCM, as well as the application of multimodality imaging in identifying patients at risk for sudden cardiac death (SCD). The discussion also examines contemporary management strategies for HCM, specifically highlighting novel therapies targeting the molecular mechanisms involved in this disease.
Transcatheter aortic valve replacement (TAVR), originally developed to treat native aortic valve disease, has become increasingly adopted in the valve-in-valve (ViV) setting to manage bioprosthetic valve dysfunction of both surgically implanted bioprostheses (TAV-in-SAV) and prior transcatheter valves (TAV-in-TAV). Recent advances have significantly refined the ViV technique to address procedural challenges, including suboptimal hemodynamic outcomes and the risk of coronary obstruction. This review summarizes the current clinical data supporting the use of TAVR in a ViV setting and outlines a structured, four-step framework that encompasses procedural planning, including determining the perioperative risk for a patient, identifying the mode of valve failure, recognizing valve-specific implantation strategies, and assessing concomitant structural lesions. This review also aims to synthesize current evidence into a clinically actionable format, helping to guide heart team discussions, pre-procedural planning, and patient counseling.
Takotsubo syndrome (TS) is an acute cardiac disease entity with a clinical presentation identical to that of an acute coronary syndrome (ACS). The terms tsubo- or takotsubo-shaped were introduced at the beginning of the 1990s to describe the silhouette of the left ventricle during systole in patients with a clinical picture similar to myocardial infarction (MI) but with no obstructive coronary arteries. Notably, TS is not a MI and is caused by a different pathogenic mechanism. Innumerable emotional and physical stress factors have been reported to trigger TS, with ACS identified as one of the known physical trigger factors for TS. The myocardial stunning, which is the characteristic feature of left ventricular wall motion abnormality (LVWMA) in TS, was first reported in patients with ACS and also used to describe LVWMA when the term takotsubo-shaped was introduced in 1990. Cases, series of cases, and studies on that ACS may trigger TS have been reported. TS is also known to cause numerous cardiac complications, such as heart failure, pulmonary edema, cardiogenic shock, life-threatening arrhythmias, left ventricular outlet tract obstruction, and cardiac thromboembolic complications. In addition to MI caused by coronary thromboembolic complications, TS may also cause other changes or complications in the coronary artery system, including the intramyocardial resistance microcirculation, the intramyocardial conductance vessels as the septal branches from both the left anterior descending artery and the posterior descending artery, the coronary segments with myocardial bridging, the epicardial coronary arteries, and coronary artery–left ventricular micro-fistulae (CALVMF). This paper reviews these coronary artery complications or changes caused by TS. Notably, the transient compression of CALVMF during the acute stage of TS and reappearance during normalization of the left ventricular function represent novel observations.
Commotio cordis is a rare but fatal cause of sudden cardiac death in young people, particularly athletes exposed to non-penetrating chest trauma. Commotio cordis occurs when an impact to the chest triggers a lethal ventricular arrhythmia in the absence of pre-existing structural heart disease. Despite advances in the understanding of commotio cordis, the prevention and management of this condition remain challenging. The literature indicates that commotio cordis is most common in adolescents and sports such as baseball, football, and ice hockey. The key pathogenic mechanism involves a chest impact occurring during a vulnerable phase of the cardiac cycle, leading to ventricular fibrillation. Immediate cardiopulmonary resuscitation and prompt use of an automated external defibrillator are crucial for survival. However, the effectiveness of preventive measures, such as chest protectors and greater awareness of cardiovascular emergencies, remains debated. As a leading cause of sudden death in young athletes, commotio cordis requires further research to refine prevention strategies and improve outcomes. This review provides an updated overview of the pathophysiological mechanisms, risk factors, intervention strategies, and preventive approaches for this condition.
Stent malapposition (SM) remains a significant challenge in percutaneous coronary intervention (PCI), particularly in cases involving calcified coronary lesions. However, the predictors of SM and their relationship with clinical outcomes remains unclear. This study aims to identify the predictors of SM through optical coherence tomography (OCT) and assess its impact on clinical outcomes.
In this single-center, retrospective observational study, we analyzed 384 patients who underwent PCI with OCT imaging for calcified coronary lesions between January 2019 and December 2023. Patients were divided into two groups based on post-PCI OCT findings: the SM group (n = 142) and non-SM group (n = 242). We compared calcium characteristics, procedural parameters, and clinical outcomes between the two groups.
The SM group exhibited more severe calcium characteristics, including a larger calcium arc (295.8° ± 58.4° vs 248.6° ± 62.3°, p < 0.001), greater thickness (1.12 ± 0.31 mm vs 0.89 ± 0.28 mm, p < 0.001), and longer length (18.6 ± 7.2 mm vs 12.8 ± 6.4 mm, p < 0.001). Multivariate analysis identified calcium arc >270° (odds ratio (OR) 2.84, 95% CI 1.86–4.32, p < 0.001), calcium thickness >1.0 mm (OR 2.16, 95% CI 1.42–3.28, p = 0.001), and diabetes mellitus (OR 1.68, 95% CI 1.12–2.52, p = 0.012) as independent predictors of SM. Over a median follow-up of 18.6 months, the SM group had higher rates of major adverse cardiovascular events (15.5% vs 8.7%, p = 0.04), primarily driven by increased target lesion revascularization (8.5% vs 4.1%, p = 0.03).
Specific calcium characteristics and diabetes mellitus are strong predictors of stent malapposition in calcified coronary lesions. The presence of stent malapposition is associated with worse clinical outcomes, highlighting the importance of optimal lesion preparation and stent deployment strategies in high-risk lesions.
Antiplatelet therapy represents a cornerstone of secondary prevention in patients with chronic coronary syndrome (CCS) who have undergone percutaneous coronary intervention (PCI). However, the optimal antiplatelet regimen and optimal duration remain under investigation, as treatment must be individualized to balance the thrombotic and bleeding risks. Thus, this systematic review aimed to present the most recent evidence on antiplatelet strategies in chronic coronary syndrome patients with prior PCI, highlighting findings relevant to subgroups with increased thrombotic risk.
A systematic search of the PubMed database, the Cochrane Library, and ClinicalTrials.gov was conducted up to 29 May 2025. Studies were screened and selected based on predefined eligibility criteria. A total of 14 studies were included and were synthesized narratively.
Extended dual antiplatelet therapy (DAPT) with ticagrelor plus aspirin, compared to aspirin alone, improved primary outcomes in 5101 patients with stable coronary disease and diabetes mellitus (hazard ratio (HR) 0.81; 95% confidence interval (CI), 0.71–0.93; p = 0.003), and reduced major adverse cardiovascular events (HR 0.85; 95% CI, 0.75–0.96; p = 0.009) among 11,260 patients with history of prior myocardial infarction and additional risk factors such as multivessel coronary artery disease or chronic kidney disease. In 2431 patients, long-term clopidogrel monotherapy, compared to aspirin monotherapy, was associated with improved primary outcomes (HR 0.74; 95% CI 0.63–0.86; p < 0.001) along with a reduction in major bleeding (HR 0.65; 95% CI 0.47–0.90; p = 0.008). Long-term ticagrelor monotherapy, compared to aspirin, was associated with fewer ischemic events, as defined by the primary endpoint (HR 0.73; 95% CI 0.57–0.94; p = 0.014), but an increased risk of Bleeding Academic Research Consortium (BARC) type 2,3, or 5 bleeding (HR 1.52; 95% CI 1.11–2.08; p = 0.009). Subgroup analyses suggested benefits of extended DAPT versus aspirin in patients with peripheral artery disease (n = 246; HR 0.54; 95% CI 0.31–0.95; p = 0.03), in those with two or more implanted stents (n = 505; p = 0.02), and in patients treated for in-stent restenosis (n = 224; p = 0.034).
Extended DAPT demonstrated benefits over 30 months, while clopidogrel monotherapy has shown sustained effectiveness for up to 5.8 years in CCS patients with a history of PCI. Individualized treatment based on thrombotic and bleeding risk remains essential. Large-scale randomized trials are warranted to define the populations most likely to benefit from long-term intensified antiplatelet therapy.
CRD420251069004, https://www.crd.york.ac.uk/PROSPERO/view/CRD420251069004.
Ischemic heart disease (IHD) is the leading cause of mortality and disability worldwide. This study aimed to investigate global trends in IHD mortality across 204 countries and territories over the past 30 years and explore the influence of age, period, birth, and cohort effects on mortality.
IHD mortality data were retrieved from the Global Burden of Disease (GBD) 2019 study. Temporal trends in the number of deaths, all-age mortality rates, and age-standardized mortality rates were assessed across countries grouped by sociodemographic index (SDI) quintiles. To quantify changes over time, we fitted age–period–cohort (APC) models and derived overall annual percentage changes (net drift) and age-specific annual percentage changes (local drift). The APC model was then used to distinguish the independent effects of age, period, birth, and cohort on IHD mortality trends.
The annual global IHD deaths increased from 5.70 million (95% uncertainty interval (UI): 5.41–5.90) to 9.14 million between 1990 and 2019 (95% UI: 8.40–9.74). All-age mortality rates also rose significantly, with a notable shift in deaths toward older populations (≥70 years). The global net drift in IHD mortality declined by 1.10% annually (95% confidence interval (CI): –1.17% to –1.04%), with high-SDI countries experiencing the greatest decline (–2.84%, 95% CI: –3.05% to –2.64%). Age, period, and birth cohort effects manifested a general declining trend. The largest positive net drift was observed in the Philippines (3.60%, 95% CI: 3.33%–3.86%). Key global risk factors included hypertension, elevated low-density lipoprotein cholesterol, ambient particulate matter pollution, and smoking. However, low temperatures were the leading environmental risk factor in high-SDI countries.
From 1990 to 2019, the global burden and temporal trends for IHD mortality varied substantially across SDI quintiles, sex, geographic regions, and countries. These disparities underscore the need for region-specific, risk-differentiated, and cost-effective interventions to prevent and manage IHD. Moreover, strengthening primary healthcare, improving health system responsiveness, and enhancing health promotion and prevention efforts are critical, especially in regions where IHD mortality remains stable or is increasing.
Percutaneous balloon mitral valvuloplasty (PBMV) is the preferred treatment for selected patients with rheumatic mitral stenosis (MS). Although prior research has established the feasibility and safety of echocardiography-guided PBMV, this study aimed to compare the mid- to long-term clinical outcomes and safety profiles between echocardiography-guided and conventional fluoroscopy-guided approaches.
Consecutive patients who underwent successful PBMV from January 2016 to December 2022 were enrolled. Participants were stratified into two groups based on procedural guidance method: echocardiography-guided and conventional fluoroscopy-guided. The primary outcome of this study was the success of PBMV, and the secondary outcome was a composite of all-cause mortality, reoperation for mitral valve surgery, or repeat PBMV after discharge. Statistical analyses included the Kaplan–Meier survival analysis with log-rank tests and propensity score matching to adjust for confounding factors.
A total of 429 patients underwent PBMV, with 71 (16.6%) in the echo-guided group and 358 (83.4%) in the conventional fluoroscopy-guided group. A success rate of 98.6% was demonstrated in the echocardiography-guided group, and 98.9% in the fluoroscopy-guided group after propensity score match (p = 0.84). During follow-up, nine (14.3%) patients in the echo-guided group required surgical intervention, and 13 (10.4%) in the fluoroscopy-guided group; one (1.6%) patient in the echocardiography-guided group and six (4.8%) in the fluoroscopy-guided group died. No significant differences were observed in freedom from re-intervention (p = 0.33) and survival (p = 0.23).
For selected patients with rheumatic MS, echocardiography-guided PBMV demonstrated an equivalent mid- to long-term efficacy and safety profile compared to fluoroscopy-guided approaches.