Current Cardiology Reviews最新文献

Introduction: Transcatheter patent foramen ovale (PFO) closure is the treatment of choice in younger patients with cryptogenic stroke or high-risk PFO features. A common complication post-procedurally is atrial fibrillation or flutter (AF/Af). In this study, we evaluate the incidence of AF/Af following PFO closure compared to medical therapy, the time to occurrence, and the role of age in AF/Af occurrence.

Methods: A systematic literature search was conducted in MEDLINE (Pubmed) and Scopus databases for studies assessing the incidence of AF/Af post-PFO closure in contrast to medical therapy, the incidence within the 1st month post-procedurally or later, and the role of age in AF/Af occurrence.

Results: Twenty-nine studies (10 randomized, 18 observational, 1 case-control) were included in this systematic review, of which 10 (7 randomized, 3 observational) were meta-analyzed. Subjects undergoing PFO closure were at higher risk of developing AF/Af (RR: 2.27, 95% CI: 1.29, 4.01, p=0.009). There was a trend for higher AF/Af rates within the 1st month post-intervention. There was no statistical difference after the 1st month of follow-up (3 studies, RR: 0.60, 95% CI: 0.02-19.88, p=0.60). Mean age of participants did not affect the primary endpoint (β: -0.03, CI: - 1.13, 0.06, p=0.45, residual I 2 =44%, R2 =4%).

Discussion: AF/Af risk is elevated following PFO closure, particularly early post-procedure, likely due to procedural factors. However, the arrhythmias are often transient and not agedependent. Study heterogeneity and limited monitoring methods may affect the reported incidence.

Conclusion: PFO closure increases short-term AF/Af risk compared to medical therapy, but the events are typically mild and age-independent. This should be weighed against the long-term benefit of stroke prevention. Moreover, standardized monitoring is needed to better define this risk.

Introduction: Pulmonary veno-occlusive disease (PVOD) is a rare subtype of pulmonary arterial hypertension (PAH), often diagnosed only in cases resistant to PAH therapy or after lung histology is obtained through transplantation or autopsy. Early diagnosis of PVOD, however, is associated with improved outcomes. We present a case of PVOD initially diagnosed and confirmed by lung biopsy.

Case presentation: A 24-year-old male military pilot, a non-smoker, was admitted with progressive dyspnea. On examination, his heart rate was 110 beats per minute, respiratory rate 20 per minute, oxygen saturation 88% at rest and 95% with 3 L/min supplemental oxygen. He was classified as WHO functional class IV, with a six-minute walking distance of 60 m and NT-proBNP of 3315 pg/ml. Electrocardiogram and echocardiography revealed right heart enlargement. Right heart catheterization confirmed precapillary pulmonary hypertension with a low cardiac index (1.75 L/min/m²). High-resolution computed tomography (HRCT) of the lungs showed septal lines, centrilobular ground-glass opacities, and latero-aortic and subcarinal lymph node enlargement, suggestive of PVOD. Diagnosis was confirmed histologically via open lung biopsy and genetically by identification of biallelic EIF2AK4 variants. Eight months after diagnosis, lung transplantation was performed, resulting in dramatic improvement of the patient's condition. This case highlights key aspects of PVOD etiology, epidemiology, diagnosis, and management.

Conclusion: Patients with PAH should undergo careful evaluation for PVOD. Recognition of characteristic clinical, radiological, and genetic features enables suspicion of this rare PAH subtype and guides cautious titration of targeted therapies. Lung transplantation remains the preferred treatment option for PVOD patients.

Introduction: Lyme disease, primarily caused by Borrelia burgdorferi in North America, is a common spirochetal infection transmitted via tick bites. The dissemination of Lyme spirochetes can result in multisystem complications, including Lyme carditis.

Methods: This review incorporated data from observational studies, retrospective analyses, systematic reviews, and case reports involving patients with confirmed or presumed Lyme carditis. Key outcomes included prevalence, reversibility, and chronicity of cardiac involvement, as well as diagnostic and prognostic implications.

Results: Atrioventricular block represents the most prevalent conduction abnormality in Lyme carditis, occurring in up to 90% of cases, with high-degree of persistent blocks potentially necessitating temporary or permanent pacing. While the majority of conduction abnormalities resolve with appropriate antimicrobial therapy, a subset of patients experience persistent dysfunction. Structural complications, including myocarditis, pericarditis, and, less frequently, endocarditis and dilated cardiomyopathy, have been documented. Emerging evidence suggests that persistent myocardial inflammation and autoimmune mechanisms may contribute to the development of long-term cardiac remodeling and dysfunction. Reports of coronary artery involvement and aneurysmal changes, though rare, raise further concern regarding chronic cardiovascular risk.

Discussion: This review highlights several cardiovascular complications of Lyme carditis that can persist despite medical therapy. While permanent conduction abnormalities, fulminant myocarditis, and subsequent ventricular dysfunction have been reported, studies on chronic heart failure are limited, and coronary artery involvement remains underrecognized, necessitating further research.

Conclusion: While Lyme carditis is generally self-limited with timely therapy, accumulating evidence indicates the potential for lasting cardiac sequelae. Further longitudinal studies are warranted to delineate risk factors, pathophysiologic mechanisms, and optimal strategies for longterm surveillance and management.

Introduction: Cardiovascular disease is a leading cause of mortality in the Gulf region, with acute Myocardial Infarction (MI) being a critical contributor due to prevalent comorbidities, including diabetes, hypertension, and obesity. This systematic review and meta-analysis evaluate the prognostic factors impacting post-MI outcomes.

Method: This study conducted a systematic review and meta-analysis to identify risk factors influencing Myocardial Infarction (MI) outcomes in Saudi Arabia and Gulf countries. A comprehensive search of major databases between 2013 and 2024 included studies examining demographic and clinical predictors such as age, gender, and comorbidities. Eligible studies were screened following PRISMA guidelines. Adjusted odds ratios for mortality were pooled, and heterogeneity was assessed through Q and I² statistics. Bias and publication bias were evaluated using ROBINS-I and funnel plots, respectively. Analyses were performed to provide regionspecific insights into MI prognosis and outcome predictors.

Results: The findings reveal that gender, age, comorbidities, and biomarkers significantly influence mortality risks. Women presented higher mortality rates than men, attributed to older age and a heavier comorbidity burden. Ventricular arrhythmias and recurrent MI emerged as predictors of adverse in-hospital outcomes, including heart failure and cardiogenic shock. The pooled odds ratio for short-term mortality indicated over three times the mortality risk following MI, although long-term mortality findings lacked statistical significance.

Discussion: The findings highlight the combined impact of demographic and clinical factors on MI outcomes in the Gulf region. The gender disparity reflects both biological and systemic influences.

Conclusion: Tailored interventions, improved risk stratification, and targeted management strategies are needed to address the high-risk profiles and outcome disparities in Gulf MI patients.

Introduction: HFpEF accounts for 12-25% of heart failure cases in South Asia, primarily driven by hypertension, diabetes, and obesity. Late diagnosis and healthcare disparities worsen outcomes. This expert consensus aims to provide region-specific guidelines for the diagnosis, management, and prevention of HFpEF.

Method: A modified Delphi process with experts from five South Asian countries was conducted, informed by a literature review (2018-2024) and adapted international guidelines.

Results: Recommendations include the use of an adjusted H2FPEF score (BMI > 25 kg/m²), essential echocardiographic criteria (E/e' > 9, LAVi > 34 mL/m²) for diagnosis, and SGLT2 inhibitors as first-line pharmacotherapy, with finerenone for cardio-renal protection. Emphasis on lifestyle modification, patient education, and aggressive management of comorbidities is highlighted to reduce hospitalizations.

Discussion: HFpEF presents earlier and is associated with higher comorbidity in South Asia. Adaptations such as lower BMI thresholds and region-specific screening are critical. Cost and accessibility challenges persist in the use of SGLT2 inhibitors and finerenone. Public health measures and infrastructure strengthening are necessary to improve outcomes.

Conclusion: Early diagnosis, multidisciplinary management, and tailored treatment strategies can enhance outcomes in HFpEF in South Asia. This consensus serves as a call for regionally focused implementation to reduce the burden of HFpEF.

Telemedicine-based cardiac rehabilitation (CR) offers a viable and accessible alternative to traditional center-based programs, leveraging remote monitoring and individualized exercise prescriptions to improve cardiovascular health in patients post-acute myocardial infarction. This overview examines the implementation of the "Accordix" system, a telemedicine platform utilized for outpatient CR. The "Accordix" system facilitates real-time ECG monitoring and communication between patients and a multidisciplinary rehabilitation team. Patients undergo an initial in-person assessment to determine individual exercise parameters, followed by home-based exercise sessions supported by the system's feedback mechanisms (e.g., heart rate alerts and Borg scale integration). The platform allows physicians to remotely monitor patient progress, adjust treatment plans, and address potential adverse events, thus enabling a hybrid CR approach that combines the benefits of in-person and remote care. Future directions include integrating video consultations to enhance guidance on exercise technique and expanding accessibility to underserved populations. The focus is on improving patient training protocols to ensure proper device use, self-monitoring skills, and adherence to exercise guidelines. Telemedicine-based CR, exemplified by the "Accordix" system, holds significant promise for improving access to cardiac rehabilitation, optimizing treatment outcomes, empowering patients through self-management, and promoting long-term adherence to lifestyle changes. Further research and implementation efforts are warranted to fully realize the potential of this approach in reducing the burden of cardiovascular disease.

Introduction: Cardiovascular diseases remain a leading cause of morbidity and mortality worldwide, with their rising incidence demanding a shift toward more personalized treatment approaches. Artificial intelligence (AI) and augmented reality (AR) are two newly evolving technologies that have found extensive usage in the field of cardiovascular medicine and surgery. AI-based models involve machine learning and deep learning neural networks. These primarily form the basis of prediction models, allowing the prediction of risk, survival, and risk stratification of patients.

Methods: A literature search was conducted using PubMed and Google Scholar, and it included studies published between 2003 and 2024. Articles were selected based on clinical relevance and applicability to cardiovascular disease management using artificial intelligence (AI) and AR. Keywords used included "cardiovascular disease," "artificial intelligence," "augmented reality," "diagnostic imaging," and "risk prediction." Studies were screened manually for inclusion based on the title and abstract review, followed by full-text evaluation for relevance and quality.

Results: This narrative review highlights how artificial intelligence (AI) and augmented reality (AR) are increasingly being applied in cardiovascular disease management. Despite recent studies, there remains a lack of proper evaluation of these models' efficacy, and therefore multiple large-scale trials are needed.

Discussion: Networks such as Convolutional Neural Networks (CNNs) and Natural Language Processing (NLP) have been used to improve image interpretation and documentation processes.

Conclusion: Further and larger studies are needed to test the efficacy and safety of these models. This narrative review summarizes recent findings in AI and AR and offers perspectives on future research.

Preterm birth (PTB) is a major challenge in public health around the globe. However, little is known about associations among maternal risk factors (mRFs), PTB, and future cardiovascular disease (CVD). This review article discusses the current status of PTB, the side effects of some traditional cultures, and the role of major mRFs related to unhealthy "environmentsleep- emotion-exercise-diet" intervention [E(e)SEEDi] lifestyle on PTB and future CVD (fCVD). This narrative review and interpretive analysis was based on literature sourced from PubMed using the keywords 'maternal,' 'risk factor,' 'lifestyle,' 'preterm birth,' and 'CVD.' The interpretation of the findings was informed by the author's extensive clinical experience over the past decades. Data were mainly extracted from about 180 articles listed in the reference section. Totally, there are more than 50 modifiable and non-modifiable mRFs before and during pregnancy (especially 28 weeks to 37 weeks), which may result in PTB and recurrent PTB. In fact, these major mRFs play a pivotal role in the development of fCVD in both pregnancy women and newborns. The origins of fCVD link to not only major mRFs but also other adverse pregnancy outcomes (APO) and adverse neonates outcomes (ANO). Possible mechanisms include increased risk of lipid disorders and atherosclerosis, as well as DNA methylation. Herein, a healthy E(e)SEEDi lifestyle is crucial for controlling and preventing PTB and fCVD, but the underlying mechanisms require further clinical and experimental investigation.