Frontiers in Cardiovascular Medicine最新文献

Introduction: Atrial fibrillation (AF) significantly detracts from health-related quality of life (HRQoL). Despite the promotion of exercise interventions for managing AF, the effectiveness of different exercise modalities remains to be clearly defined. This systematic review and network meta-analysis aims to evaluate the comparative effectiveness of various modes of exercise interventions on HRQoL in AF patients.

Methods: A random-effect network meta-analysis was performed. We conducted comprehensive searches across multiple databases, including PubMed, Web of Science, Embase, Cochrane Library, Scopus, and Chinese databases such as CNKI, WanFang Data, and VIP. The review included only randomized controlled trials (RCTs) that investigated the effects of exercise interventions on HRQoL among individuals diagnosed with AF.

Results: The network meta-analysis (NMA) incorporated 12 studies, of which five presented some concerns regarding risk of bias and one exhibited a high risk of bias. For total HRQoL in AF patients, aerobic exercise, and cardiac rehabilitation (CR) yielded standardised mean differences of 0.60 (95% CI: 0.02-1.13) and 0.59 (95% CI: 0.20-0.99), respectively. For the physical component of HRQoL, CR was most efficacious, demonstrating the highest Surface Under the Cumulative RAnking curve (SUCRA) value of 77%. For the mental component of HRQoL, high-intensity interval training (HIIT) was superior, with the highest SUCRA value of 90.7%.

Conclusions: Both aerobic exercise and CR effectively improve the physical and mental dimensions of HRQoL as well as overall HRQoL in patients with AF. However, for the mental component of HRQoL, HIIT was identified as the most effective intervention.

Background: This study investigates the feasibility and early outcomes of early myocardial reperfusion in patients with type A aortic dissection (TAAD), evaluating its effectiveness and potential benefits compared to traditional cardioplegic arrest techniques.

Methods: A retrospective analysis was conducted on 168 patients diagnosed with TAAD who underwent surgery at the General Hospital of the Northern Theater Command in China from January 2021 to July 2024. Patients were divided into two groups: early myocardial reperfusion (EMR group, n = 66) and cardioplegic arrest (CA group, n = 102). Perioperative outcomes were compared between the groups.

Results: Early myocardial reperfusion significantly reduced ventilation time 23.08 (18.21, 66.74) hours vs. 48.58 (19.18, 122.97) hours, P < 0.05], ICU stay time [58.80 (21.20, 126.68) hours vs. 84.86 (41.12, 168.81) hours, P < 0.05], and hospitalization time [13.00 (10.00, 16.00) days vs. 15.00 (11.75, 19.00) days, P < 0.05] compared to the CA group. There was no significant difference in hospital costs, first-hour chest tube drainage, left ventricular ejection fraction, or postoperative adverse events between the groups, except for the rate of CRRT treatment, where the EMR group had significantly fewer patients requiring postoperative CRRT (10.6% vs. 23.5%, P < 0.05).

Conclusion: This study demonstrates that early myocardial reperfusion is a feasible and effective technique for TAAD, offering considerable advantages in reducing ventilation time, ICU stay, hospitalization duration and postoperative renal insufficiency.

Background and purpose: The hemoglobin levels in the peripheral blood of individuals living at high altitudes are significantly higher than normal levels. These levels are closely associated with atherosclerosis and cardiovascular events. This study aimed to investigate the correlation between hemoglobin levels in the peripheral blood and hypertension in high-altitude regions, providing a basis for preventing and treating primary hypertension in these regions.

Materials and methods: From May 2020 to May 2021, patients diagnosed with primary hypertension in plateau regions of China were selected as participants. The clinical data, including lifestyle habits and blood biochemical indicators, were collected from the clinical case database for patients meeting the inclusion criteria. The logistic regression analysis was performed to identify factors influencing carotid intima-media thickness in patients with primary hypertension in plateau regions. The ROC curve was plotted to analyze the impact of peripheral blood hemoglobin levels on hypertension, determine the hemoglobin threshold for predicting hypertension in plateau areas, and evaluate the predictive value of hemoglobin level for hypertension.

Results: A total of 200 patients (105 men with an average age of 64.8 ± 12.75 years and 95 women with an average age of 69.5 ± 11.54 years) were enrolled in this study. Logistic regression analysis revealed that age, CO₂-CP, ALT, APOB, CRP, and HGB were independent risk factors for increased carotid artery intima-media thickness (P < 0.05). The hemoglobin threshold for predicting hypertension in high-altitude areas was 131 g/L. The area under the ROC curve for predicting hypertension with elevated hemoglobin level was 0.799 (0.719-0.880).

Conclusion: Elevated hemoglobin levels contribute to the thickening of the carotid artery intima-media layer and hold predictive value for high-altitude hypertension.

Background: Polyfluoroalkyl chemicals (PFCs) present potential health risks due to their persistence and bioaccumulation. However, there is currently insufficient evidence regarding their impact on cardiovascular disease (CVD). Consequently, it is imperative to investigate the correlation between PFCs and CVD.

Methods: The data was collected from National Health and Nutrition Examination Survey in 2005-2012. Logistic regression models were employed to assess the association between single PFC and CVD. Generalized additive model (GAM) was used for evaluating nonlinear relationships. Subgroup analyses were conducted to explore interaction effects. Bayesian kernel machine regression (BKMR) and weighted quantile sum (WQS) models were used to evaluate the joint effect of PFC exposures on CVD.

Results: In logistic regression, PFDE, MPAH, and PFUA were positively associated with CVD. In the GAM, there was a significant nonlinear relationship between MPAH and CVD. Subgroup analysis revealed the interaction of gender and race in the effects of PFCs and CVD. PFUA was positively correlated with CVD in males but show no significant difference in females. PFDE was positively associated with CVD among non-Hispanic white individual. The results of BKMR indicated that the impact of mixed PFCs on CVD increased initially and then weakened, showing an overall positive trend. The results of WQS suggested that PFDO contributed most to the effect.

Conclusion: Our study showed that serum PFDE, MPAH, and PFUA levels were positively correlated with CVD. PUFA was found to interact with gender and race in relation to CVD. A general positive correlation exists between mixed exposure to PFCs and CVD, with PFDO being the most contributory PFC. Our study provided important evidence for probing the impact of PFCs on CVD and laid a foundation for further mechanism research.

Background and aim: This study aims to investigate the role of the built environment in terms of urban-rural disparities in cardiovascular disease (CVD) epidemiology, focusing on middle- and long-term CVD risk assessment. Moreover, this study seeks to explore sex-specific differences in urban and rural settings.

Methods: The ATTICA Study is a prospective study conducted from 2002 onwards. At baseline, a random sample of 3,042 CVD-free adults (49.8% men) were randomly drawn from the population of the Attica region, in Greece, with 78% dwelling in urban and 22% in rural municipalities. Follow-up examinations were performed in 2006, 2012, and 2022. Of the total participants, 1,988 had complete data for CVD assessment in the 20-year follow-up.

Results: The 10-year and 20-year CVD incidence was 11.8%, 28.0% in rural municipalities and 16.8%, 38.7% in urban municipalities, respectively (ps < 0.05). Unadjusted data analyses revealed significant differences in clinical, laboratory, and lifestyle-related CVD risk factors between urban and rural residents (ps < 0.05). Additionally, sex-based discrepancies in clinical, anthropometric, circulating, and lifestyle risk factors were observed in stratified analyses of urban and rural settings. Multivariate analyses, including generalized structural equation modeling (GSEM), revealed that the impact of the urban built environment on the long-term (20-year) CVD risk is mediated by lifestyle-related risk factors.

Conclusion: Urban inhabitants exhibit a higher long-term CVD incidence compared to their rural counterparts, which was partially explained by their lifestyle behaviors. Targeted strategic city planning efforts promoting healthier lifestyle-related behaviors at the micro-environment level could potentially mitigate built-environment impacts on CVD health.

Both de Winter syndrome and Wellens syndrome mainly indicate severe stenosis in the proximal segment of the anterior descending coronary artery. However, as research deepens, the accuracy and specificity of diagnosing proximal left anterior descending coronary artery (LAD) culprit lesions separately by de Winter syndrome or Wellens syndrome are challenged. The patient in this case developed both syndromes in a short period of time, and imaging showed significant stenosis of the proximal LAD, indicating a culprit lesion. The successive appearance of these two special electrocardiogram changes may increase the accuracy and specificity of diagnosing LAD as a culprit lesion, and the short-term occurrence of these two special electrocardiogram changes also suggests that the culprit lesion may be incomplete occlusion. In addition, de Winter syndrome is prone to missed diagnosis, while Wellens syndrome is prone to misdiagnosis or underestimation of its risk.

Aim: This study aimed to protect brain functions in patients who experienced in-hospital cardiac arrest through the application of local cerebral hypothermia. By utilizing a specialized thermal hypothermia device, this approach sought to mitigate ischemic brain injury associated with post-cardiac arrest syndrome, enhance survival rates, and improve neurological outcomes as measured by standardized scales.

Methods: A prospective, single-center cohort study was conducted involving patients aged ≥18 years who experienced in-hospital cardiac arrest and achieved return of spontaneous circulation (ROSC). Patients were cooled using a hypothermia helmet to achieve a target temperature of 32°C-34°C, maintained for 36-72 h, followed by controlled rewarming and normothermia for 72 h. Neurological recovery was assessed using the Cerebral Performance Category (CPC) scale, where CPC 1-2 denotes good recovery and CPC 3-5 indicates poor outcomes. Body temperature, hemodynamic parameters, biochemical changes, and survival data were meticulously recorded and analyzed. Statistical analysis included paired t-tests to compare pre- and post-treatment data.

Results: Of 116 cardiac arrest cases, 30 (25.86%) were in-hospital, and 16 (53.33%) of these achieved ROSC. Among the patients, 62.5% underwent emergency coronary angiography due to ST-elevation myocardial infarction (STEMI). The mean time to hypothermia initiation was 32.9 ± 13.5 min, with hypothermia maintained for 58 ± 6.4 h. Neurological outcomes were favorable, with 62.5% of patients achieving CPC scores of 1 or 2, indicating functional recovery and independence. In contrast, CPC scores of 3 or higher were observed in 37.5% of patients, reflecting varying degrees of disability. Biochemical analysis revealed significant decreases in sodium, potassium, calcium, and magnesium levels, alongside increased urea and creatinine concentrations. Hemodynamic improvements included elevated systolic blood pressure and heart rate, while left ventricular ejection fraction remained stable. Overall survival was 75%, and the majority (62.5%) of survivors were discharged without significant neurological deficits.

Conclusion: The findings suggest that early and targeted application of craniocerebral thermal hypothermia has the potential to improve survival and preserve neurological function in post-cardiac arrest syndrome. The high rates of favorable outcomes, as reflected by CPC scores, underscore the neuroprotective effects of localized hypothermia. Further large-scale, multicenter trials are recommended to validate these promising results and refine protocols for optimal clinical application.

Objective: This meta-analysis aims to evaluate the safety and efficacy of indobufen in the treatment of cardiovascular diseases, cerebrovascular diseases, and thromboembolic disorders. The primary focus is on the incidence of major adverse cardiovascular events (MACE), thrombosis, bleeding events, and adverse reactions. The results are intended to provide a reference for the clinical application of indobufen and suggest directions for further large-scale, multi-center, prospective studies.

Methods: This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library databases to identify all relevant studies on indobufen. Twelve trials, all randomized controlled trials (RCTs), met the inclusion criteria. The results were presented as risk ratios (RR) with 95% confidence intervals (CI), and meta-analysis was performed using RevMan 5.3 and Stata 18.0 software.

Results: The meta-analysis included 12 randomized controlled trials. Regarding safety, indobufen showed superior clinical outcomes compared to other antiplatelet agents regarding bleeding events, gastrointestinal adverse reactions, and overall adverse reactions, with these differences being more pronounced in cardiovascular diseases. However, the effects of both treatments on efficacy outcomes, including MACE, myocardial infarction, angina, mortality, and thrombotic events, were similar. For stroke events, particularly in patients with cerebrovascular diseases, the use of indobufen was associated with some risk.

Conclusion: Indobufen is associated with a lower risk of adverse reactions and bleeding, making it a viable option for patients at risk of bleeding or adverse effects, particularly in those with cardiovascular diseases. However, compared to anticoagulants such as aspirin and clopidogrel, indobufen has a shorter history of use, and its evidence base is relatively limited, highlighting the need for further research. Currently, indobufen is widely used in secondary cardiovascular and cerebrovascular prevention and provides some guidance for antiplatelet therapy in patients with gastrointestinal discomfort or bleeding risk. However, due to the potential risks in MACE, stroke, and other events, further clinical trials are needed to assess the clinical applicability of indobufen.

Systematic review registration: https://www.crd.york.ac.uk/, identifier (CRD42024587938).

Background: Painful left bundle branch block (LBBB) syndrome is an uncommon disease that is defined as intermittent episodes of angina associated with simultaneous LBBB changes on an electrocardiogram (ECG) with the absence of flow-limiting coronary artery disease or ischemia on functional testing. Vasovagal syncope (VVS) is the most common cause of syncope and can be provoked by sublingual nitroglycerin (NTG). Herein, we report a case of painful LBBB syndrome complicated with VVS, which was misdiagnosed as acute coronary syndrome and cardiogenic shock.

Case summary: A 62-year-old woman presented with intermittent exertional chest pain for 3 years and deteriorated for 2 weeks. An ECG, transthoracic echocardiography, and laboratory test results were all normal. Exercise treadmill testing induced chest pain, accompanied by new-onset LBBB. She fainted after finishing the test and receiving sublingual NTG, with a rapid decline in heart rate and blood pressure, which was relieved by 0.5 mg of atropine administered intravenously. Coronary angiography showed no evidence of obstructive lesions. Isoprenaline stress echocardiography induced chest pain and rate-dependent LBBB and showed interventricular/intraventricular desynchrony simultaneously. A head-up tilt test verified mixed VVS in the provocative phase. A diagnosis of painful LBBB syndrome complicated with VVS induced by sublingual NTG was made. The patient received an extended-release metoprolol succinate tablet and had no symptoms at a 1-year follow-up.

Conclusion: Painful LBBB syndrome is an uncommon cause of chest pain and is often overlooked by physicians. Misdiagnosis and mistreatment of painful LBBB syndrome may even cause secondary damage, such as VVS induced by sublingual NTG, which is usually used to alleviate angina.