Frontiers in Cardiovascular Medicine最新文献

Background: Unstable angina (UA), characterized by worsening chest pain and increased risk of acute myocardial infarction or sudden death, is a major clinical condition necessitating urgent and effective intervention. Although guanxinshutong capsule (GXST) has demonstrated preliminary therapeutic potential in alleviating angina symptoms, it lacks sufficient and robust clinical evidence to confirm its efficacy and safety in UA treatment. Therefore, further clinical research is urgently needed to validate the practical value of GXST in managing UA.

Objective: To determine the efficacy and safety of GXST as an adjunctive therapy for UA and to elucidate its potential pharmacological mechanisms.

Methods: Relevant RCTs were included to investigate the effectiveness of GXST in combination with WM for UA. ROB 2 was applied to assess their methodological quality. The data integration, evidence quality assessment, and trial sequence analysis were performed using R software, the GRADE framework, and TSA software, respectively. Concurrently, the network pharmacology was employed to identify disease-relevant targets, active components, and core targets of GXST. Crucially, bioinformatics analysis was conducted to explore the potential regulatory mechanisms.

Results: Fifteen RCTs were included. Compared with WM monotherapy, GXST combined with WM exhibited significantly superior efficacy across multiple indicators: clinical effective rate(RR = 1.19, 95% CI = 1.13-1.25), ECG effective rate (RR = 1.20, 95% CI = 1.07-1.34), angina frequency (SMD = -2.20, 95% CI = -3.36 to -1.04), angina duration (SMD = -1.54, 95% CI = -2.14 to -0.94), PV levels(SMD = -0.82, 95% CI = -1.23 to -0.41), FIB levels(SMD = -1.18, 95% CI = -1.50 to -0.86), and TCM syndrome scores (SMD = -1.68, 95% CI = -2.18 to -1.18). However, no significant intergroup differences were detected in CK-MB, cTnI, or ARDI. KEGG enrichment analysis highlighted the PI3K-Akt and MAPK signaling pathways as central to the underlying mechanism. Molecular docking further demonstrated pronounced binding affinities of kaempferol, miltirone, and asiatic acid toward core targets AKT1, MAPK3, and PIK3CA, corroborating their therapeutic potential.

Conclusion: The combination therapy of GXST and WM significantly boosted clinical efficacy in patients with UA. Its mechanism of action involves regulating the PIK3CA/AKT1 and MAPK3 signaling pathways.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025634213, PROSPERO CRD42025634213.

Background: Bileaflet aortic valve prevalence in transcatheter aortic valve replacement (TAVR) patients is poorly defined. We evaluated a TAVR cohort to determine the bileaflet aortic valve prevalence and understand features which may improve detection. In addition, we related valvar morphology to the occurrence of permanent pacemaker implantation (PPI) following TAVR.

Methods: Aortic valvar morphology diagnosis was recorded from the pre-procedural cardiac CTA reports prior to TAVR. Commissural angles, comparison of commissural heights, and dynamic visual inspection of the aortic valve were subsequently evaluated on pre-procedural cardiac CTA by an expert cardiac anatomist and imager, methods previously validated in a surgical cohort, to determine aortic valvar morphology and compared to the historical diagnosis. Relationships between valvar morphological characteristics with the need for PPM within 30-days post-TAVR were determined.

Results: Four-hundred and thirty-three (mean age 81.3 ± 6.6 years, 53.8% female) underwent TAVR [corrected diagnosis: 393 (90.8%) trileaflet vs. 40 (9.2%) bileaflet valves]. Bileaflet valves were historically misdiagnosed in 80% of pre-procedural cardiac CTA reports. Thirty-four (85.0%) had intercoronary leaflet fusion [mean commissural angle = 148.1 (18.3) degrees]. A commissural angle threshold of 141.1 degrees had a sensitivity of 0.73 and specificity of 0.86 for identifying a bileaflet valve. PPI post-TAVR occurred in 38% bileaflet vs. 19% trileaflet patients (p = 0.0114) [unadjusted OR for bileaflet valve requiring PPI = 2.54, 95% CI (1.25-5.01)].

Conclusions: Bileaflet aortic valves are commonly misdiagnosed. Assessment of the commissural angle and comparison of commissural heights may improve CTA-based diagnostic accuracy prior to TAVR. Improved detection may guide improved outcomes in this higher risk population.

Aims: To analyze and compare the efficacy and safety of cryoballoon catheter ablation (CBA) and radiofrequency ablation (RFA) in the first treatment of patients with persistent atrial fibrillation (PerAF).

Methods: 116 patients with PerAF who underwent the first-time catheter ablation were enrolled retrospectively, including 56 patients in CBA group and 60 patients in RFA group. The primary endpoint was symptomatic onset after 3 months of ablation or occurrence of atrial arrhythmia (ATA) with any documented duration more than 30 s. The secondary endpoints were perioperative complications and re-ablation 3 month after procedure.

Results: No remarkable difference existed between CBA group and RFA group in the recurrence rate one year after operation (CBA 16.1% vs. RFA 23.3%, P = 0.360). Additionally, the complication rates were similar between the two groups (CBA 25.0% vs. RFA 35.0%, P = 0.312).

Conclusion: In this real-world study, the effectiveness and overall safety of CBA and RFA in the treatment of PerAF were comparable.

[This corrects the article DOI: 10.3389/fcvm.2025.1659336.].

Background: Exercise intervention has garnered significant attention for its potential to promote recovery and improve outcomes in myocardial infarction (MI) patients. However, controversy persists regarding the efficacy of exercise prescriptions in related studies. Therefore, this research aims to analyze the effects of exercise prescriptions during MI rehabilitation and associated influencing factors through systematic review and meta-analysis, thereby providing guidance for exercise prescription selection in MI patients.

Methods: A systematic review and meta-analysis were conducted by retrieving data from PubMed, Web of Science, and Scopus databases between January 2015 and June 2025. Only meta-analyses using random-effects models for cardiac function were included in the study. Subgroup analyses were conducted based on exercise type, intensity, session duration, frequency, and intervention duration.

Results: A total of 42 studies were included. The results showed that exercise intervention significantly improves cardiac function, exercise performance, and quality of life in MI patients, while significantly reducing the incidence of adverse cardiovascular events. A subgroup analysis of 26 cardiac function studies revealed that variations in exercise type, intensity, frequency, session duration, and intervention duration all exerted modulatory effects on left ventricular ejection fraction (LVEF) levels in MI patients. However, the certainty of evidence related to LVEF is generally low, and the pooled effect is mainly influenced by non-randomized studies with high risk of bias. Furthermore, the evidence is subject to inconsistency and/or imprecision, leading to a potential low or very low certainty in conclusions.

Conclusion: Current findings indicate that moderate-intensity aerobic or resistance training, with each session lasting < 30 min, < 3 times per week, and an intervention duration > 16 weeks, is more beneficial for the rehabilitation of MI patients. The clinical research on resistance training is currently insufficient, and some studies have a high risk of bias. Additionally, there is considerable heterogeneity in the heart function intervention methods (e.g., type, session duration, frequency, intensity, and intervention duration), which could potentially influence the research outcomes. Therefore, more high-quality studies are needed in the future to validate these findings and provide more reliable scientific evidence for optimizing rehabilitation strategies for MI patients.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251085069, PROSPERO CRD420251085069.

Background: Acute fulminant myocarditis (AFM) complicated by cardiogenic shock (CS) often leads to rapid multi-organ failure. While extracorporeal life support (ECLS) is commonly used as an initial stabilizing measure, mortality remains high, particularly in patients requiring extracorporeal cardiopulmonary resuscitation (ECPR). Temporary ventricular assist devices (VADs) offer superior organ perfusion and more physiological hemodynamics compared to ECLS.

Method: This retrospective study analyzed 16 AFM patients with CS who underwent VAD implantation following ECPR between December 2015 and February 2024. Clinical data, including laboratory profiles, vasopressor use, echocardiographic findings, and neurological status, were assessed. In parallel, survival outcomes from the Taiwan National Health Insurance Research Database (NHIRD) were compared among AFM patients treated with ECMO, VAD, or no mechanical circulatory support (MCS).

Result: Of the 16 patients, 12 survived (75%) and 10 achieved cardiac recovery. Pre-VAD pulmonary artery pressure >40 mmHg and failure to wean from epinephrine by postoperative day 1 were associated with mortality. NHIRD analysis of 1,731 myocarditis patients showed the highest 30-day survival in the VAD group (88%) compared to ECMO (52%) or no MCS (71%; p = 0.003).

Conclusion: AFM with CS often rapidly progresses to multi-organ failure. While ECMO provides initial circulatory support, survival remains poor once initiated. Early transition from ECMO to VAD is critical in improving survival for AFM patients with CS, particularly those receiving ECPR.

Objectives: Bilateral internal mammary artery (BIMA) grafting for coronary artery bypass surgery (CABG) was uncommon in Europe before routine coronary stenting. This study evaluates long-term outcomes from one of the earliest systematic European BIMA experiences, providing historical, epidemiological, and clinical insight.

Methods: We retrospectively identified 427 patients who underwent BIMA-CABG at a single German center between 1989 and 1993. Seventy-three patients were lost to follow-up, leaving 354 for analysis. The primary endpoint was overall survival; secondary endpoints included composites of all-cause mortality, myocardial infarction (MI), stroke, and repeat revascularization. Mean follow-up was 18.4 ± 0.8 years.

Results: Patients had a mean age of 57 ± 8.8 years; 88% were men. Preoperative risk factors included hyperlipidemia (78%) and smoking (71%). No patient had prior coronary stenting; 18% underwent balloon dilation or thrombolysis. Kaplan-Meier estimates a mean survival probability of 19.1 ± 0.2 years [95% confidence interval (CI) 18.6-19.6], freedom from mortality/MI/stroke 18.8 ± 0.2 years (95% CI 18.2-19.3), and from mortality/MI/revascularization 17.8 ± 0.3 years (95% CI 17.2-18.4). The overall 20-year revascularization rate was 11.6%, all treated percutaneously; no patient required repeat CABG.

Conclusions: Early German BIMA-CABG, performed as first-line therapy for coronary artery disease prior to the stent era, achieved excellent 20-year survival and minimal repeat revascularization. This cohort provides unique long-term evidence from the pioneering era of arterial revascularization in Europe, highlighting clinical, epidemiological and historical significance and underscore the pioneering role of BIMA grafting in shaping modern arterial revascularization strategies.

Background: Hypertension is a leading cause of morbidity and mortality in South Africa. Evidence on risk factors is scattered across study designs, limiting clinical decision support. This review synthesizes evidence to classify hypertension risk factors to strengthen prediction models and prevention strategies through causal integration.

Methods: A systematic review followed PRISMA 2020, searching PubMed, Scopus, Web of Science, Medline, CINAHL, and SABINET. Two independent reviewers screened and extracted data. Narrative synthesis and meta-analysis were performed, and risk factors were classified within a framework. Causal pathways were mapped using directed acyclic diagram.

Results: Eleven studies with 49,058 participants from nine provinces were included. Strongest risk factors were advanced age (OR: 3.67, CI 1.7-7.6) and diabetes (OR: 1.85, CI 1.39-2.46), followed by low education (OR: 1.75, CI 1.56-2.00), ethnicity (OR: 1.57, CI 1.23-2.01), and socioeconomic status (OR: 1.14, CI 1.01-1.30). Critical risk thresholds (Rw: 3.8 and 5.5) correspond to the 75th and 50th percentiles. A prediction model (Age-Ethnicity-Diabetes) achieved Rw 6.0 and net GTT 2.49. Higher education, improved socio-economic status, and diabetes management were primary prevention strategies (Rw: 4.71, net GTT: 2.49). Age and diabetes emerged as "necessary causes".

Conclusion: Older adults (≥50 years), individuals with diabetes, mixed-race ethnicity, and lower socioeconomic status are priority groups. Screening should be prompted by age and diabetes.

Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251026501, PROSPERO ID: CRD420251026501.

[This corrects the article DOI: 10.3389/fcvm.2025.1695034.].

Introduction: With the escalating global burden of population ageing, the comorbidity of geriatric coronary heart disease (CHD) and mild cognitive impairment (MCI) has emerged as a significant public health concern. This study aims to elucidate the underlying clinical disease features of MCI in elderly CHD patients through comprehensive multi-omics analyses and to establish a detailed phenomics profile.

Methods: A cross-sectional study design will be implemented, enrolling 364 elderly patients diagnosed with CHD. Participants will be divided into MCI and cognitively normal groups based on Montreal Cognitive Assessment (MoCA) scores. Extensive data collection will include demographic characteristics, clinical parameters, laboratory investigations, and echocardiographic findings. These clinical data will be integrated with multi-omics analyses (including genomics, proteomics, and metabolomics) to identify differential biomarkers between the two groups.

Discussion: This study anticipates constructing an integrative network map delineating the multi-omics mechanisms underlying MCI in elderly CHD patients by correlating macroscopic clinical phenotypes with microscopic molecular characteristics. The findings are expected to provide a scientific foundation for early detection and intervention strategies. While acknowledging the inherent limitations of the cross-sectional design, future prospective studies are warranted to validate these findings. This investigation offers novel insights and potential therapeutic strategies for the prevention and management of comorbid CHD and MCI in the ageing population. This study has completed registration in the International Traditional Medicine Clinical Trial Registration Platform (ITMCTR2024000871).

Clinical trial registration: https://itmctr.ccebtcm.org.cn, identifier ITMCTR2024000871.