Frontiers in Cardiovascular Medicine最新文献

Cardiac magnetic resonance (CMR) tissue characterisation is central to the diagnosis and risk stratification of myocardial disease. However, for certain techniques tissue characterisation CMR is limited by reliance on contrast agents, sensitivity to motion, prolonged acquisition times, and time- and labour-intensive image reconstruction and analysis. Artificial intelligence (AI) has emerged as a promising approach to address these challenges by enhancing and accelerating multiple stages of the CMR workflow. Deep learning methods can automate LGE segmentation, improve motion correction and image reconstruction for parametric mapping, and enable contrast-free characterisation of scar by exploiting native CMR signals, including myocardial motion and native T1 mapping. AI has also accelerated emerging techniques such as cardiac magnetic resonance fingerprinting and diffusion tensor imaging. In addition, radiomics and deep learning-based feature extraction offer the potential to derive high-dimensional tissue phenotypes and risk markers beyond those identifiable by expert clinicians. Despite these advances, translation remains limited by access to large-scale, heterogeneous training data, alongside concerns over generalisability, fairness, and interpretability, as well as barriers to regulatory approval and clinical deployment. In this mini-review, we summarise recent developments in AI-enabled myocardial tissue characterisation using CMR, highlighting both the promises and challenges for clinical translation.

Among all innovations in cardiovascular medicine, the left internal thoracic artery to left anterior descending artery (LITA-LAD) graft stands as one of the most successful and enduring therapeutic paradigms. Introduced in the late 1960s, it quickly transformed the surgical treatment of ischemic heart disease, establishing new standards of durability, patency, and survival. More than fifty years later, the LITA-LAD graft remains the cornerstone of coronary artery bypass grafting (CABG) and continues to define excellence in both cardiac surgery and interventional cardiology.

Pulmonary vein pulsed-field ablation (PFA) is widely regarded as a safe procedure for patients with atrial fibrillation (AF), with sinoatrial disturbances as a rare complication. A 62-year-old female patient with paroxysmal AF underwent ablation using an 8-polar circular PFA catheter. During pulmonary vein isolation (PVI) of the right superior pulmonary vein, an intermittent increase in sinus rate was noted. Recurrent sinoatrial block was observed shortly after the procedure but resolved completely within six hours. This report presents the first documented case of transient sinoatrial node dysfunction as a complication of pulmonary vein PFA. Although the underlying mechanism-whether singular or multifactorial-remains unconfirmed, this case highlights the need for caution when utilizing the 8-polar circular PFA catheter.

Coronary microvascular dysfunction (CMD) is a syndrome characterized by myocardial ischemia resulting from structural and/or functional impairments of the coronary microvasculature, which includes pre-arterioles, arterioles, and capillaries. It has taken center stage in cardiovascular research due to its established role in triggering heart failure with preserved ejection fraction (HFpEF). The pathogenesis of CMD is closely associated with endothelial dysfunction, characterized by both structural and functional impairment of endothelial cells. This interplay between functional and structural injury underlies the significant heterogeneity in clinical phenotypes and hemodynamic characteristics across CMD subtypes, thus highlighting the necessity for a multidimensional investigation of its underlying pathological mechanisms. This review article systematically elaborates the pathophysiological features of CMD with a focus on two dimensions: microcirculatory functional regulation and vascular structural remodeling, aiming to provide a theoretical foundation for innovations in clinical diagnosis and treatment strategies.

Objective: The objective of this research was to investigate the association between non-traditional lipid parameters and optical coherence tomography (OCT)-characterized high-risk plaques in patients with acute myocardial infarction (AMI).

Methods: This retrospective study included 249 first-episode AMI patients admitted to the First Affiliated Hospital of Lanzhou University between January 2022 and December 2024. All patients underwent OCT-guided assessment of culprit lesions before revascularization. High-risk plaques were defined by more than two of the following features: lipid arc ≥90 °, fibrous cap thickness <65 μm, or plaque rupture/thrombus. Lesions with fewer than two of these criteria were classified as non-high-risk plaques. Clinical and laboratory data were collected, and a comprehensive lipid profile was calculated, including traditional indicators [e.g., non-HDL cholesterol (non-HDL-C)] and non-traditional ratios [e.g., apolipoprotein B/A1 ratio (ApoB/A1)]. Spearman correlation was used to assess relationships between lipid parameters and high-risk plaques. After excluding collinear variables, logistic regression, restricted cubic spline (RCS), and subgroup analyses were performed. Model discrimination and clinical value were evaluated using receiver operating characteristic (ROC) curves, the DeLong test, integrated discrimination improvement (IDI), net reclassification index (NRI), and decision curve analysis (DCA).

Results: Among 249 AMI patients, 137 (55.0%) exhibited OCT-characterized high-risk plaques. These patients were more often male (89.8%) and presented with STEMI (84.7%). They had elevated levels of myoglobin, LDL-C, non-HDL-C, ApoB, ApoB/A1, remnant lipoprotein cholesterol (RLP-C), non-HDL-C/HDL-C ratio (NHHR), and TC/HDL-C (all P < 0.05). OCT features included thinner fibrous caps, smaller lumen areas, larger lipid arcs, and higher incidences of rupture, erosion, thrombus, macrophage infiltration, cholesterol crystals, and calcification (all P < 0.05). Both ApoB/A1 (OR = 3.688, 95% CI: 1.211-11.230) and non-HDL-C (OR = 3.023, 95% CI: 1.238-7.378) were independently and linearly associated with high-risk plaques. No significant interactions were observed across clinical subgroups (all P for interaction > 0.05). The combined model incorporating the two markers achieved the highest discriminative performance (AUC = 0.696) and significantly improved the baseline model (DeLong test P < 0.05), with additional gains confirmed by IDI, NRI, and DCA (all P < 0.05).

Conclusion: Both the non-traditional ApoB/A1 ratio and the traditional lipid marker non-HDL-C were independently and linearly associated with OCT-characterized high-risk plaques in AMI. Their combined assessment enhanced the identification of high-risk plaques morphology.

Cardiovascular diseases (CVDs) continue to be the leading cause of mortality worldwide, highlighting the need for enhanced diagnostic tools to enable early intervention. However, the complexity of these diseases poses significant challenges to their diagnosis and management. Therefore, a deeper understanding of CVD mechanisms and the development of novel diagnostic and therapeutic strategies are of critical importance. Retinol-binding protein 4 (RBP4), a member of the lipocalin family, is mainly secreted by the liver and adipose tissue and is widely recognized for its role in transporting retinol (vitamin A). Beyond functioning as a selective retinol carrier, growing evidence suggests that RBP4 is intricately involved in the pathogenesis of CVDs and their associated risk factors. Although numerous studies have established a link between RBP4 and the onset and progression of CVDs, the underlying mechanisms remain incompletely elucidated. This review summarizes the biological characteristics and multifunctional roles of RBP4 in CVD pathophysiology, examines its potential as a biomarker for diagnosis and prognosis, and explores its implications for developing new strategies to prevent and treat cardiovascular disorders.

The basic exercise after the patient's mobilization is walking, the effects of which are associated with numerous benefits both in terms of the patients' physical and mental condition. The aim of the study was to evaluate the effectiveness of earlier initiation of walking training in patients after coronary angioplasty in the first stage of cardiac rehabilitation.

Material and methods: 50 patients after NSTEMI were examined. Based on the recruitment and after meeting the inclusion and exclusion criteria, they were randomly assigned to two groups. The first group - clinical (n = 25) was subjected to 5-day rehabilitation consisting of 6 training units performed twice a day in a 30-meter corridor. The second group - control (n = 25), performed a standard cardiac rehabilitation program. Before starting and after completing training and rehabilitation, all patients underwent echocardiography to assess left ventricular functions (LVEF%, LVEDD, LVESD) and. 6-minute walk test to determine level of physical fitness.

Results: After completing the 5-day walking training, a significant increase in exercise tolerance was observed in both the clinical and control groups. In the experimental group, a significant increase in exercise tolerance was observed (distance: +184.6 m, p < 0.001, d = 0.82, η ² = 0.316; walking speed: +1.84 m/s, p = 0.032, d = 0.74, η ² = 0.501; METs: +3.07, p = 0.001, d = 0.69, η ² = 0.342; HR peak: +20.68 bpm, p < 0.000, d = 0.816, η ² = 0.662). In the control group, the improvement was small (distance: +23.2 m, p = 0.044, d = 0.20, η ² = 0.112; HR peak: +6.36 bpm, p = 0.011, d = 0.228, η ² = 0.116).

Conclusion: Early walking training significantly affects the level of exercise tolerance, similarly to a standard rehabilitation program.

Background: Lung ultrasound (LUS) has been established as a standard modality for assessing pulmonary congestion in heart failure. Remote Dielectric Sensing (ReDS) represents a novel, rapid, non-invasive technology for quantifying pulmonary fluid content. However, the correlation between ReDS and LUS findings in heart failure patients remains undefined.

Methods: In this prospective, single-center observational study from March 2024 to June 2024, patients with heart failure were consecutively enrolled and underwent ReDS and LUS examinations. We assessed the agreement between these two modalities in measurement of lung fluid.

Results: Among 153 enrolled patients [median age 74 (60, 81) years; 92 male], median values were 32% (range 16%-59%) for ReDS measurements and 7 (range 0-32) for B-line count. 49 (32%) patients demonstrated significant pulmonary congestion on LUS. There was a significant positive correlation between ReDS values and sum of B-lines on LUS (r = 0.544, p < 0.001). In multivariate linear regression, ReDS levels (β = 0.569, p < 0.001) showed independent associations with the B-line count. At a cutoff of 34.5%, ReDS demonstrated the ability to identify pulmonary congestion on LUS, with an area under the curve of 0.748, sensitivity of 73.5%, and specificity of 70.2%.

Conclusions: ReDS technology showed marked correlation with B-line counts and fair diagnostic accuracy in detecting pulmonary congestion on LUS, suggesting its potential utility for volume assessment in heart failure management.

Trial registration: ChiCTR2400081719 in the Chinese Clinical Trial Registry.

Background: Given the changing epidemiological and burden trends of non-rheumatic degenerative mitral valve disease (DMVD), it is crucial to re-examine geographical differences and trends. Here, we describe the current trends of DMVD epidemiology using data from the Global Burden of Diseases (GBD) study from 1990 to 2021, with forecasts extending to 2050.

Methods: Annual case numbers and age-standardized rates (ASR) of incidence, prevalence, deaths, and disability-adjusted life years (DALYs) for DMVD between 1990 and 2021, as well as their estimated annual percentage changes (EAPC), were derived from the 2021 GBD study. Exponential smoothing and autoregressive integrated moving average models are employed for forecasting the future trends of DMVD.

Results: Between 1990 and 2021, the number of DMVD incidence cases increased from 566,261 (95% uncertainty interval [UI]: 523,330-609,607) to 1,162,558 (1,084,358-1,244,874), corresponding to a 105.3% (77.9-137.9) rise. Additionally, DMVD-related death cases rose by 53.8% (21.2-97.7), from 23,954 (21,032-26,296) to 36,844 (31,883-41,572). However, there is a decline in ASR of incidence and death. Stratified analysis revealed that the age-standardized incidence rate (ASIR) in males is nearly twice that of females, while the age-standardized death rate (ASDR) is higher in females. These trends are not expected to improve significantly by 2050. Concurrently, the ASIR peaks in individuals aged 65-69 and 70-74. In 2021, higher socio-demographic index (SDI) countries bore a greater DMVD burden, while lower-SDI countries faced greater cross-country inequalities.

Conclusions: The number of DMVD epidemiological indicators is rising annually. Higher-SDI countries need to adjust healthcare policies to address aging populations and support lower-SDI countries with medical resources and cardiology expertise. This study suggests that age 65 is a meaningful threshold for screening. Additionally, Our findings advocate for stratified public health interventions: incidence-based screening targeting males and mortality-focused treatment intensification for females.