Frontiers in Cardiovascular Medicine最新文献

Background: Aortic arch aneurysms involving branch vessels traditionally require open surgery with cardiopulmonary bypass, which poses prohibitive risks for octogenarians with complex comorbidities. This case demonstrates the successful application of total endovascular aortic repair (TEVAR) with three dimensional (3D) printing-assisted triple-vessel in situ fenestration and a diameter-restricting technique in an 85-year-old patient with a giant (9.0 cm) aortic arch aneurysm involving the left subclavian artery.

Case presentation: The involvement of the three arch branches (brachiocephalic trunk, left common carotid artery, and left subclavian artery) necessitated precise revascularization. In comparison with traditional in situ fenestration, 3D printing-guided ex vivo fenestration enabled pre-release stent modeling on a 1:1 aortic arch replica (error <1 mm), allowing anatomically tailored fenestration positioning and eliminating blind puncture-related complications. A proximal stent diameter-restricting technique addressed the challenging anchoring zone gradient (33.6 → 27.3 mm), improving stent apposition and reducing type I endoleak risk. Intraoperative multiaccess reconstruction (femoral/axillary/cervical approach) achieved complete aneurysm exclusion. Postoperative computed tomography angiography on day 4 confirmed patent branches and absence of endoleaks, while 6-month follow-up demonstrated stable stent position and no neurological complications.

Conclusion: This case highlights that TEVAR with 3D printing-assisted ex vivo fenestration and a diameter-restricting technique can serve as a viable alternative to open surgery for high-risk octogenarians with complex aortic arch aneurysms, overcoming traditional limitations of in situ fenestration while preserving cerebral perfusion. Further studies are warranted to validate this approach in larger populations.

Background and aims: Cryoballoon ablation of atrial fibrillation alters a significant amount of vital myocardium contributing to its electrical activity. However, the effect of pulmonary vein isolation (PVI) on the P-wave is unclear. The study aimed to quantify P-wave changes following individual PVI using signal-averaged ECG analysis.

Materials and methods: Unfiltered high-resolution (2,000 samples/second) ECGs were obtained for 5 min pre- and post-isolation of each pulmonary vein in 69 participants using 12 standard and 10 additional leads optimized for atrial electrical activity detection. Signal-averaged ECGs were computed and analyzed using custom software in Matlab. This study was registered at ClinicalTrials.gov (Identifier: NCT06061120).

Results: Significant changes in ECG parameters were found. Following complete PVI, P-wave terminal force measured in lead V1 (3.08 ± 1.99 vs. 2.63 ± 1.76 mV*ms, p = 0.003), as well as P-wave complexity (2.05 ± 0.65 vs. 1.79 ± 0.51, p < 0.001) and sample entropy (0.210 ± 0.039 vs. 0.187 ± 0.028 au, p < 0.001), both averaged across all leads, decreased significantly. Ablation of the left pulmonary veins was associated with lower values in P-wave terminal force (3.07 ± 2.05 vs. 2.84 ± 1.88 mV*ms, p = 0.003), P-wave complexity (2.02 ± 0.64 vs. 1.90 ± 0.57, p = 0.003), and sample entropy (0.210 ± 0.039 vs. 0.197 ± 0.031 au, p < 0.001) after ablation. For ablation of the right pulmonary veins, a decline was observed in sample entropy (0.196 ± 0.031 vs. 0.190 ± 0.027 au, p = 0.046).

Conclusion: The observed changes in signal-averaged P-wave parameters during cryoballoon PVI may indicate acute intraprocedural effects on atrial electrophysiology. These exploratory findings suggest that high-resolution, non-invasive ECG recordings are capable to detect stepwise changes of electrical atrial activity, offering new perspectives for intraprocedural assessment of ablation effects.

Objective: To investigate the current knowledge, attitudes, and practices (KAP) status toward exercise rehabilitation in patients after percutaneous coronary intervention (PCI).

Methods: This multi-center cross-sectional survey was conducted from March to May 2025 at three hospitals and enrolled patients who underwent PCI. It was conducted at Civil Aviation General Hospital in Beijing, the Affiliated Hospital of Jining Medical University in Shandong Province, and Tangta Hospital of Yuncheng County in Shanxi Province. A questionnaire was designed to collect participants' demographic data and to assess KAP scores. The performance in each KAP dimension was categorized as poor (<60% of total score), moderate (60%-79%), or good (≥80%).

Results: The final analysis included 346 valid questionnaires. The majority of participants demonstrated poor knowledge (167/346, 48.27%), whereas attitudes were predominantly moderate (176/346, 50.87%), and practices were largely good (168/346, 48.55%). The multivariable analysis showed that the knowledge scores (OR = 1.101, 95%CI: 1.024-1.185, P = 0.009), attitude scores (OR = 1.239, 95%CI: 1.134-1.355, P < 0.001), first PCI (OR = 2.354, 95%CI: 1.158-4.782, P = 0.018), and <1 month since the last PCI (OR = 2.400, 95%CI: 1.095-5.261, P = 0.029) were independently associated with proactive practice. The results of Structural Equation Modeling showed that knowledge directly influenced attitude (β = 0.518, P = 0.012) and practice (β = 0.432, P = 0.012). Attitude directly influenced practice (β = 0.444, P = 0.006). Knowledge indirectly influenced practice through its impact on attitude (β = 0.230, P = 0.008).

Conclusion: The findings suggest that patients who underwent PCI had poor knowledge but moderate attitudes and good practices toward exercise rehabilitation. Patients with higher knowledge and attitude scores were more likely to report better practice scores, indicating associations rather than causal relationships. Future studies should explore targeted interventions and more rigorous research designs to better understand and potentially enhance KAP related to exercise rehabilitation after PCI.

Background: Catheter ablation (CA) is a standard treatment for atrial fibrillation (AF); however, some patients experience worsening heart failure (WHF) afterward. The H₂FPEF and HFA-PEFF scores are validated tools for HFpEF risk stratification, but their predictive value for WHF after CA in patients with preclinical heart failure (HF) remains unclear.

Method: This retrospective, single-center observational study included 257 AF patients with preserved left ventricular ejection fraction (LVEF) ≥50% and no history or symptoms of HF who underwent first-time CA between February 2017 and September 2022. Patients were classified as high HFpEF score group if they had H₂FPEF score ≥6 or HFA-PEFF score ≥5. The primary endpoint was WHF: HF hospitalization, initiation of oral diuretics, or intravenous administration of diuretics.

Results: Among 257 patients, 54 (21.01%) were classified as high HFpEF score group. WHF incidence was significantly higher in the high HFpEF score group than in the low HFpEF score group (log-rank p < 0.001), while AF recurrence did not differ significantly (log-rank p = 0.546). In Firth's penalized logistic regression analysis, high HFA-PEFF score (HR 6.52, 95% CI 1.54-23.21, p = 0.014) and AF recurrence (HR 8.18, 95% CI 1.80-77.60, p = 0.005) appeared to be potential independent predictors of WHF.

Conclusions: In this exploratory analysis, the HFA-PEFF score potentially represent an independent predictor of WHF after CA in AF patients with preclinical HF and preserved LVEF.

Introduction: Early identification of patients at risk for deterioration during hospitalization for acute heart failure (AHF) is essential for guiding intensive monitoring and advanced therapies. Biomarkers such as NT-proBNP and troponin I are routinely used, yet their comparative prognostic performance-particularly when stratified by sex-remains uncertain. Other emerging biomarkers, including lactate and the neutrophil-to-lymphocyte ratio (NLR), have also been linked to adverse outcomes, but their value relative to established cardiac markers has not been clearly defined.

Methods: We conducted a retrospective cohort study using de-identified electronic medical records from 2010 to March 2025 at a tertiary care center. Patients aged ≥16 years with clinician-documented AHF and available admission biomarkers were eligible. The primary endpoint was a composite of in-hospital death, mechanical ventilation, extracorporeal membrane oxygenation (ECMO), or intra-aortic balloon pump (IABP). Broad and strict endpoints were examined in sensitivity analyses. Multivariable logistic regression models, sex-stratified analyses, and penalized regressions with bootstrap resampling were performed.

Results: Among 143 eligible patients (81 men, 62 women), the primary endpoint occurred in 46.9%. In our cohort, women experienced a slightly higher crude rate of in-hospital deterioration compared with men (48.4% vs. 45.7%). Lactate was the most robust predictor across all models, with an odds ratio of 9.38 (95% CI 2.47-35.63; p = 0.001) per log10 increase and a clear dose-response (event rates 39.8%, 55.2%, and 85.7% across lactate strata ≤2, 2-4, and >4 mmol/L; p-trend = 0.002). In sex-stratified models, NT-proBNP (OR 2.87; p = 0.029) and lactate (OR 28.98; p = 0.003) were significant in men, while no biomarker reached significance in women. NLR predicted outcomes in the non-HFrEF subgroup. Model performance was modest (AUC ∼0.71-0.73) but calibration was good. Findings remained consistent in winsorized and bootstrap sensitivity analyses.

Conclusions: In this single-center AHF cohort, lactate emerged as the most consistent early biomarker associated with in-hospital deterioration, with stronger prognostic performance than the other evaluated cardiac markers. Sex-stratified and phenotype-specific findings (NT-proBNP and lactate in men, NLR in non-HFrEF) were exploratory and did not show significant sex-biomarker interaction. These results support incorporating lactate into early risk stratification and highlight the need for larger multicenter validation studies.

Objective: The aim of this study was to investigate the relationship between the platelet-to-lymphocyte ratio (PLR) and the risk of lower extremity deep vein thrombosis (DVT) in patients with femoral fracture, and to evaluate the potential influence of other risk factors, including age, gender, smoking status, neutrophil-to-lymphocyte ratio (NLR), and multiple fractures of the lower extremities.

Methods: A retrospective study was conducted on 1,083 patients with femoral fractures treated at Meizhou People's Hospital between November 2017 and April 2024. DVT was diagnosed using Doppler ultrasound. Data on clinical features, including age, gender, body mass index, history of smoking, hypertension, diabetes mellitus, and multiple fractures of the lower extremities, were collected. Routine blood tests were performed at admission to calculate inflammatory indices, including PLR, NLR, and others. Logistic regression analysis was used to assess the independent association of these factors with DVT.

Results: Among the 1,083 patients, 218 (20.1%) developed DVT. Logistic regression analysis identified that PLR (OR = 1.74, 95% CI: 1.16-2.62, P = 0.008), age (OR = 1.9, 95% CI: 1.21-3.30, P = 0.007), NLR (OR = 2.08, 95% CI:1.24-3.48, P = 0.005), gender (OR = 1.70, 95% CI: 1.17-2.49=, P = 0.005), history of smoking (OR = 2.19, 95% CI: 1.00-4.77, P = 0.05), and multiple fractures of the lower extremities (OR = 2.02, 95% CI: 1.32-3.11, P = 0.001) were independent risk factors for DVT.

Conclusions: PLR is an independent risk factor for lower extremity DVT in patients with femoral fracture, with a modest predictive performance (AUC = 0.60) that slightly outperforms age and NLR in this cohort. While these findings suggest PLR may have potential as a supplementary biomarker for DVT risk stratification, its clinical utility requires further validation in larger, multicenter studies.

Background and objectives: People living with HIV (PLWH) are increasingly at risk for cardiovascular disease (CVD) due to chronic inflammation, metabolic dysregulation, and long-term antiretroviral therapy (ART). However, limited data exist regarding coronary anatomy and long-term outcomes in PLWH with acute coronary syndrome (ACS), particularly in Chinese populations. This study aimed to compare coronary angiographic characteristics, metabolic-inflammatory profiles, and 2-year prognosis between PLWH and HIV-uninfected patients with ACS.

Methods: We conducted a single-center observational cohort study including 129 patients with a first episode of ACS between 2019 and 2023. 43 PLWH were analyzed with 86 HIV-uninfected controls. Coronary artery lesions were assessed by angiography and SYNTAX score. Laboratory parameters including CRP and lipid levels, among others, were collected. The primary outcome was the incidence of major adverse cardiovascular and cerebrovascular events during the 2-year follow-up period.

Results: PLWH had significantly higher SYNTAX scores compared to HIV-free patients (21.56 vs. 16.77, P = 0.001). They also showed elevated levels of LDL-C (3.18 vs. 2.66 mmol/L, P = 0.009) and CRP (median 9.10 vs. 5.10 mg/L, P < 0.001). At 2 years, PLWH had a higher rate of ACS recurrence (18.6% vs. 7.0%, P = 0.089), but mortality and other adverse events were similar. In multivariate analyses, HIV status was not an independent predictor of relapse, while calcified lesions were significantly associated with relapse.

Conclusion: PLWH with ACS have more complex coronary heart disease and a higher risk of recurrence, partly due to vascular calcific changes. These findings suggest the need for enhanced metabolic monitoring and individualized secondary prevention strategies in this high-risk population.

Background: Coronary heart disease (CHD) is a leading cause of death. Despite PCI improving coronary perfusion, many patients face low physical activity, reduced self-efficacy, and poor quality of life, emphasizing the need for better rehabilitation.

Objectives: To evaluate the effects of a 12-week Guozhuang dance intervention on exercise self-efficacy, functional capacity, physical activity, and health-related quality of life in CHD patients following PCI.

Methods: 88 post-PCI patients were randomly assigned to a control group (n = 44) or an intervention group (n = 44). Both groups received standard care; the control group participated in conventional rehabilitation, while the intervention group added Guozhuang dance. Outcomes measures were assessed at baseline(T0), at 4(T1) and 12(T2) weeks of intervention, and at 6 weeks after post-intervention (T3) using the Multidimensional Self-Efficacy for Exercise Scale (MSES), Six-Minute walk distance (6MWD), International Physical Activity Questionnaire (IPAQ), and the Chinese Questionnaire of Quality of Life (CQQC). Data were analyzed using intention-to-treat (ITT) analysis. The protocol was registered in the Chinese Clinical Trial Registry (ChiCTR2300069341).

Results: Both groups demonstrated comparable baseline characteristics (P > 0.05). Significant group × time interactions were found for exercise self-efficacy and 6MWT distance (both P < 0.001), while physical activity and quality of life showed significant main effects of group (both P < 0.05). The intervention group demonstrated significantly greater improvements in exercise self-efficacy, physical activity, and quality of life at T1, T2, and T3 (all P < 0.05). For 6MWD, significant between-group differences were observed at T2 and T3 (both P < 0.001), but not at T1 (P = 0.065 > 0.05).

Conclusion: A 12-week Guozhuang dance program significantly enhances exercise self-efficacy, functional capacity, physical activity, and quality of life in CHD patients after PCI, making it a valuable addition to traditional cardiac rehabilitation.

Clinical trial registration: https://www.chictr.org.cn/bin/home, identifier, ChiCTR2300069341.

Dilated cardiomyopathy (DCM) is a leading cause of heart failure worldwide and has a disproportionately high burden among young Africans. As a primary myocardial disorder, DCM frequently has a genetic aetiology. Although Africa harbours the greatest human genetic diversity, African populations remain underrepresented in genomic research, limiting variant interpretation and clinical applications of next-generation sequencing (NGS). Next Generation Sequencing has transformed the understanding of DCM by enabling comprehensive identification of disease-associated genes. This narrative review summarizes the clinical utility of NGS in the diagnosis, risk stratification, and management of DCM, with a particular focus on Africa. We also highlight some key barriers to implementation, clinical implications, and potential strategies to overcome them. Addressing these challenges through expanded African genomic research, strengthened local capacity, and equitable international collaborations is essential to advance precision cardiovascular medicine and improve outcomes for patients with DCM in Africa.