Frontiers in Cardiovascular Medicine最新文献

Heparin-induced thrombocytopenia (HIT) is a rare but severe complication of heparin therapy, characterized by a significant reduction in platelet count and a paradoxical prothrombotic state, which increases the risks of both arterial and venous thrombosis. This case report describes a 58-year-old male patient with multi-vessel coronary artery disease who developed acute ST-segment elevation myocardial infarction (STEMI) following successful percutaneous coronary intervention (PCI). Despite initial successful revascularization, the patient experienced recurrent chest pain, and HIT was clinically suspected based on a significant drop in platelet count and the 4Ts scoring system, though confirmatory anti-PF4/heparin antibody testing was unavailable at our institution. Treatment with corticosteroids was initiated; however, following transfer to another hospital, the patient received platelet transfusion-a contraindicated intervention in HIT-and subsequently succumbed to a fatal arrhythmic event. This case highlights the diagnostic and therapeutic challenges of suspected HIT in PCI patients, where it may mimic other post-procedural complications such as stent thrombosis. It underscores the critical need for vigilant monitoring of platelet counts, timely access to confirmatory diagnostic testing, immediate initiation of guideline-recommended non-heparin anticoagulants, and seamless communication during inter-hospital transfers to prevent potentially harmful interventions and improve patient outcomes.

Background: Temporary transvenous pacing in patients with permanent atrial fibrillation and significant tricuspid valve disease is technically challenging, especially in the absence of fluoroscopic guidance. Catheter looping and knot formation are rare but potentially hazardous complications.

Case summary: An 82-year-old woman with permanent atrial fibrillation and severe mitral and tricuspid valve regurgitation presented with complete atrioventricular block and a ventricular escape rhythm at 28 bpm. A temporary transvenous pacing catheter inserted via the right internal jugular vein failed to achieve consistent ventricular capture and became entrapped at 45 cm, forming a knot near the venous introducer. Given the patient's frailty and high surgical risk, a multidisciplinary team opted for a fully percutaneous strategy for removal. After definitive pacemaker implantation, the knotted catheter was successfully retrieved using a stepwise approach: engagement of the loop with a deflectable ablation catheter, externalization through a femoral sheath, and extraction using a 13-F dilator sheath to minimize venous trauma.

Discussion: This case highlights procedural pitfalls during emergency temporary pacing without fluoroscopy and illustrates a safe, creative percutaneous solution for knot retrieval using tools familiar to electrophysiology and lead extraction operators.

Aims: This study aimed to identify the association of plaque burden and morphological features, such as burden, length, and composition, with major adverse cardiovascular events (MACE) in populations with very high cardiovascular risk using coronary computed tomography angiography (CTA).

Methods and results: A retrospective cohort study was performed in Lithuania among stable symptomatic patients who underwent coronary CTA. All plaques were manually inspected using plaque analysis software. The study included 772 patients. The mean age was 59.6 ± 9.9 years in men and 65.2 ± 8.7 years in women (p < 0.001). Women exhibited relatively greater proportions of densely calcified plaque volume, whereas men demonstrated significantly higher proportions of fibrous, fibrofatty, and necrotic core volumes (all p < 0.001). Across cardiovascular risk categories, plaque burden, length, total plaque volume, and plaque dense calcium volume increased progressively from the lowest to the highest risk group (all p < 0.001). Among plaque characteristics, after adjusting plaque parameters for age, gender, and cardiovascular risk factors in the multivariable regression analysis, all analysed plaque parameters remained significant predictors of all MACE, with plaque burden, fibrofatty and necrotic core volumes being among the strongest (OR 1.048, 95% CI 1.038-1.059, OR 1.072, 95% CI 1.031-1.115, OR 1.056, 95% CI 1.003-1.111, respectively). Additionally, all analysed plaque characteristics, except fibrous volume, remained significant predictors of non-elective MACE. Plaque burden showed the strongest discrimination for all MACE (AUC 0.68; cut-off ≥17.8%) and non-elective MACE (AUC 0.64; cut-off ≥18.3%), while other plaque characteristics demonstrated modest but statistically significant discrimination value.

Conclusion: This study reveals that plaque morphology provides independent prognostic information. Among the studied very high cardiovascular risk population, patients with non-calcified plaque features-especially those with higher fibrofatty and necrotic core volumes-were the strongest independent predictors of MACE, whereas plaque burden provided the highest discriminatory performance for MACE, suggesting it's complementary role in risk assessment.

Background and aim: Myocardial infarction (MI) is a leading cause of death globally, and traditional Chinese medicine (TCM) offers therapeutic potential through its multi-targeted approach. This study aims to investigate the protective mechanisms of Qing-Xin-Jie-Yu Granule (QXJYG) against MI.

Methods: Network pharmacology was carried out to predict targets and pathways of QXJYG in the treatment of MI. An in vivo mouse model of MI was induced via left anterior descending coronary artery ligation, and hypoxia-induced H9C2 cells were performed as the in vitro model. Cardiac function was assessed by echocardiography, while histological changes were analyzed using HE and Masson's trichrome staining. The positive expression of CD31 was used to assess microvascular density in the hearts of MI mice via immunohistochemistry. Serum levels of superoxide dismutase (SOD), lactate dehydrogenase (LDH), and malondialdehyde (MDA) were evaluated, alongside LDH and MDA in cell culture supernatants. Apoptosis in cardiac tissue was detected by TUNEL staining, while apoptosis in hypoxia-induced H9C2 cells was assessed using Annexin V/PI and Hoechst 33,258 staining. Western blot analysis was conducted to evaluate the protein expression of p-p38 MAPK, p38 MAPK, Bcl-2, Bax in vivo and in vitro experiments.

Results: GO and KEGG analyses suggest that QXJYG affects potential targets related to cellular oxidative stress and apoptosis in MI. In vivo, QXJYG effectively enhanced cardiac function, increased microvessel density, lowered serum LDH and MDA levels, elevated serum SOD levels, and reduced apoptosis in cardiac tissue. It also suppressed the ratio of p-p38 MAPK/p38 MAPK, downregulated Bax protein expression, and upregulated Bcl-2 protein expression in MI mice. In vitro experiments revealed that QXJYG decreased LDH and MDA levels in the culture supernatants, reduced hypoxia-induced apoptosis, inhibited the ratio of p-p38 MAPK/p38 MAPK, decreased Bax protein expression, and enhanced Bcl-2 protein expression. The p38 MAPK inhibitor SB203580 and QXJYG combination more effectively reduced MDA levels and apoptosis in hypoxia-induced H9C2 cells than QXJYG alone.

Conclusions: This study demonstrates that QXJYG exerts cardioprotective effects against MI by improving cardiac function, reducing oxidative stress, and inhibiting apoptosis through the regulation of the p38 MAPK signaling pathway both in vivo and in vitro.

Background: The epidemiological profile of non-alcoholic fatty liver disease (NAFLD) in Wenshan City, a southwestern Chinese city with a population of 3.4 million, is not well-defined. This study aimed to examine the prevalence of NAFLD and its risk factors among healthy adults in Wenshan City.

Methods: This study included 11,997 individuals who underwent health checkups at the People's Hospital of Wenshan Prefecture in 2022. Of these, 6,419 eligible adult subjects were analyzed. Each participant received abdominal ultrasonography and laboratory tests. Statistical analysis using R language was conducted to compare NAFLD prevalence, estimate odds ratios for NAFLD risk factors via logistic regression, and examine correlations between NAFLD and factors like age and gender. Additionally, the relationship between NAFLD, hyperlipidemia, liver injury, and the combination of hyperlipidemia and liver injury was examined.

Results: Among the 6,419 patients studied, the average age was 44.8 years (SD = 14.1), with a gender distribution of 59.4% males (3,815) and 40.6% females (2,604). The overall prevalence of NAFLD was 33.3% (2,138/6,419), with 39.6% (1,511/3,815) in males and 24.1% (627/2,604) in females. The average age of NAFLD patients was 47.9 ± 13.3 years, with a tendency to rise as age increased. The study found a high prevalence of hyperlipidemia (40.4%), liver injury (32.3%), and their combination (17.3%) in Wenshan adults, with higher rates in males than females. Prevalence increased with age until 60, after which it declined in males but rose in females for NAFLD. In the NAFLD population, hyperlipidemia was prevalent in 63.9% (69.1% males, 51.5% females), liver injury in 43.4% (51.0% males, 25.2% females), and both conditions in 31.3% (38.3% males, 14.4% females).

Conclusion: The findings highlight significant associations between fatty liver, gender, age, and related health conditions. This finding suggests that special attention should be given to the prevention and management of NAFLD in border regions and integrated management.

Objective: Carotid intima-media thickness (CIMT) is considered a marker of subclinical atherosclerosis; however, its reliability in predicting cardiovascular risk across different populations remains controversial. This study aimed to evaluate the correlation between B-mode ultrasound-measured CIMT and traditional cardiovascular risk scoring systems, and to investigate its value as a marker of cardiovascular risk.

Methods: This cross-sectional study included 328 asymptomatic adults (excluding those with established cardiovascular disease). High-resolution B-mode ultrasound was used to measure CIMT bilaterally in the common carotid artery (CCA), carotid bulb, and internal carotid artery (ICA), and to calculate mean and maximum CIMT values. The Framingham Risk Score (FRS) and Pooled Cohort Equations (PCE) were computed, and data on traditional cardiovascular risk factors were collected. Pearson or Spearman correlation analyses, ROC curve analysis, and multivariate regression analysis were used to assess the relationship between CIMT and cardiovascular risk.

Results: The mean age of the 328 participants was 59.3 ± 10.2 years, with males comprising 48.2% of the cohort. The mean CIMT was 0.74 ± 0.09 mm, and the maximum CIMT was 0.95 ± 0.11 mm. CIMT showed significant positive correlations with both FRS (r = 0.68, p < 0.001) and PCE (r = 0.64, p < 0.001).Multivariate analysis demonstrated that mean CIMT (OR = 1.46, 95% CI: 1.23-1.72) and maximum CIMT (OR = 1.58, 95% CI: 1.31-1.91) were independently associated with high cardiovascular risk categories as defined by FRS and PCE after adjusting for traditional risk factors. ROC curve analysis revealed that maximum CIMT had an AUC of 0.79 (95% CI: 0.73-0.85) for identifying high FRS risk (>20%) and an AUC of 0.76 (95% CI: 0.70-0.82) for identifying high PCE risk (>7.5%).

Conclusion: B-mode ultrasound-measured CIMT significantly correlates with traditional cardiovascular risk scores and is independently associated with high cardiovascular risk categories after adjustment for traditional risk factors. CIMT measurements of the carotid bulb appear to show stronger correlation with risk scores than common carotid artery measurements. CIMT demonstrates correlation with established risk scoring systems and shows the most significant risk reclassification effect in intermediate-risk populations, supporting its potential utility as a complementary assessment tool.

Polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes (POEMS) syndrome is frequently mistaken for chronic inflammatory demyelinating polyneuropathy, as its clinical profile is highly variable and neurological symptoms often dominate the initial course. In the present case, the disorder initially presented as cardiovascular dysfunction, which delayed decision-making related to the original diagnosis. As the condition advanced, the patient developed progressive limb weakness, splenomegaly, and abnormalities in lipid metabolism. Whole-body bone scintigraphy revealed osteolytic lesions in association with a plasmacytoma, whereas the serum vascular endothelial growth factor levels were markedly elevated. Based on the cumulative findings, POEMS syndrome was diagnosed. Treatment with interventional chemotherapy combined with adjunctive symptomatic care resulted in a marked reduction in symptoms and promoted functional recovery. This case provides detailed clinical evidence highlighting the critical importance of early recognition and accurate diagnostic evaluation in POEMS syndrome. By aligning our observations with the existing literature, we emphasize strategies that promote timely diagnosis, minimize diagnostic error, and improve therapeutic outcomes.

Background: Essential hypertension (EH) in young and middle-aged adults is a major risk factor for cardiovascular morbidity, yet the detailed molecular mechanisms underlying this condition have not been fully understood. MicroRNAs (miRNAs) have emerged as critical regulators of gene expression and have been increasingly associated with hypertension pathogenesis.

Methods: Initially, high-throughput sequencing was employed to identify miRNAs with differential expression profiles in plasma collected from six EH patients compared with six matched healthy individuals. These candidate miRNAs were then confirmed through quantitative real-time PCR (qRT-PCR). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were conducted to elucidate the potential biological roles of these miRNAs. Mendelian randomization (MR) was subsequently applied to investigate causal associations between EH and proteins targeted by the identified miRNAs.

Results: Differential expression analysis revealed 14 upregulated miRNAs and 1 downregulated miRNA in the EH group. Following this, miRNAs were enriched through MiEAA, resulting in the selection of one downregulated miRNA and four upregulated miRNAs, which were subsequently validated by qRT-PCR. KEGG pathway analysis showed that genes regulated by upregulated miRNAs were significantly enriched in pathways related to hypoxia (HIF-1 signaling pathway), inflammation (MAPK and JAK-STAT signaling pathways), vascular remodeling (Focal adhesion and TGF-beta signaling pathways), and apoptosis (p53 signaling pathway). MR analysis identified GPCPD1, regulated by hsa-miR-10b-5p, as a significant risk factor for EH (OR = 1.04, 95% CI: 1.00-1.09, p = 2.32 × 10^-3). Moreover, proteins regulated by upregulated miRNAs, such as CDKN1B, PDGFRA, and THBS2, were found to be protective factors against EH.

Conclusion: GPCPD1, regulated by hsa-miR-10b-5p, is a potential risk factor for EH, while CDKN1B, PDGFRA, and THBS2, regulated by upregulated miRNAs, may act as protective factors. These findings suggest new biomarkers and therapeutic targets for hypertension.

Background and aim: Transcatheter edge-to-edge repair (TEER) is a minimally invasive approach to reduce secondary mitral regurgitation (SMR) in patients with heart failure. However, there is limited evidence on its effectiveness in achieving reverse remodeling. Our aim was to assess the effects of TEER over time and to compare the effects of TEER plus GDMT vs. GDMT alone on echocardiographic parameters.

Methods: A systematic search of MEDLINE, EMBASE, and CENTRAL was conducted from inception to November 16, 2023. Eligible studies included patients with SMR treated with TEER and echocardiographic follow-ups. We evaluated changes in left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left atrial volume (LAV), left ventricular ejection fraction (LVEF) and NTproBNP levels.

Results: Of 9,290 identified studies, 38 met inclusion criteria. After TEER, statistically significant reductions were observed in LVEDD (-1.63 mm), LVESD (-1.20 mm), LVEDV (-14.21 mL), and LVESV (-9.24 mL). Changes in LAV (-5.70 mL) and LVEF (+1.10%) were not statistically or clinically meaningful. NT-proBNP decreased substantially (-1,340 pg/mL). In comparative analyses, TEER plus GDMT did not show statistically significant differences vs. GDMT alone for any parameter, including LVEDD (-1.02 mm), LVEDV (-11.98 mL), LVEF (-0.14%), and LVESV (-5.29 mL). TEER reduced grade 3-4 MR from 99% to 9%.

Systematic review registration: identifier CRD42023483404.

Conclusion: TEER results in statistically significant but clinically small changes in echocardiographic parameters, and no clear advantage over GDMT alone. These findings should be interpreted with caution given the high heterogeneity and low certainty of evidence. Further studies are needed to define which SMR patient subgroups may derive meaningful reverse-remodeling benefit from TEER.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=483404, PROSPERO CRD42023483404.