Frontiers in Cardiovascular Medicine最新文献

Objectives: There are several studies from all over the world reporting on frozen elephant trunk implantation and total arch replacement in acute aortic syndrome demonstrating mostly favourable outcomes. Most of these studies present younger study populations carrying a rather low perioperative risk for adverse outcomes. Herein, we present our single centre experience with the frozen elephant trunk procedure in patients with acute aortic syndrome. The patients in this cohort carried a rather high perioperative risk. A considerable number of patients had undergone resuscitation, presented with neurological disorders or presented with malperfusion syndrome. We demonstrate that favourable outcomes are achievable in such high-risk patients using the frozen elephant trunk technique.

Methods: All patients who underwent frozen elephant trunk implantation in a setting of acute aortic syndrome between March 2008 and March 2023 were included in this retrospective study.

Results: Overall, 90 patients underwent frozen elephant trunk implantation due to acute aortic syndrome. Mean age was 60.0 (±11.6) years, 74 patients (82%) were male. All had extensive aortic pathologies with involvement of the aortic arch, supraaortic vessels or descending aorta. 27 patients (30%) presented with neurological disorders, including aphasia, hemiparesis, paraparesis and coma. Predicted 30-day mortality by the so called GERAADA score was 23.9% on average. In our cohort, we observed an actual 30-day mortality of 17.4%. Postoperatively, neurological disorders were observed in 34 patients (38%). Aortic redo surgery was required in 8 patients (9%). Several preoperative and intraoperative parameters were tested for prediction of 30-day-survival. Preoperative hemiparesis (p = 0.012), visceral malperfusion (p = 0.004) and preoperative resuscitation (p = 0.003) served as significant predictors in a multivariable cox regression.

Conclusions: The recent adaptation of frozen elephant trunk implantation in acute aortic syndrome led to an improved outcome. Overprediction trend of early mortality by the GERAADA score and a low rate of aortic redo surgery in the long-term course support this idea.

Introduction: The development of transcatheter aortic valve devices critically depends on preclinical testing in large animal models, yet key anatomical differences between these models and humans remain insufficiently defined. This study evaluated the translational relevance of ovine and porcine models by comparing aortic root anatomy with that of healthy individuals and patients with aortic valve disease.

Methods: Silicone root casts and ECG-gated computed tomography (CT) imaging were used to assess annular, sinus of Valsalva (SOV), and sinotubular junction (STJ) dimensions, as well as coronary ostial height and eccentricity.

Results: Pigs and sheep exhibited significantly lower and more laterally displaced left coronary ostia compared to humans-features that may predispose to coronary obstruction during valve implantation. Body weight correlated with key root dimensions, but wide individual variability precludes its use for selecting individual animals. However, it remains a useful filter for defining cohorts from which suitable subjects can be selected using CT. Sheep demonstrated flatter sinuses and lower STJ heights than pigs and humans, further reducing coronary inflow clearance. In contrast, coronary heights in humans were consistent across valve pathologies, with sinus dimensions being the most variable feature.

Conclusion: Validation of ex vivo silicone casting against in vivo CT confirmed its suitability for scalable anatomical assessment while aligning with animal welfare principles. These findings support refinement of animal selection strategies and provide an anatomically grounded framework for preclinical evaluation of transcatheter valve technologies.

Background: Percutaneous left atrial appendage (LAA) closure (LAAC) is a proven stroke prevention strategy for patients with atrial fibrillation (AF). However, incomplete sealing in complex LAA anatomies may compromise efficacy.

Objectives: This study evaluates the safety, feasibility, and efficacy of concomitant dual-device LAAC in multilobed anatomies, representing the largest cohort examined to date.

Methods: We reviewed all LAAC procedures performed at the University Hospital of Bern between 2009 and 2025. Baseline characteristics, procedural details, and follow-up data were analyzed for patients receiving dual-device LAAC. Endpoints included technical success, complications, thromboembolic events, and device-related issues. Continuous data were expressed as mean ± standard deviation or median values, while categorical data were reported as percentages. Group comparisons were conducted using t-test, Mann-Whitney U test, or chi-square test. Differences were expressed as 95% confidence intervals, and a p-value of less than 0.05 was considered significant.

Results: Of 1,307 LAAC procedures, 10 included dual-device implantation. The mean age of the patients was 71 years, and all patients were men. The Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, prior Stroke or TIA, Vascular disease, Age 65-74 years, Sex category (CHA₂DS₂-VASc) and Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, Drugs/alcohol (HAS-BLED) scores were 3.5 ± 1.8 and 2.9 ± 1.4, respectively. Most patients (70%) had paroxysmal AF. Preprocedural and intraprocedural transesophageal echocardiography (TEE) confirmed multilobed LAA anatomy in all cases. Half of the procedures were fluoroscopy-guided with one delivery sheath and transseptal puncture, while the other half were TEE-guided with a double sheath and two transseptal punctures. Only Amplatzer devices were used: Eight procedures employed two devices of the same type [five Amulet, three Amplatzer Cardiac Plug (ACP)], and two procedures combined different types (Amulet + ACP, ACP + Amplatzer Vascular Plug). Technical success was achieved in all cases. Within the first week, one (10%) patient experienced a clinically non-clinically relevant pericardial effusion. At 1-year follow-up (completed in nine patients), three (30%) patients developed pericarditis. No thromboembolic events, device-related thrombosis, or device embolization occurred.

Conclusion: In this small cohort of patients with complex multilobed LAA anatomy, concomitant implantation of two Amplatzer devices proved to be a feasible strategy with acceptable short-term safety, although potentially associated with an increased risk of pericarditis.

Emerging evidence from preclinical and observational studies indicates an association between gut flora dysbiosis and atrial fibrillation (AF). The gut flora constitutes a highly complex and dynamic community capable of producing diverse metabolites that influence host pathophysiology. External factors, such as diet and medications, further modulate its composition. This review synthesizes current knowledge on the relationship between gut flora and AF, emphasizing the role of microbial-derived metabolites in the underlying mechanisms of AF. We also explore the involvement of gut flora in AF-related conditions, including hypertension and diabetes. Additionally, we evaluate potential interventional strategies targeting the gut flora through dietary or pharmacological approaches for their antiarrhythmic effects. Finally, we address limitations in the current evidence and propose future research directions to clarify the causal relationship and therapeutic potential of targeting the gut flora in AF. While this review synthesizes the current evidence linking gut flora to AF, we also critically examine the limitations of the existing literature, including reliance on preclinical models, confounding factors in human studies, and inconsistencies in interventional outcomes, to provide a balanced perspective on the field's current state and future directions.

Background and objectives: High-sensitivity troponin T (hsTnT) is a standard biomarker for myocardial injury detection, but its prognostic value may differ by renal function status. This study evaluated how renal function modifies the prognostic significance of hsTnT in ACS patients undergoing PCI.

Methods: This study examined 14,208 acute coronary syndrome (ACS) patients who underwent percutaneous coronary intervention (PCI), stratified by renal function [estimated glomerular filtration rate (eGFR) < 60 vs. ≥60 mL/min/1.73 m²] and peak hsTnT levels [<5× vs. ≥5× upper reference limit (URL)]. Primary outcomes included one-year all-cause mortality and one-year incidence of ischemic events following the index PCI procedure.

Results: In patients with impaired renal function, elevated hsTnT was associated with significantly increased mortality [12.84% vs. 4.29%; adjusted hazard ratio [HR] 3.63, 95% confidence interval [CI] 2.04-6.49, P < 0.0001] and ischemic events (10.66% vs. 4.88%; adjusted HR: 2.72, 95% CI: 1.51-4.88, P = 0.0008). In patients with preserved renal function, the mortality association was attenuated (1.42% vs. 0.98%; adjusted HR: 1.40, 95% CI: 0.85-2.29, P = 0.1864), although ischemic events remained significantly increased (2.93% vs. 1.54%; adjusted HR: 2.06, 95% CI: 1.41-2.97, P = 0.0002). Restricted cubic spline analysis revealed a significant non-linear relationship between hsTnT levels and mortality specifically in impaired renal function cohort (P for non-linearity = 0.0004), whereas a predominantly linear association was observed in patients with preserved renal function. A significant interaction was observed between renal function and hsTnT for mortality prediction (P for interaction = 0.0089).

Conclusions: These findings indicate that renal function substantially modifies the prognostic significance of hsTnT among ACS patients post-PCI. Integrating renal function and peak hsTnT into risk assessment may help identify high-risk subgroups requiring intensified follow-up and management.

Objective: The objective of this study was to evaluate the efficacy and safety of distal transradial access (dTRA) for non-emergent percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS).

Methods: This single-center, randomized controlled study was conducted in the Department of Cardiology at Inner Mongolia Medical University Affiliated Hospital between January and July 2025. Patients with ACS who met the inclusion criteria were assigned to the distal transradial access (dTRA) group or the conventional transradial access (TRA) group at a 1:1 ratio using a random number table method. Clinical baseline data and operation data were collected. Radial artery Doppler ultrasound was performed 24 h and 30 days after PCI to detect radial artery occlusion (RAO).

Results: A total of 106 patients were included in the study, with no significant differences in clinical baseline data and operation data between the two groups. The incidence of RAO at 24 h after PCI in the dTRA group was significantly lower than that in the TRA group (1.9% vs. 15.1%, P = 0.037). However, this big difference was not significant at 30 days (0% vs. 5.7%, P = 0.241). The TRA group had a longer median compression hemostasis time (274 min vs. 200 min, P < 0.001). The median number of punctures, puncture time, and contrast agent dosage between the two groups were similar. The crossover rate in the dTRA and TRA groups was 7.5% and 5.7%, respectively. The incidences of forearm pain, bleeding, and swelling at the puncture site during and after PCI between the two groups were also similar. Logistic regression analysis identified dTRA (OR: 0.075; 95% CI: 0.008-0.723; P = 0.025) as an independent protective factor against RAO at 24 h, reducing the risk of the outcome by 92.5%.

Conclusions: For ACS patients undergoing non-emergent PCI, dTRA is a safe and effective approach. dTRA significantly reduced the incidence of RAO at 24 h after PCI and had a shorter hemostasis time, without affecting the interventional procedure.

Introduction: Mouse models play a critical role in cardiology research, offering valuable insights into the molecular mechanisms, genetics, and potential treatments for cardiovascular diseases. However, the ability to transfer findings in mice between studies is limited by the absence of standardized protocols and valid reference values for the assessment of normal cardiac function in mice. This study aims to establish comprehensive transthoracic echocardiography (TTE) reference ranges for mice, particularly focusing on C57BL/6N wild-type controls.

Methods: The study, which includes data from over 15,000 mice through the International Mouse Phenotyping Consortium (IMPC), highlights how variables such as sex, age, body weight, and anesthesia impact TTE parameters.

Results: The findings showed that anesthesia is the primary predictor of variability in cardiac function. Isoflurane- and tribromoethanol-anesthetized mice presented with modified cardiac function compared with conscious mice. In addition, we observed minimal sex differences in cardiac morphology and function, except for small variations influenced by anesthesia. The effects of aging on cardiac function were modest, characterized by a decrease in heart rate and subtle changes in ventricular dimensions without evidence of pathological remodeling, possibly attributable to disease-free cardiovascular aging.

Discussion: Validation of the reference ranges across multiple mouse strains showed that these values provide a reliable baseline for experiments involving cardiac function in mice. The data underscore the importance of using anesthesia-specific reference values when interpreting TTE results, ensuring robust comparisons in genetic and pharmacological studies. These reference ranges serve as quality assurance tools for future cardiac studies in mice, offering insights into typical TTE parameter values, supporting the detection of experimental perturbations, and contributing to more effective translation of findings from mice to humans.

Objective: Contrast transthoracic echocardiography (c-TTE) is widely used for the diagnosis of patent foramen ovale (PFO), where the Valsalva maneuver (VM) serves as the standard provocative maneuver to optimize detection. This study aimed to evaluate diaphragmatic downward excursion (DDE) as a novel c-TTE-based parameter for objectively quantifying VM efficacy, thereby establishing a standardized assessment metric.

Methods: We studied 145 patients with high clinical suspicion of PFO-related conditions. All participants underwent both c-TTE and contrast transesophageal echocardiography (c-TEE) examinations. Based on intraoral expiratory pressure exceeding 40 mmHg under c-TTE, patients were divided into adequate Valsalva maneuver (AVM) group (n = 90) and non-adequate Valsalva maneuver (non-AVM) group (n = 55). We compared the two groups in terms of DDE at the roof of the right atrium (DDE-RRA) and intracardiac hemodynamic parameters.

Results: DDE-RRA was significantly lower in the AVM group than in the non-AVM group (7.3 mm vs. 3.1 mm, P < 0.001). ROC analysis identified 5 mm as the optimal cutoff value for evaluating VM efficacy, with a sensitivity of 77.8%, specificity of 92.7%, and an AUC of 0.90. The kappa test showed good agreement between DDE-RRA and insufflation manometry (kappa = 0.63, P < 0.001). Furthermore, the DeLong test demonstrated that the AUC of DDE-RRA was significantly greater than that of all assessed intracardiac hemodynamic parameters, including mitral and tricuspid peak E and A-wave velocities, as well as mitral and tricuspid velocity time integrals (all P < 0.05).

Conclusion: DDE provides a simple and objective method for assessing VM efficacy under c-TTE, showing superior diagnostic performance compared with conventional intracardiac parameters. As this represents an initial attempt, further studies incorporating invasive validation are needed to confirm its clinical value.

Purpose: Cardiac amyloidosis (CA) and hypertrophic cardiomyopathy (HCM) may both present with left ventricular hypertrophy, making differential diagnosis challenging. This study aimed to evaluate the value of cardiac magnetic resonance (CMR) delayed enhancement combined with tissue tracking (CMR-TT) in discriminating CA from HCM.

Methods: Data from 30 patients with CA, 29 patients with HCM, and 20 normal controls (NC) were retrospectively analyzed. All subjects underwent CMR examinations. Tissue tracking techniques were adopted for CMR cine sequences to directly quantify global radial strain (GRS), global circumferential strain (GCS), and global longitudinal strain (GLS).

Results: The most common delayed enhancement pattern in CA was linear subendocardial enhancement (76.7%). Half of the CA patients had delayed enhancement involving atria and right ventricle, while 33.3% exhibited the characteristic "chaotic sign." The GRS and GCS values were significantly different between the CA group and the HCM group and between the CA group and the NC group (P < 0.05). GLS differed significantly among the CA, HCM, and NC groups (P < 0.05). ROC analysis revealed that GCS (AUC = 0.748, P = 0.001) and GLS (AUC = 0.732, P = 0.002) provided good diagnostic efficiency in differentiating CA from HCM.

Conclusion: CMR delayed enhancement patterns combined with myocardial strain parameters, particularly GLS and GCS, can aid in the differential diagnosis of CA and HCM. Optimal cutoff values of GCS (-14.6%) and GLS (-9.22%) provide a noninvasive imaging approach with significant clinical implications for guiding treatment and improving prognosis.

Objective: While systemic factors influence Kawasaki disease outcomes, this study specifically determines the independent and incremental prognostic value of the coronary aneurysm's own characteristics-maximum Z-score (ZM), morphology, and Location-for predicting persistence one year after onset.

Methods: This retrospective cohort study enrolled 135 children with KD and coronary artery aneurysms (CAA). We analyzed the maximum Z-score (ZM), morphology (fusiform/saccular), and coronary artery Location (Left/Right/Bilateral) of the index aneurysm (the largest by Z-score). Univariable and multivariable logistic regression were used to identify independent predictors. The predictive performance of a model containing only ZM was compared to that of the Comprehensive Aneurysm Characteristic (CAC) model, which incorporates ZM, morphology, and Location, by assessing the area under the receiver operating characteristic curve (AUC). A descriptive analysis was additionally performed on a high-risk subgroup defined by a ZM ≥ 5.0.

Results: The early ZM was a strong predictor of persistent coronary aneurysms at one year (OR = 4.925, P < 0.001), with an AUC of 0.909. In the multivariable analysis, larger ZM (aOR = 6.775, 95% CI: 3.133-14.648, P < 0.001), saccular morphology (aOR = 7.648, 95% CI: 1.428-40.967, P < 0.05), and LAD involvement (aOR = 4.304, 95% CI: 1.163-15.928, P < 0.05) emerged as independent predictors. The CAC model demonstrated a statistically significant improvement in predictive ability over the ZM-only model (AUC: 0.941 vs. 0.909, P = 0.025). Exploratory analysis of the high-risk subgroup (ZM ≥ 5.0) revealed a markedly higher prevalence of saccular morphology in patients with persistent aneurysms, suggesting it may serve as a crucial risk signal independent of absolute size in this population. The CAC model also showed excellent calibration and superior clinical utility across a wide range of decision thresholds.

Conclusion: The intrinsic characteristics of a coronary aneurysm-its size, shape, and distribution-collectively provide powerful, independent prediction of its persistence at one year. The strong association of specific morphological features with persistence in the high-risk subgroup underscores the value of anatomy-based assessment for refining risk stratification, complementing evaluations based on systemic host factors.