Frontiers in Cardiovascular Medicine最新文献

Background: Insulin resistance (IR) has been shown to be associated with hypertension. The triglyceride-glucose body mass index (TyG-BMI) has emerged as a novel surrogate marker for assessing IR. This study aimed to investigate the association between the TyG-BMI index and hypertension among adults in rural southwest China using a cross-sectional study.

Method: We recruited 2,998 people between the ages of 30 and 79 from Rongchang, Chongqing municipality, southwest China, as part of The China Multi-Ethnic Cohort Study, considered the largest cohort study in southwest China. Logistic regression model, restricted cubic spline (RCS) model and receiver operating characteristic (ROC) were applied to estimate the association between the TyG-BMI index and hypertension. Moreover, subgroup and sensitivity analyses were undertaken to check the consistency of the outcomes.

Results: A total of 2,998 participants were included in the present study, with a hypertension prevalence of 39.93%. After adjusting for confounding factors, the ORs of hypertension in Q2, Q3, Q4 were 1.641 (1.277-2.109), 1.768 (1.371-2.281), 2.463 (1.794-3.382) compared with the lowest quartile (Q1), respectively. RCS indicated that the TyG-BMI index was nonlinearly associated with hypertension (P _{for overall} < 0.001, P _{for nonlinear}  = 0.046). The ROC analysis indicated that the TyG-BMI index had a 64.1% (AUC: 0.641, 95% CI: 0.621-0.661) ability to distinguish hypertension. Subgroup analysis in participants without diabetes, dyslipidemia, hyperuricemia and central obesity as well as sensitivity analyses also demonstrated the similar relationship between the TyG-BMI index and hypertension.

Conclusion: The current study demonstrates that the TyG-BMI index is associated with higher risk of hypertension among rural adults in southwest China. Lifestyle modifications, including weight control, vigorous physical activity and healthy dietary pattern can help improve IR and prevent hypertension.

Background: Hemodynamic assessment of coronary artery stenosis has impact on arterial graft patency. Quantitative flow ratio (QFR) obtains hemodynamic information of coronary artery stenosis.

Methods: Patients with history of isolated coronary artery bypass grafting (with ≥1 arterial graft) and at least one postoperative coronary re-assessment were retrospectively investigated. The preoperative angiography was used for retrospective QFR analysis of the native coronary target vessel, to which the arterial bypass graft was anastomosed. Analysis was performed by certified investigators, who were blinded towards postoperative arterial graft patency status. Coronary targets with QFR values of ≤0.80 were defined as hemodynamically relevant, whereas values of >0.80 were defined as hemodynamically irrelevant.

Results: Out of 5,692 patients, 596 patients had a postoperative coronary assessment and were therefore eligible for inclusion. In 196 arterial target vessels QFR analysis was possible. Kaplan-Meier analysis revealed higher graft patency rates for arterial grafts anastomosed to coronary branches with QFR values ≤0.80 (log-rank: p = 0.017). In multivariable Cox regression analysis, QFR ≤ 0.80 remained an independent predictor for arterial graft patency (HR: 0.475, 95% CI: 0.261-0.867; p = 0.015), while visually estimated stenosis from preoperative coronary angiography did not (p = 0.160). With an area under the curve of 0.595, 95% CI (0.503-0.688), the performance of the model was poor to at most moderate. Most target vessels [546 (80.22%)] were not analysable in retrospective fashion.

Conclusion: Though target vessel QFR ≤ 0.80 was associated with higher arterial graft patency, our trial observed low feasibility (high drop out rates) and poor diagnostic performance of QFR used in retrospective fashion. Caution is warranted for retrospective use of QFR in datasets with similar constraints.

Introduction: Vasospastic angina (VSA) can mimic obstructive coronary disease and may lead to overtreatment.

Case presentation: A middle-aged Caucasian man with recurrent chest pain underwent stenting and escalating therapy despite negative angiograms. Subsequent provocative testing confirmed a diagnosis of refractory VSA. Although autonomic modulation improved symptoms, recurrence of symptoms suggested persistent endothelial dysfunction and complex pain mechanisms.

Conclusion: This case underscores the importance of early functional testing to prevent unnecessary interventions and support a tailored, holistic approach to the management of VSA.

Objective: The incidence of coronary heart disease (CHD) is progressively increasing on an annual basis. Dyslipidemia constitutes a significant pathogenic factor in CHD, exerting a substantial influence on its onset and progression. Consequently, precise and effective lipid management is crucial for the prevention and cure of CHD. This study aims to examine the risk factors, therapeutic approaches, current research status and emerging trends in lipid management related to CHD.

Method: We searched for publications on lipid management of coronary heart disease from 01/01/2014 to 12/31/2023 in Web of Science and performed bibliometrics using CiteSpace, VOSviewer, Scimago Graphica, Gephi and R Studio.

Results: A total of 6,027 related articles were retrieved from the Web of Science database. After screening, 5,954 articles were included. Journal of Clinical Lipidology and Atherosclerosis were the journals with the most publications and citations, respectively. In this discipline, the United States has the largest number of publications, research institutions, citations, and collaborative partnerships. The burst keywords include sex difference, heterozygote familial hypercholesterolemia, PCSK9, lipid peroxidation, fish oil, monoclonal antibody, insulin sensitivity, and gene, etc.

Conclusion: Research on CHD indicates that risk factors influencing lipid levels encompass sex, genetics, PCSK9, and lipid peroxidation. There has been a growing trend in investigating the underlying mechanisms of these factors. Recent research hotspots have concentrated on disease prevention, prognosis, specific treatments for CHD, the development of new pharmaceuticals, and the molecular mechanisms of action. Future research is likely to continue focusing on more precise treatment protocols and the exploration of novel mechanisms.

Objective: Our aim in this study is to evaluate the impact of continuous home-based care on depressive symptoms, quality of life, and major adverse cardiovascular events in patients with acute coronary syndrome (ACS) and mild-to-moderate depression.

Methods: A total of 200 patients with ACS diagnosed in our hospital during the period between October 2021 and April 2024 were selected for the study. All patients were screened for depression using the PHQ-9 questionnaire 1-8 weeks after myocardial infarction. Patients with scores consistent with mild to moderate depression were included in the study. After baseline assessment, eligible participants were randomly assigned 1:1 to the routine care group or the continuous home care group using a computer-generated block-randomization sequence, stratified by depression severity and ACS type. Depression, quality of life, and adverse cardiovascular events in the two groups of patients at different time points were analyzed.

Results: There were no statistical differences in clinical data and background between the two groups of patients included in the study (P > 0.05). However, as the follow-up time prolonged, the anxiety and depression scores of patients in the continuous home care group were significantly lower than those in the routine care group (EQOL-VAS score at 6 months' follow-up: routine care group 70.31 ± 7.77, continuous home care group 79.69 ± 6.07, P = 0.043; EQOL-VAS score at 12 months' follow-up: routine care group 63.82 ± 6.73, continuous home care group 74.42 ± 7.24, P = 0.046; EQOL-VAS score at 18 months' follow-up: routine care group 54.15 ± 13.30, continuous home care group 63.94 ± 11.28, P = 0.038). In addition, compared with the routine care group, the quality of life of patients in the continuous home care group significantly improved, and the overall incidence of adverse cardiovascular events was lower (P < 0.05) in this group than in the former group.

Conclusions: The results of the study showed that continuous home care can alleviate the anxiety and depression of patients with ACS, enhance their quality of life, reduce the incidence of adverse cardiovascular events, and improve their prognosis. After adjusting for confounding factors such as age, history of MI, heart failure, and medication adherence, the intervention effect did not show significant attenuation, further confirming its independent protective role.

Background: The monocyte-to-high-density lipoprotein cholesterol ratio (MHR) has emerged as a novel biomarker for cardiovascular outcomes. However, its role in atrial fibrillation (AF) remains unclear. This meta-analysis aimed to evaluate the diagnostic efficacy of MHR in predicting AF risk.

Methods: We systematically searched PubMed, Embase, and Web of Science up to March 20, 2025. The primary outcome was to assess the diagnostic accuracy of MHR for predicting AF using summary receiver operating characteristic (SROC) curve analysis. The secondary outcome was to explore the relationship between MHR and AF risk. Pooled odds ratio (OR), sensitivity, specificity, and area under the curve (AUC) were calculated.

Results: A total of 13 studies comprising 5,499 participants were included. Elevated MHR was independently associated with an increased AF risk (OR = 1.21; 95% CI, 1.11-1.31; P < 0.001). The pooled sensitivity and specificity were 0.85 (95% CI, 0.71-0.93) and 0.68 (95% CI, 0.60-0.75), yielding an area under the SROC curve of 0.80 (95% CI, 0.76-0.83). Subgroup analyses revealed significant diagnostic performance variations by AF phenotype: MHR had the highest sensitivity (0.91; 95% CI 0.74-1.00) and AUC (0.94; 95% CI 0.91-0.96) in non-procedural AF, followed by post-ablation recurrence (sensitivity = 0.86, AUC = 0.83) and new-onset AF (sensitivity = 0.80, AUC = 0.83). Large-sample studies (>600) showed lower sensitivity (0.71 vs. 0.90) but higher specificity (0.78 vs. 0.60) than small-sample studies (≤600). No significant publication bias was detected (p = 0.45).

Conclusions: MHR demonstrates moderate diagnostic accuracy for AF risk prediction and is better suited as a screening or complementary biomarker than a standalone diagnostic tool. Its diagnostic performance varies significantly by AF phenotype and clinical context. Given the limited number of studies, significant heterogeneity, and unstandardized MHR cut-offs, large-scale prospective studies with standardized protocols are warranted to validate these findings and facilitate targeted clinical application.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD420251030225.

Objective: To explore the impact of the integrated treatment model under the "smart + specialty" concept on the treatment success rate and adverse events in emergency patients with aortic dissection (AoD).

Methods: A total of 166 patients with AoD treated at our hospital from March 2022 to April 2024 were selected and divided into two groups according to the order of treatment. The control group consisted of 81 patients treated from March 2022 to March 2023 and received routine emergency procedures, while the study group included 85 patients treated from April 2023 to April 2024 under the "smart + specialty" integrated treatment model. The treatment success rate, treatment efficiency, incidence of adverse events, and nursing satisfaction were compared between the two groups.

Results: The treatment success rate in the study group was 100% (85/85), which was higher than the control group's rate of 92.59% (75/81), with a statistically significant difference (P = .03). The study group had shorter triage time, diagnosis time, emergency stay time, referral time to intensive care unit (ICU), and symptom remission time compared to the control group, with statistically significant differences (P < .001). The total incidence of adverse events in the study group was 3.53% (3/85), significantly lower than the control group's rate of 12.00% (9/75), and the total family nursing satisfaction in the study group was 96.47% (82/85), significantly higher than the control group's rate of 87.65% (71/81), with statistically significant differences (P = .04).

Conclusion: The "smart + specialty" integrated treatment model can improve treatment efficiency and success rates in emergency AoD patients, reduce the risk of adverse events, and enhance family nursing satisfaction.

Introduction: Anomalous aortic origin of a coronary artery (AAOCA) is associated with sudden cardiac death. The intramural (IM) length is considered high-risk, yet radiologic measurements by computed tomography angiography (CTA) show variable agreement with measurements at surgery. We aimed to develop a semi-automatic computational method to estimate IM length in a retrospective cohort of surgical AAOCA patients.

Methods: In 58 patients [49 right(R), 9 left(L)], CTA images were used to generate 3D segmentations of the aorta and a centerline of the anomalous coronary. The distance from the centerline to the aortic segmentation was calculated. The IM length was estimated from a transition point in the derivative of the distance curve and compared to radiologic and surgical measurements.

Results: Our method demonstrated an overall root-mean-square error (RMSE) of 3.4 mm, comparable to radiologic estimates (3.2 mm). For L-AAOCA subjects, our method showed lower root-mean-square error compared to radiologic estimates (our method: 3.6 mm, radiologic: 4.7 mm). For R-AAOCA subjects, the RMSE was higher in our method compared to radiologic estimates (our method: 3.4 mm, radiologic: 2.8 mm).

Conclusion: This is a pilot study of a computational approach to measure intramural length that is shown to be accurate relative to surgical measurements. Computational methods that represent and quantify morphology, including acute take-off angle, ostial characteristics, minimal luminal area, and intramural length, may be helpful for risk stratification and surgical planning in AAOCA.

Background: The treatment of patients with severe pulmonary embolism complicated by intracerebral hemorrhage is challenging: anticoagulation or thrombolysis, essential for treating pulmonary embolism, can substantially worsen intracranial hemorrhage and threaten life.

Case presentation: We report a case of a 78-year-old female who developed hemorrhagic transformation following acute ischemic stroke, complicated by massive pulmonary embolism and rapidly progressing to shock. In this case, emergent percutaneous mechanical thrombectomy was successfully performed under a zero-anticoagulation and zero-thrombolysis strategy, resulting in hemodynamic stabilization.

Conclusion: This case provides valuable evidence supporting the feasibility of purely mechanical percutaneous intervention in high-risk, complex clinical scenarios.

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.