Frontiers in Cardiovascular Medicine最新文献

There is a strong correlation between delayed diagnosis and high mortality rate in pulmonary arterial hypertension (PAH). Recent research indicates that circular RNAs (circRNAs) may serve as potential diagnostic biomarkers for PAH. This study aimed to identify important circRNAs associated with PAH to support early diagnosis and explore possible key disease mechanisms. GSE171827 and GSE113439 were obtained from the Gene Expression Omnibus (GEO) database to evaluate differentially expressed circular RNAs (DECs) and genes (DEGs). MicroRNAs (miRNAs) related to PAH were obtained from the Human microRNA Disease Database (HMDD). We validated changes in DEC expression levels using RT-qPCR in hypoxia- and normoxic-induced human pulmonary artery endothelial cells. Then, the potential relationship between DEC expression levels and mean pulmonary artery pressure (mPAP) in PAH patients was investigated. Finally, bioinformatics analyses were performed to construct a competing endogenous RNA (ceRNA) network and excavate the potential functions of DECs. Only hsa_circ_0005623 expression was significantly downregulated in PAH. Low hsa_circ_0005623 expression levels in the plasma of PAH patients were significantly associated with mPAP (p < 0.001). A ceRNA network comprising 1 circRNA (hsa_circ_0005623), 4 miRNAs (has-miR-424-5p, has-miR-503-5p, has-miR-331-3p, and has-miR-17-3p), and 10 mRNAs (CDH5, ANGPT2, DLL4, CLDN5, ANGPTL4, EDN1, HEY1, GATA2, CLEC14A, and ADM) was identified. Functional enrichment analysis of these 10 hub genes showed enrichment in endothelium development and blood vessel endothelial cell migration. These results suggest that hsa_circ_005623 in plasma is a potential biomarker for early PAH and may play an important role in the development of PAH.

Introduction: Continuous atrial fibrillation burden assessment is clinically relevant but often limited by the invasiveness of current tools. Wearables offer a non-invasive alternative, but evidence in the post-ablation setting is limited. We assessed the feasibility of smartwatch-based atrial fibrillation burden quantification after catheter ablation and its association with quality of life.

Methods: In this prospective, single-centre study, patients undergoing atrial fibrillation ablation entered a 12-month digital follow-up program using a smartwatch (daily electrocardiogram recommended). Atrial fibrillation burden was defined as the percentage of monitored days with atrial fibrillation-detected electrocardiograms. A Bayesian multivariable model examined the association between atrial fibrillation burden and quality-of-life score (AFEQT).

Results: Twenty patients (mean age 52.6 ± 10.3 years; 10% female) were enrolled. Over 12 months, 3,604 electrocardiograms were collected (mean 180 per participant); atrial fibrillation was detected in 55%. Electrocardiograms were submitted on 36% of days. Median atrial fibrillation burden was 1.4% (range: 0%-25%). AFEQT improved significantly over time (+1.71 points/month; 95% Credible Interval: 0.78-2.65), with 69% achieving a clinically meaningful improvement. Unlike atrial fibrillation recurrence, higher atrial fibrillation burden was associated with smaller AFEQT gains (interaction estimate: -0.23; 95% Credible Interval: -0.40 to -0.06). Each 1% increase in atrial fibrillation burden corresponded to an estimated 2.8-point lower AFEQT at 12 months.

Conclusion: Smartwatch-based monitoring of atrial fibrillation burden is feasible after ablation. Higher atrial fibrillation burden was associated with reduced improvement in quality of life, supporting its value as a patient-centred outcome metric.

Objective: To explore experiences and perspectives on community hospital-led home-based cardiac rehabilitation for coronary heart disease patients.

Methods: Semi-structured, face-to-face focus group interviews were conducted at a community hospital in Baoding, China, from December 2024 to October 2025. The interview guide was developed on the study objectives and rigorous internal deliberations within the research team. Data analysis was performed using Colaizzi's 7-step method.

Results: Three focus group interviews were conducted involving 15 coronary heart disease patients. Data analysis resulted in the identification of five themes and 15 subthemes. The five themes are presented as follows: motivations for engaging in cardiac rehabilitation and cognitive shifts; positive experiences and perceived benefits of cardiac rehabilitation; challenges in self-managing during home-based cardiac rehabilitation; expectations and suggestions for cardiac rehabilitation services; and meaning-making in disease management and life course.

Conclusion: Cardiac rehabilitation experiences for coronary heart disease patients are a dynamic process involving physiological, psychological, and behavioral adaptations, which present multidimensional challenges. Developing a patient-centered, community-based support system requires integrating several key elements: culturally congruent strategies, multidisciplinary collaboration, personalized protocols, continuous monitoring, and robust psychosocial support. This holistic approach empowers patients to transition from a passive state of illness to active health stewardship, thereby achieving sustainable long-term outcomes.

A crossing patent foramen ovale (PFO) thrombus is a thrombus that straddles both atria through a PFO, also called a transseptal thrombus or an impending paradoxical embolism. Although rare, this condition represents a highly critical clinical emergency. Clinically, such thrombi are usually classified as primary intracardiac (in situ) thrombosis or emboli in transit from the venous system. We report two contrasting cases of a thrombus straddling the foramen ovale documented with high-quality multimodality imaging and serial transesophageal echocardiography (TEE) during follow-up. Case 1 involved a 21-year-old man who presented with sudden severe dyspnea, profuse sweating, and transient loss of consciousness after a long-distance train journey. TEE demonstrated a large, highly mobile thrombus straddling the PFO with right heart enlargement and pulmonary hypertension, and CT pulmonary angiography (CTPA) confirmed extensive pulmonary embolism. During emergency surgery, thrombi were removed from the right atrium, PFO, left atrium, and pulmonary arteries with concomitant PFO closure. Subsequent targeted genetic testing revealed a heterozygous SERPINC1 nonsense variant classified as likely pathogenic for antithrombin deficiency, suggesting underlying hereditary thrombophilia. Case 2 involved a 75-year-old woman with hypertension and persistent atrial fibrillation who underwent TEE screening before planned catheter ablation, which revealed a small, relatively fixed thrombus confined to the PFO tunnel. She was managed conservatively with 20 mg of rivaroxaban once daily, and serial TEE at 54 and 141 days revealed progressive thrombus regression without peripheral embolic events. These cases illustrate typical imaging features and clinical contexts that help distinguish an embolus in transit from a presumed in situ PFO thrombus and show how careful determination of the thrombus origin and nature can guide individualized management, help prevent catastrophic embolic events, and improve patient outcomes.

Introduction: While the deterioration in the general health of patients with long COVID (LC) is well documented, no studies have assessed changes in medication use and their relationships with vascular health. This study aimed to evaluate the increase in the use of various drug classes in LC and its relationship with vascular structure and function.

Methods: Each participant in the sample of 305 subjects diagnosed with LC completed a questionnaire on medication use, verified in medical records. Pre-pandemic and current drug use were recorded. Arterial stiffness was measured with the VaSera device, which estimates the cardio-ankle vascular index and brachial-ankle pulse wave velocity (ba-PWV); carotid-femoral pulse wave velocity was determined using the Sphygmocor device. Vascular structure was assessed by carotid intima-media thickness (c-IMT), measured with a Sonosite Micromax ultrasound. This analysis focuses exclusively on macrovascular parameters. Statistical analyses were performed with SPSS software.

Results: Use of all classes of medication increased. Patients with a greater rise in drug use after an LC diagnosis showed higher vascular parameters. Greater cardiovascular drug use was positively associated with ba-PWV, an indicator of arterial stiffness (β = 0.301, 95%CI: 0.024-0.577). Increased anti-inflammatory/analgesic drug use was positively associated with c-IMT, a marker of vascular wall thickness (β = 0.012, 95%CI: 0.001-0.023).

Conclusions: Medication use rose from 2019 to the time of inclusion in the study. The increase in cardiovascular and anti-inflammatory/analgesic drug use was positively associated with ba-PWV and c-IMT, respectively, suggesting a link between greater drug use and impaired vascular health in LC.

Pneumopericardium is a rare, life-threatening condition characterized by abnormal gas accumulation in the pericardial cavity, most commonly secondary to trauma, surgical procedures, or fistulous communications with adjacent hollow organs. We report a 59-year-old male patient who presented with chest pain. Initial transthoracic echocardiography (TTE) only detected minimal pericardial effusion, failing to identify pneumopericardium. Subsequent serial TTE monitoring progressively revealed pathognomonic signs of pneumopericardium, including microbubble swirl, air gap artifact, and a definitive fluid-gas level. Notably, the microbubble swirl sign is a typical marker for the early diagnosis of pneumopericardium, and its presence should raise an immediate suspicion of this condition. The diagnosis was ultimately confirmed, and computed tomography (CT) was further performed to corroborate these echocardiographic findings. Therapeutically, ultrasound-guided pericardiocentesis was successfully conducted to drain the pericardial gas. However, post-procedural recurrent pneumopericardium occurred, prompting suspicion of an underlying persistent fistula, specifically a bronchopericardial fistula. Despite aggressive clinical interventions, the patient ultimately succumbed to the disease following voluntary withdrawal of care. This case highlights three key clinical implications: (1) Serial TTE monitoring is of critical value in the dynamic diagnosis of pneumopericardium, particularly when initial imaging yields non-diagnostic results; (2) TTE serves as a dual utility tool-guiding emergent therapeutic interventions (e.g., ultrasound-guided pericardiocentesis) and facilitating etiological investigation (e.g., identifying fistula-related gas recurrence); (3) Clinicians should maintain heightened vigilance for underlying pathological causes (e.g., bronchopericardial fistula) in patients with recurrent pneumopericardium to optimize treatment strategies.

Cardiorenal syndrome (CRS) refers to the pathophysiological interaction between cardiac dysfunction and kidney injury. Traditional CRS research has focused primarily on the impact of left heart failure on renal function. However, increasing evidence suggests that abnormalities in right heart function, particularly tricuspid regurgitation (TR), critically exacerbate the progression of CRS by promoting renal venous congestion, worsening kidney function, and further aggravating right heart failure. With the aging population and prolonged survival of patients with heart failure, the prevalence of TR has significantly increased and has a substantial impact on prognosis. Therefore, there is an urgent need to reassess the role of TR in heart-kidney interactions. This review summarizes the pathophysiology, clinical evidence, and treatment strategies of TR in the context of CRS, with the aim of raising awareness of the right-heart-centered perspective. Kidney injury caused by right heart dysfunction is driven by multiple mechanisms, among which elevated right atrial pressure and consequent renal venous congestion appear to be more important than reduced renal perfusion caused by low cardiac output alone. In patients with moderate or severe TR, renal function deteriorates significantly, whereas interventional treatment that reduces TR can improve right heart function and lower the risk of adverse events. Future research should challenge the traditional left-heart-dominant paradigm, focusing on mechanistic studies, early assessment and risk stratification, interventional therapy, and the synergistic effects of new drug combinations. Addressing current limitations and research gaps is crucial to overcoming therapeutic bottlenecks and improving long-term outcomes in patients with chronic cardiorenal syndrome.

Background: Cardiovascular disease (CVD) remains the leading cause of mortality and disability globally, with high body mass index (HBMI) playing a pivotal role in its worldwide burden. Gaining a clear understanding and forecasting the effect of HBMI on CVD is crucial for developing effective health policies and interventions.

Methods: We used data from the 2021 Global Burden of Disease study to analyze the CVD burden attributable to HBMI. An age-period-cohort (APC) analysis was conducted to investigate trends in CVD-related mortality attributable to HBMI, whereas the Bayesian Age-Period-Cohort (BAPC) model projected the number of deaths and mortality up to 2035.

Results: The study revealed a significant increase in CVD deaths and disability-adjusted life years (DALYs) due to HBMI globally, despite slightly decreased age-standardized rates (ASR) for HBMI-related CVD. The ASR of deaths and DALYs decreased from 1990 to 2021 in the high and high-middle Socio-Demographic Index (SDI) regions while increasing in the lower SDI regions. A pinpoint analysis revealed the most significant decline in HBMI-related CVD mortality from 2003 to 2010. The BAPC model projected an increase in global HBMI-related CVD deaths to 2,369,451 by 2035. The ASR of deaths is projected to increase to 37.53 per 100,000, with an increase for females and a decrease for males.

Conclusion: This study emphasizes global trends in HBMI-related CVD burden and the importance of targeting HBMI as a modifiable risk factor. It provides crucial information for public health strategies aimed at reducing CVD mortality. Further research is warranted, especially with an aging global population.

Background: While 4D contrast-enhanced computed tomography (CT) is used to plan cardiovascular interventions such as transcatheter valve replacement, it is not yet routinely used to characterize minimally calcified aortic valves for planning of surgical valve repair. It is widely recognized that aortic valve morphology has implications for the durability of valve repair surgery.

Purpose: The objective is to demonstrate the potential of CT image segmentation for elucidating aortic valve morphology prior to surgery and to illustrate a potential benefit of 4D CT and photon counting CT (PCCT) for patient-specific modeling of dysmorphic aortic valves.

Materials and methods: This observational series includes nine patients who were suspected to have minimally calcified bicuspid aortic valve morphology on transthoracic echocardiography (TTE). Mean age was 53 +/- 13 years and seven patients were male. For the seven patients who underwent aortic root surgery, CT-based segmentation of the aortic valve was compared to echocardiographic interpretation and direct intraoperative visualization of valve morphology. Two patients who have not yet undergone aortic surgery were imaged longitudinally with 4D energy-integrating detector CT (EID-CT) and 4D PCCT, and the morphological interpretation of the aortic valve was compared to previous TTE reports.

Results: In most surgical cases, CT-based segmentation and direct visualization of the valve revealed morphological features not previously confirmed on TTE, particularly related to the cusp fusion pattern. Moreover, 4D CT enabled morphological assessment at both systole and diastole, which captured maximal cusp separation and valve closure. PCCT images were reconstructed with slice thickness as low as 0.2 mm, and revealed detailed dysmorphic features such as a small accessory cusp with fistula and a double raphe in separate patients.

Conclusion: 4D CT-based segmentation has the potential to dynamically capture aortic valve features that are relevant to risk stratification and surgical planning at high spatial resolution.

Background: The triglyceride-glucose (TyG) index demonstrates strong links to heightened cardiovascular risk and progressive renal dysfunction. However, its prognostic implications in individuals diagnosed with cardiovascular-kidney-metabolic (CKM) syndrome who underwent Percutaneous Coronary Intervention (PCI) have yet to be fully elucidated.

Methods: A retrospective investigation was conducted involving CKM patients who underwent PCI between January 2014 and September 2017. The TyG index categories were established utilizing X-tile software for classification purposes. The principal endpoints comprised 5-year all-cause mortality (ACM) and cardiac mortality (CM). Associations between the TyG index and ACM/CM were evaluated using Cox proportional hazards models, and further examined through restricted cubic spline (RCS) analyses.

Results: Of the 2,040 patients analyzed, 1,186 (58.14%) were male and 854 (41.86%) female, with 55.83% aged ≥65 years. After analysis with multivariate Cox regression, elevated TyG index measurements demonstrated a notable association with heightened probabilities of ACM and CM occurrence. In comparison to the medium TyG index group, individuals categorized within the low TyG index group exhibited markedly elevated risks for ACM [hazard ratio [HR] = 1.82, 95% confidence interval [95%CI]: 1.15-2.88] and CM (HR = 2.68, 95%CI: 1.32-5.43). Additionally, a higher ACM risk was noted in the high TyG index group (HR = 1.39, 95%CI: 1.01-1.92). The RCS analysis identified no nonlinear association between the TyG index and either outcome (P-values for nonlinearity test: 0.177 and 0.153, respectively).

Conclusions: The TyG index independently predicted increased risks of all-cause and cardiac mortality, thus highlighting its utility for risk stratification in CKM syndrome patients following PCI.