Frontiers in Cardiovascular Medicine最新文献

Background: The prevalence of valvular heart disease is increasing. Early detection remains poor as screening relies on front line detection of audible or symptomatic disease and confirmation requires specialized echocardiography.

Methods: We conducted a single center, observational pilot study. Eligible subjects were stratified into groups based on echocardiographic findings. In addition to chart extraction of demographics, medical history, and echocardiographic parameters, each subject underwent three auscultation recordings that were analyzed via computational nonlinear dynamics to extract features and construct predictors without fitting or weighting. Predictors were used to create logistic regression binary classification models. Training and test set performance was reported for each model with a focus on area-under-the-curve and sensitivity as the primary benchmarks.

Results: We analyzed the recordings of 248 subjects, median age 73 years, 43.6% female, 99% White. All recordings were chaotic and of low dimensionality. Personnel and subject collected recordings had a normalized mutual information entropy of 1.0, indicating they shared the same information and could be interchangeable for model development. Three models for aortic stenosis met predetermined metrics, with the best performing model reporting an AUC of 0.872 and a sensitivity of 0.923. Mitral regurgitation models were explored but limited by sample size.

Conclusions: This study established the feasibility of two innovative approaches, by combining the sound recordings collected from unmodified mobile phones with analysis via nonlinear dynamics software. This work has the potential to improve valvular heart disease detection by overcoming barriers that remain for current standards of care and emerging artificial intelligence solutions.

Background: A novel balloon-in-basket pulsed field ablation (BiB-PFA) catheter enables efficient pulmonary vein isolation (PVI) and allows posterior wall isolation (PWI) within the same procedure. The incremental biological effect of PWI compared to PVI alone remains uncertain, particularly regarding inflammation, myocardial injury, and hemolysis.

Methods: In this prospective, single-center study, consecutive patients with atrial fibrillation underwent first-time BiB-PFA, either PVI only or PVI plus PWI. Venous blood samples were collected before and one day after ablation. Biomarkers included leukocytes, platelets, hemoglobin, C-reactive protein (CRP), haptoglobin, bilirubin, lactate dehydrogenase (LDH), creatinine, estimated glomerular filtration rate (GFR), myoglobin, creatine kinase (CK), and troponin T.

Results: A total of 60 patients were enrolled (PVI only n = 30, PVI + PWI n = 30). Baseline characteristics were comparable. PVI + PWI required more applications (19 vs. 16; p < 0.001) but had similar procedure time. Both groups showed significant increases in inflammatory (CRP, leukocytes), myocardial (troponin T, CK, LDH, myoglobin), and hemolysis markers (bilirubin, LDH, haptoglobin changes; all p < 0.001). However, the magnitude of biomarker release did not differ between PVI only and PVI + PWI: Δ troponin T (1,154 vs. 1,029 ng/L, p = 0.694), Δ CK (217 vs. 197 U/L, p = 0.652), Δ CRP (2.7 vs. 3.4 mg/L, p = 0.475), Δ bilirubin (2.4 vs. 2.8 µmol/L, p = 0.842), Δ creatinine (3.3 vs. 9.0 µmol/L, p = 0.085).

Conclusion: BiB-PFA PVI provokes systemic responses involving inflammation, myocardial injury, and hemolysis. Adjunctive PWI increases application number but does not further increase biomarker release, supporting the biological safety of PWI.

Objective: Heart failure is a common sequela of third-degree heart block. This study examines trends in mortality and utilization of medical resources before and during the COVID-19 pandemic in patients with heart failure and third-degree heart block. We also seek to investigate outcomes for different patient demographics, hospital characteristics, and related medical comorbidities.

Methods: Hospital admissions of adults with a primary diagnosis of heart failure and a history of third-degree heart block during the period between 2017 and 2022 were selected from the Healthcare Cost and Utilization Project National Inpatient Sample. The primary outcome was all-cause mortality; secondary outcomes were hospital length of stay and total hospital charges. Propensity matching was performed to account for differences between the two sample populations and reduce selection bias. Mortality was analyzed using logistic regression; the secondary outcomes were analyzed by using linear regression.

Results: There were 22,900 prepandemic (2017-2019) hospitalizations of patients with heart failure and third-degree heart block and 37,530 hospitalizations during the pandemic (2020-2022). There was no associated difference in all-cause mortality (p = 0.36), length of hospital stay (p = 0.066), or total hospital charges (p = 0.65) during the pandemic. An increased odds of in-hospital mortality was associated with the presence of chronic pulmonary disease [odds ratio (OR): 1.79, 95% confidence interval (CI): 1.07-3.01, p = 0.027], valvular disease (OR: 1.63, 95% CI: 1.01-2.63, p = 0.046), uncomplicated diabetes (OR: 1.89, 95% CI: 1.02-3.51, p = 0.042), liver disease (OR: 3.22, 95% CI: 1.79-5.79, p < 0.001), and coagulopathy (OR: 1.97, 95% CI: 1.18-3.30, p = 0.010).

Conclusion: There was no change in all-cause mortality length of stay or total charges of hospitalized patients with heart failure and a history of third-degree heart block during the COVID-19 pandemic as compared to before the pandemic. Certain comorbidities, however, were associated with higher mortality in this population.

Myocarditis is an inflammatory disease of the heart muscle that can lead to significant morbidity and mortality, particularly in the elderly population (≥65 years). This study aimed to provide a comprehensive global, regional, and national burden analysis of myocarditis from 1990 to 2021, with a prediction for 2050. We employed a variety of methodologies, including the estimation of age-standardized incidence rates, prevalence, disability-adjusted life years (DALYs), and their estimated annual percentage change (EAPC). Additionally, we analyzed age, sex, and temporal trends using line graphs and trend charts, revealing the shifts in disease burden across different demographics. Joinpoint regression analysis was performed to identify significant changes in burden over time, while the relationship between disease burden and the Socio-Demographic Index (SDI) was explored through a curve plot with a dot plot overlay. Age-period-cohort analysis was conducted to assess the influences of age effects, period effects, and cohort effects on disease burden. Decomposition analysis was employed to understand the impacts of population growth, aging, and epidemiological changes on the overall burden. Furthermore, we identified key risk factors contributing to myocarditis burden through curves and attributable risk ratios. Finally, Bayesian Age-Period-Cohort (BAPC) modeling was utilized to project the disease burden of myocarditis globally until 2050. Evidence suggests that a pivotal shift in disease burden occurred after 2010, with low temperature emerging as a primary risk factor for mortality. Our findings indicate a concerning trend in the increasing burden of myocarditis among the aging population, underscoring the urgent need for targeted public health strategies and further research to mitigate this growing health crisis.

Background: Left ventricular hypertrophy (LVH), a hallmark of pathological ventricular remodeling, is highly prevalent and strongly predicts mortality in patients undergoing maintenance hemodialysis (MHD). This study aimed to compare the efficacy of sacubitril/valsartan (SV) vs. angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) on ventricular remodeling in hypertensive MHD patients.

Methods: In this single-center retrospective cohort study conducted between January 2023 and June 2025, 111 hypertensive patients undergoing MHD for at least 3 months were divided into SV (n = 46) and ACEi/ARB (n = 65) groups based on their antihypertensive regimen. The primary endpoint was the change in left ventricular mass index (LVMI) after 6 months. Secondary endpoints included changes in blood pressure, other echocardiographic parameters, NT-proBNP, and safety outcomes.

Results: The mean age was 56.17 ± 13.47 years and 68.5% were male. After 6 months, LVMI significantly decreased in the SV group (-5.52 g/m², 95% CI -9.35 to -1.69, P = 0.006) but not in the ACEi/ARB group (1.11 g/m², 95% CI -3.27 to 5.50, P = 0.615). Two-way repeated measures ANOVA revealed a significant group × time interaction for LVMI (P = 0.033). Both groups achieved significant blood pressure reductions: systolic blood pressure decreased by 9.81 mmHg (P < 0.001) in the ACEi/ARB group and by 10.46 mmHg (P < 0.001) in the SV group. New-onset intradialytic hypotension occurred in 7 (6.3%) patients and hyperkalemia in 9 (8.1%) patients, with similar incidences between groups and no treatment discontinuations.

Conclusions: Compared to ACEi/ARB, SV is more effective in reversing ventricular remodeling in hypertensive MHD patients.

Background: Subclinical left ventricular (LV) impairment-characterized by reduced global longitudinal strain (GLS) despite normal left ventricular ejection fraction (LVEF)-is frequently encountered in hypertensive patients. While speckle-tracking echocardiography is the standard method for detecting early myocardial dysfunction, it is not universally available. Artificial intelligence-enhanced electrocardiography (AI-ECG) has emerged as a promising tool capable of uncovering subtle electrical patterns linked to early myocardial impairment. This study investigates the diagnostic capability of AI-ECG for detecting GLS-defined subclinical LV dysfunction.

Methods: In this retrospective analysis, 348 hypertensive adults who underwent both ECG and echocardiography within the same clinical visit (2022-2024) were evaluated. Subclinical LV dysfunction was defined as LVEF ≥50% and GLS > -18%.A convolutional neural network-based AI algorithm generated an AI-ECG probability score (range 0-1) representing the likelihood of LV dysfunction. Statistical analyses included correlation testing, regression modeling, and ROC curve evaluation.

Results: Subclinical LV dysfunction was identified in 134 participants (38.5%). The AI-ECG probability score differed markedly between the abnormal GLS group and the normal GLS group (0.61 ± 0.20 vs. 0.29 ± 0.18; p < 0.001). GLS values demonstrated a strong negative association with AI-ECG scores (r = -0.63). ROC analysis showed robust diagnostic ability with an AUC of 0.86 (95% CI: 0.82-0.89). In multivariable logistic regression adjusting for LV mass index, E/e', age, and hypertension duration, the AI-ECG probability score remained independently associated with subclinical LV dysfunction (adjusted OR 1.12 per 0.1 increase, 95% CI 1.07-1.18; p < 0.001).

Conclusion: AI-ECG accurately detects GLS-defined subclinical LV dysfunction in hypertensive adults and may serve as an accessible tool for early risk stratification in routine clinical settings.

Purpose: This study aimed to investigate risk factors for cardiovascular toxicity following anti-PD-1/PD-L1 therapy and develop a predictive model.

Methods: We retrospectively collected data from 2,665 patients with solid tumors treated with anti-PD-1/PD-L1 therapy at two-center between October 2018 and October 2023.We performed univariate and multivariate logistic regression to identify predictors of cardiovascular toxicity and developed a nomogram. Internal evaluation and internal validation were performed using receiver operating characteristic (ROC), decision curve analysis (DCA), calibration curve (CC) for internal evaluation and internal validation.

Results: Univariate logistic regression identified the Systemic Inflammatory Response Index (SIRI;OR 2.26, 95% CI 1.19-4.27, p = 0.012), Eastern Cooperative Oncology Group performance status (ECOG;OR 9.67, 95% CI 3.04-30.69, p < 0.001), hypertension (OR 3.50, 95% CI 1.78-6.88, p < 0.001), diabetes (OR 2.52, 95% CI 1.13-5.66, p = 0.025), tumor metastasis (OR 0.17, 95% CI 0.08-0.39, p < 0.001), tumor stage (OR 0.40, 95% CI 0.21-0.76, p = 0.006), and sex (male vs. female)(OR 0.43, 95% CI 0.19-0.96, p = 0.040) as significant predictors. Multivariate analysis confirmed ECOG (OR 9.81, 95% CI 2.73-35.25, p < 0.001) and tumor metastasis (OR 0.26, 95% CI 0.10-0.71, p = 0.008) as independent predictors. Seven variables (p < 0.05 in univariate analysis) were included in a nomogram, which showed good accuracy and discrimination (AUC 0.77, 95% CI 0.70-0.85).

Conclusions: SIRI, ECOG, hypertension, diabetes, tumor metastasis, tumor stage, and sex were significant predictors of cardiovascular toxicity. ECOG was an independent risk factor, while tumor metastasis was an independent protective factor, after adjusting for other covariates. The nomogram showed good accuracy and discrimination, with clinical utility for predicting cardiovascular toxicity risk in patients receiving anti-PD-1/PD-L1 therapy.

Background: Preclinical models of heart failure (HF) play a key role in developing new therapeutic strategies. Tachypacing is the gold standard to induce dilated cardiomyopathy (DCM) with reduced ejection fraction (EF) in large animals, but it is not exempted from failures and can induce relevant stress.

Aim: Establishing a revised porcine model of tachypacing-induced HF to improve reliability and reduce stress on the animals.

Methods: Eight (n = 8) females Göttingen minipigs were divided in two groups: 4 animals were implanted a right ventricular two-lead pacemaker to induce HF via tachypacing, while 4 animals without implant served as controls. After a recovery period, pigs were paced asynchronously at 180 bpm for 2-weeks and 200 bpm for 4-weeks. Disease progression was assessed by echocardiography, while hemodynamics was measured invasively before sacrifice. Stress was evaluated by jacketed external telemetry (JET), cortisol, body weight, and clinical symptoms.

Results: Echocardiographic assessment showed that all paced animals developed stable DCM as demonstrated by increase of end-systolic and end-diastolic volume at highly depressed ejection fraction. Invasive measurements confirmed these results with stable mAOP despite impaired pump function. JET showed no alterations of respiratory rate and daily activity throughout the protocol. Cortisol and cortisone levels and body weight showed no significant differences between groups or during pacing.

Conclusions: We established a reliable model of tachypacing-induced HF based on slower pacing and milder progression to HF, while reducing the stress and suffering of the animals.

Objective: Psychological distress significantly affects the progression of coronary heart disease (CHD), functional recovery and overall well-being. This study aims to establish an evidence-based foundation for clinical practice by systematically retrieving and synthesizing the best evidence on the assessment and management of psychosocial distress in CHD.

Methods: According to the '5S' evidence model, a top-down search strategy was conducted to collect relevant evidence, including guidelines, best practice, evidence summaries, expert consensus, systematic reviews or Meta-analyses. The search for this study covered the period from the database inception through September 10, 2025. Two reviewers independently screened and assessed the literature, then synthesized the evidence using the JBI evidence grading and recommendation system.

Results: A total of 21 articles were ultimately included, comprising 3 guidelines, 5 expert consensuses, 1 clinical decision, and 12 systematic reviews. This study summarizes 24 pieces of evidence across five aspects of social and psychological distress in patients with CHD: Personnel Qualifications and Team Composition, Psychological Assessment, Psychological Interventions, Continuity of Care and Follow-up Management, and Identification and Referral of Severe Issues.

Conclusion: This study systematically synthesizes the best available evidence from five core domains concerning early assessment and intervention for psychosocial distress in patients with CHD. The findings may inform the development of individualized psychological support strategies in clinical settings, facilitating timely alleviation of negative emotions and improving patient engagement in cardiac rehabilitation.

Systematic review registration: http://ebn.nursing.fudan.edu.cn/resource/summary, identifier ES20244245.