Frontiers in Cardiovascular Medicine最新文献

Background: Given the changing epidemiological and burden trends of non-rheumatic degenerative mitral valve disease (DMVD), it is crucial to re-examine geographical differences and trends. Here, we describe the current trends of DMVD epidemiology using data from the Global Burden of Diseases (GBD) study from 1990 to 2021, with forecasts extending to 2050.

Methods: Annual case numbers and age-standardized rates (ASR) of incidence, prevalence, deaths, and disability-adjusted life years (DALYs) for DMVD between 1990 and 2021, as well as their estimated annual percentage changes (EAPC), were derived from the 2021 GBD study. Exponential smoothing and autoregressive integrated moving average models are employed for forecasting the future trends of DMVD.

Results: Between 1990 and 2021, the number of DMVD incidence cases increased from 566,261 (95% uncertainty interval [UI]: 523,330-609,607) to 1,162,558 (1,084,358-1,244,874), corresponding to a 105.3% (77.9-137.9) rise. Additionally, DMVD-related death cases rose by 53.8% (21.2-97.7), from 23,954 (21,032-26,296) to 36,844 (31,883-41,572). However, there is a decline in ASR of incidence and death. Stratified analysis revealed that the age-standardized incidence rate (ASIR) in males is nearly twice that of females, while the age-standardized death rate (ASDR) is higher in females. These trends are not expected to improve significantly by 2050. Concurrently, the ASIR peaks in individuals aged 65-69 and 70-74. In 2021, higher socio-demographic index (SDI) countries bore a greater DMVD burden, while lower-SDI countries faced greater cross-country inequalities.

Conclusions: The number of DMVD epidemiological indicators is rising annually. Higher-SDI countries need to adjust healthcare policies to address aging populations and support lower-SDI countries with medical resources and cardiology expertise. This study suggests that age 65 is a meaningful threshold for screening. Additionally, Our findings advocate for stratified public health interventions: incidence-based screening targeting males and mortality-focused treatment intensification for females.

Background: Cardiovascular disease (CVD) prediction models for persons living with HIV (PLWH) depend on traditional CVD risk factors, but these underestimate true risk. We aimed to identify proteins and genetic variants and create proteo-genomic risk scores for CVD in PLWH.

Methods: We analyzed genetic and protein data from participants involved in trials for PLWH. We used state-of-the-art statistical methods for data integration, identified correlated signatures, and developed a protein score (PS) and a genetic score (GS) to predict CVD. We conducted functional enrichment analysis to explore biological functions of signatures identified in relation to CVD.

Results: A panel of 14 proteins and a set of 15 genetic variants were found to be better at distinguishing between CVD cases and controls than individual proteins or genetic variants. The PS or GS was each independently associated with a higher risk of CVD (OR for PS: 2.36, CI: 1.78-3.19; OR for GS: 4.59, CI: 3.21-6.80). Combining CVD-, HIV-related factors, genetics, and protein scores resulted in the most powerful discrimination with an AUC of 0.86 (CI: 0.82-0.90). Having a PS in the top 25% compared to the bottom 75% resulted in a 3.9 times higher risk of CVD. Having a GS in the top 25% compared to the bottom 75% resulted in a 7.3 times higher risk of CVD. For individuals with both PS and GS in the top 25% compared to others, the risk of CVD was 7.9 times higher. Functional enrichment analysis showed an upregulation of the cytokine tumor necrosis factor (TNF) and strong enrichment for inflammation related pathways such as the pathogen induced cytokine storm.

Conclusions: A panel of protein biomarkers, some new (IGFBP7, HGF) and some previously known in PLWH (CLEC6A), could help identify PLWH at higher risk of developing CVD. If confirmed, these scores could be used with CVD and HIV-related factors to identify PLWH at risk for CVD who would benefit from proactive risk reduction strategies.

Introduction: Left ventricular-arterial interaction, also termed ventricular-arterial coupling (VAC), determines cardiovascular efficiency by matching cardiac performance and arterial functions, and comprehensively assesses cardiac contractility and arterial load in a common framework. Volume expansion is a commonly used hemodynamic measure in the management of circulatory shock. However, its hemodynamic effects on each component of the cardiovascular system are not fully understood. This study aimed to evaluate the effects of volume expansion on the left VAC and determine whether the left VAC is associated with fluid responsiveness in circulatory shock.

Materials and methods: This prospective observational study enrolled mechanically ventilated patients with circulatory shock, for whom the attending physician decided to perform a fluid challenge. Hemodynamics and left VAC were measured immediately before and after the fluid challenge. Fluid responsiveness was defined as a 15% or greater increase in cardiac index following the fluid challenge. Left VAC was quantified by the ratio of arterial elastance (Ea) to left ventricular end-systolic elastance (Ees), measured by echocardiography. Multivariable logistic regression analyses were used to identify hemodynamic variables associated with fluid responsiveness.

Results: Of 58 enrolled patients, 26 (44.8%) were fluid responders. Fluid responders exhibited a higher baseline Ea/Ees ratio compared to non-responders (1.22 ± 0.28 vs. 1.02 ± 0.30, P = 0.011), while the Ea and Ees were comparable between them. Volume expansion caused significant reductions in the Ea and the Ea/Ees ratio in fluid responders, and led to remarkable increases in the Ea and the Ea/Ees ratio in non-responders, while the Ees remained unchanged in both groups. The baseline Ea/Ees ratio was significantly correlated with the fluid-induced changes in cardiac index (r = 0.373, P = 0.004). Multivariable regression analysis suggested that the baseline Ea/Ees ratio was independently associated with fluid responsiveness after adjusting for confounders (odds ratio 1.339, 95% confidence interval: 1.075-1.668, P = 0.009).

Conclusion: In mechanically ventilated patients with circulatory shock, volume expansion optimized the left VAC in preload-dependent patients, primarily by reducing arterial load, and the baseline left VAC was associated with fluid responsiveness.

Background: During transcatheter aortic valve replacement (TAVR) procedures, traditional wire pacing demonstrates safety and efficacy profiles similar to, or even superior to, right ventricular pacing. However, it still has disadvantages such as high thresholds and impedance and unstable pacing in some patients.

Methods: Our center pioneered the following J-wire pacing technique: inserting a J-wire through the auxiliary access 8F sheath (for balloon-expandable valves) or the main access 20F sheath (for self-expanding valves) into the descending aorta and aligning it at the same height as the left ventricular wire creates a loop circuit between the J-wire and the left ventricular wire after the balloon or prosthesis has been inserted into the annulus. This study included a total of 26 patients. The impedance and threshold of traditional wire pacing and J-wire pacing were measured, and the pacing method with the lower threshold was selected as the intraoperative pacing method.

Results: All 26 patients were assigned to the J-wire pacing group, achieving a 100% surgical success rate. The proportion of patients with a pacing threshold ≤5 V was significantly higher compared to traditional wire pacing (76.92% vs. 0%), while the proportion with a threshold ≥10 V was significantly lower (0% vs. 38.46%).

Conclusions: J-wire pacing offers improved safety and effectiveness compared to traditional wire pacing in TAVR procedures. We herein share this single-center experience, hoping to provide novel insights for the refinement of TAVR procedures.

Aims: Pulmonary vein isolation (PVI) is a common treatment for atrial fibrillation (AF), but many patients experience recurrences. Physical activity can be beneficial in reducing recurrences. In Belgium, patients can join a reimbursed cardiac rehabilitation (CR) program after PVI, although not all do. This study retrospectively examined the impact of CR on AF recurrence after PVI.

Methods: A database of AF patients who underwent primary PVI ablation between 2007 and 2020 was analysed for documented AF recurrences. Patients were retrospectively divided into control and intervention groups based on their participation in the CR program.

Results: Of 1,765 included patients, 1,177 were controls, and 588 participated in CR [median age 64 (56-70) years (p = 0.186), BMI 27.7 kg/m² (p < 0.001), median follow-up 1,516 days (p < 0.001)]. The prevalence of hyperlipidemia (p = 0.009), smoking history (p = 0.001), and sleep apnea (p = 0.009) differed between both groups. Survival analysis showed no significant difference overall (p = 0.340), although there was an intriguing crossover of the recurrence curves after about 1,500 days. Despite an initial higher recurrence, patients who followed CR had a 32.2% lower odds of AF recurrence from 1 year post-PVI until study end (OR: 0.677 p = 0.005). After 3 months, BMI decreased significantly in the intervention group and increased in the control group (between-group p = 0.004).

Conclusion: Overall, we did not observe a lower AF recurrence in post-PVI patients with a CR program. Nevertheless, physical activity from the CR program may have long-term benefits based on weight loss and VO₂ max increase.

Stress hyperglycemia (SHG) is frequently observed in patients with acute myocardial infarction (AMI). Substantial evidence has established both SHG and the stress hyperglycemia ratio (SHR) as significant, independent predictors of adverse outcomes, linking them to an increased risk of major adverse cardiovascular events and demonstrating a strong association with in-hospital new-onset atrial fibrillation (NOAF). This review consolidates epidemiological evidence linking SHG to these clinical endpoints and details the key underlying pathophysiological mechanisms by which SHG promotes NOAF, including inflammatory activation, oxidative stress activation, calcium handling dysfunction, and autonomic remodeling. Future research should prioritize standardizing diagnostic criteria for SHG, developing integrated dynamic prediction models that incorporate SHG/SHR for NOAF risk, and conducting targeted clinical trials to evaluate early interventions.

Introduction: With the increasing utilization of left ventricular assist devices (LVADs) as a pivotal treatment option for end-stage heart failure, the rehospitalization of patients equipped with these devices has emerged as a significant issue impacting both quality of life and healthcare costs. This study evaluates readmission trends, predisposing factors, and their effects on survival over a long-term follow-up period for patients undergoing LVAD implantation.

Methods: The study included 141 patients who underwent LVAD implantation between 2015 and 2023 and were followed for a minimum of 12 months. We analyzed the reasons for readmission, trends related to the devices, and overall outcomes.

Results: The median duration of LVAD support was 49 months (IQR: 22-60). Overall, 102 patients (72.3%) experienced at least one readmission, with a median of two readmissions per patient (IQR: 0-3). Patients who were readmitted had a significantly higher body mass index (median 26.3 kg/m² vs. 23.4 kg/m², p = 0.003). In the multivariable Cox regression analysis, right ventricular dysfunction was the only factor independently associated with hospital readmission (HR = 1.769, 95% CI: 1.097-2.854, p = 0.019). Other variables-including body mass index, reoperative surgery, male gender, and tricuspid valve intervention-were not significantly associated with readmission. The most frequent causes of readmission were wound or driveline infections (33.7%), arrhythmias (16.9%), and right ventricular failure (11.8%). Long-term survival did not differ significantly between readmitted and non-readmitted patients (p = 0.335). Among device types, HeartMate III demonstrated the best survival outcomes [median 60 (40-60) months].

Conclusion: Although LVAD implantation substantially improves survival in advanced heart failure, hospital readmissions remain common throughout long-term follow-up. Right ventricular dysfunction represents a key determinant of readmission risk, highlighting the importance of optimized perioperative management and vigilant monitoring for right-sided failure. Preventive strategies aimed at early detection of RV dysfunction and driveline complications may further reduce rehospitalizations and improve patient outcomes.

Of the anterior mediastinal tumors, cavernous hemangiomas originating from the superior vena cava (SVC) in this region are rare. We present a case in which the chest CT scan during a health check-up revealed an irregular, patchy soft-tissue density shadow in the thymic region, measuring approximately 5.5 × 3.5 cm in diameter. Eight months later, an enhanced chest CT scan at our hospital demonstrated an irregular, mass-like soft-tissue density shadow in the anterior mediastinum, with poorly defined borders adjacent to vascular structures and an increased diameter of approximately 6.0 × 3.8 cm. During surgery, the lesion exhibited a hemangioma-like appearance, with its base located at the confluence of the left and right innominate veins into the SVC. Mediastinal lesion resection and SVC plasty were therefore performed under cardiopulmonary bypass. Postoperative pathological examination confirmed the diagnosis of SVC cavernous hemangioma. The patient recovered uneventfully and was discharged on postoperative day 6. A follow-up chest CT scan more than three months after surgery showed imaging changes consistent with resection of the cavernous hemangioma. In addition, atelectasis in the right middle and lower lobes had significantly improved compared to earlier imaging. This case offers valuable clinical experience and insights to support treatment decision-making in similar scenarios.