Frontiers in Cardiovascular Medicine最新文献

Introduction: Early identification of patients at risk for deterioration during hospitalization for acute heart failure (AHF) is essential for guiding intensive monitoring and advanced therapies. Biomarkers such as NT-proBNP and troponin I are routinely used, yet their comparative prognostic performance-particularly when stratified by sex-remains uncertain. Other emerging biomarkers, including lactate and the neutrophil-to-lymphocyte ratio (NLR), have also been linked to adverse outcomes, but their value relative to established cardiac markers has not been clearly defined.

Methods: We conducted a retrospective cohort study using de-identified electronic medical records from 2010 to March 2025 at a tertiary care center. Patients aged ≥16 years with clinician-documented AHF and available admission biomarkers were eligible. The primary endpoint was a composite of in-hospital death, mechanical ventilation, extracorporeal membrane oxygenation (ECMO), or intra-aortic balloon pump (IABP). Broad and strict endpoints were examined in sensitivity analyses. Multivariable logistic regression models, sex-stratified analyses, and penalized regressions with bootstrap resampling were performed.

Results: Among 143 eligible patients (81 men, 62 women), the primary endpoint occurred in 46.9%. In our cohort, women experienced a slightly higher crude rate of in-hospital deterioration compared with men (48.4% vs. 45.7%). Lactate was the most robust predictor across all models, with an odds ratio of 9.38 (95% CI 2.47-35.63; p = 0.001) per log10 increase and a clear dose-response (event rates 39.8%, 55.2%, and 85.7% across lactate strata ≤2, 2-4, and >4 mmol/L; p-trend = 0.002). In sex-stratified models, NT-proBNP (OR 2.87; p = 0.029) and lactate (OR 28.98; p = 0.003) were significant in men, while no biomarker reached significance in women. NLR predicted outcomes in the non-HFrEF subgroup. Model performance was modest (AUC ∼0.71-0.73) but calibration was good. Findings remained consistent in winsorized and bootstrap sensitivity analyses.

Conclusions: In this single-center AHF cohort, lactate emerged as the most consistent early biomarker associated with in-hospital deterioration, with stronger prognostic performance than the other evaluated cardiac markers. Sex-stratified and phenotype-specific findings (NT-proBNP and lactate in men, NLR in non-HFrEF) were exploratory and did not show significant sex-biomarker interaction. These results support incorporating lactate into early risk stratification and highlight the need for larger multicenter validation studies.

Objective: The aim of this study was to investigate the relationship between the platelet-to-lymphocyte ratio (PLR) and the risk of lower extremity deep vein thrombosis (DVT) in patients with femoral fracture, and to evaluate the potential influence of other risk factors, including age, gender, smoking status, neutrophil-to-lymphocyte ratio (NLR), and multiple fractures of the lower extremities.

Methods: A retrospective study was conducted on 1,083 patients with femoral fractures treated at Meizhou People's Hospital between November 2017 and April 2024. DVT was diagnosed using Doppler ultrasound. Data on clinical features, including age, gender, body mass index, history of smoking, hypertension, diabetes mellitus, and multiple fractures of the lower extremities, were collected. Routine blood tests were performed at admission to calculate inflammatory indices, including PLR, NLR, and others. Logistic regression analysis was used to assess the independent association of these factors with DVT.

Results: Among the 1,083 patients, 218 (20.1%) developed DVT. Logistic regression analysis identified that PLR (OR = 1.74, 95% CI: 1.16-2.62, P = 0.008), age (OR = 1.9, 95% CI: 1.21-3.30, P = 0.007), NLR (OR = 2.08, 95% CI:1.24-3.48, P = 0.005), gender (OR = 1.70, 95% CI: 1.17-2.49=, P = 0.005), history of smoking (OR = 2.19, 95% CI: 1.00-4.77, P = 0.05), and multiple fractures of the lower extremities (OR = 2.02, 95% CI: 1.32-3.11, P = 0.001) were independent risk factors for DVT.

Conclusions: PLR is an independent risk factor for lower extremity DVT in patients with femoral fracture, with a modest predictive performance (AUC = 0.60) that slightly outperforms age and NLR in this cohort. While these findings suggest PLR may have potential as a supplementary biomarker for DVT risk stratification, its clinical utility requires further validation in larger, multicenter studies.

Background and objectives: People living with HIV (PLWH) are increasingly at risk for cardiovascular disease (CVD) due to chronic inflammation, metabolic dysregulation, and long-term antiretroviral therapy (ART). However, limited data exist regarding coronary anatomy and long-term outcomes in PLWH with acute coronary syndrome (ACS), particularly in Chinese populations. This study aimed to compare coronary angiographic characteristics, metabolic-inflammatory profiles, and 2-year prognosis between PLWH and HIV-uninfected patients with ACS.

Methods: We conducted a single-center observational cohort study including 129 patients with a first episode of ACS between 2019 and 2023. 43 PLWH were analyzed with 86 HIV-uninfected controls. Coronary artery lesions were assessed by angiography and SYNTAX score. Laboratory parameters including CRP and lipid levels, among others, were collected. The primary outcome was the incidence of major adverse cardiovascular and cerebrovascular events during the 2-year follow-up period.

Results: PLWH had significantly higher SYNTAX scores compared to HIV-free patients (21.56 vs. 16.77, P = 0.001). They also showed elevated levels of LDL-C (3.18 vs. 2.66 mmol/L, P = 0.009) and CRP (median 9.10 vs. 5.10 mg/L, P < 0.001). At 2 years, PLWH had a higher rate of ACS recurrence (18.6% vs. 7.0%, P = 0.089), but mortality and other adverse events were similar. In multivariate analyses, HIV status was not an independent predictor of relapse, while calcified lesions were significantly associated with relapse.

Conclusion: PLWH with ACS have more complex coronary heart disease and a higher risk of recurrence, partly due to vascular calcific changes. These findings suggest the need for enhanced metabolic monitoring and individualized secondary prevention strategies in this high-risk population.

Background: Coronary heart disease (CHD) is a leading cause of death. Despite PCI improving coronary perfusion, many patients face low physical activity, reduced self-efficacy, and poor quality of life, emphasizing the need for better rehabilitation.

Objectives: To evaluate the effects of a 12-week Guozhuang dance intervention on exercise self-efficacy, functional capacity, physical activity, and health-related quality of life in CHD patients following PCI.

Methods: 88 post-PCI patients were randomly assigned to a control group (n = 44) or an intervention group (n = 44). Both groups received standard care; the control group participated in conventional rehabilitation, while the intervention group added Guozhuang dance. Outcomes measures were assessed at baseline(T0), at 4(T1) and 12(T2) weeks of intervention, and at 6 weeks after post-intervention (T3) using the Multidimensional Self-Efficacy for Exercise Scale (MSES), Six-Minute walk distance (6MWD), International Physical Activity Questionnaire (IPAQ), and the Chinese Questionnaire of Quality of Life (CQQC). Data were analyzed using intention-to-treat (ITT) analysis. The protocol was registered in the Chinese Clinical Trial Registry (ChiCTR2300069341).

Results: Both groups demonstrated comparable baseline characteristics (P > 0.05). Significant group × time interactions were found for exercise self-efficacy and 6MWT distance (both P < 0.001), while physical activity and quality of life showed significant main effects of group (both P < 0.05). The intervention group demonstrated significantly greater improvements in exercise self-efficacy, physical activity, and quality of life at T1, T2, and T3 (all P < 0.05). For 6MWD, significant between-group differences were observed at T2 and T3 (both P < 0.001), but not at T1 (P = 0.065 > 0.05).

Conclusion: A 12-week Guozhuang dance program significantly enhances exercise self-efficacy, functional capacity, physical activity, and quality of life in CHD patients after PCI, making it a valuable addition to traditional cardiac rehabilitation.

Clinical trial registration: https://www.chictr.org.cn/bin/home, identifier, ChiCTR2300069341.

Dilated cardiomyopathy (DCM) is a leading cause of heart failure worldwide and has a disproportionately high burden among young Africans. As a primary myocardial disorder, DCM frequently has a genetic aetiology. Although Africa harbours the greatest human genetic diversity, African populations remain underrepresented in genomic research, limiting variant interpretation and clinical applications of next-generation sequencing (NGS). Next Generation Sequencing has transformed the understanding of DCM by enabling comprehensive identification of disease-associated genes. This narrative review summarizes the clinical utility of NGS in the diagnosis, risk stratification, and management of DCM, with a particular focus on Africa. We also highlight some key barriers to implementation, clinical implications, and potential strategies to overcome them. Addressing these challenges through expanded African genomic research, strengthened local capacity, and equitable international collaborations is essential to advance precision cardiovascular medicine and improve outcomes for patients with DCM in Africa.

Objective: Growing evidence suggests major outcome and risk factor disparities between men and women undergoing cardiovascular surgery. Thus, sex-specific approaches are increasingly being adopted in cardiovascular medicine. However, data on sex-specific outcomes and risk stratification in complex thoracoabdominal aortic repair remain limited.

Methods: We present a retrospective single-center analysis of 311 consecutive patients, including 99 women (31.8%), who underwent open surgical thoracoabdominal aortic repair between 2000 and 2024. Propensity score matching was performed prior to a comparative analysis of intraoperative parameters, postoperative outcome, and complications, as well as short- and long-term mortality between female and male patients.

Results: In the initial study population, men had a significantly higher BMI (26.3 vs. 23.1 kg/m², p < 0.001) and greater prevalence of coronary artery disease (37.7% vs. 21.2%, p = 0.004) and hyperlipidemia (27.8% vs. 12.1%, p = 0.002) compared to women. Postoperatively, wound infections were more frequent in women in the unmatched cohort (12.1% vs. 4.3%, p = 0.01), but no sex-related differences in mortality, ICU length of stay, or long-term survival were observed after propensity score matching. Multivariate regression revealed highly distinct predictors of early mortality in each sex: prior cardiac surgery and urgency in men versus hypertension, chronic kidney disease, coronary artery disease, and older age at the time of operation in women.

Conclusion: Overall outcomes and survival following thoracoabdominal aortic repair were comparable between men and women. However, underlying risk factors for early mortality differed fundamentally between sexes. These findings underscore the importance of a sex-specific preoperative risk assessment in the surgical decision-making process prior to open thoracoabdominal aortic repair.

Background: In the context of cardiac surgery, morbid obesity poses several perioperative challenges. Some surgeons consider obesity a relative contraindication for minimally invasive aortic valve replacement (MIAVR) due to anatomical and technical complexities. Although MIAVR is increasingly used in standard-risk populations, evidence supporting its safety and efficacy in morbidly obese patients remains limited.

Methods: This retrospective cohort consisted of 920 patients who underwent MIAVR via partial upper ministernotomy at a high-volume cardiac surgery center between 2010 and May 2025. Patients were categorized into three groups based on BMI: Class I obesity (BMI 30-35 kg/m²; n = 164), Class II-III obesity (BMI > 35 kg/m²; n = 54), and a non-obese control group (n = 702). Key clinical outcomes, echocardiographic parameters, postoperative complications, and long-term mortality rates were compared. Additionally, a pairwise meta-analysis was conducted, incorporating five studies to assess outcomes of MIAVR vs. conventional full sternotomy in obese individuals.

Results: There were no significant differences in most of postoperative outcomes. However, higher rates of pneumothorax and arrhythmias were observed in Class II-III obesity. Multivariate regression did not identify obesity as an independent predictor of adverse outcomes. Meta-analysis confirmed comparable operative times and a trend toward shorter ICU stays and lower respiratory complications in the MIAVR group.

Conclusion: This study argues that (i) obesity alone should not delay, deter, or preclude appropriate candidates from being referred for surgical aortic valve replacement, and (ii) partial upper ministernotomy should be considered the preferred access route in obese patients, as it consistently facilitates recovery without compromising safety.

Background: Diffuse pulmonary arteriovenous malformations (PAVMs) are a rare but serious complication after the Glenn procedure. Clinically, they typically present with progressive hypoxemia, which can lead to worsening cyanosis, reduced exercise tolerance, and may even progress to heart failure.

Case summary: We report an 8-year-old boy with complex congenital heart disease, including double outlet right ventricle, ventricular septal defect, atrial septal defect, and pulmonary stenosis. He underwent a bidirectional Glenn procedure at 6 months of age and subsequently developed progressive cyanosis. At 5 years old, he presented to our center, where comprehensive evaluation confirmed extensive PAVMs. Consequently, an extracardiac total cavopulmonary connection (TCPC) was performed. During the 3-year postoperative follow-up, the PAVMs completely resolved, oxygen saturation normalized, and clinical symptoms improved markedly.

Conclusion: In patients with a history of Glenn procedure who present with unexplained hypoxemia, the possibility of postoperative PAVMs should be carefully considered. Early diagnosis and timely intervention can significantly improve outcomes. This case highlights the therapeutic value of TCPC in managing this complication.

Background: Left ventricle-right atrium (LV-RA) connection may develop secondary to ventricular septal defect (VSD) repair, particularly when the membranous septum or tricuspid valve is affected, leading to a leaflet defect. While surgery remains the standard treatment, reports of transcatheter valve closure are limited. This highlights the importance of exploring the safety and feasibility of transcatheter approaches for LV-RA connection, especially in high-risk patients.

Case presentation: This is the first reported case of a retrograde Konar-MF closure of an LV-RA connection on a 6-year-old male patient with a history of VSD surgery. Pre-procedural transesophageal echocardiography (TEE) showed a 4 mm defect in the septal leaflet of the tricuspid valve. A residual membranous septal aneurysm (MSA) extending from the subaortic region to the septal annulus of the tricuspid valve without residual shunt, and a small atrial septal defect (ASD) were also identified. The cardiac team performed closure using Konar-MF VSD Occluder No. 6/8 mm via a retrograde right femoral arterial approach, advancing the catheter through the left ventricle and across the defect. A well-positioned device with minimal residual central shunt and without peripheral leakage were confirmed from the post-procedural TEE. Clinical evaluation immediately after procedure and at 3-month follow-up demonstrated good results.

Conclusion: Percutaneous transcatheter device closure of an LV-RA connection in pediatrics is a feasible alternative to surgery using a retrograde technique.