Frontiers in Cardiovascular Medicine最新文献

Objective: This study evaluated the prognostic value of nutritional status indexes [albumin (ALB), hemoglobin (Hb), Geriatric Nutritional Risk Index (GNRI)] in elderly chronic heart failure (CHF) patients.

Methods: A total of 190 elderly CHF patients were categorized into good (n = 142) and poor (n = 48) prognosis groups based on 1-year outcomes (rehospitalization or all-cause death). Clinical data, including cardiac function [New York Heart Association (NYHA) class], inflammatory markers, and nutritional indexes (ALB, Hb, GNRI), were analyzed. Spearman correlation was used to assess the relationship between nutritional markers and NYHA class. Patients were stratified by median ALB, Hb, and GNRI levels to compare poor prognosis incidence. Kaplan-Meier survival and Cox regression analyses identified prognostic factors, while Receiver Operating Characteristic (ROC) curves evaluated predictive performance.

Results: The poor prognosis group exhibited significantly lower ALB, Hb, and GNRI levels (P < 0.001). These markers declined with worsening NYHA class (P < 0.001) and correlated negatively with cardiac function. Low ALB, Hb, and GNRI groups had higher poor prognosis rates (P < 0.001), confirmed by Kaplan-Meier analysis. Cox regression identified left ventricular ejection fraction (LVEF), N-terminal pro-B-type natriuretic peptide (NT-proBNP), NYHA class, ALB, Hb, and GNRI as independent prognostic factors. ROC analysis showed ALB [area under the curve (AUC) = 0.845], Hb (AUC = 0.884), and GNRI (AUC = 0.896) as strong predictors with high sensitivity/specificity.

Conclusion: Reduced ALB, Hb, and GNRI levels are associated with poor CHF prognosis in elderly patients. These nutritional indexes offer reliable predictive value for clinical prognosis assessment.

Drug-coated balloons (DCBs) are emerging as a valuable alternative to drug-eluting stents (DES) in percutaneous coronary intervention (PCI), especially in the context of complex coronary artery disease (CAD). While DES remain the standard of care in PCI, their use is associated with several well-recognized limitations, including impairment of vascular physiology, inhibition of positive remodeling, and a persistent risk, estimated at approximately 2% per year, of stent-related adverse events, which increases with increasing stent length and anatomical and clinical complexity. DCBs deliver antiproliferative agents without leaving a permanent metallic scaffold, offering the potential to reduce stent burden, preserve native vessel physiology, and shorten the duration of dual antiplatelet therapy. Their efficacy is well established in the treatment of in-stent restenosis (ISR) and de novo lesions in small vessels (SVD). However, the use of DCBs in large-vessel and complex lesions (such as bifurcations, long lesions, and chronic total occlusions) remains under investigation. Preliminary observational data suggest feasibility and potential benefits, particularly in carefully selected cases with adequate lesion preparation. This review synthesizes current pathophysiological insights, procedural considerations, and clinical data on the use of DCBs in complex large-vessel CAD and underscores the need for large-scale randomized trials to define their long-term safety and efficacy in this setting.

Background: Severe COVID-19 frequently necessitates prolonged intensive care treatment, including long-term mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO). While survival outcomes of these modalities have been extensively studied, data on long-term psychological sequelae remain limited. This study compared psychosocial outcomes in COVID-19 ICU survivors treated with ECMO vs. prolonged MV alone.

Materials and methods: In this exploratory single-centre study combined retrospective clinical data with prospective long-term psychosocial follow-up, 150 adult patients with severe COVID-19 treated between March 2020 and December 2021 were included (ECMO: n = 98; MV: n = 52). Clinical data were collected retrospectively. The primary outcome of the study was long-term psychosocial outcome, which was assessed prospectively using validated questionnaires for depression, post-traumatic stress symptoms, attachment-related anxiety and avoidance, and health-related quality of life during structured long-term follow-up after ICU discharge.

Results: ECMO patients were significantly younger (mean 53.8 vs. 66.0 years; p < 0.001) and required longer invasive ventilation (29.3 vs. 13.3 days; p = 0.011). Among survivors completing long-term follow-up, substantial psychological morbidity was observed in both treatment groups, with differences in attachment-related anxiety and numerically higher depressive and post-traumatic stress symptoms depending on ventilation strategy. Multivariate Cox regression identified older age, chronic obstructive pulmonary disease, and the need for hemodialysis as independent predictors of mortality A total of 29 survivors (ECMO: n = 16; MV: n = 13) completed psychological follow-up assessments. The observed pattern of higher depressive and trauma-related symptom burden among ECMO survivors may reflect the cumulative psychological impact of prolonged life-support, high perceived threat to life, and prolonged dependency during critical illness rather than a direct effect of ECMO itself. Survival did not differ significantly between groups.

Conclusion: Survivors of severe COVID-19 requiring either ECMO or prolonged mechanical ventilation exhibit a substantial long-term psychological burden. Distinct psychosocial profiles were observed between treatment modalities, with higher attachment-related anxiety among MV survivors and numerically greater depressive and trauma-related symptoms among ECMO survivors. These findings highlight the importance of systematic post-ICU psychological screening and the integration of psychosocial outcomes into long-term critical care follow-up.

Background: Although symptom perception appears promising for enhancing health-related quality of life in patients with heart failure (HF), no quantitative pooling of effect sizes has been described to summarize and test its efficacy on clinical outcomes. This systematic review and meta-analysis aimed to determine the effect of symptom perception interventions on HF patients' symptom perception (primary outcome), self-care, HF knowledge, self-care efficacy, quality of life, rehospitalisation, emergency department visits, and mortality (secondary outcomes).

Methods: We systematically searched four databases: PubMed, Embase, the Cochrane Library, and CINAHL, from inception to March 31, 2025. RCT studies exploring the effectiveness of symptom perception interventions among HF patients were included. The studies were independently screened and extracted by two reviewers. ROB2 was applied to assess risk bias. A meta-analysis was performed using STATA 17.0.

Results: Eight articles involving a total of 1030 patients were included. Pooled results showed that for HF patients, symptom perception interventions failed to decrease rehospitalization, emergency department visits and mortality. However, such interventions significantly improved patients' immediate post-intervention outcomes, including symptom perception (SMD: 0.579, 95% CI: 0.259-0.898, P = 0.000), self-care (SMD: 0.697, 95% CI: 0.436-0.959, P = 0.000), HF knowledge (SMD: 1.481, 95% CI: 0.270-2.692, P = 0.017), self-care efficacy (MD: 7.875, 95% CI: 1.054-14.695, P = 0.024), and ultimately enhanced quality of life (MD: -8.240, 95% CI: -16.088 to -0.392, P = 0.040).

Conclusion: The review suggests that symptom perception interventions can improve HF patients' symptom perception, self-care, HF knowledge, self-care efficacy, and quality of life, although they do not reduce rehospitalization, emergency department visits, or mortality. The findings provide a basis for optimizing symptom perception intervention plans for future researchers.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251035486, PROSPERO CRD420251035486.

Background: Hemodynamic monitoring enables the optimization of care for patients admitted in a critical state. Nurses often rely on their own clinical judgment and intervention in the cardiac ICU environment, especially when feedback loops are interrupted. This is very much dependent on nurses being competent in hemodynamic monitoring and interventions, an area in which research has been limited, particularly in low-resource settings like Iraq.

Aim: The study aimed to investigate the relationships between competencies in hemodynamic monitoring and clinical decision-making, surrounding contextual factors that helped or hindered these practices within the Iraq context.

Methods: To achieve the aim of this study, a mixed-methods approach was used to bring together a cross-sectional survey of the 120 ICU nurses and 17 detailed interviews. The quantitative surveys included during the study produced data with measures of knowledge, interpretation, and clinical decision-making ability. To understand the lived experiences of nurses in this context, qualitative data was collected and systematically analysed using thematic analysis.

Results: The quantitative results found a statistically significant that the competency levels of the hemodynamic monitoring of patients were positively correlated to the quality of clinical decision-making outcomes (r = 0.59, p < 0.001). The regression analysis found that competency level, years of ICU experience and level of education were significant predictors (R ² = 0.42, p < 0.001). The qualitative analysis identified many barriers to competence, including the absence of advanced training opportunities, relying on physicians for decision-making, and inconsistency of protocols.

Conclusion: Although clinical competence significantly influences nurses' clinical decision-making, its effective application is strongly shaped by organizational and contextual factors, including training opportunities, workload, and institutional support.

Coronary microvascular dysfunction (CMD) is increasingly recognized as a significant cardiovascular condition, particularly among women, yet its diagnosis and management during pregnancy remain poorly understood. CMD may arise de novo in the context of hypertensive disorders of pregnancy or represent an exacerbation of pre-existing endothelial dysfunction. This article views current evidence surrounding CMD in pregnancy, outlines the limitations of current diagnostic and treatment approaches, and highlights critical research gaps that must be addressed to improve outcomes in this vulnerable population.

As the vital power organ of the human body, the health of the heart directly determines an individual's quality of life and longevity. With the accelerating global aging population, cardiac aging-related diseases have become a major public health threat. Although existing interventions (e.g., senolytics) can delay cardiac aging to some extent, their efficacy remains limited, necessitating the exploration of novel mechanisms to develop more effective therapeutic strategies. In recent years, PANoptosis-an integrated cell death pathway-has emerged as a new research focus in cardiac aging. It may contribute to cardiac functional decline by accelerating cardiomyocyte loss, fibrosis, and chronic inflammation. Targeting PANoptosis-based intervention strategies (e.g., gene editing, RNAi, combination therapy, and novel delivery systems) has demonstrated significant therapeutic potential, offering new preclinical avenues to delay or alleviate cardiac aging. This review summarizes the molecular mechanisms and roles of PANoptosis in cardiac aging, including its regulatory networks, key evidence driving cardiac aging, and targeted intervention strategies, thereby providing a theoretical foundation for developing PANoptosis-targeted therapies against cardiac aging.

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are integral to quadruple therapy for perioperative heart failure management in valvular heart disease (VHD) patients. Despite cardioprotective benefits, SGLT2i use correlates with acute sarcopenia and mobility impairment. This study evaluated whether Enhanced Recovery After Surgery (ERAS) protocols mitigate SGLT2i-associated mobility limitations.

Methods: In a single-center, retrospective cohort study [conducted from (Start Date) to (End Date)], 48 VHD patients undergoing valve surgery under an Enhanced Recovery After Surgery (ERAS) protocol were analyzed (Quadruple therapy [QT] with SGLT2i, n = 34; Triple therapy [TT] without SGLT2i, n = 14). Primary outcomes assessed mobility via Activities of Daily Living (ADL, Barthel Index), stress ulcer risk (Braden scale), and fall risk (Modified Thomas scale) at multiple perioperative timepoints. Secondary outcomes included ERAS metrics (ICU duration, mobilization times), cardiac function, and laboratory parameters.

Results: The QT group experienced significantly longer ICU stays than the TT group (median 49 vs. 43 h, p = 0.003), indicating greater initial morbidity and resource utilization. The time to first off-bed mobilization was also delayed in the QT group (67 vs. 53 h, p = 0.042), a 14-hour delay that heightens the risk of muscle atrophy and pulmonary complications. Post-anesthesia recovery: QT showed lower ADL scores (10 vs. 15, p = 0.007) and higher stress ulcer risk (Braden 13 vs. 16, p = 0.025). ICU discharge: QT maintained higher stress ulcer risk (Braden 16 vs. 17, p = 0.006). Secondary care: QT demonstrated superior ADL recovery (95 vs. 85, p = 0.017) and lower stress ulcer risk (Braden 22 vs. 21, p = 0.043). No intergroup differences in cardiac function or laboratory parameters (p > 0.05). Multivariate analysis identified ICU duration, mechanical ventilation time, platelets, albumin, and NT-proBNP as significant mobility correlates (|r| = 0.368-0.625, p < 0.05).

Conclusion: SGLT2i use is associated with transient perioperative mobility impairment in VHD patients, evidenced by longer ICU stays and delayed mobilization. However, a structured ERAS protocol effectively mitigates these limitations, facilitating superior functional recovery by discharge. These findings underscore the necessity of adapting or closely monitoring ERAS protocols, particularly for patients on SGLT2i, to mitigate early mobility deficits. This supports tailoring ERAS pathways, particularly early mobilization, for this patient population.

Background: Danon disease is a rare X-linked dominant lysosomal storage disorder caused by lysosome-associated membrane protein 2 (LAMP2) deficiency. Female carriers demonstrate highly variable penetrance, and neurological manifestations are under-recognized, which delays diagnosis and targeted management.

Case presentation: A 27-year-old woman presented with sudden-onset left-sided weakness that resolved within three weeks. Initial magnetic resonance imaging demonstrated a right basal ganglia infarction with distal right middle cerebral artery narrowing, and she received dual antiplatelet therapy and statins. When she was referred for etiologic evaluation, physical and neurological examinations were unremarkable, yet N-terminal pro-B-type natriuretic peptide and cardiac troponin I levels were elevated. Transthoracic echocardiography revealed left ventricular dilation with global hypokinesia (ejection fraction 30%). Right heart contrast echocardiography excluded patent foramen ovale, whereas 24 h Holter monitoring captured frequent atrial and ventricular ectopy with short ventricular tachycardia runs. Cardiac magnetic resonance showed markedly reduced systolic function (left ventricular ejection fraction 21%) and mid-wall late gadolinium enhancement, while myocardial perfusion imaging confirmed global hypoperfusion. Whole-exome sequencing identified a heterozygous LAMP2 frameshift variant (c.1079_1083delGAAAG; p.Gly360Valfs*11), which was validated by Sanger sequencing. Cascade testing revealed a hemizygous carrier son and wild-type parents. She was treated with contemporary heart failure therapy, oral dabigatran for presumed cardioembolic stroke, and listed for heart transplantation.

Conclusion: This case underscores that Danon disease in women may initially mimic cryptogenic stroke. Multimodality cardiac imaging combined with genetic analysis is crucial for recognizing atypical presentations and guiding anticipatory heart failure management.