Future cardiology最新文献

Right ventricular (RV) function is a major determinant of clinical outcomes in patients undergoing cardiac surgery and transcatheter interventions. Although left ventricular morphology and function have been the traditional focus of preprocedural assessment, RV dysfunction is now recognized as an important predictor of morbidity and mortality. Therefore, inclusion of RV-related parameters in preprocedural risk assessment is on the rise. This review summarizes current evidence on the role of RV function in various cardiac diseases that require surgery or interventions. Conventional two-dimensional echocardiographic parameters, such as tricuspid annular plane systolic excursion, RV fractional area change, and peak systolic tissue Doppler velocity, provide limited information due to the complex RV geometry. Advanced imaging techniques, including speckle-tracking, three-dimensional echocardiography, and cardiac magnetic resonance imaging, enable more accurate quantification of RV volumes, ejection fraction, strain, RV motion components and RV-pulmonary artery coupling, and have demonstrated superior prognostic value. Therefore, a comprehensive assessment of RV function using advanced imaging techniques should be incorporated into routine clinical practice to improve risk stratification and preprocedural planning before cardiac surgery and transcatheter interventions. However, it is necessary to standardize imaging protocols and define validated reference thresholds to support the clinical implementation of these state-of-the-art parameters.

Heart failure (HF) remains a major clinical and healthcare challenge with high morbidity, mortality, and impaired quality of life (QOL). Approximately 30-40% of HF cases in the western world are of nonischemic heart failure (NIHF) origin; yet, regenerative therapies are lacking. Evidence suggests that systemic inflammation contributes to disease progression in NIHF, highlighting immunomodulation as a potential therapeutic target. Mesenchymal stromal cells (MSCs) possess regenerative and immunomodulatory properties, with adipose tissue derived stromal cells (ASCs) emerging as particularly promising. ARIISE is a Danish, multicenter, randomized, double-blinded, placebo-controlled study evaluating the efficacy and safety of intravenous allogeneic ASC therapy (C2C_ASC110) in patients with NIHF and reduced left ventricular ejection fraction (LVEF ≤ 45%). Ninety patients will be randomized to receive either C2C_ASC110 or placebo dimethyl sulfoxide (DMSO) (Cryostor®) intravenously twice 1 month apart, in addition to optimal guideline-directed medical therapy. The primary endpoint is a change in LVEF at 6-month follow-up after second ASC/placebo infusion. Secondary endpoints include other echocardiographic measurements, functional capacity, biomarkers, quality of life (QOL), and safety outcomes. If successful, ARIISE may establish clinical evidence for intravenous ASC therapy as a safe, feasible, and effective regenerative treatment for patients with NIHF.Clinical trial registration: EU CT number: 2025-520837-22-00, UTN number: U1111-1315-7011, Clinicaltrials.gov number: NCT06840275.

Background: Patients with dialysis-dependent chronic kidney disease (CKD) have a high cardiovascular burden, prompting interest in fish oils or long-chain omega-3 polyunsaturated fatty acids (n-3 PUFAs) as potential risk-reducing therapies in this population.

Methods: We conducted a systematic review and meta-analysis of studies in adults receiving dialysis that assessed associations between n-3 PUFA supplementation, baseline levels, or dietary intake and CV outcomes, or all-cause mortality. Hazard ratios (HRs) were pooled using random-effects models.

Results: Twelve studies met inclusion criteria. In hemodialysis-dependent CKD, fish oil supplementation lowered cardiovascular events by 44% (HR 0.56; 95% CI 0.46-0.68) and myocardial infarction by 48% (HR 0.52; 95% CI 0.34-0.78). Higher baseline n-3 PUFA levels were associated with a 31% reduction in all-cause mortality (HR 0.69; 95% CI 0.54-0.88). Higher dietary n-3 PUFA intake showed a non-significant trend toward lower all-cause mortality (HR 0.92; 95% CI 0.79-1.08).

Conclusion: In dialysis-dependent CKD, higher n-3 PUFA exposure through fish oil supplementation or higher baseline levels was associated with fewer cardiovascular events and all-cause mortality. Appropriately dosed n-3 PUFA supplementation represents a promising cardiovascular risk reduction strategy in dialysis-dependent CKD, although confirmatory randomized trials are warranted.

Cardiovascular diseases (CVDs) remain a leading cause of global morbidity and mortality, requiring precise risk prediction models for effective prevention and management. This review maps and evaluates globally utilized and country-specific CVD risk prediction models, including the Framingham Risk Score, Pooled Cohort Equations, PREVENT, WHO/ISH Risk Charts, INTERHEART, and SCORE2. A structured literature search was conducted using PubMed and Google Scholar, from which 30 relevant studies were selected. Most of the models integrate traditional risk factors such as age, sex, blood pressure, cholesterol, and smoking status to estimate CVD risk. While these models demonstrate moderate to good discrimination (C-statistics ranging from 0.66 to 0.80) and validation, their applicability varies across populations, with concerns about overestimation or underestimation in non-original cohorts. Notably, the WHO/ISH and Globorisk models address global diversity by incorporating regional calibrations, making them suitable for low- and middle-income countries. Similarly, the country-specific risk scores outperform global models due to their incorporation of local socio-demographics. Limitations persist across existing models, including the underrepresentation of younger individuals, ethnic minorities, and the exclusion of emerging risk factors. Future efforts must prioritize the development of locally validated, population-specific models to support equitable and effective CVD risk assessment and prevention.

Background: Inflammatory bowel disease (IBD) is associated with systemic inflammation and increased cardiovascular risk, but its impact on in-hospital outcomes after acute myocardial infarction (MI) remains unclear.

Methods: We conducted a retrospective cohort study using the National Inpatient Sample (2016-2022) to identify hospitalizations for acute MI and compared outcomes between patients with and without IBD. Multivariate logistic regression was used to evaluate the association between IBD and post-MI complications. Associations were summarized as adjusted odds ratios (aORs) with 95% confidence intervals (CIs).

Results: Among 1,456,940 MI hospitalizations, 7,430 had IBD. After adjustment, IBD was associated with higher odds of mortality (aOR 3.32, 95% CI 3.18-3.47; p < 0.0001), left ventricular rupture (aOR 4.46, 95% CI 3.16-6.28; p < 0.0001), left ventricular aneurysm (aOR 1.93, 95% CI 1.61-2.31; p < 0.0001), acute mitral regurgitation (aOR 9.80, 95% CI 6.81-14.10; p < 0.0001), and stent restenosis (aOR 1.16, 95% CI 1.07-1.26; p = 0.0002). IBD was also associated with longer hospital stay (coefficient 2.13 days, 95% CI 2.03-2.23; p < 0.0001) and higher total hospital charges.Conclusion: IBD was associated with worse in-hospital outcomes and higher resource utilization after MI in this nationwide hospitalization-level analysis.

Background: Older adults with Non-ST-Segment Elevation Myocardial Infarction (NSTEMI) are often undertreated invasively due to concerns about risks and comorbidities, despite potential benefits. Their limited inclusion in clinical trials leaves a gap in evidence-based management. This meta-analysis compared invasive versus conservative strategies in elderly NSTEMI patients.

Methods: A systematic search was conducted across PubMed, CENTRAL, Web of Science, Scopus, and Embase through December 2024. Pooled results were reported using risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes with 95% confidence intervals (CI).

Results: A total of 11 randomized controlled trials involving 4114 patients were included. Invasive treatment significantly reduced the composite of all-cause mortality and non-fatal MI (RR: 0.82; 95% CI: 0.68-0.99; p = 0.04) and MI alone (RR: 0.68; 95% CI: 0.56-0.84; p = 0.0003). There was no significant difference in all-cause mortality (RR: 1.04; 95% CI: 0.92-1.16; p = 0.55) or cardiovascular death (RR: 0.96; 95% CI: 0.78-1.18; P = 0.67). Invasive strategy significantly lowered the need for revascularization (RR: 0.29; 95% CI: 0.21-0.40; p < 0.0001).

Conclusion: In NSTEMI patients aged ≥70, invasive management reduces the risk of MI and revascularization without increasing mortality risk. More elderly-focused trials are warranted.

Protocol registration: https://www.crd.york.ac.uk/prospero identifier is CRD42025633157.

Severe pure native aortic regurgitation (PNAR), if untreated, carries a high mortality rate. Many patients are ineligible for surgical aortic valve replacement (SAVR) due to high risk. While transcatheter aortic valve replacement (TAVR) is an alternative, its application in PNAR is challenged by anatomical factors like the absence of calcification for anchoring. Dedicated transcatheter devices are not widely available, leading to the off-label use of self-expanding valves, though robust comparative evidence is lacking. The TRAMPERS trial is a prospective, multicenter, controlled, open-label clinical trial that aims to evaluate the safety and effectiveness of transfemoral TAVR using the VitaFlow™ Liberty self-expanding valve system compared to the J-Valve system in patients with severe PNAR. A total of 180 patients with severe PNAR will be enrolled across four centers in China and evaluated by a heart team. Patients will be allocated in a 1:1 ratio to the VitaFlow™ group (n = 90) or the J-Valve control group (n = 90). The primary endpoint is a composite of all-cause mortality, disabling stroke and rehospitalization for heart failure at 12 months post-procedure, assessed for non-inferiority. Secondary endpoints include procedural complications, clinical events, health status and cost-effectiveness. All endpoints are adjudicated according to VARC-3 criteria.Clinical Trial Registration:NCT06818084 (ClinicalTrials.gov).

Consumer wearables are increasingly used to document palpitations, but their algorithms are almost exclusively validated for atrial fibrillation (AF). We report a 70-year-old man with recurrent palpitations, no prior cardiovascular history, and controlled hypertension. A single-lead Apple Watch ECG classified sinus rhythm at 75 bpm, while a same-day 12-lead ECG revealed typical atrial flutter with sawtooth waves and regular atrioventricular conduction. After adequate anticoagulation, the patient underwent successful electrical cardioversion with 120 J and remains in stable sinus rhythm. This case highlights that AF-validated smartwatch algorithms may miss other supraventricular arrhythmias, particularly with regular ventricular response. Smartwatches can aid AF screening and symptom capture, but persistent symptoms require confirmation with standard 12-lead ECG. Future work should prioritize algorithm refinement and rigorous, post-market validation beyond AF to ensure that consumer devices transition from wellness tools to clinically reliable instruments for arrhythmia management.

Background: MASLD is a prevalent liver condition linked to increased cardiovascular risks and higher mortality, particularly among those with AMI. This study explores the impact of MASLD on clinical outcomes in patients with AMI, focusing on mortality, hospital charges, and length of stay.

Methods: The NIS database from 2018 to 2020 was utilized to evaluate the prevalence, mortality, costs, and resource use related to primary AMI hospitalizations with and without MASLD.

Results: A total of 1,885,105 hospitalizations with AMI were identified, with 39,000 (2.1%) patients having AMI and MASLD. The mean length of hospital stay was significantly longer in AMI patients with MASLD (5.58 days) compared to those without MASLD (4.34 days) (p < 0.001). In-hospital mortality was significantly higher in patients with MASLD (7.8%) compared to those without (4.6%), with 45% increased odds of mortality (OR: 1.45, p < 0.001). The hospital charges were also higher for patients with MASLD ($128,494) compared to non-MASLD patients ($104,836) (p < 0.001), with regression analysis indicating an additional $9,911 in charges (p < 0.001).

Conclusions: AMI patients with MASLD experience higher mortality rates, longer hospital stays, and increased healthcare costs. Further research is essential to develop improved management strategies.