Journal of Cardiovascular Development and Disease最新文献

Extracellular matrix metalloproteinase ADAMTS1 (adhesion metalloproteinase with thrombospondin-type domain 1) is a key regulator in cardiovascular remodeling with functional paradoxes. This review synthesizes existing evidence to clarify its context-dependent dual roles across various cardiovascular diseases: on the one hand, ADAMTS1 exerts protective functions by maintaining vascular integrity and mitigating inflammatory responses; on the other hand, in conditions such as myocardial infarction and aortic aneurysms, ADAMTS1 promotes pathological progression by excessively hydrolyzing the multifunctional proteoglycan versican and other substrates, leading to tissue disruption and adverse remodeling. This functional switch in ADAMTS1 is jointly regulated by its cellular origin, temporal expression dynamics, and local microenvironment. In summary, ADAMTS1 represents a critical homeostasis node in the cardiovascular system. Therapeutic interventions targeting it should avoid broad-spectrum inhibition strategies; instead, future efforts should focus on developing precise, context-specific regulatory approaches.

This study examines pediatric cardiomyopathies by analyzing genetic and clinical data from 55 patients (2021-2024) at Beijing Anzhen Hospital. Four subtypes were studied: dilated (DCM, 24), hypertrophic (HCM, 22), arrhythmogenic right ventricular (ARVC, 7), and restrictive (RCM, 2). Clinical data, imaging, labs, and family histories were collected, with whole-exome sequencing (WES) identifying disease-causing variants classified via ACMG guidelines. Statistical analysis revealed a median age of 11 years, a proportion of 58% male participants, and ethnic diversity (21 northern Han, 29 southern Han, 5 minorities). In the cohort, 13 cases had an LVEF below 35%. Pathogenic/likely pathogenic (P/LP) variants were found in 21.8% of the patients, and variants of uncertain significance (VUS) were present in 38.2%, with MYH7 (seven cases) and MYBPC3 (five) being the most common. The WES positivity rates varied, at 58.3% (DCM), 72.7% (HCM), and 33.3% (ARVC/RCM). DCM patients with P/LP/VUS variants showed better contractile function (Fractional Shortening: 29.0% vs. 16.5%, p = 0.008). Females in the DCM group had poorer cardiac function (lower LVEF, higher LVESd, lower cardiac output) compared to males, with more females (nine vs. three) exhibiting an LVEF < 35% (p = 0.041). No significant gender differences were observed in the HCM cases. These findings highlight genotype-phenotype correlations and underscore the need for early intervention in female DCM patients.

Background: Ventricular assist devices serve as a critical bridge to transplantation for pediatric patients with end-stage heart failure. This study evaluated the outcomes of pediatric patients who received Berlin Heart EXCOR support for end-stage heart failure.

Methods: We retrospectively analyzed data from 11 consecutive pediatric patients (63.64% male, median age 60 months) who underwent Berlin Heart implantation from November 2021 to April 2025. The majority (90.90%) had dilated cardiomyopathy, and 72.73% were INTERMACS class I.

Results: Of the 11 patients, 54.54% received an LVAD only, 36.36% received a BiVAD, and 9.09% required an LVAD followed by an RVAD. The postoperative mean ICU stay was 140 ± 73 days, and total hospital stay was 192 ± 96 days. Significant post-implant complications included stroke (27.27%), bleeding requiring exploration (27.27%), and pneumonia (36.36%). Ten patients (90.91%) were successfully bridged to heart transplantation, with one pre-transplant mortality (9.09%) due to brain hemorrhage. The median time to transplantation was 88 days (interquartile range, IQR: 78-177). During a median follow-up of 17 months (IQR: 7-32), two patients died post-transplant, resulting in an overall survival rate of 67.50% at 3 years.

Conclusions: Despite significant complications and prolonged hospitalization, the Berlin Heart demonstrated effectiveness as a mechanical circulatory support device for pediatric patients, with a high rate of successful bridging to transplantation and acceptable mid-term survival. These findings support its use as a viable bridge to transplantation in pediatric end-stage heart failure.

Aortic stenosis (AS), a progressive valvular disease that results in increasing left ventricular (LV) afterload, leads to ventricular dysfunction and heart failure if left untreated. Transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive and effective alternative to surgical replacement, especially in elderly or high-risk patients. Objectives: The present study aims to assess the influence of the tricuspid annular plane systolic excursion (TAPSE)/pulmonary systolic arterial pressure (PASP) ratio on clinical outcomes in patients with aortic stenosis undergoing TAVR and offer valuable insights into patient selection and tailored management strategies for individuals undergoing TAVR. Methods: A retrospective analysis was conducted on 100 patients with AS who underwent TAVR, included in two distinct groups based on their median TAPSE/PASP ratio. Results: Patients were divided according to their median TAPSE/PASP ratio into two groups. Those with lower TAPSE/PASP ratios had a higher incidence of post-procedural atrial fibrillation (AF) (48% vs. 28%, p = 0.0404), lower left-ventricular ejection fraction (LVEF) (41.06% vs. 49.50%, p < 0.0001), a more pronounced inflammatory and hematologic response, and longer hospitalization. Receiver-operating characteristic (ROC) analysis demonstrated modest but significant discrimination rather than high sensitivity or specificity for postprocedural arrhythmias, particularly atrial fibrillation. Conclusions: TAPSE/PASP should be regarded as a clinically useful risk-stratification marker in patients with AS undergoing TAVR, enabling the identification of high-risk patients and optimizing peri-procedural management.

(1) Background: Whether anticoagulation can be resumed in atrial fibrillation (AF) combined with intracranial hemorrhage (ICH), and which anticoagulation modality is used with better efficacy and safety, is unknown. (2) Method: Randomized controlled trials (RCTs) and observational studies on relevant topics were included by searching five databases: PubMed, EMBASE, EBSCO, Cochrane Central Register of Controlled Trial and ClinicalTrials. Bayesian network meta-analysis was performed to analyze the effect of oral anticoagulant (OAC), new oral anticoagulant (NOAC), warfarin, antiplatelet, left atrial appendage occlusion (LAAO) and no therapy in patients with AF after intracranial hemorrhage. (3) Results: We included 16 studies involving 25,483 patients. Compared with no antithrombotic therapy, the risk of thromboembolism and all-cause mortality were both reduced with OAC (OR: 0.38, 95% CI: 0.21-0.67; OR: 0.45, 95% CI: 0.25-0.8) and LAAO (OR: 0.11, 95% CI: 0.01-0.76; OR: 0.11, 95% CI: 0.01-0.88), and there was no increased risk of recurrent intracranial hemorrhage. Regarding thromboembolism, OAC (OR: 0.28, 95% CI: 0.11-0.69) was superior to antiplatelet therapy, and antiplatelet therapy (OR: 12.59, 95% CI: 1.57-133.50) was associated with a higher risk of thromboembolism than LAAO. There were no significant differences in recurrent intracranial hemorrhage between the interventions. LAAO appeared to be the best option for reducing thromboembolism (SUCRA: 0.96), recurrent intracranial hemorrhage (SUCRA: 0.75) and all-cause mortality (SUCRA: 0.94). (4) Conclusions: Based on this network meta-analysis, we hypothesize that LAAO has the highest likelihood of reducing the risk of thromboembolism and recurrent intracranial hemorrhage, as well as all-cause mortality in patients with AF after intracranial hemorrhage, followed by OAC.

Thoracic aortic aneurysms (TAAs) carry a high risk of fatal rupture, necessitating improved preoperative risk stratification. This study evaluates the predictive value of systemic risk scores-specifically the Model for End-Stage Liver Disease (MELD) and the Charlson Comorbidity Index (CCI)-for in-hospital mortality, length of stay, and one-year mortality in patients undergoing elective ascending aortic surgery. The study further compares MELD variants (MELD-Na and MELD-XI) for their prognostic performance in this context. This retrospective single-center study analyzed digital medical records of 500 patients undergoing elective surgery for ascending thoracic aortic disease between 2003 and 2023. MELD, MELD-Na (incorporating sodium), and MELD-XI (excluding INR for anticoagulated patients) were calculated from preoperative laboratory data. The CCI was derived from documented comorbidities. Outcomes included in-hospital mortality, length of stay (from admission to discharge), and one-year mortality assessed via outpatient follow-up. The study excluded patients undergoing emergency surgery for Stanford type A aortic dissection. MELD-Na incorporates serum sodium, while MELD-XI is a variant that excludes INR for patients with anticoagulation. The Charlson Comorbidity Index (CCI) was derived from patients' medical histories prior to surgery. Length of stay was defined as total inpatient days between admission and discharge. One-year mortality was assessed via outpatient follow-up data. Loss to follow-up did not exceed 30%. Of 500 patients (median age 64 years, 72.8% male), the MELD-Na score showed the strongest ability to predict in-hospital mortality (AUC = 0.698), outperforming both the standard MELD (AUC = 0.690) and the age-adjusted CCI (AUC = 0.631). For one-year mortality (N = 355), MELD-Na again performed best (AUC = 0.732), while the unadjusted CCI showed minimal predictive value (AUC = 0.509). Predictive power for hospital length of stay was limited across all scores; the age-adjusted CCI achieved the highest, though modest, discrimination (AUC = 0.627). 1-year mortality was assessed in 355 patients with available follow-up data (29.0% lost to follow-up). Among these, non-survivors had significantly higher MELD scores (p < 0.001). MELD-Na demonstrated the strongest predictive performance (AUC = 0.732). The MELD score, particularly MELD-Na, demonstrated strong predictive ability for in-hospital and 1-year mortality, but showed limited value in estimating hospital stay duration. MELD-Na and the age-adjusted CCI provide valuable preoperative prognostic information for patients undergoing elective ascending aortic surgery. While not intended to replace established risk models, their simplicity and reliance on routine clinical data make them attractive tools for early triage, especially in older or multimorbid patients. Their integration into preoperative planning may enhance individualized risk assessment and resource allocation.

Background: Adult patients undergoing cardiac surgery are at an elevated risk of experiencing postoperative complications. However, there is currently no consensus on the most accurate instrument for assessing clinical outcomes following the occurrence of such complications in cardiac surgery.

Objective: The objective was to validate the comprehensive complication index (CCI^®) and Clavien-Dindo classification (CDC) regarding their ability to evaluate clinical outcomes in adult cardiac surgery.

Methods: This retrospective study included 1896 adult patients who underwent cardiac surgery between September 2023 and October 2024. Among these patients, 849 developed postoperative complications. Complications were graded using the CDC, which were then converted to the CCI^®. The validation of the CCI and CDC was evaluated. The strength of the correlation between the CCI^®/CDC and clinical outcomes, including ICU stay duration, length of hospital stay, and hospitalization cost were compared using Spearman's ρ and Fisher's z-transformation. We also employed generalized linear models to analyze the variables that influenced clinical outcomes.

Results: The median age of the patients was 58.0 years; the median CCI^® score was 0.0 (interquartile range [IQR]: 0.0, 20.9). Pneumonia (92.8%) was the most common complication. The correlation of the CCI^® with postoperative outcomes was stronger than the CDC: ICU stay (ρ = 0.786 vs. 0.401, p < 0.001), LOS (ρ = 0.465 vs. 0.342, p = 0.002), and hospitalization cost (ρ = 0.602 vs. 0.354, p < 0.001).

Conclusions: Both the CCI^® and CDC are valid tools for evaluating postoperative outcomes, while the CCI^® has superior discriminative ability for evaluation ICU stay duration, LOS, and hospitalization cost in adult cardiac surgery patients.

Background: Abdominal aortic aneurysm (AAA) is a life-threatening condition with no proven pharmacological treatment to halt its progression. While animal models offer insights into pathophysiology and drug response, clinical translation remains limited.

Methods: We conducted a systematic review of repurposed drugs, classified by Anatomical Therapeutic Chemical (ATC) codes, tested in animal models for their effects on AAA progression. Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and a PROSPERO-registered protocol (CRD42024323430), we screened 14,127 articles and included 144 studies across 13 of the 14 ATC categories.

Results: Most drug classes, particularly cardiovascular, metabolic, and immunomodulatory agents-including statins, angiotensin II receptor blockers (ARBs), metformin, and rapamycin-showed a reduced aneurysm diameter. However, high heterogeneity in models, treatment timing, and methodological shortcomings, including a lack of blinding and power calculations, limit translational value. The predominance of positive findings suggests potential publication bias.

Conclusions: Nevertheless, drugs effective post-aneurysm initiation may offer the greatest clinical promise. Our findings underscore the need for standardized, high-quality, preclinical research to support future human trials.

Background: Despite the increasing adoption of minimally invasive direct coronary artery bypass (MIDCAB), data on its long-term outcomes-particularly regarding sex-based differences-remain limited. This study presents a robust 20-year analysis comparing males and females, assessing perioperative outcomes, long-term survival, and independent predictors of mortality to inform sex-sensitive clinical decision-making.

Methods: A retrospective cohort analysis of 676 patients (138 females, 538 males) undergoing MIDCAB was performed. Propensity score matching (PSM) generated balanced female and male cohorts (n = 129 each). Preoperative demographics, short-term outcomes, and long-term survival were assessed using Kaplan-Meier analysis and Cox regression modelling.

Results: In unmatched cohorts, females exhibited significantly lower NYHA class distribution (p = 0.011) and higher atrial fibrillation prevalence (p = 0.038), with otherwise comparable comorbidities. Propensity score matching achieved cohort balance, and short-term outcomes-including 30-day mortality, stroke/TIA, and reoperation-were similar across sexes. Kaplan-Meier analysis of matched cohorts revealed no significant survival difference (log-rank p = 0.3370), though females demonstrated greater 20-year survival than males (77.6% versus 55.8%). In females, age 70-79 (HR 2.66; 95% CI: 1.02-6.95; p = 0.046) and cerebrovascular disease (HR 5.33; 95% CI: 1.49-19.03; p = 0.010) were independently associated with mortality. In males, significant predictors included diabetes (HR 1.86; 95% CI: 1.02-3.38; p = 0.042), chronic kidney disease (HR 4.92; 95% CI: 1.21-20.02; p = 0.026), pulmonary disease (HR 2.35; 95% CI: 1.20-4.60; p = 0.013), cerebrovascular disease (HR 4.77; 95% CI: 1.97-11.56; p < 0.001), and reduced left ventricular ejection fraction (HR 0.17; 95% CI: 0.06-0.43; p < 0.001).

Conclusions: This 20-year study, the longest to date, demonstrates that MIDCAB achieves durable and equivalent long-term survival in males and females. It highlights sex-specific predictors of mortality, emphasizing the necessity for personalized preoperative risk assessment and postoperative management.

Background: Minimally invasive off-pump coronary artery bypass grafting (MICS-OPCAB) offers potential advantages over conventional sternotomy, including reduced trauma and faster recovery. This study evaluates the safety and feasibility of MICS-OPCAB at our centre.

Methods: We retrospectively analysed 50 consecutive MICS-OPCAB procedures performed via left anterior thoracotomy at our institution between January 2023 and June 2025. Data collected included patient demographics, operative details, and postoperative outcomes. Endpoints were 30-day mortality, conversion to sternotomy, and postoperative complications.

Results: The cohort included 41 males (82%) with a mean age of 63.1 ± 8.7 years (range 40-80) and mean BMI 27.8 ± 4.3 kg/m². Comorbidities included diabetes mellitus in 26%, COPD in 12%, and chronic kidney disease in 8%. Canadian Cardiovascular Society angina classes III-IV were present in 46%. The majority of patients (64%) had single-vessel CAD while 34% had two-vessel and 2% had three-vessel involvement. The mean Logistic EuroSCORE I was 2.19 ± 1.53. Left internal mammary artery (LIMA) grafting was performed in 96% of cases. Additional conduits included left radial artery in 32% and saphenous vein in 8%, with T-grafts in 26% and sequential grafting in 4%. The average number of grafts per patient was 1.35 ± 0.53 (range 1-3). The procedure was performed off-pump in 96% of cases, with two patients (4%) requiring CPB support during conversion from mini-thoracotomy. The overall conversion rate to sternotomy was 16% (eight patients), predominantly due to difficult or injurious IMA harvest or anatomical limitations. The mean operative time was 197.8 ± 76.8 min and decreased significantly after the first 25 cases (220 min vs. 175 min). Atrial fibrillation occurred in 18%, pleural effusion in 28% (10% requiring drainage), and chest infection in 8%. Wound complications arose in 4%. There was no 30-day mortality. ICU stay averaged 2 ± 2.2 days (range 1-14), and total hospital stay was 5.7 ± 2.7 days where institutional coronary bypass stay is normally 7.9 +/- 7.0 days.

Conclusion: These results demonstrate that MICS-OPCAB is a safe and feasible approach for selected patients requiring multivessel coronary artery bypass grafting. There are some technical challenges during the learning curve for which conversion to open surgery can confer good outcomes. Traversing the early learning curve can confer additional benefits to later patients.