Journal of Cardiovascular Development and Disease最新文献

Background and aims: Vericiguat lowers cardiovascular death or heart-failure hospitalization in recently worsened heart failure with reduced ejection fraction (HFrEF), but its effects on cardiac remodeling are less well characterized. Our aim was to evaluate whether the addition of vericiguat to guideline-directed medical therapy (GDMT) promotes reverse myocardial remodeling in patients with HFrEF and recent worsening.

Methods: We conducted a prospective, non-randomized, single-center study enrolling 34 consecutive patients with HFrEF who had experienced recent worsening and were on stable GDMT for at least 3 months prior to decompensation. Clinical, biochemical, and echocardiographic assessments were performed at baseline and at 6 months.

Results: A total of 24 patients completed the 6-month follow-up (mean age 63 ± 9 years; 92% male), 96% of whom were in New York Heart Association (NYHA) class III or IV. After 6 months of vericiguat therapy, right ventricular systolic function improved significantly, with an increase in tricuspid annular plane systolic excursion (TAPSE) from 18.5 ± 4.3 mm to 21.4 ± 4.8 mm (p = 0.003). Left ventricular systolic function improved, with a numerical increase in left ventricular ejection fraction (LVEF) (30.1 ± 5.9% to 32.2 ± 10.5%; p = 0.122) and a significant increase in left ventricular outflow tract velocity-time integral (LVOT VTI) (14.8 ± 3.7 cm to 16.1 ± 3.8 cm; p = 0.011). Functional improvements were accompanied by structural remodeling, including reductions in right ventricular internal diameter in diastole (RVIDd) (40.5 ± 5.8 mm to 37.9 ± 6.9 mm; p = 0.002) and left ventricular end-systolic volume (LVESV) (144.0 ± 40.3 mL to 132.4 ± 61.0 mL; p = 0.031). N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels also decreased significantly (median 1829.0 ng/mL to 1241.0 ng/mL; p = 0.03).

Conclusions: In patients with HFrEF and recent worsening, the addition of vericiguat to GDMT may be associated with reverse myocardial remodeling.

Cardiac myosin inhibitors have been shown to improve diastolic function in patients with obstructive hypertrophic cardiomyopathy (HCM). Comparative studies to evaluate the diastolic effects of mavacamten versus alcohol septal ablation (ASA) have yet to be examined. In this single-center retrospective analysis, we compared echocardiographic parameters of diastolic function in adult patients with obstructive HCM treated with mavacamten (n = 23) or ASA (n = 22). Baseline imaging was obtained prior to therapy, and follow-up imaging was obtained five months after ASA and or initiation of mavacamten. Left-sided filling pressures (E/e') improved with both ASA (18.6 versus 15.3, p < 0.001) and mavacamten (17.4 versus 13.5, p = 0.01). Among patients who underwent ASA, mitral annular tissue velocity (e') was increased at the lateral annulus (6.0 versus 6.1, p = 0.02) with a trend to improvement at the septum (4.0 versus 5.0, p = 0.14). Similarly, among patients treated with mavacamten, septal e' was increased (6.0 versus 6.7, p < 0.01) and a trended improvement was observed for the lateral e' (5.7 versus 7.0, p = 0.06). Mavacamten therapy was also associated with an improvement in the LA volume index (45.6 versus 34.5, p < 0.001). Patients treated with ASA were older, more likely to have used tobacco, and had greater limitation in functional status. In this retrospective analysis, ASA and mavacamten were similarly associated with improvements in echocardiographic parameters of diastolic function and left-sided filling pressures, though mavacamten had a more discernible effect on the left-atrial volume index. Larger studies are required to further characterize the relative efficacy of the two therapeutic modalities.

Background: The ex vivo evaluation of the aortic wall aims to identify potential risk factors predictive of acute aortic syndrome. The comparison of aortic wall properties in patients with bicuspid aortic disease versus those with tricuspid aortic disease has been the subject of many studies. However, the heterogeneity of aortic wall characteristics in individual patients has never been thoroughly investigated. In this study, we focused on comparing the heterogeneity of aortic wall characteristics in patients with bicuspid (BAV) and tricuspid (TAV) aortic valve disease.

Materials and methods: Out of 113 patients enrolled in our cumulative study on the ex-vivo evaluation of the aortic wall, in patients with dilated ascending aorta, 56 patients with >3 specimens taken from the anterior wall were selected for the present study. The heterogeneity of anatomical characteristics (aortic wall thickness) was assessed by measuring the coefficient of variability (cV). In 35 patients, furthermore, mechanical (uniaxial ultimate stress-strain test) characteristics heterogeneity was also evaluated. Intra-patient mechanical and anatomical variability was then compared between the BAV and TAV groups.

Results: Heterogeneity of aortic wall thickness was significantly less important compared to heterogeneity of mechanical properties: peak strain (Pstr p = 0.0042), peak stress (PS p = 0.001) and maximum elastic modulus (EM p = 0.001). Only EM heterogeneity was significantly reverse-correlated to patient's age (p = 0.0005), and this correlation was peculiar for patients with BAV. In BAV patients, furthermore, age > 66 was associated with a significantly superior EM heterogeneity (p = 0.008). A direct comparison of anatomical and mechanical intra-patient variability between BAV and TAV groups, however, did not show significant differences.

Discussion: Our study clearly demonstrates that the anatomical and mechanical characteristics of the aortic wall in patients with aortic dilation are not homogeneous. The heterogeneity of aortic wall thickness appears to be less significant than that of mechanical properties, thus confirming a limited correlation between anatomical and mechanical characteristics. The comparison between the BAV and TAV groups revealed limited peculiarities, further suggesting a preservation of the mechanical properties of the aortic wall in patients with bicuspid aortic disease and, therefore, without a peculiar mechanical properties-related increased risk of acute aortic syndrome.

(1) Background: Malignant arrhythmia complicating fulminant myocarditis is associated with high in-hospital mortality, but evidence regarding its long-term prognosis and specific risk factors is limited. (2) Methods: This single-center retrospective cohort study (2016-2025) analyzed 241 consecutive fulminant myocarditis patients, stratified by malignant arrhythmia status (n = 58 vs. 183). The malignant arrhythmia group was further subclassified into malignant tachyarrhythmia (n = 22) and bradyarrhythmia (n = 36). Endpoints included major adverse cardiovascular events (MACE), cardiac dysfunction, and structural abnormalities. (3) Results: At 3-month follow-up, malignant arrhythmia patients had a significantly higher incidence of MACE compared to non-malignant arrhythmia patients (15.5% vs. 4.9%, p = 0.008), but no significant differences were found in cardiac dysfunction or structural abnormalities. Multivariate analysis identified low triglyceride level as an independent risk factor for in-hospital malignant tachyarrhythmia. For in-hospital malignant bradyarrhythmia, independent risk factors were delayed, such as intrinsicoid deflection, low diastolic blood pressure, bradycardia, and an elevated E/Em ratio, with the predictive model showing high discriminatory power. (4) Conclusions: Malignant arrhythmia is an independent predictor of adverse short-term, but not long-term, prognosis in fulminant myocarditis patients, with distinct risk factor profiles identified for malignant tachyarrhythmia and malignant bradyarrhythmia subtypes.

Background: The impact of diabetes on the management and outcomes of patients with borderline CT-derived fractional flow reserve (FFR_CT) remains unclear. Methods: This multicenter study enrolled symptomatic patients with suspected coronary artery disease who underwent Coronary computed tomography angiography (CCTA) between June 2021 and May 2023, yielding FFR_CT values between 0.70 and 0.80. Revascularization occurring within 90 days after CCTA was documented. The endpoint was major adverse cardiovascular events (MACE), as a composite of all-cause death, nonfatal myocardial infarction, and unplanned revascularization. Outcomes were analyzed using Cox proportional hazards models, while the relationship between FFR_CT and MACE was examined using restricted cubic spline analysis (RCS). Results: This analysis included 1515 patients with borderline FFR_CT values, comprising 503 (33.2%) with diabetes. Over a median follow-up of 985 days, 117 MACE occurred. Multivariate analysis showed that revascularization was independently associated with a reduced risk of the endpoint, a protective effect consistent in both non-diabetic (adjusted HR [aHR] 0.53, 95% CI 0.29-0.96; p = 0.036) and diabetic patients (aHR 0.25, 95% CI 0.09-0.71; p = 0.009). RCS revealed a significant non-linear relationship between FFR_CT and MACE in non-diabetic patients (p = 0.002). Conclusions: In patients with borderline FFR_CT, revascularization was linked to a lower incidence of MACE, and this association was consistent regardless of diabetes status.

Background: The aim of this study was to explore the baseline characteristics, risk factors, and prognosis of surgical patients with left-sided valvular infective endocarditis (IE) complicated by preoperative neurological complications, as well as the impact of complication subtypes and surgical timing on outcomes.

Methods: A retrospective analysis of 605 consecutive surgical patients with left-sided valvular IE (May 2012-June 2024) was performed. Patients were stratified into neurological complication and non-complication groups, with 1:1 propensity score matching (PSM) balancing baseline confounders. Six neurological complication subtypes were defined; surgical timing was categorized as early (≤7 days for infarction, ≤30 days for hemorrhage) or delayed. Logistic/Cox regression analyzed risk factors and prognosis; subgroup analyses compared modified Rankin Scale (mRS) scores, and Kaplan-Meier curves evaluated long-term survival.

Results: Mitral valve involvement, highly mobile vegetations, and longer IE symptom-to-surgery time were risk factors for neurological complications. After PSM balancing, the neurological complications group had similar in-hospital, long-term mortality to the control group, but a significantly higher new-onset cerebral complication rate. In total, 81.5% of complication patients achieving mRS ≤ 2 (good functional status) with infarction showed improved postoperative mRS scores. Cerebral hemorrhage was an independent predictor of in-hospital mortality, while cerebral hemorrhage and regional infarction were independent predictors of new-onset cerebral complication. Early surgery in infarction patients increased the neurological complication rate.

Conclusion: Neurological complication incidence was 27.8%. Mitral valve involvement, high vegetation mobility, and preoperative emboli were risk factors. Except for preoperative cerebral hemorrhage and regional infarction, which increase the risk of in-hospital mortality, neurological complications overall do not affect short-term and long-term mortality rates, but increase the risk of postoperative neurological deterioration. Individualized surgical timing is recommended.

Background: Optimal cerebral protection strategies for acute Stanford type A aortic dissection (aTAAD) surgery remain controversial. This study aimed to evaluate the role of near-infrared spectroscopy (NIRS)-guided monitoring and its association with clinical outcomes.

Methods: We retrospectively analyzed 619 patients undergoing aTAAD surgery (Hemi-Arch, Total-Arch, or Arch-Stent procedures). Intraoperative cerebral oxygenation was monitored using NIRS, with the magnitude of desaturation quantified as ΔNIRS. We assessed correlations between ΔNIRS and nasopharyngeal temperature, employed generalized additive models (GAM) to analyze nonlinear relationships with major adverse cardiovascular events (MACE), and used piecewise logistic regression to identify procedure-specific ΔNIRS risk thresholds.

Results: ΔNIRS showed a significant positive correlation with lower temperatures in Total-Arch (R = 0.486, p < 0.001) and Arch-Stent (R = 0.216, p < 0.001) groups. GAM analysis revealed a nonlinear, accelerating relationship between higher ΔNIRS and increased log odds of MACE in Hemi-Arch and Total-Arch groups. Procedure-specific ΔNIRS thresholds were identified: 8.5% for Hemi-Arch, 19.6% for Total-Arch, and 20.9% for Arch-Stent. Patients with ΔNIRS above these thresholds had significantly higher rates of stroke and MACE.

Conclusions: This study identifies ΔNIRS as a significant, procedure-dependent intraoperative monitoring indicator in aTAAD surgery, and the proposed risk thresholds provide a rationale for real-time NIRS-guided clinical decision-making.

Adherence to exercise-based cardiac rehabilitation (CR) is essential for preventing and managing cardiovascular disease (CVD). Participation in CR reduces all-cause mortality by 27% and cardiac deaths by 31% and lowers rehospitalization rates while also improving functional capacity and quality of life. However, many patients do not start, complete, or maintain CR, resulting in reduced functional abilities, a higher risk of recurring events, and poorer long-term outcomes. This narrative review summarizes patterns of adherence to exercise and CR in CVD, with a specific focus on sex- and gender-related differences in referral, participation, and completion. We synthesize evidence on biological, psychological, and social barriers that limit engagement and describe emerging strategies, such as technology-enabled and home-based programs, multidisciplinary care, and family-centered models, to enhance adherence. Finally, we propose a practical, gender-aware framework for CR design and delivery that can be adjusted and evaluated across diverse healthcare settings to guide clinical practice and future research.

Fast-track extubation has emerged as a vital component of Enhanced Recovery After Surgery pathways, designed to optimize recovery and resource utilization after cardiac surgery, contrasting with traditional prolonged ventilation. This review explores the evidence supporting fast-track extubation, detailing patient selection criteria based on preoperative risk factors and functional status and outlining perioperative management strategies. It synthesizes findings from various studies, including randomized controlled trials, retrospective studies, and meta-analyses, focusing on intraoperative techniques such as low-dose opioids, neuromuscular blockade reversal, controlled cardiopulmonary bypass duration, judicious inotrope use, and minimal transfusion, alongside structured postoperative protocols emphasizing early sedative weaning and spontaneous breathing trials. Results demonstrate that fast-track extubation decreases intensive care unit stay, reduces costs and ventilator-associated complications, with a safety comparable to conventional care. Prolonged cardiopulmonary bypass time, dependency on inotropes, and intraoperative blood transfusions are identified as critical predictors of fast-track extubation failure. In conclusion, the successful implementation of fast-track extubation protocols requires a collaborative, multidisciplinary approach, proving essential for improving patient outcomes, minimizing complications such as postoperative delirium, and enhancing hospital efficiency in cardiac surgery. Further research should aim to refine patient selection and standardize protocols across healthcare systems.

Cardiogenic shock (CS) remains a significant clinical challenge with persistently high mortality rates. Defined by impaired cardiac output resulting in end-organ hypoperfusion, CS commonly arises from acute myocardial infarction (AMI-CS) or acute exacerbations of heart failure (HF-CS). The severity of CS is classified by the Society for Cardiovascular Angiography and Interventions (SCAI) into stages A (at risk) through E (extremis), which informs treatment strategies, including pharmacotherapy and mechanical circulatory support (MCS). Recent advancements in percutaneous mechanical circulatory support devices, including intra-aortic balloon pumps (IABPs), Impella devices, TandemHeart, Protek-Duo, and veno-arterial extracorporeal membrane oxygenation (VA-ECMO), have transformed management paradigms by offering targeted hemodynamic support. While DanGer-SHOCK, a pivotal randomized trial, demonstrated improved outcomes with early Impella use in anterior STEMI-associated CS, the trial's focus population and center expertise suggest that its findings should be interpreted in the context of broader AMI-CS and HF-CS presentations. Device selection is guided by shock severity, anatomical considerations, comorbidities, and institutional capabilities. This review synthesizes current evidence, evaluates the clinical utility and efficacy of existing and emerging percutaneous MCS technologies, and highlights ongoing clinical trials and future directions in optimizing CS management. Emphasis is placed on individualized patient selection, evidence-based deployment of MCS devices, and multidisciplinary team collaboration, which collectively represent a critical transition towards improving clinical outcomes in CS.