Journal of Cardiovascular Development and Disease最新文献

Background: Cardiac rehabilitation (CR) and mechanics are individually associated with cardiovascular outcomes in ischemic heart disease (IHD); however, their interaction remains less defined. We hypothesized that a 36-session CR program improves cardiac strain and torsional mechanics in IHD patients.

Methods: Ninety IHD patients on guideline-directed medical therapy with complete revascularization were prospectively enrolled, of which 27 electively completed a 36-session standardized exercise CR program. Speckle-tracking echocardiography was utilized to assess left ventricular (LV) global longitudinal strain (GLS) and peak twist, and right ventricular free wall strain (RVFWS) at baseline and after program completion. Participants were propensity-scoring matched 1:1 with 27 patients who declined participation (No-CR).

Results: Clinical characteristics were similar between groups (mean age: 63 ± 10 years, 82% male, 31% three-vessel coronary artery disease). When compared with baseline, the CR group experienced a significant improvement in LV GLS (-14.9 ± 2.9 vs. -16.2 ± 3.1%, p = 0.003), with a numerical but non-significant increase in peak LV twist (14.4 ± 7.4 vs. 16.8 ± 5.3°, p = 0.162). The No-CR group showed significant deterioration in RVFWS (-22.9 ± 4.6% vs. -19.3 ± 5.4%, p = 0.009), with no other changes including in GLS (-14.8 ± 3.1 vs. -15 ± 3.3%, p = 0.831). Follow-up comparisons between CR versus No-CR revealed significantly greater peak LV twist (16.8 ± 5.3 vs. 12.1 ± 4.2°, p = 0.001) and a healthier RVFWS (-22.2 ± 4.5 vs. -19.3 ± 5.4, p = 0.044) in CR participants.

Conclusions: CR in patients with IHD improved LV GLS and, compared with No-CR, conferred better LV twist and RVFWS.

Postpericardiotomy syndrome (PPS) is the most frequent inflammatory after-effect of cardiac surgery and is characterized by high morbidity, delayed hospitalization, and increased long-term mortality rates. Although PPS is common, empirical anti-inflammatory therapy has historically been employed for its prevention, and mechanism-based approaches have not yet been standardized. In this literature review, which was conducted on the basis of randomized controlled trials, meta-analyses, cohort studies, and mechanistic research regarding pharmacologic interventions, surgical modalities, and biomarker-based preventive strategies, the deficiencies of a critical synthesis of existing preventive strategies and emerging risk stratification instruments for PPS are addressed. The review affirms that the most evidence-based pharmacologic intervention is colchicine, which demonstrates a consistent reduction in PPS incidence across a range of randomized trials. Nonsteroidal anti-inflammatory drugs show variable responses, whereas corticosteroids are no longer recommended for routine prophylaxis due to relapse. Specific anti-interleukin-1 therapies represent a promising novel approach for high-risk patients. Surgical interventions, such as pericardial closure using biomaterials and posterior pericardiotomy, are important and do not lead to increased hemodynamic complications, while postoperative effusions, atrial fibrillation, and tamponade are reduced. Less invasive methods may also be employed to mitigate inflammatory causes, particularly in valve-sparing procedures and congenital operations. Emerging biomarker data, including postoperative neutrophil-to-lymphocyte ratios, C-reactive protein levels, and pericardial fluid cytokines, enable the identification of high-risk patients and form the basis for a personalized prevention approach. In summary, pharmacologic prophylaxis, innovative surgical techniques, and biomarker-based risk stratification represent a pathway toward reducing the incidence and burden of PPS in modern cardiac surgery.

Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide. This increases the demand for real-world evidence to complement findings from randomized controlled trials. The German IQVIA Disease Analyzer (DA) database, which is populated with anonymized electronic medical records from general practitioners and specialists, has become an increasingly valuable source for cardiovascular research. Over the past two decades, and especially between 2020 and 2025, numerous epidemiological studies have used this database to explore associations between cardiovascular risk factors, comorbidities, therapeutic patterns, and cardiovascular outcomes in large, broadly representative outpatient populations. This review synthesizes evidence from 13 selected DA-based studies examining atrial fibrillation, heart failure, cardiometabolic disease, lipid management, non-alcoholic fatty liver disease (NAFLD)-related cardiovascular risks, cerebrovascular complications, COVID-19-associated vascular events, and modifiable behavioral and anthropometric factors. These studies were selected based on predefined criteria including cardiovascular relevance, methodological rigor, large sample size, and representativeness of key disease domains across the 2000-2025 period. Eligible studies were identified through targeted searches of peer-reviewed literature using the German IQVIA Disease Analyzer database and were selected to reflect major cardiovascular disease domains, risk factors, and therapeutic areas. Across disease domains, the reviewed studies consistently demonstrate the DA database's capacity to identify reproducible associations between cardiometabolic risk factors, comorbidities, and cardiovascular outcomes in routine outpatient care. While causal inference is not possible, the database enables the identification of clinically meaningful associations that inform hypothesis generation, help quantify disease burden, and highlight gaps in prevention or treatment. The database's strengths include large sample sizes (often exceeding 100,000 patients), long follow-up periods, and high external validity, while limitations relate to coding accuracy, residual confounding, and the absence of detailed clinical measures. Collectively, the evidence underscores the importance of the DA database as a crucial platform for real-world cardiovascular research.

Pressure-controlled intermittent coronary sinus occlusion (PICSO) was initially developed to salvage ischemic myocardium. However, recent evidence suggests a more profound role: reawakening embryonic molecular pathways that facilitate myocardial regeneration. This review examines the paradigm shift in PICSO's mechanism-from its traditional focus on infarct size reduction to its emerging role as a catalyst for myocardial repair through the reactivation of embryonic signaling. Findings suggested that myocardial decay could be ameliorated beyond salvage, revealing that PICSO enhances vascular activation in the coronary venous system, thereby influencing the fate of endothelial and myocardial cells. The theorem "embryonic recall" posits that PICSO induces molecular signals reminiscent of early cardiac development, offering a novel approach to cardiac repair in myocardial jeopardy. Noncoding RNA serves as a universal signaling event, thereby supporting the hypothesis. Yet, conflicting clinical outcomes highlight the need to redefine PICSO's objectives, optimize device settings, and realize interventional strategies. The evolution of PICSO demands a radical shift in scientific perspective. Beyond ischemic salvage, its true potential may lie in harnessing regenerative mechanisms within the failing heart. Modern cardiology must adopt this dual role, bridging mechanical intervention with molecular rejuvenation to ensure its continued viability as a therapeutic option. PICSO, like the phoenix, may yet rise anew as a transformative force in cardiovascular medicine.

Background: Catheter ablation is a validated treatment for ventricular arrhythmias (VA), but conventional radiofrequency (RF) energy may cause collateral injury due to non-selective thermal damage. Pulsed Field Ablation (PFA), a non-thermal modality based on irreversible electroporation, offers myocardial tissue selectivity and enhanced safety. While PFA is widely adopted for atrial arrhythmias' ablation, its application in the ventricles remains an evolving frontier.

Methods: We report a single-center experience using the Centauri PFA system integrated with a focal, contact-force sensing irrigated catheter (Tacticath™ SE, Abbott Laboratories, St. Paul, MN, USA) in four consecutive patients with drug-refractory VA. Two patients presented with frequent premature ventricular complexes (PVC) arising from the right and left ventricular outflow tract, respectively, while two had ischemic cardiomyopathy with recurrent scar-related ventricular tachycardia (VT). All procedures were guided by high-density mapping using the EnSite X system (Abbott Laboratories, St. Paul, MN, USA). Procedural safety, acute efficacy, and early follow-up outcomes were assessed.

Results: All ablations achieved acute procedural success without complications. In both PVC cases, PFA led to immediate and complete suppression of ectopy, with a ≥95% reduction in arrhythmic burden at 12- and 9-months follow-up, respectively. In the VT cases, the arrhythmogenic substrate was effectively modified, rendering the clinical VT non-inducible. ICD interrogation during a 9-month follow-up showed complete absence of recurrent sustained VT. No coronary spasm, atrioventricular block, pericardial effusion, or other adverse events occurred.

Conclusions: In this initial experience, focal PFA using a contact-force sensing catheter appeared feasible and effective for both focal and scar-related VA. This system provides an intuitive workflow similar to RF ablation. While our data suggest a favourable safety profile, larger studies are required to definitively confirm safety margins near critical structures.

Background: Health literacy can be defined as the ability to access, understand, evaluate, and apply health information in order to make informed health decisions in daily life. Despite its importance, little is known about health literacy in the domains of physical activity and nutrition among children with congenital heart disease. The aim of this study was to examine differences in health literacy related to physical activity and nutrition between children and adolescents with congenital heart disease and a healthy control group (Control).

Methods: A total of 244 children and adolescents (age 8-18 years; mean age 13.4 ± 3.1 years, 53.3% girls) were enrolled, comprising 122 patients with congenital heart disease and 122 age- and sex-matched healthy controls. Patients were recruited during routine medical examinations at the German Heart Center, while controls were recruited from Munich schools. The Physical Activity Health Literacy Scale for Children (PAHL-C) and the Nutrition Health Literacy Scale for Children (NHL-C) were used to assess health literacy in the domains of physical activity and nutrition. Scores for both scales were calculated as additive sum scores and converted to a scale from 0 to 100, where higher scores indicate better health literacy. Physical activity levels were measured via self-reported frequency of days per week in which children engaged in at least one hour of physical activity.

Results: Children with congenital heart disease showed lower PAHL-C scores (Patients: 65.9 ± 18.0 vs. Control: 72.9 ± 14.9, p = 0.001) and lower NHL-C scores (Patients: 63.6 ± 19.0 vs. Control: 69.3 ± 14.8, p = 0.009) than healthy controls. Boys reported significantly higher self-reported physical activity levels (p = 0.001) and had significantly higher PAHL-C scores than girls (p < 0.001). Patients with congenital heart disease reported significantly less physical activity compared to controls (Patients: 4.2 ± 1.7 days/week vs. Control: 5.2 ± 1.8 days/week, p < 0.001).

Conclusions: Children with congenital heart disease demonstrate lower health literacy in the domains of physical activity and nutrition than their healthy counterparts and report being less active. This highlights the need for targeted interventions to address both physical activity and health literacy in children with congenital heart disease.

Background: Vascular aging (VA) reflects arterial biological aging and is closely linked to cardiovascular risk. Carotid-femoral pulse wave velocity (cfPWV) is the gold standard for assessing arterial stiffness and VA. However, evidence is limited on cfPWV-derived vascular age and its association with subclinical target organ damage (TOD) in the general population. This study evaluated whether Δ-age (vascular age minus chronological age) could identify individuals at higher risk of early vascular injury in a Chinese community cohort.

Methods: This cross-sectional study included participants from two Beijing communities. Δ-age was calculated as cfPWV-derived vascular age minus chronological age. Participants were categorized as supernormal vascular aging (SUPERNOVA, <10th percentile), normal VA, and early vascular aging (EVA, 90th percentile). TOD included mean and maximum carotid intima-media thickness (CIMT), and carotid plaque. Associations between Δ-age and TOD were analyzed using multivariable regression models adjusted for conventional cardiovascular risk factors and cfPWV.

Results: A total of 6305 participants (mean age 62.5 ± 7.8 years; 34.2% male) were included. Higher Δ-age was associated with increased mean and maximum CIMT and higher carotid plaque prevalence, independent of cfPWV. EVA participants had a higher risk, whereas SUPERNOVA participants had a lower risk of TOD compared with normal VA. After cfPWV adjustment, EVA remained associated with increased mean CIMT and carotid plaque, while SUPERNOVA showed a nonsignificant trend toward a lower risk. Associations were consistent across subgroups.

Conclusions: Δ-age, independent of cfPWV, was an independent risk factor for TOD. This simple, practical indicator may help identify individuals at risk of early vascular damage in community settings.

Background: Structural and functional adaptation of the heart to chronic exercise is dependent on multiple factors, including the volume and type of training, and has direct implications for pre-participation cardiac screening (PPCS). Sailing is a unique multi-training modality sport with limited prior description of cardiac adaptation to training. The aims of this study are (1) to describe electrocardiogram (ECG) changes in sailors, informing PPCS guidelines; (2) to assess structural and functional cardiac changes in sailors; and (3) to examine sex- or discipline-specific cardiac adaptations in sailors. Methods: Seventy elite sailors (33 females) underwent standard ECG and echocardiography. Echocardiographic data were compared to population norms and analysed by sex and sailing discipline based on training type: isometric (IG), pumping (PG), and movement (MG). Results: One sailor presented with abnormal ECG findings (T wave inversion) which warranted further investigation. Primary training-related ECG changes noted were early repolarisation (24%) and sinus bradycardia (30%). The left ventricular volume index was dilated in 18% of all sailors compared to reference values, with similar findings noted on right ventricular parameters for 22% of the study population, although in males only. The impact of predominant training stimulus (IG, PG, MG) did not mediate differences in the structure of any cardiac chambers (p > 0.05). Ejection fraction was lower in the PG (Δ4%, p ≤ 0.001), whereas global longitudinal strain was higher (Δ2%, p = 0.02) compared to MG and IG. Conclusions: Elite-level sailors present with electrical and structural cardiac phenotypes associated with exercise adaptation, with dilation of both left- and right-sided chambers. These data should be considered when interpreting results of PPCS in male and female sailors from different, specific disciplines.

Background: Insulin resistance (IR) has been implicated in cardiovascular diseases, and a correlation between IR and the slow flow phenomenon (CSF)has been identified. The triglyceride-glucose index (TGI), a simple surrogate marker for IR, has recently emerged as a potential predictor of CSF, though data are limited. The aim of this study was to evaluate the association of TGI and other prognostic parameters in patients with CSF.

Methods: This retrospective study included 693 patients who underwent diagnostic coronary angiography between January 2022 and December 2024. A total of 132 patients were diagnosed with CSF based on the corrected TIMI frame count (cTFC > 27 in at least one epicardial coronary artery), while 561 patients had normal coronary flow (NCF). Patients with confounding cardiovascular or systemic conditions were excluded. Clinical, demographic, and laboratory data were gathered, and TGI was calculated as ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2].

Results: Statistically significant distinctions were found between the CSF and NCF groups regarding TGI, age, glucose, HbA1c, creatinine, sodium, CRP, platelet count, heart rate, PR interval, and cQT interval (p < 0.05). Age, hypertension, diabetes mellitus, HbA1c, glucose, sodium, and cQT were identified as potential clinical and laboratory factors associated with CSF in univariate logistic regression analysis; however, no independent predictor was found in multivariate analysis. ROC analysis showed that a TGI cut-off value of ≥8.93 predicted CSF with 67.6% sensitivity and 66.7% specificity.

Conclusions: Our study demonstrated that TGI was significantly greater in patients with CSF compared to those with NCF. Although TGI showed limited sensitivity and specificity in discriminating CSF, its possible value as a prognostic indicator warrants further validation in prospective, large-scale studies.