Journal of Cardiovascular Development and Disease最新文献

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.

This study aimed to evaluate the effects of exercise on vascular flow-mediated dilation (FMD) in patients with heart failure (HF) and to identify the optimal exercise model for this population. A comprehensive search was conducted in the Web of Science, Scopus, PubMed, Embase, and Cochrane databases, including data published up to 18 August 2025. A meta-analysis was conducted to calculate standardized mean difference (SMD) and 95% confidence interval. Eleven studies met the inclusion criteria, comprising 224 participants in the intervention groups and 185 participants in the control groups. The results demonstrated that exercise significantly improved FMD (SMD = 1.14, p < 0.0001). Subgroup analysis showed that aerobic exercise (SMD = 1.25, p < 0.0001), intervention period ≤ 8 weeks (SMD = 2.19, p < 0.00001) Intervention frequency > 3 times per week (SMD = 2.82, p < 0.00001) and each intervention duration < 60 min (SMD = 1.22, p = 0.01) were the most effective in improving FMD in patients with HF. This meta-analysis indicates that aerobic exercise performed more than three times per week, for sessions under 60 min and over an intervention period of up to 8 weeks, is associated with meaningful improvements in FMD in HF patients. These findings offer clear and actionable guidance for clinicians when prescribing exercise to support vascular health in this population.

Venous stenosis or occlusion often hinders transvenous cardiac device lead implantation, especially in patients with prior devices or long-term venous access. Surgical alternatives and femoral routes carry higher risk. We retrospectively evaluated percutaneous transluminal angioplasty (PTA) in 11 patients with significant venous obstruction. Recanalization was successful in 10/11 cases (91%). Eight leads were implanted immediately, two delayed, with one re-occlusion linked to delay. No peri-procedural complications occurred. Technical success was defined as successful lead implantation through the recanalized vein; clinical success was defined as absence of subclavian venous syndrome (no arm pain or swelling) during follow-up. During follow-up, no symptomatic re-occlusion was observed. PTA appears safe and effective, with same-session lead implantation minimizing re-occlusion risk, offering a valuable alternative when conventional venous access is not feasible.

High-risk pulmonary embolism (PE) is a life-threatening condition characterized by hemodynamic instability, often leading to catastrophic outcomes such as cardiac arrest and cardiogenic shock. We conducted a retrospective analysis of patients diagnosed with high-risk PE at a single tertiary center between 2018 and 2024. Catastrophic PE was defined as high-risk PE with hemodynamic collapse, including cardiac arrest and/or the requirement for high-dose vasopressors. Data on clinical characteristics, treatments, and outcomes were analyzed. Catastrophic PE accounted for 59% of cases. Systemic thrombolysis was the most frequent reperfusion strategy (67%), while catheter-directed therapies (35.4%) and VA-ECMO (11.4%) were used selectively. Despite aggressive management, catastrophic PE exhibited significantly higher mortality rates at 7 days (40%) and 30 days (49%) compared to non-catastrophic cases (9% and 12.5%, respectively). These patients also showed higher rates of multiorgan failure and required more invasive support. This study underscores the importance of early recognition and tailored treatment strategies for catastrophic PE, highlighting its distinct clinical presentation and worse outcomes compared to non-catastrophic high-risk PE. Further research is essential to refine treatment protocols and improve survival in this critically ill population, emphasizing the utility of a standardized classification to enhance clinical management and research consistency.

Cardiogenic shock is a critical pathological state marked by end-organ hypoperfusion due to severe cardiac dysfunction and is associated with high mortality. A substantial portion of patients with cardiogenic shock have concomitant severe mitral regurgitation (MR), which exacerbates hemodynamic instability by reducing forward cardiac output and contributes to pulmonary edema and respiratory failure through regurgitant backflow. In this high-risk setting, mitral transcatheter edge-to-edge repair (M-TEER) offers a minimally invasive treatment that can lead to hemodynamic and symptomatic improvement and potential mortality benefit. Initially indicated for patients with severe MR at prohibitive surgical risk, M-TEER is now guideline-supported for both primary and secondary MR in select populations. Emerging data suggest that M-TEER can reduce heart failure hospitalizations and improve patient quality of life. As clinical indications for M-TEER continue to expand, there is growing interest in the role of M-TEER as a stabilizing intervention in patients with cardiogenic shock and severe MR. This review aims to synthesize the current evidence surrounding the use of M-TEER in cardiogenic shock with a focus on patient selection, procedural and clinical considerations, and short- and long-term outcomes.

Background: Coronary heart disease (CHD) is the leading cause of premature mortality. The incremental value of a polygenic risk score (PRS) to a clinical risk score towards improving CHD prediction is controversial. Meanwhile, the effect of PRSs on CHD prediction in the chronic disease population is unclear.

Methods: Utilizing publicly available summary statistical data, we developed several PRSs using the genome data of European ancestry from the Atherosclerosis Risk in Communities Study. Furthermore, we investigated the association of CHD with the best-performing PRS in both the overall and chronic disease cohorts. Additionally, we evaluated whether adding the best-performing PRS to the clinical risk score improves risk prediction.

Results: A total of 6152 subjects (767 CHD cases) were included in this study. The high values from the developed best-performing PRS were significantly associated with an increased risk of CHD, with a stronger association in the hypertensive population (interaction p = 0.0144). Compared with individuals in the bottom 20% of the PRS values, those in the top 20% were more than 3-fold more likely to develop CHD in the overall cohort, rising to 5-fold in the hypertensive cohort. Adding PRS to the clinical risk score significantly improved the C-index (0.72 to 0.74; p = 0.004), with a 10% net reclassification improvement overall. The hypertensive population showed the greatest improvements. Furthermore, we observed a significant gradient of 10-year and lifetime risk of CHD based on the PRS within each clinical risk category.

Conclusions: Compared to the clinical risk score, integrating the PRS significantly improved CHD prediction and better identified CHD risk trajectories, especially in the European hypertensive adult population.

Background: Atrial fibrillation (AF) is a prevalent condition with a major influence on patients' quality of life, especially when blood glucose and heart rate are disrupted and systemic inflammation is present.

Objective: This study aimed to compare Kansas City Cardiomyopathy Questionnaire (KCCQ) scores of diabetic patients by AF type and their correlations with different clinical and biological parameters.

Material and methods: The retrospective study included 220 patients, from which only 200 were selected because of missing data. Patients were divided into three groups: paroxysmal AF (n = 49), persistent AF (n = 54), and permanent AF (n = 97). Demographic, clinical, and analytical data, echocardiographic parameters, heart rate, blood glucose, renal function, and inflammatory markers were compared between the three groups and their relationship with KCCQ scores.

Results: The KCCQ score was significantly higher in patients with paroxysmal AF (69.50 ± 5.93), compared to persistent AF (56.92 ± 3.04) and permanent AF (42.28 ± 5.89), p < 0.001. In subanalyses, based on left ventricular ejection fraction (LVEF), the same trend was maintained, with lower KCCQ scores associated with more severe forms of AF. Significant negative correlations of the KCCQ score with blood glucose level (r = -0.2535, p = 0.0003), heart rate (r = -0.3071, p < 0.0001), and neutrophil-lymphocyte ratio (NLR) (r = -0.2395, p = 0.0006), and a positive correlation with glomerular filtration rate (GFR) (r = 0.4349, p < 0.0001) were identified.

Conclusions: The type of atrial fibrillation significantly influences the quality of life assessed by the KCCQ score. Clinical and analytical parameters such as blood glucose, heart rate, systemic inflammation, and renal function significantly correlate with patients' perception of health, indicating the importance of integrated management of AF.

Background: Since the study of Lev and Thaemert in 1973, little has been published concerning the overall arrangement of the murine conduction tissues, in particular with relation to gross anatomical landmarks. We recently emphasised the potential value of the mouse as an experimental animal in determining the role, if any, of the superior septal pathways in ventricular activation, comparing the findings to the arrangement in the human heart. Our previous study, however, was confined to the atrioventricular conduction axis. In the light of recent controversies regarding atrial conduction, we have now extended our study to evaluate the overall arrangement of the conduction tissues in the murine heart. Methods: We have re-examined serially sectioned histological datasets previously prepared from adult mouse hearts, incorporating new datasets to permit assessment in the three orthogonal planes, correlating the histological findings with the gross anatomy as revealed in episcopic datasets prepared from late foetal and neonatal mice. Results: The overall arrangement of the conduction tissues is comparable with the human arrangement, but with subtle differences. The sinus node straddles the superior cavoatrial junction, rather than being embedded within the terminal groove. Conduction from the node to the atrial walls is through working atrial myocardium. The atrioventricular conduction axis, as we have recently emphasised, is much more comparable, in particular with presence of well-formed nodo-ventricular and fasciculo-ventricular pathways. In many of the hearts it is also possible to recognise a well-formed retro-aortic node. Conclusions: Despite the differences in the arrangement of the sinus node, mouse is an ideal model for further investigations of cardiac conduction, in particular to clarify the potential roles of the superior septal pathways and the retro-aortic node.