Journal of Cardiovascular Development and Disease最新文献

In the cardiovascular system, geometric remodeling of the cardiac chambers is the main mechanism enabling increased cardiac performance during exercise in athletes, as well as underlying pathological progression toward heart failure. In this study, we investigated cardiac mechanics in healthy children across five phases of physical exercise, Rest, Mid, Peak, and Recovery, at 5 and 10 min, using three-dimensional echocardiography. Analyses were conducted relative to a reference cohort of healthy children to identify exercise-induced modifications that may contribute to cardiac remodeling. Ventricular performance was assessed through two complementary approaches: myocardial deformation, quantified by the principal values and directions of the strain tensor, and intraventricular flow dynamics, including assessments of ventricular filling patterns as the vorticity, vortex formation time and hemodynamic forces. This preliminary study offers promising insights into early cardiac function changes that may inform our understanding of cardiac remodeling during adaptation, healing or disease progression.

Background: A sternum-sparing approach of minimally invasive total coronary revascularization via left anterior thoracotomy (TCRAT) demonstrated favorable early and midterm results in unselected patients with coronary artery multivessel disease. However, safety and outcomes in elderly patients remain less well defined. Particularly in octogenarians with relevant comorbidities, data are scarce, and the role of TCRAT compared to conventional coronary artery bypass grafting (CABG) remains uncertain. This study aimed to evaluate in-hospital and midterm outcomes of TCRAT in patients aged ≥ 80 years.

Method: From 11/2019 to 10/2025, CABG via left anterior minithoracotomy on cardiopulmonary bypass and cardioplegic arrest was performed as a routine procedure in 859 consecutive, nonemergency patients. Among them, 82 patients (9.5%) were octogenarians, all presenting with multivessel coronary artery disease.

Results: In the group of octogenarians, mean BMI was 26.5 ± 3.1 kg/m², left ventricular ejection fraction was 49.2 ± 9.1% (range 20-55%), and mean EuroSCORE II was 5.1 ± 2.4. Comorbidities included diabetes mellitus (24.4%), chronic lung disease (7.3%), prior PCI (23.2%), and peripheral vascular disease (78.5%). The mean follow-up (100%) was 9.1 months. Left internal thoracic artery was used in 98.8% and radial artery was used in 43.9%. A mean of 3.0 ± 0.9 (range 2-5) anastomoses per patient was performed. Total operation time was 299 ± 64 min (range 164-480). In-hospital mortality was 1.2%, stroke rate was 1.2%, myocardial infarction rate was 0%, and repeat revascularization rate was 1.2%. At follow-up, all-cause mortality, myocardial infarction, repeat revascularization, and stroke were 4.9%, 0%, 2.4%, and 1.2%, respectively. The overall major adverse cardiac and cerebrovascular events rate (MACCE) was 7.3% at follow-up.

Conclusion: TCRAT enables complete coronary artery revascularization in multivessel coronary artery disease without sternotomy and can be safely performed in octogenarians. Both in-hospital and midterm outcomes were favorable and comparable to reported contemporary outcomes of conventional CABG in elderly patients.

Background: Acute heart failure (AHF) is a common reason for emergency care, yet data on its epidemiology and prognosis in the prehospital setting remain limited. This study aims to analyze the characteristics and long-term survival outcomes of patients with AHF managed by emergency medical services (EMSs). Methods: A multicenter, prospective, observational study was conducted in adult patients attended by EMSs and transferred to emergency departments (EDs). Collected data included demographics, vital signs, laboratory parameters, chronic obstructive pulmonary disease (COPD) history, comorbidity burden assessed using the Age-adjusted Charlson Comorbidity Index (aCCI), and clinical outcomes. The primary endpoint was 2-year mortality (M2Y). Survival analysis was performed using Cox regression and Kaplan-Meier analysis. Results: A total of 417 patients were included. Their median age was 84 years, and 48.2% were women. A total of 92.3% of the patients had an elevated aCCI. Overall, M2Y was 57.6%, rising to 74.4% among COPD patients. aCCI range and elevated plasma potassium and lactate levels were independently associated with reduced survival (HR 2.86, 1.45 and 1.15, respectively). Overall, 50% of all deaths occurred within the first 49 days. Conclusions: AHF patients attended by EMSs exhibited high 2-year mortality, likely due to advanced age and comorbidities. High comorbidity burden and abnormal potassium and lactate levels were linked to worse outcomes.

Background: Orthotopic heart transplantation (OHT) remains the gold standard for end-stage heart failure, yet individualized risk assessment for postoperative mortality remains challenging. We aimed to develop and interpret random forest-based models for predicting 30-day and 1-year mortality and to examine whether the key predictors differ between the 30-day and 1-year models.

Methods: We analyzed 581 patients who underwent OHT between 2012 and 2024. The 30-day and 1-year mortality rates were 9.9% and 17.6%, respectively. Eighty-seven preoperative and forty-eight postoperative variables were considered as input features for model development. Random forest models were trained and validated using five-fold cross-validation, and explainability was assessed using SHapley Additive exPlanations (SHAP).

Results: Using preoperative features only, the random forest models achieved AUCs of 0.62 (95% CI, 0.48-0.75) for 30-day and 0.67 (95% CI, 0.56-0.78) for 1-year mortality. SHAP analysis revealed that early mortality predictions were primarily driven by features reflecting acute physiological stress-hepatic dysfunction, inflammation, and hemodynamic instability-whereas long-term predictions were increasingly influenced by renal function, metabolic reserve, and frailty. Incorporating postoperative features improved performance (AUC 0.98 [95% CI, 0.97-0.99] and 0.86 [95% CI, 0.80-0.92], respectively), with model predictions dominated by the severity and persistence of organ dysfunction: short-term risk driven by hepatic injury, hemodynamic compromise, and critical illness, and long-term risk by sustained hepatic and renal impairment, metabolic resilience, and duration of circulatory support.

Conclusions: Random forest models integrating preoperative and immediate postoperative data could predict short- and mid-term mortality after OHT. SHAP analysis demonstrated temporal shifts in the most important predictors, supporting the role of dynamic, data-driven risk assessment in transplant care.

Heart failure (HF) remains a major challenge in cardiovascular medicine, contributing to high global rates of hospitalization and mortality. Recent research (2022-2025) has emphasized its heterogeneity, highlighting distinct phenotypes-HFpEF, HFmrEF, and HFrEF-driven by mechanisms such as chronic inflammation, myocardial fibrosis, and neurohormonal imbalance. Advances in therapy, particularly with sodium-glucose cotransporter-2 inhibitors (SGLT2i), angiotensin receptor-neprilysin inhibitors (ARNI), and iron supplementation, have reshaped treatment strategies. Moreover, the growing recognition of overlaps between HF and cardiomyopathies such as hypertrophic, Takotsubo, and amyloidosis underscores the need for integrated care. This review summarizes recent findings from leading journals, mapping the evolving understanding of HF pathophysiology and management, and outlining emerging directions for research and clinical practice.

(1) Background: The systemic right ventricular (SRV) dysfunction and severe tricuspid regurgitation (TR) remain significant challenges in patients with congenitally corrected transposition of the great arteries (ccTGA) or following atrial switch procedures. Currently, there is no established, evidence-based medical therapy specifically designed for SRV failure, and treatment approaches are largely extrapolated from left ventricular heart failure (HF) guidelines. This therapeutic gap highlights the need for tailored pharmacologic strategies and optimized perioperative management in this unique population. The optimal timing of surgical intervention and the role of modern HF therapy are still under active investigation. (2) Methods: We present a case series of four patients (three adults and one child) with SRV dysfunction and severe TR, who underwent staged treatment consisting of optimized medical therapy followed by surgical tricuspid valve (TV) replacement. Medical therapy included positive inotropes, sacubitril/valsartan, sodium-glucose co-transporter 2 inhibitors (iSGLT2), beta-blockers, mineralocorticoid receptor antagonists (MRAs), and loop diuretics. (3) Results: All patients demonstrated clinical and hemodynamic improvement prior to surgery, with an increase in systemic ventricular ejection fraction (SVEF > 40%) and cardiac index. TV replacement was performed with favorable early postoperative outcomes and preserved ventricular function at mid-term follow-up. No mortality or major adverse events occurred during follow-up. One case of acute cystitis was associated with dapagliflozin. In all patients, postoperative SVEF remained >40%, and no recurrence of significant TR was observed. (4) Conclusions: A stepwise approach combining modern heart failure therapy and elective TV replacement in patients with SRV dysfunction and TR is safe and effective. Preoperative optimization leads to improved ventricular function and may enhance surgical outcomes. These findings support the integration of contemporary pharmacotherapy in the management strategy for SRV failure.

Background. Accurate anatomical assessment is essential for pre-procedural planning in structural heart disease. Advanced 3D imaging could offer improved visualization for more accurate reconstruction. We assessed the performance of a novel immersive 3D virtual reality (VEA) for the pre-procedural planning of transcatheter aortic valve implantation (TAVI) candidates. Methods. Measurement of cardiac-gated contrast-enhanced computed tomography (CT) scans was performed with the novel VEA and established tools: 3Mensio and Horos. Results. 50 consecutive patients were included. Annular and LVOT measurements obtained with VEA were strongly correlated with those derived from standard CT analysis. The intraclass correlation coefficient (ICC) confirmed excellent consistency for annular measurements (ICC = 0.93), while the concordance correlation coefficient indicated very good overall agreement (CCC = 0.83, 95% CI 0.73-0.90). Similarly, LVOT measurements obtained with VEA showed strong correlation with CT values, with good consistency (ICC = 0.90) and good overall agreement (CCC = 0.77, 95% CI 0.64-0.86). VEA-based planning improved prosthesis size selection accuracy, achieving higher concordance with implanted valves and a significant net reclassification gain over conventional CT. Conclusions. Given the increasing use of advanced 3D cardiac imaging technologies, understanding their diagnostic accuracy to guide pre-procedural planning of TAVI is paramount. In our study, VEA provided reliable assessment of aortic root anatomy for TAVI planning. This novel 3D software provides accurate, patient-specific reconstructions of the aortic root and surrounding structures that may optimize valve sizing, improve procedural safety and enhance procedural outcomes. This provides a rationale for future studies to assess the procedural benefit derived from a three-dimensional assessment of the aortic valve geometry.

Background: Left atrial appendage (LAA) closure is an alternative to oral anticoagulants (OAC) for stroke prevention in atrial fibrillation (AF), but comparative evidence remains inconsistent. This study systematically evaluates the efficacy and safety of LAA closure versus OAC in AF patients.

Methods: We systematically searched PubMed, EmBase, Cochrane Library, and Web of Science for randomized controlled trials (RCTs) and propensity score-matched (PSM) studies published up to 30 September 2025. Treatment effects were estimated using relative risks (RR) with 95% confidence intervals (CI), and a random-effects model was applied for all analyses.

Results: Fifteen studies (17,116 AF patients) were included, comprising 4 RCTs, 3 prospective PSM studies, and 8 retrospective PSM studies. Compared with OAC, LAA closure significantly reduced the composite endpoint (RR: 0.79; 95% CI: 0.66-0.95; p = 0.010), all-cause mortality (RR: 0.58; 95% CI: 0.49-0.69; p < 0.001), and cardiovascular mortality (RR: 0.55; 95% CI: 0.44-0.67; p < 0.001). Risks of any stroke (RR: 1.06; 95% CI: 0.86-1.31; p = 0.555), ischemic stroke (RR: 1.00; 95% CI: 0.85-1.17; p = 0.972), hemorrhagic stroke (RR: 0.96; 95% CI: 0.54-1.70; p = 0.879), and major bleeding (RR: 0.84; 95% CI: 0.67-1.04; p = 0.112) were not significantly different between groups.

Conclusions: In AF patients, LAA closure significantly reduces mortality and a composite clinical endpoint compared to OAC, with similar risks of stroke and major bleeding. It is a favorable alternative for patients unsuitable for long-term anticoagulation.

Unsaturated fatty acids have the potential to reduce residual cardiovascular risk. Sea buckthorn (Hippophae rhamnoides L.) contains several valuable bioactive substances, including lipids with a balanced fatty acid composition. The aim of this study was to evaluate the effects of sea buckthorn seed lipid extract (SBS-LE) on residual cardiovascular risk in high-risk patients. In this pilot study, 86 patients with chronic coronary syndrome receiving statin (atorvastatin or rosuvastatin) and/or ezetimibe were enrolled. SBS-LE capsules (1000 mg, twice daily) were prescribed in addition to standard medical therapy, with each capsule containing 300 mg of omega-3 alpha-linolenic acid, 370 mg of omega-6 linoleic acid, 170 mg of omega-9 oleic acid and 7 mg of the plant sterol beta-sitosterol. For this clinical trial, SBS-LE was produced via supercritical fluid extraction with carbon dioxide. Clinical effects and impacts on laboratory test results were evaluated at baseline and after three months. Additionally, lipidomics testing was performed to confirm the bioavailability of the formulation. Significant reductions in systolic blood pressure by 2.9 mmHg (2.1%, p = 0.012), LDL-C by 0.3 mmol/l (12.0%, p = 0.005) and CRP by 1.0 mg/l (37.0%, p = 0.032) were observed. These data suggest that SBS-LE may have potential as an add-on preventive strategy for residual cardiovascular risk reduction.

Background: While the 2024 ESC Guidelines provide guidance on utilising incidental CAC findings from non-gated CT scans to enhance risk stratification and guide treatment decisions, there remain gaps in detailed protocols for managing such incidental findings, particularly in inpatient settings. An incidental finding of CAC in a patient without known atherosclerosis provides an opportunity to assess cardiac risk, promote risk factor optimisation and evaluate need for further cardiac work up. The aim of this study was to assess the prevalence of incidental coronary artery calcification on non-cardiac dedicated gated CT thorax scans among general medical inpatients and to evaluate the subsequent management of these findings.

Methods: This was a single-centre retrospective observational study of consecutive general medical inpatients aged 40-75, who had undergone a non-cardiac gated CT thorax during their admission, between February and March 2025. Data were collected using local electronic health records. Exclusion criteria were patients with known ischaemic heart disease (IHD). Risk factor assessment was noted by documentation of smoking status, hypertension, diabetes and low-density lipoprotein (LDL) values.

Results: A total of 186 patients with thoracic CT scans were identified. On review of all CT reports, 53 (28.4%) patients had CAC reported, of whom 17 had known IHD. Therefore 36 (19.4%) patients were identified for further analysis. An exercise stress test was booked in none of the patients. A coronary angiogram was booked in 1 patient.

Conclusions: One fifth of medical inpatients in our study had a new finding of CAC on thoracic imaging. Cardiovascular risk factors of LDL and HbA1c were checked in less than half of patients. None of these patients went on to have functional testing. There is a valuable opportunity to optimise cardiac risk factors and evaluate the need for functional testing in a subset of patients with CAC reported on non-cardiac CTs. This can be facilitated by raising awareness and implementing a flowchart tool for hospital physicians to reference.