Journal of Cardiovascular Development and Disease最新文献

Atrioventricular (AV) node ablation represents an established therapeutic option in the management of atrial fibrillation (AF) and other atrial tachyarrhythmias, particularly in patients with symptomatic tachycardia who remain unresponsive or intolerant to pharmacological therapy. The procedure is often considered in cases of refractory arrhythmias, antiarrhythmic drugs intolerance, or tachycardiomyopathy, and plays a key role in optimizing outcomes in patients undergoing cardiac resynchronization therapy, where achieving adequate biventricular pacing is otherwise compromised by rapid ventricular responses. Traditionally, AV node ablation is performed using radiofrequency energy delivered at the region of the His bundle, guided by the earliest His potential recordings. However, the anatomical complexity of the AV node and Koch's triangle poses important challenges, including the risk of incomplete ablation, persistence of conduction, lack of reliable junctional escape rhythms, and increased risk of proarrhythmia. Recent advances in high-resolution mapping and electroanatomical guidance have enabled a more precise anatomical approach, selectively targeting the compact AV node while reducing collateral injury. These developments offer the potential for improved procedural safety, long-term efficacy, and a more standardized strategy for patient management. This review summarizes current evidence, techniques, and clinical implications of AV node ablation, highlighting its role in the evolving landscape of arrhythmia treatment.

Background: Catheter ablation of atrial fibrillation (AF) is now a Class I recommendation therapy. However, the standard inferior vena cava (IVC) approach of catheter ablation is not feasible in all patients. Case presentation: We report a case of a 64-year-old woman in whom guidewire passage was hindered by prior left iliac vein stent placement and with symptomatic recurrent paroxysmal AF who underwent successful pulmonary vein isolation with a pulsed-field ablation system by superior vena cava (SVC) access from the right internal jugular vein. Conclusions: PFA administered via the SVC provides an effective and efficient treatment strategy for patients with paroxysmal AF ineligible for standard IVC catheter ablation.

(1) Background: Ventricular arrhythmias (VAs) are a leading cause of morbidity and mortality in ischemic and non-ischemic heart disease. While automated implantable cardioverter-defibrillators (AICDs) are standard treatment for high-risk patients, predicting future VA post-implantation remains limited. This study evaluated echocardiographic and strain parameters for predicting VA risk in AICD recipients. (2) Methods: This retrospective cohort study included patients who underwent AICD implantation at Westmead Hospital, New South Wales, Australia (January 2014-May 2024). Pre-implant transthoracic echocardiograms (TTEs) were analysed for structural and functional parameters, including left-ventricular (LV) ejection fraction (LVEF), LV global longitudinal strain (GLS), mechanical dispersion (MD), and delta contraction duration (DCD). VA events, defined as appropriate AICD shock or anti-tachycardia pacing, were identified from electronic medical records and device checks. Univariate and multivariate Cox regression analyses were performed. (3) Results: Among 242 patients, 98 experienced VA events. Increased LV end-diastolic diameter, indexed LV mass, and right-ventricular basal diameter were associated with VA events (p < 0.05), whilst LVEF and GLS were not. LV dyssynchrony was greater in affected patients (MD 69.2 ms vs. 63 ms, p = 0.036; DCD 288.8 ms vs. 246.4 ms, p = 0.010). DCD was an independent predictor of VA events (HR 1.003; 95% CI: 1.000-1.006; p = 0.022). (4) Conclusions: DCD may improve risk stratification in AICD patients.

Managing refractory cardiogenic shock is individualized, with few aspects considered routine or universally contraindicated. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a temporary mechanical circulatory support strategy, providing hemodynamic stabilization and gas exchange for patients with severe cardiogenic shock. It is increasingly used as salvage therapy for advanced cardiopulmonary failure and serves as a bridge to myocardial recovery, heart transplantation, or durable mechanical support such as a left ventricular assist device. Over the past decade, VA-ECMO utilization has risen, even though robust clinical trial evidence supporting its use remains limited. Furthermore, consensus is lacking on key aspects of care, including patient selection, cannulation strategy, weaning protocols, and complication management. This review outlines a structured approach to daily VA-ECMO care, emphasizing multidisciplinary coordination and individualized patient support to optimize outcomes and mitigate complications. We also address the implications of limited trial data and highlight the need for evidence-based frameworks to guide clinical decision-making.

ST-segment elevation myocardial infarction (STEMI) represents a time-critical medical emergency where complete coronary artery occlusion initiates progressive myocardial necrosis. The fundamental principle of modern STEMI care-"Time is Muscle"-establishes that ischemic duration directly determines infarct size and clinical outcomes. Each minute of delay correlates with increased mortality, larger infarcts, and a higher risk of heart failure development. Total ischemic time encompasses both patient-mediated delays (often the largest component) and system-related delays, each influenced by distinct factors requiring targeted interventions. This comprehensive review analyzes the components of total ischemic time, quantifies the clinical consequences of delay, and evaluates evidence-based mitigation strategies. We examine the evolution from fibrinolysis to primary percutaneous coronary intervention and the resulting logistical challenges. System-level interventions-including public awareness campaigns, regionalized STEMI networks, pre-hospital ECG acquisition, and standardized hospital protocols-have dramatically reduced treatment times. However, persistent disparities based on geography, presentation timing, sex, race, and age remain problematic. Emerging technologies, particularly artificial intelligence for ECG interpretation, offer promise for further time reduction.

Cardiac computed tomography (CT) has long evolved as a highly accurate screening tool for coronary artery disease. New technologies such as multi-detector rows and artifact reduction by a new motion correction algorithm have made it possible to evaluate coronary artery stenosis with higher diagnostic accuracy and lower radiation exposure. In addition to the anatomical evaluation of coronary arteries, the introduction of fluid dynamic analysis enables the measurement of coronary fractional flow reserve (FFR) for each stenotic lesion, which can only be achieved through invasive catheter evaluation. Myocardial ischemia can now also be detected using myocardial stress perfusion CT imaging. In addition, with the advent of dual-energy imaging or new image reconstruction technology, the addition of late contrast phase imaging enables myocardial late enhancement and left ventricular (LV) extracellular volume (ECV) analysis, which was previously possible only with cardiac magnetic resonance imaging (MRI). It has also been reported that LV ECV may be useful in predicting prognosis in cases with cardiomyopathies. In addition, retrospective imaging of the entire heart in a single cardiac cycle is now possible with lower radiation exposure, enabling not only morphological evaluation of the heart and valves but also myocardial strain analysis, which has conventionally been evaluated mainly by echocardiography and is expected to be applied in clinical practice in the future. Cardiac CT, which overcomes the weaknesses of other modalities while demonstrating greater usefulness through the latest technological development, is expected to expand its field of application to the entire heart analysis. The purpose of this review is to provide an overview of the technological development of cardiac CT, which has seen remarkable development in recent years, along with its clinical utility, with the aim of enabling clinicians to fully utilize it in daily practice.

Mitral regurgitation is one of the most prevalent valvular heart diseases globally and the second most common indication for cardiac valve surgery, surpassed only by aortic stenosis. Over the past decades, open-heart mitral valve surgery has been the gold-standard intervention for this complex disorder, but in recent years, transcatheter edge-to-edge repair has emerged as a valuable option in selected clinical scenarios. However, a considerable proportion of patients develop recurrent mitral regurgitation during follow-up, leading to a significant increase in morbidity and mortality. In this context, data is limited regarding the optimal approach. This review provides an overview of the current evidence on transcatheter mitral valve intervention therapies for the management of recurrent mitral regurgitation following transcatheter edge-to-edge repair.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated significant cardiovascular and renal benefits beyond glycemic control, yet their integrated mechanisms remain incompletely understood. Emerging evidence highlights the gut-kidney-heart axis as a pivotal pathological network, wherein gut dysbiosis, toxic metabolite accumulation, intestinal barrier disruption, and systemic inflammation synergistically drive cardiorenal injury. This review systematically elucidates how SGLT2i modulate this axis through multi-level interventions: reshaping gut microbiota composition, enriching short-chain fatty acid-producing bacteria, suppressing trimethylamine and other toxin-generating microbes, restoring tight junction integrity, and regulating bile acid metabolism. These upstream effects reduce systemic inflammatory and metabolic stress, interrupt kidney-derived toxin amplification, and mitigate myocardial remodeling. Unlike previous reviews focusing on single-organ pathways, this work integrates microecological regulation, metabolite reprogramming, and cross-organ protection into a unified "three-axis convergence to the heart" framework. We also highlight potential species-specific microbiota regulatory profiles among different SGLT2i and propose future directions, including fecal microbiota transplantation and microbiota-targeted co-therapies, to clarify causal relationships and optimize therapeutic strategies. By positioning the gut as a modifiable upstream driver, this framework provides novel mechanistic insight and translational potential for expanding SGLT2i applications in metabolic cardiovascular disease, including in non-diabetic populations.

Background: Acute kidney injury (AKI) is a frequent complication following transcatheter aortic valve implantation (TAVI) and has been linked to increased mortality. However, the temporal pattern of this association remains uncertain. This study aimed to evaluate the time-dependent impact of AKI on mortality after TAVI using advanced survival analyses.

Methods: We retrospectively analyzed 381 consecutive patients who underwent transfemoral TAVI between December 2016 and October 2024 at two tertiary cardiovascular centers. AKI was defined according to the Acute Kidney Injury Network (AKIN) criteria. The primary outcome was all-cause mortality. Patients were categorized into AKI and non-AKI groups. Clinical outcomes, including 30-day, 1-year, and overall mortality, were evaluated.

Results: Among 381 patients who underwent TAVI, 59 (15.5%) developed AKI according to the AKIN criteria. During a 33.9 months (18.0-59.2) median follow-up of overall mortality was significantly higher in the AKI group compared with those without AKI. In the multivariate Cox regression analysis, AKI was significantly associated with long-term mortality (HR: 2.07, 95% CI 1.32-3.25; p = 0.002). The time-varying hazard ratio curve demonstrated that the excess mortality risk associated with AKI was most pronounced in the early period and gradually declined thereafter. In time-interval-specific analyses, AKI was strongly associated with mortality within the first month (HR 6.30, 95% CI 3.03-13.08, p < 0.001) and remained significant up to 12 months (HR 2.18, 95% CI 1.32-3.59, p = 0.002). Beyond the first year, this association attenuated and lost statistical significance at 12-36 months (HR 0.90, p = 0.79), 36-60 months (HR 0.57, p = 0.24), and >60 months (HR 0.43, p = 0.13).

Conclusions: AKI is an important predictor of early and mid-term mortality following TAVI, but its long-term prognostic impact is less pronounced. Preventive strategies and early management of AKI may improve outcomes in this high-risk population.

Cardiovascular magnetic resonance (CMR) imaging is a key component of current diagnostic pathways in subjects with acute myocarditis. The 2020 ESC Guidelines on Sports Cardiology recommend athletes with acute myocarditis to abstain from sports during the recovery phase from inflammation and to undergo comprehensive evaluation-including CMR-before safely returning to play. This retrospective study analyzed 95 non-competitive athletes presenting with acute myocarditis and evaluated by initial and repeated CMRs. CMR exams assessed myocardial inflammation, edema, and scarring as defined based on the updated Lake Louise criteria. As per 2020 ESC Guidelines, eligibility was granted by excluding extensive myocardial damage. Initial CMR showed 84% positive STIR (edema) and 79% with LGE ≥ 3 segments. After 3-6 months, STIR positivity dropped to 12%, LGE extent remained globally stable, but with some reduction in 42%. Few experienced recurrent myocarditis or LVEF decline; 24% met return-to-play criteria by repeated CMR. Our study shows that few non-competitive athletes recovering from acute myocarditis meet ESC CMR criteria to resume competitive sports at prescribed follow-up evaluation. The long-term prognostic value of CMR markers like LGE and edema remains unclear, highlighting the need for further research to refine return-to-play guidelines and ensure athlete safety.