Reviews in cardiovascular medicine最新文献

Background: The utilization of catheter ablation among patients with atrial fibrillation (AF) and heart failure (HF) has garnered significant attention. There has been a rapid proliferation of diverse articles addressing this topic. This study evaluated the potential redundancy in meta-analyses about this subject.

Methods: We searched PubMed, Embase, and the Web of Science for meta-analyses comparing catheter ablation with other therapies among patients with AF and HF from the inception date to December 25, 2023. The extracted data encompassed details about the author, country, publication time, journal, pre-registration status, number and type of included studies, primary endpoints, and results. Additionally, we scrutinized whether these meta-analyses referenced, described, or discussed prior relevant meta-analyses, or were cited within prominent international guidelines.

Results: A total of 34 meta-analyses were included. Authors predominantly originated from the United States and China. The majority of articles were published in cardiovascular journals without pre-registration. There were two publication peaks, notably in 2018-2019 and 2023. Primary endpoints predominantly focused on all-cause mortality and alterations in left ventricular ejection fraction (LVEF). A consistent trend emerged across most articles, indicating a 40-50% reduction in mortality and a 5-9% elevation in LVEF associated with catheter ablation. Approximately 79.4%, 64.7%, and 50% of the articles respectively cited, described, and discussed previous meta-analyses on the same subject. Only 9 meta-analyses were referenced in impact international guidelines.

Conclusions: Our study demonstrates a notable prevalence of redundant meta-analyses within the domain of catheter ablation among patients with AF and HF.

Background: Coronary obstruction (CO) is a fatal complication in transcatheter aortic valve replacement (TAVR). However, data on the outcomes and details of coronary protection (CP) use in TAVR are limited.

Methods: We retrospectively analyzed the patients who had undergone CP during TAVR at our tertiary cardiac center from March 2017 to January 2024. CP was achieved by an undeployed coronary balloon or stent positioned within the coronary artery, which releases the stent at CO occurrence. Patients' computed tomography (CT) evaluation reports and perioperative and follow-up outcomes were reviewed.

Results: A total of 33 out of 493 patients (6.7%) underwent CP during TAVR due to the high risk of CO based on preoperative CT analysis. The mean sinus dimensions measured 30.1 ± 3.6 mm, 29.2 ± 3.4 mm, and 30.4 ± 3.7 mm for the left, right, and non-coronary sinus, respectively. The average left main height was 11.7 mm, and the right coronary height was 14 mm. Self-expanding valves were used in 93.9% of the patients. Coronary balloons were used for CP in 30 patients, whereas undeployed coronary stents were used in three cases. A total of 36 coronary arteries were protected, including 28 left coronary arteries alone, two right coronary arteries alone, and three dual coronary arteries. Eight patients (24.2%) developed CO and underwent stent release. The in-hospital and 30-day all-cause mortality rates were 9.1% and 0%, respectively. The median follow-up time was 10 months, and only one patient died 2 months after discharge due to stroke during the follow-up.

Conclusions: Pre-emptive coronary balloons or stents for CP allow for revascularization in the shortest possible time in the event of CO. Early and mid-term outcomes of CP during TAVR in patients with a high risk of CO show that CP is safe and feasible.

Background: The relationship between cardiovascular outcomes and niacin consumption levels remains unclear. This study aimed to examine the correlation between niacin intake and the incidence of cardiovascular disease, as well as the mortality rates associated with cardiovascular disease and other causes.

Methods: From 2003 to 2018, we continually investigated updated information from the National Health and Nutrition Examination Survey. Based on the quartiles of niacin intake levels, four distinct categories of participants were established: Q1 (<14.646 mg), Q2 (14.646-21.302 mg), Q3 (21.302-30.401 mg), and Q4 (>30.401 mg). Baseline variable differences were assessed employing the Chi-Square and Student's t-tests. A weighted logistic regression with multiple variables was used to determine the association between niacin intake and cardiovascular disease prevalence. Hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause death and cardiovascular disease were determined utilising hazard regression models. Kaplan-Meier curves were used to compare survival probability between the high and low niacin intake groups, and dose-response linear relationships were evaluated with restricted cubic splines.

Results: The cohort analysis included 80,312 participants for the assessment of niacin intake. Comparing the Q1 dataset to the Q4 dataset in the overall population, weighted Cox regression analysis showed a negative association with all-cause mortality (95% CI: 0.71-0.96, HR: 0.82) and mortality owing to cardiovascular disease (95% CI: 0.67-0.96, odds ratio (OR): 0.80). Sex-based subgroup analysis revealed a detrimental correlation between niacin use and overall mortality in females (Q4 cohort: 95% CI: 0.62-0.97, HR: 0.78) but not in males. Additionally, the Q3 (95% CI: 0.59-0.94, HR: 0.75) and Q4 (95% CI: 0.51-0.97, HR: 0.7) groups exhibited a negative association with female cardiovascular disease mortality compared to the Q1 group. Niacin intake was not significantly correlated with prevalence, all-cause mortality, or death from cardiovascular disease in males.

Conclusions: Higher niacin consumption was correlated with a decreased risk of cardiovascular disease and death from all causes across the entire study population. Nevertheless, only females, and not males, exhibited a beneficial effect on mortality.

Background: Prolonged mechanical ventilation (PMV) is a common complication after cardiac surgery and is considered a risk factor for poor outcomes. However, the incidence and in-hospital mortality of PMV among cardiac surgery patients reported in studies vary widely, and risk factors are controversial.

Methods: We searched four databases (Web of Science, Cochrane Library, PubMed, and EMBASE) for English-language articles from inception to October 2023. The odds ratio (OR), 95% confidence interval (CI), PMV incidence, and in-hospital mortality were extracted. Statistical data analysis was performed using Stata software. We calculated the fixed or random effects model according to the heterogeneity. The quality of each study was appraised by two independent reviewers using the Newcastle-Ottawa scale.

Results: Thirty-two studies were included. The incidence of PMV was 20%. Twenty-one risk factors were pooled, fifteen risk factors were found to be statistically significant (advanced age, being female, ejection fraction <50, body mass index (BMI), BMI >28 kg/m², New York Heart Association Class ≥Ⅲ, chronic obstructive pulmonary disease, chronic renal failure, heart failure, arrhythmia, previous cardiac surgery, higher white blood cell count, creatinine, longer cardiopulmonary bypass (CPB) time, and CPB >120 min). In addition, PMV was associated with increased in-hospital mortality (OR, 14.13, 95% CI, 12.16-16.41, I² = 90.3%, p < 0.01).

Conclusions: The PMV incidence was 20%, and it was associated with increased in-hospital mortality. Fifteen risk factors were identified. More studies are needed to prevent PMV more effectively according to these risk factors.

The prospero registration: This systematic review and meta-analysis was recorded at PROSPERO (CRD42021273953, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=273953).

This review addresses the diagnosis and management of ventricular septal defects (VSDs). The VSDs are classified on the basis of their size, their number, and their location in the ventricular septum. Natural history of VSDs includes spontaneous closure, development of pulmonary hypertension, onset of infundibular obstruction, and progression to aortic insufficiency. While initial diagnostic approaches such as careful history-taking, physical examination, chest X-rays, and electrocardiograms provide basic information, echo-Doppler studies are essential for assessing the defect's clinical significance and determining the need for intervention. Intervention is usually indicated for symptomatic patients with moderate- to large-sized VSDs. Surgical closure is advised for perimembranous, supracristal and inlet VSDs, and for deficits involving prolapsed aortic valve leaflets. While percutaneous methods to occlude perimembranous VSDs with Amplatzer Membranous VSD Occluder are feasible, they are not recommended due to a notable risk of inducing complete heart block in a significant number of patients. Alternatively, percutaneous and hybrid methods employing the Amplatzer Muscular VSD Occluder are effective for treating large muscular VSDs. The majority of treatment options have demonstrated satisfactory outcomes. However, practitioners are urged to exercise caution in managing small defects to avoid unnecessary procedures and to ensure timely intervention for large VSDs to prevent pulmonary vascular obstructive disease.

Background: Dietary choices are inextricably linked to the incidence of cardiovascular disease (CVD), whereas an optimal dietary pattern to minimize CVD morbidity in high-risk subjects remains challenging.

Methods: We comprehensively assessed the relationship between food consumption frequencies and CVD in 28,979 high-risk subjects. The outcome was defined as the composite of the incidence of major CVD events, including coronary heart disease and stroke. Risk factors associated with CVD were screened through a shrinkage approach, specifically least absolute shrinkage and selection operator (LASSO) regression. Hazard ratios (HRs) for various dietary consumption frequencies were assessed using multivariable Cox frailty models with random intercepts.

Results: Increased egg and seafood consumption were associated with a lower risk of CVD (daily vs little, HR 1.70, 95% confidence interval, CI: 0.79-3.64, p _trend = 0.0073 and HR 1.86, 95% CI: 1.24-2.81, p _trend = 0.024, respectively). 6 non-food (age, sex, smoke, location, heart ratio, and systolic blood pressure) and 3 food (fruit, egg, and seafood) related risk factors were included in the nomogram to predict 3 and 5-year incidence of CVD. The concordance indexes of the training and validation cohorts were 0.733 (95% CI: 0.725-0.741) and 0.705 (95% CI: 0.693-0.717), respectively. The nomogram was validated using the calibration and time-dependent receiver operating characteristic curves, demonstrating respectable accuracy and discrimination.

Conclusions: Guided by the concept of "food as medicine", this nomogram could provide dietary guidance and prognostic prediction for high cardiac risk subjects in CVD prevention.

Background: Both acute myocardial infarction (AMI) and its salvage treatment, venoarterial-extracorporeal membrane oxygenation (VA-ECMO), may lead to the production of proinflammatory cytokines and further aggravate tissue damage. Xuebijing (XBJ) may modulate cytokine production involved in the inflammatory response. We aimed to determine the efficacy of XBJ in cardiogenic shock patients on VA-ECMO.

Methods: This was a prospective, randomized trial carried out in an intensive care unit of a tertiary teaching hospital. Patients with cardiogenic shock after acute myocardial infarction undergoing percutaneous coronary intervention (PCI) with VA-ECMO support were randomly divided into a Xuebijing group and a control group. Cytokines, inflammatory factors and left ventricular ejection fraction (LVEF) were compared between the groups.

Results: 41 patients were enrolled in the study, with 21 in the Xuebijing group and 20 in the control group. 28 (68.3%) were male, and the average age was 64.71 ± 8.18 years old. There was no difference in APACHEII (acute physiology and chronic health evaluation II) score, LVEF, or cytokine and inflammatory factors collected before extracorporeal membrane oxygenation (ECMO) between the two groups. The levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in the Xuebijing group were lower than those in the control group in the first 24 hours, 48 hours and 72 hours after ECMO (p < 0.05). The LVEF in the Xuebijing group was higher than that of the control group at 48 hours (31.57 ± 3.43 vs. 28.35 ± 4.42, p = 0.013). This trend persisted at 72 hours. The duration of ECMO support in the Xuebijing group was 5.57 ± 2.11 days, which was shorter than that in the control group (p = 0.033).

Conclusions: Xuebijing injection can reduce the inflammatory response and improve cardiac function in patients with acute myocardial infarction treated with VA-ECMO to a certain extent.

Clinical trial registration: Chinese Clinical Trial Registry (ChiCTR), ChiCTR2100054069, Registered 8, December 2021, https://www.chictr.org.cn/showproj.html?proj=142869.

Cancer patients have an increased risk of venous thromboembolism (VTE), and VTE is the second most common cause of death among them. Anticoagulation plays a key role in the treatment of cancer-associated thrombosis (CAT). Low-molecular-weight heparin (LMWH) or direct oral anticoagulants (DOACs) are effective and generally safe options for cancer-associated VTE. However, those patients have a 10-20% risk of VTE recurrence in spite of using anticoagulants. The main reasons for recurrent VTE (rVTE) can be non-compliance, inadequate dosing of anticoagulants, thrombocytopenia and malignancy progression. Despite the publication of major guidelines regarding the management of CAT, the treatment of patients with rVTE is undefined. Treatment options for rVTE include bridging to LMWH in cases of oral anticoagulants use, LMWH dose escalation, and sometimes considering inserting a vena cava filter. This review paper summarizes the management of cancer-associated VTE, risk factors for rVTE and the treatment algorithm of rVTE.