Reviews in cardiovascular medicine最新文献

Traditional parameters, such as left atrial size or volume, typically reflect chronic pressure and volume overload; however, these abnormalities only become evident at advanced stages, often missing early signs of dysfunction. In contrast, left atrial reservoir strain (LASr), measured by speckle-tracking echocardiography, offers a sensitive and dynamic assessment of atrial mechanics, integrating atrial compliance with left ventricular diastolic interaction. Moreover, impaired LASr reflects atrial stiffness and fibrosis, and correlates with elevated filling pressures, making the LASr parameter a comprehensive biomarker of left-sided cardiac function. Indeed, LASr has demonstrated diagnostic and prognostic value across a wide spectrum of conditions. In heart failure with preserved ejection fraction, LASr refines the assessment of diastolic dysfunction and predicts hospitalization and mortality. In atrial fibrillation, reduced strain correlates with atrial fibrosis and left atrial appendage dysfunction, identifying patients at increased risk of arrhythmia recurrence and thromboembolism. In valvular disease, LASr uncovers subclinical remodeling and stratifies risk even in patients with apparently moderate aortic stenosis. Meanwhile, in addition to cardiovascular disease, LASr can detect early atrial impairment in systemic disorders such as hypertension, diabetes, obesity, and amyloidosis, often before structural enlargement becomes evident. Our group has shown that LASr predicts persistent hypertension after gestational hypertensive disorders, reveals subclinical diastolic dysfunction in idiopathic pulmonary fibrosis, non-invasively predicts left atrial appendage thrombus in atrial fibrillation, stratifies outcomes in moderate aortic stenosis, and provides prognostic information in acute ischemic stroke. This narrative review outlines the physiological basis, technical considerations, and clinical applications of LASr, discusses its limitations and future perspectives-including multimodality imaging and artificial intelligence-and underscores its transition from a research metric to a dynamic biomarker ready for clinical practice.

Electrocardiograms (ECGs) remain a foundational pillar of cardiovascular diagnostics, providing rapid, non-invasive diagnosis and being universally accessible to all clinicians. An ECG captures the electrical signals of the heart via a standard 12-lead configuration, offering insights into arrhythmias, conduction delays, ischemic injury, structural remodeling, and systemic pathologies with cardiac implications. This review presents a structured framework for ECG interpretation by discussing general approaches to rate, rhythm, axis, intervals, and repolarization dynamics, and by outlining both cardiac and non-cardiac conditions associated with ECG abnormalities. We explore the accelerating pace of innovations in artificial intelligence (AI) for ECG analysis. Deep learning algorithms now rival and, in select domains, surpass expert clinicians in detecting left ventricular systolic and diastolic dysfunction, hypertrophic obstructive cardiomyopathy, and acute myocardial infarction. The integration of AI-enhanced ECG interpretation enables earlier disease recognition, refined risk stratification, and optimized clinical decision-making across acute and chronic care settings. This review systematically guides readers through ECG interpretation, linking fundamental principles with nuanced clinical patterns using AI to enhance accurate diagnosis and improve patient outcomes across a wide range of cardiovascular conditions.

Continuous-flow left ventricular assist devices (LVADs) represent a leading option in the treatment of end-stage heart failure (HF), provided that right ventricular (RV) contractile function is sufficiently preserved to ensure cardiac output after LVAD implantation. In this context, evaluating the RV before surgery is crucial, as the onset of early right heart failure (RHF) following LVAD placement is linked to increased mortality and morbidity. Unfortunately, the contractile performance of the RV is a difficult issue to evaluate and requires a multimodal approach based on the application of multiple diagnostic tools, including clinical assessment, echocardiography, right heart catheterization (RHC), and risk models, all of which have variable predictive power in the currently available literature. Pre-implantation RV assessment is even more challenging and misleading in patients with hemodynamic instability under extracorporeal membrane oxygenation (ECMO) support, a situation characterized by complete right heart unloading, which renders most assessment techniques unreliable. The present paper proposes a simple and comprehensive preoperative appraisal strategy for the RV, which is adapted to the clinical status (critical or more stable) of the patient, based on a review of the advantages and limitations of each diagnostic modality and derived parameters.

Acute Stanford type A aortic dissection (ATAAD) is a life-threatening cardiovascular emergency that demands prompt and accurate diagnosis due to a high associated mortality. Although imaging remains the diagnostic gold standard, the limited accessibility and time sensitivity of this technique underscore the need for reliable serum biomarkers. D-dimer is the most widely used biomarker, offering high sensitivity; however, the limited specificity of using D-dimer has prompted a search for novel biomarkers with greater diagnostic precision. Interestingly, proteoglycans (PGs) are essential constituents of the extracellular matrix (ECM) and have emerged as promising candidates for ATAAD, as PGs are released into the circulation during medial degradation, a defining histological feature of ATAAD. Moreover, emerging evidence suggests that specific PGs exhibit favorable specificity and stability, potentially enabling distinction between ATAAD and other acute cardiovascular syndromes. Additionally, in contrast to D-dimer, which is rapidly cleared within 8 hours, certain PGs, such as aggrecan, remain stable for up to 72 hours, offering an advantage for detecting ATAAD in patients presenting beyond the early acute phase. This review summarizes the potential of aortic PGs as biomarkers of medial degeneration and circulating PGs as serum diagnostic markers of ATAAD. Future research is warranted to establish PGs as clinically reliable biomarkers, with the potential to enhance current diagnostic frameworks and support an earlier, more accurate identification of ATAAD.

Cardiac computed tomography (CT) has become an essential imaging modality in structural cardiac interventions, providing high-resolution anatomical and functional assessments. Moreover, the role of cardiac CT spans pre-procedural planning, intra-procedural guidance, and post-procedural follow-up in interventions such as transcatheter aortic valve implantation (TAVI), mitral, tricuspid, and pulmonary valve interventions, left atrial appendage occlusion (LAAO), atrial septal defect (ASD), and paravalvular leak (PVL) closures. Furthermore, compared to traditional imaging techniques, cardiac CT offers superior spatial resolution, precise anatomical characterization, and improved procedural success rates by minimizing complications. Additionally, advances in artificial intelligence (AI)-driven CT analysis, perfusion imaging, and four-dimensional cardiac CT are expanding the associated applications. This review discusses the current role, benefits, limitations, and future perspectives of cardiac CT in guiding structural heart interventions.

Background: The study aimed to compare the differences in reverse left ventricular (LV) remodeling following transcatheter aortic valve replacement (TAVR) between patients with the bicuspid aortic valve (BAV) and those with tricuspid aortic valve (TAV), both with aortic stenosis, in a Chinese population.

Methods: A total of 137 patients were enrolled who were treated with a self-expandable Venus A valve at our center, who underwent TAVR from January 1, 2019, to June 30, 2022. We retrospectively included patients with BAV and TAV who underwent echocardiographic follow-ups at baseline and at least 6 months after the procedure.

Results: Patients with a BAV were younger than those with a TAV. The BAV patients had a larger aortic root diameter (ARD), although the size of valve implantation was comparable between the two groups. Patients with a BAV might experience less reverse LV remodeling post-TAVR than patients with a TAV during the one-month follow-up (140.09 ± 36.94 g/m² vs. 126.36 ± 26.96 g/m²; p = 0.044). There were no significant differences in the LV mass index (LVMi) between the two groups throughout the 24 hours or the six-month follow-up post-TAVR. Patients with a higher mean pressure gradient (MPG) (95% confidence interval (CI): 0.112-0.581; p = 0.004) and a larger ARD (95% CI: 0.519-5.573; p = 0.019) before TAVR had favorable mid-term LV reverse remodeling (ΔLVMi within 6 months) post-TAVR. Patients with much more severe aortic stenosis (AS) had favorable mid-term LV reverse remodeling post-TAVR.

Conclusions: Patients with BAV might experience less reverse LV remodeling post-TAVR than patients with TAV during a short-term follow-up, but similar remodeling during mid-term follow-ups.

Transthyretin cardiac amyloidosis (ATTR-CA) is an increasingly recognized and underdiagnosed cause of heart failure (HF), encompassing both preserved (HFpEF) and reduced (HFrEF) ejection fraction phenotypes. Once identifiable only following a biopsy, the advent of bone scintigraphy has dramatically improved noninvasive detection and detected a higher community prevalence, particularly among older patients with unexplained left ventricular hypertrophy. ATTR-CA arises from misfolding of transthyretin (TTR), leading to amyloid fibril deposition within the myocardium, which impairs cardiac compliance, conduction, and output. This review explores the evolving epidemiology of ATTR-CA in HF, mechanisms of disease progression, and key features for screening, emphasizing clinical red flags, biomarkers, and imaging features. This review also addresses the nuanced role of guideline-directed medical therapy in this population, where neurohormonal agents may offer limited benefit or be poorly tolerated due to restrictive physiology and autonomic dysfunction. Crucially, the emergence of amyloid-specific therapies, including TTR silencers, stabilizers, and degraders, has transformed the therapeutic landscape, offering mortality and morbidity benefits that were previously unavailable. Early diagnosis and individualized management, integrating conventional and amyloid-targeted approaches, are essential to improving outcomes in this complex and increasingly treatable cardiomyopathy.

[This retracts the article DOI: 10.31083/RCM44024.].

Background: The efficacy of beta-blockers in stable coronary artery disease (CAD) patients with preserved left ventricular function remains controversial. We aimed to evaluate the cardiovascular associations of beta-blocker therapy in this population through a comprehensive meta-analysis.

Methods: We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching PubMed, EMBASE, Web of Science, Scopus, Google Scholar, and Cochrane databases from inception to May 2025, updating and extending the previous meta-analysis. We included observational studies comparing beta-blocker therapy versus control in stable CAD patients, defined as those without acute coronary syndrome manifestations for a sufficient period (typically >6 months) to ensure clinical stability, with preserved left ventricular ejection fraction (left ventricular ejection fraction >50%). Primary outcome was cardiac death. Secondary outcomes included all-cause mortality, heart failure, myocardial infarction (MI), and stroke. Random-effects models were used for all analyses. Subgroup analyses were conducted for cardiac and all-cause death stratified by propensity score matching status and prior beta-blocker use exclusion criteria. Publication bias was assessed using funnel plots and Peter's test.

Results: Nine observational studies encompassing 903,870 patients (616,645 beta-blocker users vs. 287,225 controls) were included. Beta-blocker therapy showed no significant association with the primary endpoint: cardiac death (hazard ratio (HR) 0.98, 95% CI: 0.93-1.04, p = 0.54). Secondary outcomes similarly demonstrated no significant associations: all-cause mortality (HR 0.98, 95% CI: 0.91-1.05, p = 0.49), MI (HR 1.02, 95% CI: 0.93-1.11, p = 0.72), stroke (HR 1.02, 95% CI: 0.97-1.08, p = 0.43), and heart failure (HR 1.10, 95% CI: 0.95-1.27, p = 0.20). Substantial heterogeneity was observed for all-cause death (I² = 87%) and heart failure (I² = 95%). Subgroup analyses failed to identify populations with clear associations between beta-blocker therapy and improved outcomes.

Conclusion: Beta-blocker therapy was not significantly associated with cardiovascular benefits in stable CAD patients with preserved left ventricular function. These findings provide additional contemporary evidence supporting current guideline recommendations from both American Heart Association (AHA)/American College of Cardiology (ACC) and European Society of Cardiology (ESC) regarding beta-blocker use in this population. Clinicians should conduct individualized risk-benefit assessments rather than adopting routine prescribing patterns.

The prospero registration: CRD420251141812, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=1141812.