Reviews in cardiovascular medicine最新文献

Infective endocarditis (IE) is a life-threatening cardiac infection. The incidence of IE is increasing due to complex sociodemographic shifts, including increases in intravenous drug use (IVDU) attributed to opioid epidemics. Cardiac rehabilitation (CR) is a comprehensive form of secondary prevention for heart disease. Current guidelines suggest that CR may be beneficial in the recovery from IE, but supporting evidence is limited. Given the utility of CR in the recovery from other cardiac conditions and the unique characteristics of patients with IE, this narrative review summarizes the existing data on the use of CR following surgical treatment of IE. The existing literature is limited to the CopenHeart_IE randomized clinical trial (RCT) and four case reports. Thus, to our knowledge, this represents the first review to focus specifically on CR in the context of IE. The CopenHeart_IE RCT found that patients receiving CR showed greater improvements in levels of physical fatigue, general fatigue, maximal power, systolic blood pressure, and some questionnaire scores than the control group. The results of multiple case reports represent unique and extreme cases of IE from which support for the use of CR following IE can be drawn from the relative successes of each patient. Moreover, it is important to consider that the complex social needs of the IE population may require additional psychosocial support, which can be achieved by integrating social workers into the multidisciplinary CR team. While further research is warranted, the existing evidence supports the use of CR as part of the comprehensive recovery from IE.

Takotsubo syndrome (TTS) is an acute, reversible form of left ventricular dysfunction, typically triggered by emotional or physical stress. The hallmark feature is reversible regional wall motion abnormality extending beyond a single coronary distribution, most commonly presenting with an apical ballooning pattern. The pathophysiology is multifactorial, encompassing neurohormonal dysregulation, catecholamine-mediated toxicity, microvascular dysfunction, oxidative stress, inflammation, and metabolic disturbances. Nonetheless, despite growing recognition, an evidence gap persists in diagnosing TTS. Meanwhile, TTS is classified within myocardial infarction with non-obstructive coronary arteries (MINOCAs) and frequently treated as a diagnosis of exclusion. Further complicating the diagnostic algorithm, emerging evidence indicates that TTS and coronary artery disease (CAD) may coexist, suggesting a potential bidirectional relationship rather than a bystander phenomenon. Moreover, TTS shares several pathophysiological mechanisms with coronary microvascular dysfunction syndromes: angina with non-obstructive coronary arteries (ANOCAs) and ischemia with non-obstructive coronary arteries (INOCAs). These overlaps underscore the need for rigorous differential diagnosis and careful comprehensive evaluation of hemodynamic significance, plaque morphology, and microvascular phenotyping to enhance clinical recognition and optimize therapeutic decision-making. This review synthesizes current evidence on the diagnosis and management of TTS, emphasizing the intersection between TTS and coronary and microvascular disorders to promote a more targeted, mechanism-based therapeutic approach.

Background: Atrial fibrillation (AF) represents a major public health burden, especially in its long-standing persistent form, which is often resistant to pharmacological or catheter-based therapies. Hybrid ablation, which integrates minimally invasive surgical and endocardial catheter techniques, has been introduced to address these complex cases. However, data evaluating the long-term comparative effectiveness of immediate versus staged ablation strategies remain limited, and the specific contribution of adjunctive targets, such as Bachmann's bundle (BB), remains unclear.

Methods: In this single-center retrospective cohort study, we analyzed 60 patients with long-standing persistent AF who underwent hybrid ablation between 2008 and 2020. All patients received thoracoscopic epicardial ablation followed by endocardial catheter ablation either during the same hospitalization ("immediate group", n = 20) or ≥4 weeks later ("staged group", n = 40). A subset of patients underwent adjunctive BB ablation. The primary outcome was freedom from documented AF recurrence. Secondary outcomes included procedural complications, hospitalization duration, and long-term survival.

Results: At a mean follow-up of 106 ± 12 months, sinus rhythm was maintained in 90.0% of patients in the immediate group and 62.5% in the staged group (p = 0.034). BB ablation was associated with significantly improved rhythm control (90% vs. 70%; p = 0.04). No major adverse events or procedural mortality were reported. The immediate group had significantly shorter hospital stays (5.6 ± 1.5 vs. 8.8 ± 1.3 days; p < 0.001). Subgroup analyses did not reveal significant differences in recurrence among patients without BB ablation.

Conclusions: Hybrid ablation provides durable rhythm control and excellent safety over long-term follow-up. BB ablation enhances success and should be considered in procedural planning. Immediate catheter ablation may be a viable strategy in appropriately selected patients, potentially reducing hospitalization time and healthcare resource utilization. Our findings support the need for individualized ablation strategies in complex AF management and underscore the importance of integrating adjunctive targets, such as BB, into advanced procedural workflows.

Background: This study aimed to systematically investigate the association between serum branched-chain amino acids (BCAAs) and the risk of chronic rheumatic heart disease (RHD), as well as to explore potential mediating mechanisms through immune markers.

Methods: The data utilized in this prospective cohort study were derived from the UK Biobank. Serum BCAAs (leucine, isoleucine, and valine) were measured using metabolic profiling of nuclear magnetic resonance data. Chronic RHD cases were identified through hospital inpatient records and death registries. Multivariable Cox regression models were used to analyze the association between BCAAs and RHD risk. Causal mediation analysis was employed to investigate the mediated role of immune markers.

Results: A total of 273,595 participants were included, with 6051 (2.21%) participants developing chronic RHD. Each one-unit standard deviation increase in total BCAAs was associated with a 4.8% increased risk of RHD (hazard ratio (HR) = 1.048, 95% confidence interval (CI): 1.023-1.074). Among individual BCAAs, valine exhibited the strongest association (HR = 1.061, 95% CI: 1.035-1.088). Subgroup analyses revealed significantly stronger associations in participants aged <65 years compared to those aged ≥65 years (p for interaction = 0.032). Mediation analysis demonstrated that immune markers significantly mediated the BCAA-RHD association, with lymphocyte-to-C-reactive protein ratio accounting for 30.8% of the total effect.

Conclusions: Observational data suggest serum BCAAs correlate with increased RHD risk, especially in individuals aged <65 years; however, causation requires experimental verification. Immune markers significantly mediate the BCAA-RHD association, indicating that immunomodulatory pathways may be potential therapeutic targets. These findings provide novel insights into RHD pathogenesis and may inform risk stratification and prevention strategies.

Background: Left atrial appendage aneurysm (LAAA) is a rare cardiac abnormality associated with thromboembolic events and arrhythmias. This systematic review aimed to provide a comprehensive evaluation of literature reports on the demographics, clinical presentation, electrocardiographic and imaging findings, treatment, and outcomes of patients with LAAA.

Methods: A literature search was conducted using the PubMed, MEDLINE, and Scopus databases through September 2025. Only case reports and series explicitly describing LAAA were included. Extracted data included age, sex, clinical symptoms, electrocardiogram (ECG) characteristics, imaging findings, associated cardiac abnormalities, treatment modalities, and outcomes.

Results: A total of 216 cases were included. The mean age at diagnosis was 30.41 ± 22.39 years, with a slight predominance of males (50.5%). Symptoms included palpitations (32.4%), dyspnoea (17.2%), and thromboembolic events (7.8%). Atrial fibrillation and flutter were the most commonly detected arrhythmias. Echocardiography was the most frequently used initial diagnostic tool, with computed tomography (CT) and magnetic resonance imaging (MRI) providing additional anatomical details. Chest X-rays often yielded non-specific findings. The mean aneurysm diameter was 6.87 ± 2.64 cm. Surgical treatment, mainly aneurysm resection, was the most commonly used approach (72.7%), while conservative and device-based therapies were applied selectively. Concomitant cardiac anomalies were present in 13.7% of cases and influenced case management. The mortality rate was 4.6%, although significant morbidity was observed. Multivariate logistic regression analysis revealed that atrial fibrillation/flutter was the sole variable significantly linked with clot formation/embolism (p < 0.05).

Conclusion: LAAA is a rare, although clinically significant, entity with variable presentation and management challenges. However, early recognition and individualized treatment are essential. Further research is needed to define standardized diagnostic criteria and treatment guidelines.

Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality worldwide, creating an urgent demand for small-diameter vascular substitutes with durable long-term patency. Large-caliber synthetic grafts, such as polyethylene terephthalate (PET) and ePTFE, are well established in clinical practice; however, these synthetic grafts fail in small-diameter applications due to thrombosis and intimal hyperplasia. Moreover, autologous grafts are constrained by limited availability and variable quality. Recently, synthetic degradable polymers (e.g., polycaprolactone (PCL), poly(lactic-co-glycolic acid) (PLGA)), and extracellular matrix-derived natural materials (collagen, gelatin, silk fibroin, bacterial cellulose) have drawn increasing attention, as each offers distinct advantages and limitations in terms of mechanics, biocompatibility, and degradation behavior. Meanwhile, emerging fabrication technologies, including electrospinning, thermally induced phase separation, microfluidic spinning, and three-dimensional printing, are advancing the structural biomimicry and functional optimization of artificial vascular grafts. Thus, building on these developments, this review further examines the design strategies of tissue-engineered vascular grafts (TEVGs), focusing on cell sourcing, in vitro and in situ endothelialization, antithrombotic modification, and the prevention of intimal hyperplasia, while also summarizing outcomes from preclinical models and early clinical trials. Despite promising progress, the widespread clinical translation of TEVGs remains limited by prolonged manufacturing cycles, high costs, and insufficient long-term patency. Hence, future efforts toward standardized cell sources, integrated structure, function design, and multicenter clinical validation are critical to the development of next-generation vascular grafts.

Evidence is accumulating that shows spontaneous coronary artery dissection (SCAD) as a recognized cause of acute coronary syndrome (ACS), disproportionately affecting younger people and women. Moreover, despite continuing progress, the understanding of the pathophysiology, diagnosis, and management of SCAD remains limited. SCAD, by definition, is a non-atherosclerotic formation of an intramural hematoma or intimal tear, yet current diagnostic criteria and management are derived from atherosclerotic ACS guidelines. This review encompasses the current understanding of the condition, including risk factors, diagnostic and imaging modalities available for detection, differentials to be considered, associations with other comorbidities, prognostic factors, and management options for both the short and long term, encompassing both medical and interventional therapies. Meanwhile, a lack of research in key populations, such as non-pregnant women, postmenopausal women, and men, prevents the generalizability of these findings and has been highlighted. However, by identifying and conceptualizing existing evidence, this review aims to provide direction to future research.

Modern medicine increasingly offers the potential to individualise patient care and tailor therapies to meet specific patient needs. Catheter ablation in atrial fibrillation has undergone radical evolution since the advent of early ablative therapies; however, more comprehensive or extensive strategies are now possible. Moreover, novel energy sources, catheters, and mapping platforms are being developed and implemented, raising the potential to deliver ablation strategies more effectively, durably, quickly, and potentially more extensively. This poses the challenge of whether to prioritise anatomical landmark-based ablation or pursue individual mechanisms of arrhythmia on a personalised basis. Thus, this review aims to summarise the current state-of-the-art developments in catheter ablation for atrial fibrillation, recent advances, and developments in both the ablation and understanding of arrhythmia pathophysiology.

Cardiovascular diseases (CVDs) are a leading cause of mortality, significantly influencing quality of life and causing a burden on the healthcare system. Current treatment strategies utilize modern therapeutics, such as sodium-glucose cotransporter 2 (SGLT2) inhibitors and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, which are both effective and safe. However, despite current medicines, acute cardiovascular events and chronic complications of CVDs remain significantly prevalent. Furthermore, CVDs are strongly linked to metabolic and inflammatory conditions that create a pathophysiological network of interactions, worsening the health of individuals. Therefore, identifying novel therapeutic targets and treatment combinations is of great importance to further mitigate the harmful effects of CVDs. Recently, aprocitentan, an endothelin-1 inhibitor, was approved to treat arterial hypertension. Meanwhile, endothelin has become a therapeutic target in CVDs, with inhibitors previously registered and used to treat pulmonary hypertension. Thus, this review aims to comprehensively discuss the role of endothelin-1 as a therapeutic target in CVDs and related disorders.

Atrial fibrillation (AF) is the most common sustained arrhythmia and a major cause of cardioembolic stroke, with the left atrial appendage representing the predominant site of thrombus formation. Oral anticoagulation (OAC)-particularly with direct oral anticoagulants-remains the cornerstone of stroke prevention; however, contraindications and bleeding risks limit the use of OAC in selected patients. Percutaneous left atrial appendage closure (LAAC) has emerged as a device-based alternative to oral anticoagulation. Moreover, the indications of LAAC are expanding to include recurrent ischemic stroke despite adequate anticoagulation and patients with advanced chronic kidney disease. Thus, this review synthesizes the current evidence on LAAC and provides a practical, step-by-step procedural roadmap, from preprocedural imaging with transesophageal echocardiography or cardiac computed tomography and anatomical sizing, to transseptal puncture, device selection, deployment, and release criteria, as well as intraprocedural imaging and hemodynamic assessment. Advances in imaging modalities, procedural planning, and device technology have improved both efficacy and safety. However, postprocedural antithrombotic strategies remain heterogeneous and the subject of ongoing clinical trials. Future research is expected to refine patient selection, optimize pharmacotherapy after LAAC, and further define the role of LAAC in the contemporary management of AF.