Reviews in cardiovascular medicine最新文献

Background: The implementation of the fibrosis 4 (FIB-4) index was initially associated with hepatic dysfunction; however, this index may also provide prognostic information in heart failure (HF). Thus, this study aimed to assess whether combining the FIB-4 and carbohydrate antigen 125 (CA125) indices in patients hospitalized for acute heart failure (AHF) can identify subgroups with differing risks of morbidity and mortality.

Methods: This retrospective study included 402 patients consecutively admitted for AHF between January 2023 and December 2024, after excluding elective admissions (n = 403), inter-hospital transfers (n = 232), and low-output cases (n = 51). Patients were stratified into four groups according to the FIB-4 score (<1.3 or high) and CA125 value (≤50 U/mL or high): Group 1 (low FIB-4 + low CA125; n = 43), Group 2 (low FIB-4 + high CA125; n = 57), Group 3 (high FIB-4 + low CA125; n = 117), and Group 4 (high FIB-4 + high CA125; n = 185). Clinical, echocardiographic, therapeutic, and laboratory variables were analyzed, as well as morbidity (HF-related emergency visits and readmissions) and all-cause mortality.

Results: Patients with both elevated FIB-4 and CA125 values had a higher prevalence of systemic/mixed congestion (p < 0.01), higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels (p < 0.01), and less frequent inspiratory inferior vena cava (IVC) collapse (p < 0.01). Although no survival differences were observed (p = 0.29), morbidity was significantly higher in group 4: more worsening episodes per patient (p = 0.0001), increased HF readmissions (p = 0.004), and more emergency visits (p = 0.001). The FIB-4 index correlated positively with worsening episodes (p < 0.0001), and the CA125 value showed a trend with mortality. No significant correlation was found between FIB-4 and CA125 or between FIB-4 and mortality (p > 0.1).

Conclusions: The FIB-4 index may be a useful indicator in AHF. Elevated values at admission for decompensation, in combination with high CA125 levels, can be used to identify a subgroup of patients with poor short- to medium-term outcomes, particularly in terms of worsening. Further studies are needed to determine the actual utility of the FIB-4 index in the context of AHF.

Coronary artery disease is a leading cause of morbidity and mortality in patients with type 2 diabetes mellitus. Indeed, diabetic patients often present with silent or atypical symptoms and are more likely to develop complex, diffuse, rapidly progressive, and recurrent atherosclerosis. While current guidelines favor coronary artery bypass grafting in diabetic patients with multivessel disease, advances in percutaneous coronary intervention technology have broadened the range of revascularization options for this high-risk population. Nevertheless, despite major improvements in stent platforms over the past two decades, diabetic patients continue to experience higher rates of in-stent restenosis and adverse cardiovascular events compared to non-diabetics, in part, because of the permanent metallic scaffold. Therefore, novel strategies, including drug-coated balloons, minimize chronic inflammation and eliminate permanent vessel caging, thereby offering promising alternatives in this setting, particularly for lesion subsets typical of diabetic patients. This review discusses the current landscape and future directions of percutaneous coronary revascularization in diabetic patients, outlining the evolution from drug-eluting stents to emerging metal-sparing technologies, and highlighting the persistent challenges in achieving optimal outcomes in this population.

Pulsed field ablation (PFA) is a novel ablation technique for atrial fibrillation (AF). Indeed, PFA utilizes cell electroporation and exhibits selectivity for myocardial tissue, depending on the method used to deliver the pulsed electric field, potentially sparing surrounding non-cardiac structures. Recent clinical trials have demonstrated the non-inferiority of PFA compared with conventional thermal ablation for arrhythmia recurrence, including radiofrequency and cryoballoon ablation. Currently, large registry data present an acceptable safety profile. However, PFA is not without risk, and some unique, albeit infrequent complications have been recognized with this ablation modality, including stroke, coronary artery spasm, and intravascular hemolysis. Thus, given the associated safety, efficacy, and improved procedural workflow of this technique, the advent of PFA will likely lower the threshold for patient selection for AF ablation, particularly owing to the growing burden of AF in our community. This review provides an overview of the biophysics of PFA, various catheter designs, clinical trial and registry data, potential complications associated with PFA, and future directions in this promising area of AF management.

Background: Mitral commissural prolapse or flail, characterized by intricate and diverse anatomical features, poses a significant challenge in mitral transcatheter edge-to-edge repair (M-TEER). Previous studies have largely focused on central mitral regurgitation with favorable valve anatomy or a general broad spectrum of complex mitral regurgitation. However, no established approach is currently available for M-TEER in commissural degenerative mitral regurgitation (DMR).

Methods: Therefore, this study aimed to evaluate the efficacy and safety of a novel morphology classification-guided M-TEER strategy for treating commissural DMR using the MitraClip system. This prospective, multicenter, single-arm, objective performance criteria study involved 12 experienced centers in Asia, primarily located in China. Patients with symptomatic moderate-to-severe (3+) and severe (4+) native DMR and commissural involvement were stratified into three morphological categories based on an echocardiographic core laboratory analysis, and tailored M-TEER strategies were proposed. The primary endpoint is the proportion of patients achieving a mitral regurgitation (MR) grade of ≤1+ without repeat mitral intervention at one-year follow-up. Clinical, echocardiographic, functional, and quality-of-life outcomes were assessed over one year.

Results: Based on statistical power calculations, a total of 148 patients are required to achieve adequate power to test the primary efficacy hypothesis, accounting for an estimated 10% attrition rate at 12 months.

Conclusions: The morphology classification system enhances M-TEER for commissural DMR by addressing the unique challenges of this approach, enabling tailored interventions that optimize procedural success and patient outcomes.

Clinical trial registration: ChiCTR2400090258, https://www.chictr.org.cn/showproj.html?proj=239191.

Background: The association between elevated perfusion pressure and neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors remains unclear. Specifically, to our knowledge, no studies have currently investigated whether the duration of elevated perfusion pressure influences neurological prognosis following OHCA. Thus, this study aimed to examine the association between the duration of a mean arterial pressure (MAP) >80 mmHg during the first 48 hours after return of spontaneous circulation (ROSC) and neurological outcomes in OHCA survivors.

Methods: This observational study included adult patients (≥18 years) with OHCA treated between January 2019 and May 2021. The cumulative duration of a MAP >80 mmHg was recorded during the 0-24, 25-48, and 0-48 hour intervals following ROSC. The primary outcome was the neurological status at 6 months, with good outcomes defined as Cerebral Performance Category (CPC) scores of 1 or 2.

Results: Among the 468 patients with OHCA, 132 (28.2%) achieved good neurological outcomes. The duration of a MAP >80 mmHg over 0-48 hours was significantly longer in the good outcome group compared with the poor outcome group (35 (26-42) vs. 28 (16-39) hours; p < 0.001). In the multivariable analysis after adjusting for confounders, longer durations of a MAP >80 mmHg at 0-48 hours (odds ratio (OR): 1.047, 95% confidence interval (CI): 1.021-1.073) and 25-48 hours (OR: 1.086, 95% CI: 1.042-1.131), but not at 0-24 hours, were associated with good neurological outcomes at 6 months.

Conclusions: The duration of a MAP >80 mmHg during the 0-48 and 25-48 hour periods after ROSC was associated with good neurological outcomes at six months in OHCA survivors.

Pulmonary hypertension (PH) is a progressive disease caused by structural and functional changes in the pulmonary vasculature resulting from diverse etiologies. PH ultimately leads to increased right ventricular (RV) afterload, RV hypertrophy, fibrosis, and right heart failure (RHF). Moreover, RV fibrosis initially serves as a protective mechanism against pressure overload-induced RV dilatation, but eventually progresses to excessive fibrosis, which impairs cardiac function. This review explores the relationship between RV fibrosis and RV function in PH patients, examines the clinical relevance of this relationship, evaluates techniques for quantifying RV fibrosis, and presents potential therapeutic strategies aimed at preserving right heart function in PH patients.

Cardiac amyloidosis, once considered a rare and untreatable disorder, is now increasingly recognized as a significant cause of heart failure, particularly in older adults. The two most clinically relevant subtypes of cardiac amyloidosis-immunoglobulin light-chain amyloidosis (AL) and transthyretin-related amyloidosis (ATTR)-differ in pathogenesis, natural history, and management strategies, thereby necessitating a tailored approach to diagnosis and therapy. Advances in multimodality cardiac imaging, including echocardiography, cardiac magnetic resonance, and nuclear scintigraphy, have enabled earlier detection and improved differentiation between subtypes. Management of AL centers on rapid initiation of plasma cell-directed therapies to suppress light-chain production, with autologous stem cell transplantation and novel chemotherapeutic regimens improving survival. In contrast, ATTR management focuses on stabilizing or reducing transthyretin deposition through disease-modifying agents, such as stabilizers, gene-silencing therapies, and emerging fibril-disrupting approaches. Supportive care, including guideline-directed heart failure therapies and arrhythmia management, as well as advanced therapies such as transplantation, remains essential across both subtypes, albeit with unique considerations due to amyloid-related hemodynamics. This review synthesizes current evidence on the diagnosis and treatment of AL and ATTR, highlights recent therapeutic breakthroughs, and discusses ongoing challenges in optimizing patient outcomes, from equitable access to therapies to the integration of multidisciplinary care.

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and frequently co-occurs with metabolic diseases, such as diabetes and obesity. Due to the intricate and multifactorial pathophysiology of AF, this disorder often eludes effective prevention and durable control with current therapeutic strategies; thus, these strategies may not consistently mitigate the onset, persistence, and related adverse outcomes of AF. Moreover, atrial metabolic remodeling and mitochondrial stress can promote the development of atrial cardiomyopathy and AF through electrophysiological and structural changes. Hence, targeting these metabolic alterations may prevent the onset of this arrhythmia. A contemporary therapeutic paradigm prioritizes restoration of metabolic homeostasis, led by sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists and complemented by emerging mitochondria-targeted strategies with potential for incremental disease modification. Concurrently, integrative multi-omics is mapping atrial metabolic diversity in AF to support biomarker-guided, individualized interventions, while next-generation imaging is enhancing the detection of pathologic substrates and refining risk assessment. This review provides a comprehensive analysis of the mechanisms through which metabolic remodeling and mitochondrial stress cause AF, evaluates current experimental and diagnostic methods, and discusses emerging substrate-targeted therapies.

Background: Significant differences often exist between estimated glomerular filtration rates (eGFR) calculated using various biomarkers. However, the relationship between these eGFR methods and atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA) remains unclear.

Methods: Thus, this study employed a retrospective analysis of 523 patients with AF who underwent an initial RFCA between July 2019 and October 2022. The eGFR was calculated using three methods based on the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula: serum creatinine (eGFRcr), serum cystatin C (eGFRcys), and a combination of both (eGFRcrcys). Cox regression models were used to explore the relationship between eGFR and AF recurrence.

Results: Over a 1-year follow-up period, 174 (33.3%) patients experienced AF recurrence after RFCA. Multivariable Cox regression analysis indicated that only eGFRcys showed a consistent, significant inverse association with AF recurrence (hazard ratio (HR) = 0.990, 95% confidence interval (CI): 0.982-0.998, p = 0.019). In contrast, eGFRcrcys showed borderline significance after full adjustment (p = 0.067). Meanwhile, stratifying by optimal cutoff values identified an association for eGFRcys ≤64.280 mL/min/1.73 m², and eGFRcrcys ≤76.093 mL/min/1.73 m² with significantly higher recurrence risks after full adjustment (p = 0.008 and p = 0.036, respectively). Additionally, incorporating eGFRcys or eGFRcrcys into the baseline risk model led to a greater improvement in predictive accuracy than adding eGFRcr.

Conclusions: The association between eGFR and AF recurrence after ablation appears to vary depending on the measurement methods; eGFRcys seems to provide the most reliable information. Incorporating eGFRcys into the pre-ablation risk stratification may enhance patient management and improve outcomes for patients undergoing AF ablation.