Reviews in cardiovascular medicine最新文献

In-stent restenosis (ISR) remains the predominant cause of stent failure and the most common indication for repeat revascularization. Despite technological advances in stent design, ISR continues to pose significant challenges, contributing to increased morbidity and mortality among patients undergoing percutaneous coronary interventions. In the last decade, intravascular imaging has emerged as an important method for identifying the mechanisms behind ISR and guiding its treatment. Treatment options for ISR have expanded to include balloon angioplasty, cutting or scoring balloons, intravascular lithotripsy, atheroablative devices, drug-eluting stents, drug-coated balloons, surgical revascularization, and intravascular brachytherapy. The aim of the current review is to describe the classification and mechanisms of ISR, provide a comprehensive and updated overview of the evidence supporting different treatment strategies, suggest a management algorithm, and present insights into future developments in the field.

Catheter ablation-based management strategies for the drug-refractory electrical storm (ES) have been proven to abolish acute ventricular arrhythmic episodes and improve long-term outcomes. However, this effect is highly influenced by multiple independently acting factors, which, if identified and addressed, may allow a more tailored management to each particular case to improve results. This review synthesizes existing evidence concerning ES outcome predictors of patients undergoing ablation and introduces the role of novel scoring algorithms to refine risk stratification. The presence of these factors should be assessed during two distinct phases in relation to the ablation procedure: before (based on preprocedural multimodal evaluation of the patient's structural heart disease and comorbidities) and after the ablation procedure (in terms of information derived from the invasive substrate characterization, procedural results, postprocedural recurrences (spontaneous or during non-invasive testing), and complications).

Background: Quantitative flow ratio (QFR) can identify functionally significant coronary disease non-invasively. Myocardial contrast echocardiography (MCE) is a non-invasive and effective procedure for detecting abnormalities in hemodynamic coronary artery stenosis. Currently, there is no research confirming the correlation between MCE and QFR. This study aims to compare the capacity of the perfusion index (PI) from MCE to diagnose functionally significant coronary disease in patients with chest pain. The investigators use QFR as the gold standard for comparison.

Methods: 112 patients referred for coronary angiography (CAG) due to suspicion of coronary artery disease (CAD) were included. 64 patients with functionally significant coronary disease were diagnosed. 48 patients were defined as CAD without functionally significant coronary disease. MCE was performed 24 h before angiography. PI was calculated for each triggering interval by adding the perfusion scores of segments and dividing by the number of segments. Logistic regression analyses were performed to evaluate the association among functionally significant coronary disease, echocardiographic and clinical parameters. Spearman correlation analysis was used to investigate the correlation between PI and QFR. A receiver operating characteristic (ROC) curve was used to assess the capability of echocardiographic and clinical parameters to diagnose functionally significant coronary disease.

Results: Patients with functionally significant coronary disease had the worse perfusion in MCE compared with those without functionally significant coronary disease. In multivariable logistic regression analysis, global perfusion index (GPI) (OR: 43.409, p < 0.001) was associated with functionally significant coronary disease in patients with CAD. Based on the Spearman correlation analysis. Left anterior descending artery (LAD)-PI showed a strong negative correlation with LAD-QFR (r = -0.652, p < 0.01). ROC curves showed LAD-PI to be superior to GPI, left circumflex artery PI (LCX-PI) and right coronary artery PI (RCA-PI) in identifying functionally significant coronary disease.

Conclusions: The PI derived from MCE has diagnostic value for functionally significant coronary disease with QFR ≤0.80 in 1 or more vessels, with LAD-PI showing the highest diagnostic efficiency. GPI is independently associated with functionally significant coronary disease, but among the branch PIs, LAD-PI has the highest diagnostic efficiency.

Background: It is not uncommon that atrial fibrillation (AF) coexists with left bundle branch block (LBBB). Whether LBBB is an independent predictor of poor prognosis in AF patients remains undetermined. This study aims to investigate the impact of LBBB on the AF-related outcomes in non-valvular AF patients.

Methods: The clinical data of AF patients were collected from the Medical Information Mart for Intensive Care-III (MIMIC-III) database. The frequencies of acute arterial embolism events (AEE) and in-hospital cardiac death were compared between the non-LBBB and LBBB groups. And, their 1-year mortality was assessed through a survival analysis model. Additionally, the two groups were matched in a 1:2 ratio by a propensity score matching (PSM) method according to the CHA₂DS₂VASc score and AF type.

Results: 5051 patients diagnosed with non-valvular AF without apparent structural heart disease were enrolled in this study, among them, there were 65 with LBBB which had more AEE (13.8% vs 6.8%, p = 0.04). After PSM, with balanced CHA₂DS₂VASc score and AF type, LBBB was still related with AEE (13.8% vs 3.8%, p = 0.02) significantly, and it was also independent of heart failure (HF) (odds ratios (OR) 6.38, 95% confidence intervals (CI) [1.10, 36.93], p = 0.04). LBBB was also correlated with in-hospital cardiac death (OR 5.33, 95% CI [1.01, 28.28], p = 0.04). And, the LBBB patients had a lower 1-year survival rate in the subgroup of HF (67.6% vs 83.0%, p = 0.06).

Conclusions: The LBBB was an independent risk factor of AEE and related to in-hospital cardiac death and 1-year all-cause mortality in this non-valvular AF cohort from MIMIC-III.

Background: Real-world data on the clinical benefit of vericiguat are currently limited. This multicenter, real-world study was conducted to evaluate the clinical characteristics and therapeutic effects of vericiguat in real-world settings.

Methods: This study analyzed heart failure (HF) patients who initiated vericiguat treatment from September 2022 to August 2023 across nine hospitals in the Anhui Province, China. The clinical data were retrospectively collected and cases were prospectively followed to assess changes from baseline in N-terminal pro-B type natriuretic peptide (NT-proBNP) at 12 months. Baseline characteristics were compared with those in the VICTORIA trial.

Results: Of the 285 patients enrolled, the mean age was 64.8 ± 12.9 years. Of these, 22.8% were female, and 94.7% were classified as New York Heart Association class III-IV. Additionally, 66.4% had a reduced ejection fraction with a median NT-proBNP level of 2915 pg/mL. Vericiguat therapy was initiated during hospitalization in 223 patients (78.2%), with 105 (37.1%) receiving quadruple anti-HF therapy. Only 44.9% met the VICTORIA trial inclusion criteria.

Conclusions: In this multicenter, real-world study of vericiguat in Anhui Province, only 44.9% of vericiguat users met the inclusion criteria for the VICTORIA trial. This suggests that vericiguat is being applied more broadly by physicians to treat HF in real clinical settings.

Background: Neutrophil gelatinase-associated lipocalin (NGAL) is not only a sensitive marker of acute kidney injury but may also be a prognostic marker of acute heart failure (AHF). This study aimed to investigate the relationship between serum NGAL and all-cause death (ACD) and the composite outcome of ACD or AHF readmissions in patients with AHF.

Methods: The Embase, Cochrane Library, and PubMed databases were searched for articles focusing on serum NGAL and ACD and the composite outcome of ACD or AHF readmissions in patients with AHF. The hazard ratios (HRs) were pooled with random-effects models.

Results: The results from 2428 patients from seven studies were pooled in this article. Higher NGAL was relevant to an increased risk of ACD (HR, 1.89; 95% CI, 1.38 to 2.61) and the composite outcome of ACD or AHF readmissions (HR, 2.92; 95% CI, 1.62 to 5.27) in patients with AHF.

Conclusions: Serum NGAL has prognostic value for ACD and the composite outcome of ACD or AHF readmissions in AHF.

The prospero registration: CRD42022322057, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022322057.

Ventricular remodeling in right heart failure is a complex pathological process involving interactions between multiple mechanisms. Overactivation of the neuro-hormonal pathways, activation of the oxidative stress response, expression of cytokines, apoptosis of cardiomyocytes, and alterations of the extracellular matrix (ECM) are among the major mechanisms involved in the development of ventricular remodeling in right heart failure. These mechanisms are involved in ventricular remodeling, such as myocardial hypertrophy and fibrosis, leading to the deterioration of myocardial systolic and diastolic function. A deeper understanding of these mechanisms can help develop more effective therapeutic strategies in patients with right heart failure (RHF) to improve patient survival and quality of life. Despite the importance of ventricular remodeling in RHF, there are a limited number of studies in this field. This article explores in-depth historical and current information about the specific mechanisms in ventricular remodeling in RHF, providing a theoretical rationale for recognizing its importance in health and disease.

Background: This study aims to systematically review the efficacy of various surgical approaches in the treatment of ischemic mitral regurgitation (IMR).

Methods: A comprehensive literature search was conducted using computerized databases, including PubMed, Cochrane Library, Embase, and Web of Science, up to February 2024. In our network meta-analysis, we utilized the Cochrane Handbook tool for quality evaluation, while a consistency model and the odds ratio (OR) were used to compile and analyze the data from the studies included, employing Stata 17.0 software for this purpose.

Results: The systematic review included a total of 20 randomized controlled trials (RCTs), which collectively involved 3111 patients and evaluated six different surgical techniques. The network meta-analysis demonstrated that mitral valve repair (MVr) exhibited a significant reduction in 30-day all-cause mortality rates when compared to coronary artery bypass grafting (CABG), mitral valve replacement (MVR), CABG combined with MVR, and transcatheter mitral valve edge-to-edge repair (TEER) using MitraClip. Furthermore, probability ranking analysis suggested that MVr may be the most effective approach in reducing 30-day all-cause mortality, while CABG combined with MVr had significantly fewer renal complications compared to CABG combined with MVR. Probability rankings also indicated that CABG+MVr may be the most effective technique in minimizing renal complications. However, there were no statistically significant differences observed in other outcome measures among the different surgical techniques.

Conclusions: Current limited evidence indicates that CABG combined with MVr may be the best surgical approach for patients with IMR. However, these conclusions are tentative and require further confirmation from more additional high-quality studies.

Inplasy registration number: INPLASY202420049. This study can be accessed at the following detailed address: https://inplasy.com/inplasy-2024-2-0049/, last accessed on February 11, 2024.

Background: Social connections impact cardiovascular diseases (CVD) morbidity and mortality, but their role in hypertension, as a CVD risk factor, and their gender inequities is less understood. This review aimed to examine the longitudinal evidence on the impact of changes in social connections on risk of hypertension among aging adults, with a specific focus on gender.

Methods: A systematic search of peer-reviewed literature in Medline, Embase, Scopus, and CINAHL conducted until 10 June 2024. Prospective studies evaluating the effect of changes in living arrangement, marital status, social network, or social participation on changes in blood pressure or incident hypertension among adults aged 45 and above were included.

Results: We found 20,026 records (13,381 duplicates), resulting in 6645 eligible titles/abstracts for screening and 29 texts read in full. Only six studies from three countries met inclusion criteria, with four focused on marital transitions and two on changes in living arrangement. Overall, loss of close social connections had mixed effects on changes in blood pressure or risk of hypertension. More consistent adverse CVD outcomes were observed across studies for aging adults who entered marriage or became co-living (gain of close social connections). Similarly, persistent lack of close social connections appeared to result in greater increases in blood pressure or higher risk of hypertension. Two included studies were of high quality and the rest were medium quality. Excluded studies assessing change in either CVD risk or social tie transitions were also described (n = 9).

Conclusions: There is a surprising paucity of prospective evidence on social relationships as determinants of CVD risk in the aging population, despite ample research on social factors correlated with health. Limited research suggests that both gains and losses of close social connections as well as persistent lack of close social connections may alter CVD risk, but effects are specific to single-sex samples. Research and policy should prioritize causally robust high-quality studies to unravel social determinants of CVD risk as actionable evidence to inform social prescribing in CVD prevention and healthy aging strategies is still tenuous.

The prospero registration: CRD42022373196, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=373196.