Reviews in cardiovascular medicine最新文献

Background: This study aimed to decode the spatiotemporal trajectory of atrial fibrillation/flutter (AF/AFL) burden (1990-2021) through hierarchical quantification of socioeconomic health gradients and Bayesian projection modeling across 204 countries and territories until 2036.

Methods: This study, based on data from the 2021 Global Burden of Disease (GBD) study, systematically investigates the geopolitical and temporal dynamics of AF/AFL from 1990 to 2021. This study quantified the impact of population structure, age distribution, and disease rates on the disease burden, assessed the inequality of burden among different countries, and predicted the disease trends for the next 15 years.

Results: From 1990 to 2021, when the age-standardized death rate (ASDR) was the only indicator showing an upward trend (estimated annual percentage change (EAPC) = 0.1 (0.06-0.13)), the absolute number of AF/AFL cases continued to rise. Decomposition analysis revealed that population growth (43.17%) and aging (56.31%) were the primary drivers of the global AF/AFL burden in 2021. The study found that from 1990 to 2021, inequality in the social indicators index (SDI) worsened, whereas the slope index of inequality (SII) values for AF/AFL incidence (41.68 vs. 81.71), prevalence (499.54 vs. 1076.65), mortality (3.23 vs. 8.50), and disability-adjusted life years (DALYs) (82.36 vs. 189.81) all increased. Notably, the global AF/AFL burden is projected to continue rising through 2036. The age-standardized incidence rate (ASIR) (52.36 vs. 56.07) for AF/AFL is expected to increase annually, while the ASDR (4.12 vs. 3.93) and age-standardized DALYs rate (ASDAR) (107.45 vs. 90.87) are projected to decline. However, the number of cases is expected to maintain growth.

Conclusions: This study shows that the global burden of AF/AFL has an overall increasing trend from 1990 to 2021, primarily driven by population growth and aging. Countries with a high SDI bear a disproportionately high burden of AF/AFL, while SDI-related inequalities among countries have worsened over time. This study highlights the significant challenges in the prevention and management of AF/AFL, including the rising number of cases and the unequal distribution of the subsequent burden worldwide. These findings may be instructive for developing more effective public health policies and reasonably allocating medical resources.

Background: The urinary sodium-to-potassium (UNa/UK) ratio reflects the dietary sodium and potassium balance and may serve as a biomarker for hypertension (HTN). An imbalance in the dietary sodium-potassium ratio may contribute to systemic inflammation, alterations in gut microbiota (GM), and related metabolic disorders. This study aimed to investigate the relationship between the UNa/UK ratio, HTN, inflammation, GM, and metabolic abnormalities using cross-sectional and Mendelian randomization (MR) analyses.

Methods: We included 1210 hospitalized patients (median age, 51 (43-57) years; 57.9% male) who underwent 24-hour urine electrolyte measurement. Participants were grouped by the median UNa/UK ratio (4.40) for subsequent analysis, with 605 participants in each group. Additionally, we performed two-sample MR analyses to evaluate causal relationships between the UNa/UK ratio and HTN, circulating inflammatory proteins and immune cells, GM, and plasma metabolites.

Results: A cross-sectional analysis revealed significant associations between the UNa/UK ratio and HTN prevalence, inflammation scores, and metabolites. Logistic regression confirmed the UNa/UK ratio as an independent predictor of HTN (odds ratio (OR): 1.076; 95% confidence interval (CI): 1.037-1.116). Spearman correlation analysis showed a positive correlation between the UNa/UK ratio and several inflammatory scores. The MR analyses indicated a causal effect of the UNa/UK ratio on HTN (inverse-variance weighted method: OR: 1.5130, 95% CI: 1.1613-1.9712), inflammatory proteins, immune cells, GM, and plasma metabolites.

Conclusions: The UNa/UK ratio was significantly associated with HTN risk, systemic inflammation, GM dysbiosis, and metabolic disorders. Integrating both cross-sectional and MR approaches, our findings highlight the UNa/UK ratio as a clinically relevant biomarker and reinforce the role of dietary sodium-potassium balance in modulating HTN through underlying mechanisms involving inflammation, GM alterations, and metabolites.

Hypertension is a prominent cardiovascular risk factor, especially among patients with diabetes and obesity. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a class of drugs originally developed to improve glycemic control in patients with diabetes; however, these agonists have subsequently demonstrated additional cardioprotective effects, including modest reductions in blood pressure (BP). This literature review examines the various mechanisms through which GLP-1 RAs reduce BP, including weight loss, improved endothelial function, and renal sodium management. While GLP-1 RAs are less potent in BP reduction compared to conventional antihypertensive agents, the broader metabolic benefits of these agonists make this class of drug a valuable adjunct in managing hypertension, particularly in patients with metabolic syndrome. Nonetheless, further studies are needed to explore the long-term effects of BP and optimize patient selection for maximal cardiovascular benefit.

Background: Patients bridged to heart transplantation (HTx) and patients with primary graft dysfunction (PGD) after HTx are typically treated with circulatory support. However, the survival of patients in both indications might depend on the type of circulatory support. Thus, this meta-analysis aimed to investigate the survival of HTx patients supported during bridging with a durable left ventricular assist device (d-LVAD), a temporary LVAD (t-LVAD), or venoarterial extracorporeal membrane oxygenation (VA-ECMO). We also investigated the survival rate of patients with PGD by type of circulatory support device.

Methods: We performed a random-effects meta-analysis.

Results: We included four studies evaluating bridging to HTx (n = 1678 patients) and three studies for the PGD analysis (n = 35 patients). The 1-year survival after HTx was significantly higher in patients bridged with a t-LVAD (92.7%; 95% confidence interval (CI): 89.2 to 95.6%; p = 0.027) and with a d-LVAD (86.8%; 95% CI: 75.8 to 94.8%; p = 0.001) compared to VA-ECMO (71.6%; 95% CI: 63.7 to 78.9%). The 30-day survival in patients with PGD and t-LVAD was 100% (95% CI: 59.2-100%), while with PGD and VA-ECMO, survival was 92.4% (95% CI: 66 to 100%).

Conclusions: Both d-LVAD and t-LVAD bridging methods appear to have comparable 1-year survival rates, which are higher than those after VA-ECMO bridging. Nonetheless, more prospective clinical studies are needed to investigate outcomes after using circulatory support devices for PGD after HTx. The PROSPERO registration: CRD420251149065, https://www.crd.york.ac.uk/PROSPERO/view/CRD420251149065.

Background: Coronary heart disease (CHD), one of the most severe cardiovascular conditions, poses a significant threat to the health and survival of older adults. Numerous studies have confirmed that diabetes, inflammation, and dyslipidemia are key risk factors for CHD. However, the relationship between the C-reactive protein-triglyceride glucose index (CTI) and CHD risk in older adults across different glucose metabolism statuses remains unexplored. Thus, this study aimed to investigate the correlation between the CTI and CHD risk in older adults with varying glycemic statuses.

Methods: Patients aged ≥60 years, who underwent coronary angiography between January 2019 and December 2023, were enrolled. A diagnosis of CHD was performed when the coronary angiography demonstrated ≥50% stenosis in at least one major epicardial vessel. Demographic characteristics, medical history, laboratory data, and procedural records were systematically collected. Least absolute shrinkage and selection operator (Lasso) and multivariate logistic regression identified potential predictors. Receiver operating characteristic (ROC) curves were employed to assess the clinical value of CTI in predicting CHD risk. A restricted cubic spline (RCS) was used to examine all nonlinear relationships. A nomogram for the occurrence of CHD in older adults was constructed, and a subgroup analysis was performed.

Results: A total of 1204 patients were included (919 diagnosed with CHD, 285 non-CHD (NCHD) controls). The CTI was identified as an independent risk factor for CHD (odds ratio (OR) = 4.88, 95% confidence interval (CI): 3.59-6.62). The CTI, analyzed both as a continuous and categorical variable, showed significant associations with CHD incidence across various adjusted models. The RCS analysis across different glucose metabolism statuses revealed a nonlinear relationship between the CTI and coronary artery stenosis severity in the overall population. The nomogram model based on multivariate logistic regression demonstrated good predictive accuracy for CHD in older adults.

Conclusion: A positive correlation exists between the CTI and both CHD risk and the severity of coronary stenosis in older adults.

Background: Predicting cardiac death in patients with acute myocardial infarction (AMI) remains a major challenge. The Coronary Artery Tree description and lesion evaluation (CatLet) angiographic scoring system can describe the variability in coronary artery anatomy, the degree of stenosis of the affected coronary artery, and the subtended myocardial territory. Therefore, this study aimed to establish an effective and interpretable machine learning (ML) model to explore the relationship between the CatLet score and cardiac death in patients with AMI.

Methods: The CatLet score was calculated in 767 consecutively enrolled patients with AMI. Cox regression analysis, Kaplan-Meier survival analysis, and restricted cubic spline analysis were used to explore the association between the CatLet score and cardiac death in patients with AMI. Six ML methods were used to build predictive models. The Shapley Additive Explanations (SHAP) analysis was used to visualize model features and individual case predictions.

Results: Compared to the lowest CatLet score of tertile 1, patients with the highest CatLet score (tertile 3) had a higher risk of cardiac death (hazard ratio (HR) = 3.71; 95% confidence interval (CI) = 1.36-10.08; p = 0.010). Restricted cubic spline analysis indicated a linear association between the CatLet score and cardiac death. The ML results showed that the adaptive boosting (Adaboost) model had the most reliable performance with an area under the curve (AUC) of 0.927, a sensitivity of 0.902, and a specificity of 0.796. The SHAP analysis showed that the CatLet score was a significant contributor to the cardiac death outcome.

Conclusions: The Catlet score positively correlates with the risk of cardiac death in patients with AMI, while the use of ML modeling can effectively predict the risk of cardiac death.

Background: Biological age (BA) more accurately reflects the true ageing status of the body compared with chronological age. While biological aging is associated with various cardiovascular diseases, the relationship between BA and abdominal aortic aneurysms (AAAs) remains unclear.

Methods: This study utilized data from the UK Biobank for analysis. Telomere length (TL) and BA acceleration, calculated using the Klemera-Doubal method (KDM) and phenotypic age (PhenoAge) methods, were used as surrogate measures of biological aging. Cox regression was primarily performed to explore the association between biological aging and AAA risk. Genetic susceptibility was assessed by constructing a polygenic risk score (PRS).

Results: This study included 311,646 participants with a median age of 58 years. A total of 1339 new cases of AAA (4.33‰) were reported over a median follow-up period of 12.54 years. Each standard deviation (SD) increase in TL was associated with a 17% decreased risk of AAA (hazard ratio (HR) = 0.83, 95% confidence interval (CI) = 0.79-0.88). Each SD increase in BA acceleration in the KDM was associated with a 21% increased risk (HR = 1.21, 95% CI = 1.12-1.29), and and each SD increase in acceleration in the PhenoAge method was associated with a 40% increased risk (HR = 1.40, 95% CI = 1.32-1.48). These associations were independent of genetic risk, as assessed by the PRS, and a joint effect on AAA occurrence was observed. Additionally, we identified a sex-specific modification in the association between telomere shortening and AAA risk, with a significant association observed exclusively in men.

Conclusions: Accelerated biological aging was longitudinally associated with an increased risk of AAA, suggesting that BA may be a significant factor and a potential biomarker for AAA.

In the era of mitral transcatheter edge-to-edge repair (M-TEER), growing evidence continues to support a shift from a binary classification of mitral regurgitation (MR) into primary and secondary forms toward a more refined, subtype-based approach. Additionally, anatomical and pathophysiological heterogeneity significantly influences procedural complexity, durability of repair, and clinical outcomes within both primary and secondary MR. Furthermore, recent trials suggest that the timing of the intervention is as critical as patient anatomy; delaying treatment until advanced ventricular remodeling has occurred may limit the benefits of MR reduction. Moreover, long-term data on durability and device-failure management remain limited, particularly in secondary MR, where the progression of the underlying cardiomyopathy largely determines the outcomes. Thus, this review underscores how integrating MR subtyping with intervention strategies may influence patient selection and highlights the need for future research to adopt a more individualized, mechanism-driven approach.

Background: While sinus bradycardia and atrioventricular (AV) block in athletes have traditionally been viewed as benign consequences of enhanced vagal tone, recent evidence suggests that, in some individuals, nodal dysfunction may be intrinsic and potentially mediated by epigenetic mechanisms. Therefore, differentiating between these mechanisms is crucial for guiding appropriate clinical management.

Methods: Among 550 elite athletes undergoing routine cardiovascular evaluation, 72 were referred for a transesophageal electrophysiological study (EPS): 58 with significant sinus bradycardia or suspected AV node dysfunction (cases) and 14 athletes with symptoms consistent with supraventricular tachyarrhythmias but no bradyarrhythmia (controls). All participants underwent an EPS to assess corrected sinus node recovery time (CSNRT) and AV nodal Wenckebach point. In the case group, 24 athletes exhibited abnormal parameters at baseline and underwent a repeat EPS following complete autonomic blockade with intravenous propranolol and atropine, aimed at suppressing extrinsic autonomic influences.

Results: The corrected sinus node recovery time exceeded 550 ms in 18 (31%) cases, and the Wenckebach point was greater than 500 ms in 8 (14%) cases. In all eight athletes with baseline AV conduction abnormalities, they normalized after autonomic blockade, consistent with a functional vagal mechanism. In contrast, the mean sinus rate remained unchanged after autonomic blockade, and in 12/18 (67%) of the athletes with prolonged CSNRT, continued to exhibit abnormal values despite autonomic suppression, indicating a probable intrinsic origin. Control subjects showed normal EPS parameters.

Conclusions: The EPS with a pharmacological autonomic blockade represents a useful approach for distinguishing extrinsic, functional bradycardia from intrinsic nodal disease in athletes. While AV node dysfunction appears exclusively vagally mediated and reversible, a subset of sinus node dysfunction cases may reflect early, possibly epigenetically driven, intrinsic alterations.