Reviews in cardiovascular medicine最新文献

Congenital heart disease (CHD) is increasingly detected in cardiac imaging. Effective management of CHD requires thorough imaging of the heart and circulation, extending beyond simple anatomical identification. Cardiovascular computed tomography angiography (CCTA) provides rapid imaging, high spatial resolution, and precise visualization of three-dimensional vascular structures, while offering strong multi-planar reconstruction capabilities at sub-millimeter resolution and a wide field of view. These features enable CCTA to overcome the challenges faced by other imaging modalities. Thus, this review highlights the advantages of CCTA in evaluating simple cardiac shunts in adult congenital heart disease pre- and post-intervention.

Background: Previous studies on acute myocardial infarction (AMI) complicated by atrial fibrillation (AF) have mainly focused on anatomy or underlying disease state, and its prognostic predictors have not been fully explored. Therefore, there is a need for an effective prognosis model for patients with AMI-AF.

Methods: We retrospectively selected 126 patients with acute myocardial infarction complicated with AF hospitalized in Beijing Anzhen Hospital from January 2020 to December 2024 as the case group, and 1719 patients without AF as the control group. The clinical characteristics and laboratory test results of the two groups were compared to determine independent risk factors for AF in patients with acute myocardial infarction. The predictive performance of the model was evaluated by plotting Receiver Operating Characteristic (ROC) for each independent predictor. For the combined model, we used R software to build pattern plots, calibration plots, and Decision Curve Analysis (DCA) based on a multivariate logistic regression model.

Results: Multivariate Logistic regression analysis showed that older age (Odds Ratio (OR) = 1.067, 95% CI: 1.044-1.092), longer hospitalization days (OR = 1.039, 95% CI: 1.013-1.066). The AUCs for age, hospitalization days, history of coronary heart disease, heart rate, International Normalized Ratio (INR), Hemoglobin, and mean platelet volume were 0.721, 0.663, 0.577, 0.614, 0.688, 0.438, and 0.607. The AUC of nomogram model for predicting AF in AMI patients was 0.833 (95% CI: 0.796-0.870, p < 0.001), the sensitivity was 0.817, and the specificity was 0.726. The nomogram model indicated a clinical net benefit when the predicted risk threshold exceeded 0.06.

Conclusions: Multivariable prediction model has good prediction effect. The variables in this nomogram model are easily obtained in clinical practice and can provide reference for individualized prediction of AF in AMI patients.

The coexistence of type 2 diabetes (T2D), metabolic dysfunction-associated steatotic liver disease (MASLD), and cardiovascular disease (CVD) defines a clinical profile that is frequently observed in clinical practice. In addition to being highly prevalent, patients with this triad of diseases experience accelerated vascular aging and poor prognosis. Insulin resistance remains the common symptom; however, the systemic impact of this extends far beyond glucose handling, shaping inflammation, oxidative stress, and endothelial dysfunction. In this review, we highlight how these intertwined conditions challenge current diagnostic frameworks and therapeutic approaches. Moreover, we discuss under-recognized aspects, such as the contribution of gut-derived metabolites and adipose dysfunction, which often remain neglected in routine care despite strong mechanistic evidence. We also summarize the potential of noninvasive tools, biomarkers, and cardioprotective agents, such as sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and tirzepatide. While promising, these agents still face gaps in translation to everyday hepatology and cardiology clinics. Our message is that prevention and care should not be compartmentalized. Instead, an integrated, patient-centered approach, with early screening and multidisciplinary management, is needed to address this complex interplay. Moreover, recognizing the shared pathways of T2D, MASLD, and CVD may help clinicians anticipate potential complications and design more effective and sustainable strategies for long-term outcomes.

[This corrects the article DOI: 10.31083/j.rcm2203113.].

Background: Atrial fibrillation (AF) is a major complication of hypertrophic cardiomyopathy (HCM) with significant prognostic implications. Current risk prediction models lack the integration of comprehensive cardiac magnetic resonance (CMR) metrics and subtype-specific analyses.

Methods: A retrospective study of 405 HCM patients (86 with AF) was performed from 2019 to 2024. After excluding highly correlated variables (|r| > 0.8), the cohort was split into training and validation sets in a 7:3 ratio. Least Absolute Shrinkage and Selection Operator (LASSO) regression and multivariable logistic regression analyses were used to identify predictors, with model performance assessed via receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis. Subgroup analyses were conducted for obstructive (HOCM) and non-obstructive (HNCM) subtypes.

Results: Independent predictors of AF in the overall HCM cohort included right atrial diameter anteroposterior (RAD anteroposterior: odds ratio (OR) = 1.819, 95% confidence interval (CI) 1.130-3.007; p = 0.016), left ventricular end-systolic volume (LVESV: OR = 0.978, 95% CI 0.963-0.991; p = 0.002), septal mitral annular plane systolic excursion (MAPSE septal: OR = 0.850, 95% CI 0.736-0.976; p = 0.023), tricuspid annular plane systolic excursion (TAPSE: OR = 0.919, 95% CI 0.852-0.987; p = 0.022), and maximum left atrial volume (MaxLAV: OR = 1.016, 95% CI 1.004-1.029; p = 0.010). The model achieved an area under the curve (AUC) value of 0.850 in the training set and an AUC of 0.861 in the validation set. The HOCM subtype predictors included septal MAPSE and left atrial ejection fraction (LAEF); meanwhile, the HNCM predictors included septal MAPSE, maximal left atrial volume (MaxLAV), and right atrial ejection fraction (RAEF).

Conclusions: A validated multiparametric CMR model can accurately predict AF risk in HCM patients, with subtype-specific predictors enabling personalized monitoring and early intervention.

The coronary sinus reducer (CSR) is a percutaneous device designed to improve coronary blood flow and alleviate symptoms of refractory angina in patients with severe coronary artery disease (CAD) who are unsuitable for revascularization therapy. CSR originated from earlier surgical techniques, such as coronary sinus ligation (CSL), and functions by narrowing the coronary sinus to enhance perfusion in ischemic myocardial territories-particularly in the subendocardial regions-while also reducing microvascular resistance and increasing capillary recruitment. CSR is currently recognized as an effective treatment for patients with chronic refractory angina, especially those deemed ineligible for revascularization according to current European Society of Cardiology (ESC) guidelines. Moreover, emerging studies are expanding the understanding of the mechanism of action involved in CSR, demonstrating that this technique may also improve microvascular function, particularly in patients with coronary microvascular dysfunction. These trials have shown significant improvements in coronary microcirculation and reductions in angina symptoms, suggesting that CSR may have therapeutic potential beyond obstructive CAD. Thus, CSR may represent a promising treatment option for microvascular ischemia, thereby broadening its clinical applicability to patients with angina/ischemia and non-obstructive coronary arteries (ANOCA/INOCA).

Angiography remains the standard imaging modality during cardiac catheterization; however, this technique provides only a two-dimensional representation of the coronary lumen, which limits the assessment of vessel wall pathology. In comparison, intravascular imaging techniques, such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), provide high-resolution cross-sectional and two-dimensional reconstructions of the coronary arteries. Thus, these modalities complement angiographic findings, enable detailed evaluation of underlying pathology, and facilitate precise procedural guidance. Advancements in imaging technologies, including near-infrared spectroscopy and virtual histology intravascular ultrasound, further enhance lesion characterization and procedural planning. An increasing body of evidence from registries, randomized controlled trials, and meta-analyses supports the use of intravascular imaging-guided percutaneous coronary interventions, demonstrating improved procedural success rates and superior long-term clinical outcomes. In the context of acute coronary syndromes (ACS), OCT offers critical diagnostic insights that enhance accuracy and inform optimal treatment strategies. This review highlights the evolving role of OCT in the management of ACS and the favorable impact of this technique on patient outcomes.

This review aims to synthesize current evidence on the role of cardiac energy metabolism in the pathogenesis of dilated cardiomyopathy (DCM), with a focus on myocardial blood flow, substrate utilization, genetic and metabolic pathways, and potential energy-targeted therapeutic strategies. DCM involves structural and functional impairments of the myocardium, often linked to genetic mutations (e.g., in titin (TTN) and lamin) or acquired factors, including infection, alcohol, drugs, and endocrine disorders. Moreover, the disruption of cardiac energy homeostasis is central to the pathogenesis of DCM, characterized by compromised energy supply, altered substrate metabolism, and reduced adenosine triphosphate (ATP) production, all of which collectively contribute to contractile dysfunction and disease progression. Emerging evidence indicates that impaired myocardial energetics, including reduced coronary blood flow, shifts in fuel utilization, and dysregulation of energy metabolic pathways, are hallmark features of DCM. Nonetheless, energy deficiency is increasingly being recognized as a key driver of DCM development and heart failure. Cardiac energy metabolic disruption is intimately involved in the pathophysiology of DCM and represents a promising target for novel therapeutic interventions. Current management strategies often overlook metabolic aspects; therefore, this review highlights the need to integrate energy-based approaches into the treatment paradigm for DCM.

Coronary artery bypass grafting (CABG) remains a cornerstone in the treatment of advanced ischemic heart disease, offering durable and effective revascularization. Despite surgical success, long-term patient outcomes are often shaped by the progression of native coronary disease and the development of comorbid conditions. This narrative review explores seven critical domains in secondary prevention following CABG: Early recognition of postoperative complications, evidence-based pharmacotherapy, management of atrial fibrillation, lifestyle modification, psychological well-being, preservation of ventricular function, and collaboration within the multidisciplinary team. Effective secondary prevention can significantly reduce the risk of further cardiovascular events and support the longevity of the graft. Interventions such as lipid management, smoking cessation, and structured cardiac rehabilitation promote both physiological recovery and emotional resilience. Timely treatment of arrhythmias and ventricular dysfunction further reduces the risk of heart failure and recurrent ischemia. Primary care practitioners are uniquely positioned to lead the delivery of long-term secondary prevention. By integrating evidence-based strategies into routine care, these strategies can play a pivotal role in improving quality of life and long-term outcomes for post-CABG patients.