Reviews in cardiovascular medicine最新文献

Background: Predicting resistance to intravenous immunoglobulin (IVIG) in the treatment of Kawasaki disease (KD) remains a focus of research. Fibrinogen and albumin in systemic inflammation play an important role. This study aims to investigate the predictive value of fibrinogen to albumin ratio (FAR) for initial IVIG resistance in patients with KD.

Methods: The study prospectively recruited 962 patients with KD between July 2015 and June 2022. The serum characteristics of the two groups were compared by comparing fibrinogen and albumin, as well as other laboratory and clinical data between the IVIG-responsive and IVIG-resistant groups. Multivariate logistic regression was used to explore the relationship between FAR and IVIG resistance. Receiver operating characteristic (ROC) curves were used to determine the effectiveness of FAR in predicting initial IVIG resistance.

Results: Our results demonstrated that IVIG-resistant patients had significantly higher fibrinogen levels (603.35 ± 99.00 mg/L), FAR (17.30 ± 3.31), and lower albumin (35.47 ± 5.24 g/L) compared to IVIG-responsive patients (fibrinogen 572.35 ± 145.75 mg/L; FAR 15.08 ± 4.32; albumin 38.52 ± 4.55 g/L). 15.20 was the best cut-off value of FAR for predicting initial IVIG resistance. The sensitivity was 72.5%, the specificity was 51.3%, the positive predictive value was 91.8%, and the negative predictive value was 20.0%. Multivariate logistic regression analysis, found that FAR was an independent predictor of initial IVIG resistance in KD children.

Conclusions: The FAR was an independent risk factor for initial IVIG resistance, its predictive power for initial IVIG resistance exceeded that of albumin and fibrinogen alone. FAR may not be suitable as a single marker but might serve as a complementary laboratory marker to accurately predict initial IVIG resistance in KD.

Background: There is limited data regarding the influence of lung compliance on the outcome of patients with cardiogenic shock (CS). Thus, a registry study was conducted to assess the prognostic influence of lung compliance in invasively ventilated patients with CS.

Methods: Hospital records for consecutive invasively ventilated CS-patients from June 2019 to May 2021 were collected into a prospective registry. Our study evaluated the prognostic influence of lung compliance on 30-day all-cause mortality. Statistical analyses comprised t-tests, analysis of variance (ANOVA), Kruskal-Wallis-tests, Spearman's correlation, Kaplan-Meier survival analyses, and Cox regression.

Results: A total of 141 patients with CS requiring invasive mechanical ventilation were included. Stratification by quartiles revealed that patients with the lowest lung compliance (≤23.8 mL/cmH₂O) experienced the highest mortality rates (77.1% vs. 66.7% vs. 48.6% vs. 51.4%; log-rank p = 0.018) both overall and among the subgroup of CS-patients with cardiac arrest (80% vs. 74% vs. 53% vs. 59%; log-rank p = 0.037). After stratifying by the median, patients with lung compliance <30.4 mL/cmH₂O demonstrated a significantly higher 30-day all-cause mortality compared to those above this threshold (71.8% vs. 50.0%; log-rank p = 0.007) for both the overall cohort and the cardiac arrest subgroup (77.2% vs. 55.9%; log-rank p = 0.008). Multivariable adjustment confirmed that lung compliance <30.4 mL/cmH₂O was significantly associated with increased 30-day all-cause mortality in the entire cohort (hazard ratio [HR] = 1.698; 95% CI 1.085-2.659; p = 0.021). Notably, this association was not significant in CS-patients with cardiac arrest (HR = 1.523; 95% CI 0.952-2.438; p = 0.080). Additionally, those with lung compliance below the median experienced fewer ventilator-free days (p = 0.003).

Conclusions: In invasively ventilated CS-patients, low lung compliance was associated with higher all-cause mortality and fewer ventilator-free days at 30 days.

Clinical trial registration: NCT05575856, https://clinicaltrials.gov/study/NCT05575856.

Atherosclerosis (AS) is an important cause of morbidity and mortality in cardiovascular diseases such as coronary atherosclerotic heart disease and stroke. As the primary natural barrier between blood and the vessel wall, damage to vascular endothelial cells (VECs) is one of the initiating factors for the development of AS. VECs primarily use aerobic glycolysis for energy supply, but several diseases can cause altered glucose metabolism in VECs. Glucose metabolism reprogramming of VECs is the core event of AS, which is closely related to the development of AS. In this review, we review how glucose metabolism reprogramming of VECs promotes the development of AS by inducing VEC barrier dysfunction, autophagy, altering the inflammatory response, and proliferation of VECs, in the hopes of providing new ideas and discovering new targets for the prevention and treatment of AS.

Current guidelines recommend closing a patent foramen ovale (PFO) in patients who have experienced a cryptogenic or cardioembolic stroke, have a high-risk PFO, and are aged between 16 and 60 years (class A recommendation, level I evidence). In terms of efficacy, in the CLOSE and RESPECT trials, the number needed-to-treat (NNT) to prevent one stroke recurrence in a five-year term was between 20 and 44. Other trials, such as the REDUCE trial, presented much better data with a NNT of 28 at two years and as low as 18 over a follow-up period of 10 years. Interventional PFO closure is relatively straightforward to learn compared to other cardiology procedures; however, it must be performed meticulously to minimize the risk of post-procedural complications. Usually, a double-disk occlusion device is used, followed by antiplatelet therapy. While the potential benefits of PFO closure for conditions such as migraines are currently being studied, robust trials are still required. Therefore, deciding to close a PFO for reasons other than stroke should be considered on a case-by-case basis.

Background: Tricuspid transcatheter edge-to-edge repair (T-TEER) has emerged as an attractive option for severe tricuspid regurgitation (TR). To avoid the radiation exposure for both patients and medical staff, we propose a sole-echocardiography-guided method for T-TEER. The purpose of this article was to investigate the feasibility of sole-echocardiography-guided T-TEER.

Methods: This was a retrospective observational study, including 43 patients who underwent sole-echocardiography-guided T-TEER at two medical centers in China between June 2022 and September 2023. Clinical and echocardiographic data were collected at baseline, discharge and 6-month follow-up.

Results: Patients enrolled in this study were elderly (71.6 ± 8.2 years) with significant comorbidities, 67.4% had baseline massive or torrential TR and 76.7% were classified as New York Heart Association (NYHA) functional class III/IV. All patients achieved successful device implantation, and no severe device-related complications or mortality occurred during the follow-up period. Significantly reduced TR and reversed right ventricular remodeling were observed at 6-month follow-ups. Patients classified as NYHA functional class I/II increased from 23.3% at baseline to 81.4% at 6-month follow-up (p < 0.001).

Conclusions: Sole-echocardiography-guided T-TEER has a low incidence of complications and can effectively reduce TR. It is feasible to substitute conventional fluoroscopy and echocardiography guidance for echocardiography guidance alone. Further large-scale randomized controlled trials are needed to validate the safety, efficacy and patient benefits of this technique.

The P2Y12 receptor plays a central role in platelet activation, secretion, and procoagulant activity. The CURE (clopidogrel in unstable angina to prevent recurrent events) trial, conducted in 2001, was the first to effectively demonstrate the benefit of dual anti-aggregation therapy with aspirin and clopidogrel in patients with acute coronary syndromes (ACS) undergoing invasive treatment. Since then, the field of interventional cardiology has changed considerably. The introduction of drug-eluting stents (DES) and the development of new, potent P2Y12 inhibitors such as ticagrelor, prasugrel and cangrelor have revolutionized the treatment of ACS. Nevertheless, ST-elevation myocardial infarction (STEMI) remains a critical condition that requires rapid and effective intervention. The use of P2Y12 receptor antagonists as part of the pretreatment strategy is an interesting topic to optimize outcomes in STEMI patients. This review summarizes the existing evidence on the efficacy and safety of pretreatment with P2Y12 receptor antagonists in STEMI, and emphasizes the importance of making pretreatment decisions based on individual clinical characteristics. The review also looks to the future, pointing to the potential role of artificial intelligence (AI) in improving STEMI diagnosis and treatment decisions, suggesting a future where technology could improve the accuracy and timeliness of care for STEMI patients.

According to current statistics, the mortality rate of cardiovascular diseases remains high, with coronary artery disease being the primary cause of death. Despite the widespread adoption of percutaneous coronary intervention (PCI) in recent years, which has led to a notable decrease in the mortality rate of myocardial infarction (MI), the pathological cardiac remodeling and heart failure that follow myocardial infarction still pose significant clinical challenges. Myocardial ischemia-reperfusion (MIR) injury represents a complex pathophysiological process, and the involvement of macrophages in this injury has consistently been a subject of significant focus. Following MIR, macrophages infiltrate, engulfing tissue debris and necrotic cells, and secreting pro-inflammatory factors. This initial response is crucial for clearing damaged tissue. Subsequently, the pro-inflammatory macrophages (M1) transition to an anti-inflammatory phenotype (M2), a shift that is essential for myocardial fibrosis and cardiac remodeling. This process is dynamic, complex, and continuous. To enhance understanding of this process, this review elaborates on the classification and functions of macrophages within the heart, covering recent research on signaling pathways involved in myocardial infarction through subsequent MIR injury and fibrosis. The ultimate aim is to reduce MIR injury, foster a conducive environment for cardiac recovery, and improve clinical outcomes for MI patients.

Background: The purpose of this meta-analysis was to evaluate the efficacy and safety of pulsed field ablation (PFA) and to compare it with the efficacy and safety of traditional thermal ablation in patients with atrial fibrillation (AF).

Methods: PubMed, Web of Science, and Embase were searched for randomized or observational studies exploring the efficacy and safety of PFA and comparing PFA with traditional thermal ablation in patients with AF.

Results: A total of 4437 patients from 16 studies that only included PFA as the ablation method and 1792 patients from 9 comparing PFA to traditional thermal ablation were included in the final analysis. In studies that considered PFA alone, the freedom from atrial arrhythmia recurrence was 0.80 (95% confidence interval [CI] 0.76-0.84), and the incidence of periprocedural complications was 0.03 (95% CI 0.02-0.05). In comparative studies, there was no significant difference in the freedom from atrial arrhythmia recurrence (odds ratio (OR) 1.24, 95% CI 0.90-1.72) and the incidence of periprocedural complications (OR 0.74, 95% CI 0.37-1.48) of PFA compared to that of traditional thermal ablation. In the subgroup with a follow-up period less than 12 months, PFA had higher freedom from atrial arrhythmia recurrence rate compared to thermal ablation (OR 2.19, 95% CI 1.14-4.20).

Conclusions: PFA is a safe and effective catheter ablation method that is not inferior to the traditional and well-established thermal ablation. It can be used as a treatment of choice for patients with AF.

The prospero registration: CRD42023473026, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=473026.

Mitral regurgitation is the second most prevalent valvular disease, with primary mitral regurgitation (PMR) accounting for 61%-67% of cases. Chronic PMR can result in progressive left ventricular remodeling and dysfunction, ultimately leading to heart failure or other adverse cardiac events. This, in turn, necessitates frequent referrals, hospitalizations, and cardiac surgeries. The optimal timing for PMR surgery has been a subject of ongoing debate and remains a controversial issue. Presently, it is recommended that patients with chronic PMR undergo earlier mitral valve surgery to enhance post-operative outcomes. For example, the recommendation of European and American guidelines about left ventricular end-systolic diameter for surgery has been altered from 45 mm to 40 mm. Echocardiographic parameters are regarded as noteworthy indicators for intervention in patients with PMR. Extensive research has been undertaken in the field of echocardiography to identify more effective indicators that can propose the optimal timing for surgery, encompassing both conventional and novel echocardiography parameters. However, some parameters are not known to clinicians and the cut-off values for these parameters have shown some variations. Furthermore, a comprehensive review of this topic is currently missing. Consequently, this review aims to provide a thorough summary and elucidation of the prognostic significance of various echocardiographic measurements and their corresponding cut-off values, to help the clinical decision-making and further improve the outcomes of patients with PMR.

Background: The systemic immune-inflammatory index (SII), calculated by (platelet count × neutrophil count)/lymphocyte count, is a novel biomarker with predive and prognostic value in numerous diseases. However, the relationship between SII and congestive heart failure (CHF) is not clear. This study aims to document the association of SII with the prevalence of CHF in the whole population and the long-term prognosis in CHF patients.

Methods: This study included 57,500 participants in the National Health and Nutritional Examination Surveys, who were categorized into 3 categories based on their SII levels. A cross-sectional study was conducted to examine the relationship between SII and CHF prevalence in the whole population, followed by a prospective longitudinal study with a 5.4-year follow-up period for CHF patients to assess the predictive significance of SII for CHF. The main focus of the longitudinal study was on all-cause death as the primary outcome, with cardiovascular (CV) death as the secondary outcome. Associations were estimated using multivariate logistic regression and Cox proportional hazards models. The dose-response relationship was assessed with the restricted cubic spline (RCS) analysis.

Results: In the cross-sectional analysis, there were 1927 (3.35%) participants diagnosed with CHF. The high SII group showed a significantly higher prevalence of CHF than the low SII group (odds ratio (OR) 1.24, 95% confidence interval (CI): 1.05, 1.45). In the longitudinal analysis, 882 all-cause deaths including 379 CV deaths were collected among CHF patients, and high SII was associated with a significant increase in the risk of all-cause death (hazard ratio (HR) 1.44; 95% CI: 1.14, 1.81) and CV death (HR 1.31; 95% CI: 1.08, 1.58). RCS confirmed the positive correlation of SII with the prevalence of CHF in the whole population, as well as the mortality risk in CHF patients.

Conclusions: This study is the first to reveal that high SII was related to a high prevalence of CHF and a poor prognosis in CHF patients. These findings underscore the potential role of SII in the prevention and management of CHF.