Progress in cardiovascular diseases最新文献_第2页

Radionuclide imaging techniques for assessing myocardial viability: Clinical applications, evidence, and future directions 放射性核素成像技术评估心肌活力：临床应用、证据和未来方向。

IF 7.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2025-11-01 DOI: 10.1016/j.pcad.2025.08.005

Jonathan D. Knott, Ellen Kronzer, Nandan Anavekar, Panithaya Chareonthaitawee, J. Wells Askew

Ischemic cardiomyopathy (ICM) is a leading cause of heart failure globally. Myocardial viability testing aims to identify dysfunctional but potentially reversible myocardium in patients with ICM. This review examines the clinical application and diagnostic performance of radionuclide imaging techniques including thallium-201 (²⁰¹Tl) and technetium-99 m (^99mTc) single positron emission tomography (SPECT), and flourine-18-flourodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET) for assessing myocardial viability. ²⁰¹TI SPECT assesses viability via active myocardial uptake and delayed redistribution but is limited by prolonged protocols and suboptimal image quality. ^99mTc-labeled agents (sestamibi and tetrofosmin) offer improved spatial resolution, shorter half-life, and higher photon energy, enabling faster imaging and better image quality. When combined with nitrate augmentation or gated imaging, ^99mTc SPECT enhances detection of viable but under perfused myocardium. ¹⁸F-FDG PET is considered the gold standard modality for viability assessment due to its superior sensitivity, image quality and quantitative capabilities for myocardial blood flow. While observational studies associate viability with improved outcomes after revascularization, randomized trials have yielded mixed results. However, contemporary guidelines continue to support viability testing in selected high-risk patients. Emerging technologies including novel PET tracers, artificial intelligence, and hybrid imaging may further improve diagnostic accuracy and clinical utility of radionuclide viability testing. Radionuclide imaging remains a valuable tool in assessing myocardial viability in ICM. While PET offers superior diagnostic accuracy, SPECT remains widely used given its accessibility. Future studies incorporating modern imaging technologies and contemporary heart failure therapies are needed to clarify the role of viability testing in guiding revascularization strategies.

缺血性心肌病（ICM）是全球心力衰竭的主要原因。心肌活力测试旨在识别ICM患者功能失调但可能可逆的心肌。本文综述了放射性核素成像技术，包括铊-201 （201Tl）和锝-99 m （99mTc）单正电子发射断层扫描（SPECT）和氟-18-氟脱氧葡萄糖（18F-FDG）正电子发射断层扫描（PET）在评估心肌活力方面的临床应用和诊断性能。SPECT通过主动心肌摄取和延迟再分配来评估生存能力，但受时间延长和图像质量欠佳的限制。99mtc标记剂（sestamibi和tetrofosmin）提供更高的空间分辨率、更短的半衰期和更高的光子能量，从而实现更快的成像和更好的图像质量。当与硝酸盐增强或门控成像联合使用时，99mTc SPECT增强了对存活但灌注不足的心肌的检测。18F-FDG PET因其优越的灵敏度、图像质量和心肌血流定量能力而被认为是活力评估的金标准模式。虽然观察性研究将生存能力与血运重建术后改善的结果联系起来，但随机试验得出了不同的结果。然而，当代的指导方针仍然支持在选定的高危患者中进行生存能力测试。包括新型PET示踪剂、人工智能和混合成像在内的新兴技术可能进一步提高放射性核素活力测试的诊断准确性和临床实用性。放射性核素成像仍然是评估ICM心肌活力的一种有价值的工具。虽然PET提供了优越的诊断准确性，但由于其可及性，SPECT仍被广泛使用。未来的研究需要结合现代成像技术和当代心力衰竭治疗来阐明生存能力测试在指导血运重建策略中的作用。

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引用次数: 0

List of recent issues 近期刊物一览表

IF 7.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2025-11-01 DOI: 10.1016/S0033-0620(25)00175-6

引用次数: 0

Cover 2 (Masthead) 封二（报头）

IF 7.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2025-11-01 DOI: 10.1016/S0033-0620(25)00173-2

引用次数: 0

The role of 18F-fluorodeoxyglucose positron emission tomography for vascular imaging 18f -氟脱氧葡萄糖正电子发射断层扫描在血管成像中的作用。

IF 7.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2025-11-01 DOI: 10.1016/j.pcad.2025.09.012

Nidaa Mikail , Fabien Hyafil

Vasculitides are caused by a pathological inflammatory reaction inside the arterial wall that may involve all three layers (endothelium, media and adventitia). They are typically grouped according to the caliber of the vessels involved—large, medium or small. The diagnosis of vasculitis should be made rapidly because of the risk of ischemic complications due to vascular occlusion and immunosuppressive treatment initiated without delay. Histological analysis of vascular samples remains the gold standard for the diagnosis but may be inconclusive or not accessible. Non-invasive imaging is playing an increasing role for the diagnosis of vasculitis. Among the different imaging modalities available, ¹⁸F-fluorodeoxyglucose positron-emission tomography (FDG-PET) has demonstrated its interest for the diagnosis of vasculitis. FDG is an analogue of glucose bound to a positron emitter, that accumulates in activated inflammatory cells. FDG-PET imaging provides high sensitivity for the detection of vascular wall inflammation associated with vasculitis. PET imaging has a spatial resolution of only 4–5 mm which is adequate for large vessel vasculitis such as giant cell or Takayasu arteritis, but insufficient for medium or small vessels. FDG-PET has demonstrated high diagnostic performance for the diagnosis of giant cell arteritis and Takayasu arteritis as well as for monitoring the regression of vascular inflammation under immunosuppressive therapy. The role of FDG-PET for the detection and prediction of relapse remains, however, largely discussed. In addition to its role in inflammatory vasculitis, FDG-PET can also help identify vascular complications of sepsis due to septic emboli, such as infectious aortitis or mycotic aneurysms.

血管粥样硬化是由动脉壁内的病理性炎症反应引起的，可能涉及所有三层（内皮、中膜和外膜）。它们通常根据所涉船只的口径进行分组——大、中、小。血管炎的诊断应迅速作出，因为由于血管闭塞和免疫抑制治疗立即开始缺血性并发症的风险。血管样本的组织学分析仍然是诊断的金标准，但可能不确定或无法获得。无创影像在血管炎的诊断中发挥着越来越重要的作用。在可用的不同成像方式中，18f -氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）已证明其对血管炎的诊断有兴趣。FDG是葡萄糖的类似物，与正电子发射器结合，在激活的炎症细胞中积累。FDG-PET成像为血管炎相关血管壁炎症的检测提供了高灵敏度。PET成像的空间分辨率仅为4-5 mm，对于巨细胞或高须动脉炎等大血管血管炎是足够的，但对于中、小血管是不够的。FDG-PET在巨细胞动脉炎和高松动脉炎的诊断以及监测免疫抑制治疗下血管炎症的消退方面表现出很高的诊断性能。然而，FDG-PET在检测和预测复发方面的作用仍有很大的讨论。除了在炎性血管炎中的作用外，FDG-PET还可以帮助识别脓毒症引起的脓毒症血管并发症，如感染性大动脉炎或真菌性动脉瘤。

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引用次数: 0

Updates in fluorodeoxyglucose positron emission tomography (18FDG-PET) in the diagnosis and management of cardiac sarcoidosis 氟脱氧葡萄糖正电子发射断层扫描（18FDG-PET）在心脏结节病诊断和治疗中的最新进展

IF 7.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2025-11-01 DOI: 10.1016/j.pcad.2025.08.004

Ellen Kronzer , Grace Hagan , Caroline Ledet , Jonathan Knott , John Bois , J. Wells Askew , Panithaya Chareonthaitawee

Cardiac sarcoidosis (CS) is an infiltrative cardiomyopathy characterized by non-caseating granulomatous inflammation that results in significant morbidity and mortality. It has become increasingly recognized over the past several decades; however, diagnosis remains challenging due to its heterogeneous nature and limited diagnostic yield of endomyocardial biopsy. As such, there has been increasing reliance on advanced cardiac imaging to aid in the diagnosis and management of CS. Fluorodeoxyglucose positron emission tomography (¹⁸FDG-PET) has emerged as the most robust imaging modality and remains the preferred method for assessing active inflammation, treatment response, and surveillance. Nevertheless, it requires meticulous patient preparation and image acquisition to ensure optimal imaging and interpretation. This article aims to provide a comprehensive review of the various imaging modalities used for the diagnosis of CS, with a particular focus on the intricacies of ¹⁸FDG-PET, including the latest advancements in patient preparation and study interpretation. Other future directions for the diagnosis and management of CS will also be discussed.

心脏结节病（CS）是一种浸润性心肌病，以非干酪化肉芽肿性炎症为特征，导致显著的发病率和死亡率。在过去的几十年里，人们越来越认识到这一点；然而，由于其异质性和有限的心内膜肌活检诊断率，诊断仍然具有挑战性。因此，越来越多的人依赖于先进的心脏成像来帮助诊断和治疗CS。氟脱氧葡萄糖正电子发射断层扫描（18FDG-PET）已成为最强大的成像方式，仍然是评估活动性炎症、治疗反应和监测的首选方法。然而，需要细致的病人准备和图像采集，以确保最佳的成像和解释。本文旨在全面回顾用于CS诊断的各种成像方式，特别关注18FDG-PET的复杂性，包括患者准备和研究解释的最新进展。本文还将讨论CS的其他诊断和治疗方向。

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引用次数: 0

Outcomes of TAVR in severe aortic stenosis: Very low gradient is not necessarily good news TAVR治疗严重主动脉瓣狭窄的结果：非常低的梯度不一定是好消息。

IF 7.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2025-11-01 DOI: 10.1016/j.pcad.2025.10.006

Philippe Pibarot

引用次数: 0

First presentation of atherosclerotic cardiovascular disease in previously healthy individuals: The multi-ethnic study of atherosclerosis 先前健康个体首次出现动脉粥样硬化性心血管疾病：动脉粥样硬化的多种族研究

IF 7.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2025-09-01 DOI: 10.1016/j.pcad.2025.05.004

Jonathan Kermanshahchi , Andrew S. Kao , Charlotte C. Ellberg , Edward Duran , Michael H. Criqui , Michael D. Shapiro , Harpreet S. Bhatia

Aim

To evaluate the first presentation of atherosclerotic cardiovascular disease (ASCVD) in individuals without known ASCVD.

Methods

Distribution of first ASCVD events (angina, stroke, myocardial infarction [MI], or death/resuscitated cardiac arrest [RCA]), and the association between traditional risk factors, coronary artery calcium (CAC) and lipoprotein(a) [Lp(a)] with these events in Cox proportional hazards models were evaluated in 6779 participants in the Multi-Ethnic Study of Atherosclerosis. Risk prediction improvement with addition of CAC to the pooled cohort equations (PCE) was evaluated using net reclassification improvement (NRI).

Results

The mean age was 62.1 ± 10.2 years and 1037 participants (15.3 %) experienced an ASCVD event over a median of 15.8 years. The most common first presentation was cardiovascular death/RCA (n = 287;27.7 %). Among those with events, Black (35.6 %, p = 0.001)) individuals more often presented with death/RCA, Hispanic (29.3 %, p = 0.037) individuals more often presented with stroke compared to White individuals (24.8 % and 21.7 %, respectively). Compared to men, women more frequently presented with stroke (29.5 vs. 20.7 %, p = 0.002) and death/RCA (29.8 vs 26.3 %, p = 0.243) though this did not meet statistical significance. CAC score was significantly associated with first presentation of all events, including death/RCA (HR 1.13, 95 % CI 1.07–1.19) and improved risk prediction when added to the PCE (continuous NRI 0.6081, 95 % CI 0.4971–0.7141). Lp(a) was significantly associated with MI only (HR 1.15 per SD, 95 % CI 1.02–1.29).

Conclusions

In previously asymptomatic individuals, the most common initial presentation of ASCVD was death/resuscitated cardiac arrest, particularly among women, minority groups, and those with CAC. CAC scoring may identify individuals at risk for death/resuscitated cardiac arrest as a first presentation of ASCVD.

目的：评价未发现动脉粥样硬化性心血管疾病（ASCVD）的患者首次出现ASCVD的情况。方法：在多民族动脉粥样硬化研究的6779名参与者中，评估了首次ASCVD事件（心绞痛、卒中、心肌梗死[MI]或死亡/复苏性心脏骤停[RCA]）的分布，以及Cox比例风险模型中传统危险因素、冠状动脉钙（CAC）和脂蛋白（Lp(a)）与这些事件的关系。在合并队列方程（PCE）中加入CAC对风险预测的改善使用净重分类改善（NRI）进行评估。结果：平均年龄为62.1 ± 10.2 岁，1037名参与者（15.3 %）经历了ASCVD事件，中位时间为15.8 年。最常见的首发表现是心血管死亡/RCA （n = 287;27.7 %）。在这些事件中，黑人（35.6 %,p = 0.001）更常出现死亡/RCA，西班牙裔（29.3 %,p = 0.037）个体比白人（分别为24.8 %和21.7 %）更常出现中风。与男性相比，女性更频繁地出现中风（29.5 vs 20.7 %,p = 0.002）和死亡/RCA (29.8 vs 26.3 %,p = 0.243)，尽管这没有统计学意义。CAC评分与所有事件的首次出现均显著相关，包括死亡/RCA （HR 1.13, 95 % CI 1.07-1.19）以及添加PCE后改善的风险预测（连续NRI 0.6081, 95 % CI 0.4971-0.7141）。Lp(a)仅与心肌梗死显著相关（HR 1.15 / SD, 95 % CI 1.02-1.29）。结论：在先前无症状的个体中，ASCVD最常见的初始表现是死亡/复苏性心脏骤停，特别是在女性、少数民族和CAC患者中。CAC评分可以作为ASCVD的首次表现来识别有死亡/复苏性心脏骤停风险的个体。

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引用次数: 0

Effect of inclisiran on lipid and mechanical vascular profiles in familial hypercholesterolemia subjects: results from a single lipid center real-world experience inclisiran对家族性高胆固醇血症患者的脂质和机械血管的影响：来自单一脂质中心的真实世界经验。

IF 7.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2025-09-01 DOI: 10.1016/j.pcad.2025.05.008

Giosiana Bosco , Francesco Di Giacomo Barbagallo , Maurizio Di Marco , Sabrina Scilletta , Nicoletta Miano , Stefano Esposto , Giovanni Pennisi , Simone Prezzavento , Antonio Gallo , Ernestina Marianna De Francesco , Roberta Malaguarnera , Antonino Di Pino , Francesco Purrello , Salvatore Piro , Roberto Scicali

Background and aims

Familial hypercholesterolemia (FH) is characterized by elevated LDL-C and an increased risk of premature cardiovascular events. Inclisiran is a small interfering RNA that inhibits hepatic PCSK9 synthesis and promotes LDL-C clearance by enhancing LDLR expression on hepatocytes. This study aimed to evaluate the efficacy of six-months add-on inclisiran on lipid profile and PWV in FH; furthermore, we investigated the association between LDL-C reduction and PWV variation.

Methods

This prospective observational study involved 78 genetically confirmed FH subjects with an LDL-C off-target despite high-intensity statins plus ezetimibe. All subjects obtained biochemical analysis and PWV evaluation at baseline and after six months add-on inclisiran.

Results

After six months add-on inclisiran, 41 % of subjects achieved LDL-C targets. Significant reductions of LDL-C (−41.5 %, p < 0.001), ApoB (−33.7 %, p < 0.01), Non-HDL-C (−35.9 %, p < 0.001), and Lp(a) (−18 %, p < 0.01) were observed, while PWV improved by 14.4 % (p < 0.001). In a secondary analysis, the Primary prevention group showed a higher prevalence of subjects on LDL-C target than the Secondary prevention group (59 % vs 23.1 %, p < 0.001). Both groups exhibited significant improvements of lipid profile and PWV (Δ - 14.1 %, p < 0.01 and Δ - 14.6 %, p < 0.001, respectively). Linear regression showed a significant association between ΔPWV and ΔLDL-C in the whole study population as well as in the Primary and Secondary prevention groups (p for all <0.001).

Conclusion

Inclisiran significantly improved lipid profile and PWV in FH subjects. ΔPWV was significantly associated with ΔLDL-C.

背景和目的：家族性高胆固醇血症（FH）的特征是LDL-C升高和过早心血管事件的风险增加。Inclisiran是一种小干扰RNA，可抑制肝脏PCSK9的合成，并通过增强肝细胞上LDLR的表达来促进LDL-C的清除。本研究旨在评估6个月加用inclisiran对FH患者血脂和PWV的疗效；此外，我们还研究了LDL-C降低与PWV变化之间的关系。方法：这项前瞻性观察性研究涉及78名基因证实的FH患者，尽管使用高强度他汀类药物和依折替米布，但LDL-C仍脱靶。所有受试者在基线和6个月后进行生化分析和PWV评估。结果：6个月后，41% %的受试者达到了LDL-C目标。显著降低LDL-C（-41.5 %,p ）结论：Inclisiran显著改善FH受试者的血脂和PWV。ΔPWV与ΔLDL-C显著相关。

{"title":"Effect of inclisiran on lipid and mechanical vascular profiles in familial hypercholesterolemia subjects: results from a single lipid center real-world experience","authors":"Giosiana Bosco , Francesco Di Giacomo Barbagallo , Maurizio Di Marco , Sabrina Scilletta , Nicoletta Miano , Stefano Esposto , Giovanni Pennisi , Simone Prezzavento , Antonio Gallo , Ernestina Marianna De Francesco , Roberta Malaguarnera , Antonino Di Pino , Francesco Purrello , Salvatore Piro , Roberto Scicali","doi":"10.1016/j.pcad.2025.05.008","DOIUrl":"10.1016/j.pcad.2025.05.008","url":null,"abstract":"<div><h3>Background and aims</h3><div>Familial hypercholesterolemia (FH) is characterized by elevated LDL-C and an increased risk of premature cardiovascular events. Inclisiran is a small interfering RNA that inhibits hepatic PCSK9 synthesis and promotes LDL-C clearance by enhancing LDLR expression on hepatocytes. This study aimed to evaluate the efficacy of six-months add-on inclisiran on lipid profile and PWV in FH; furthermore, we investigated the association between LDL-C reduction and PWV variation.</div></div><div><h3>Methods</h3><div>This prospective observational study involved 78 genetically confirmed FH subjects with an LDL-C off-target despite high-intensity statins plus ezetimibe. All subjects obtained biochemical analysis and PWV evaluation at baseline and after six months add-on inclisiran.</div></div><div><h3>Results</h3><div>After six months add-on inclisiran<strong><em>,</em></strong> 41 % of subjects achieved LDL-C targets. Significant reductions of LDL-C (−41.5 %, <em>p</em> < 0.001), ApoB (−33.7 %, <em>p</em> < 0.01), Non-HDL-C (−35.9 %, <em>p</em> < 0.001), and Lp(a) (−18 %, <em>p</em> < 0.01) were observed, while PWV improved by 14.4 % (<em>p</em> < 0.001). In a secondary analysis, the Primary prevention group showed a higher prevalence of subjects on LDL-C target than the Secondary prevention group (59 % vs 23.1 %, <em>p</em> < 0.001). Both groups exhibited significant improvements of lipid profile and PWV (Δ - 14.1 %, <em>p</em> < 0.01 and Δ - 14.6 %, <em>p</em> < 0.001, respectively). Linear regression showed a significant association between ΔPWV and ΔLDL-C in the whole study population as well as in the Primary and Secondary prevention groups (<em>p</em> for all <0.001).</div></div><div><h3>Conclusion</h3><div>Inclisiran significantly improved lipid profile and PWV in FH subjects. ΔPWV was significantly associated with ΔLDL-C.</div></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"92 ","pages":"Pages 108-117"},"PeriodicalIF":7.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Burden and severity of respiratory syncytial virus infection in adults with cardiovascular diseases: A systematic literature review 成人心血管疾病患者呼吸道合胞病毒感染的负担和严重程度：系统文献综述

IF 7.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2025-09-01 DOI: 10.1016/j.pcad.2025.06.010

Yolanda Penders , Ann R. Falsey , Deepak L. Bhatt , Michael Böhm , Andrew J.S. Coats , Lauren M.K. Mason , Laura Mora , Pouya Saeedi , Jean-Philippe Michaud , Frithjof Kosfeld , Lauriane Harrington

Cardiovascular diseases (CVD) are risk factors for severe respiratory syncytial virus (RSV) infection, which in turn increases the risk of cardiovascular complications. The burden of RSV disease among adults with CVD is not yet fully understood and evidence remains to be consolidated through a systematic approach. Covering the publication period from January 1, 2000 to November 28, 2023, this systematic literature review documented RSV disease burden among adults ≥18 years with CVD including heart failure (HF), ischemic heart disease (IHD), and non-specified CVD. Relevant publications were retrieved from databases (PubMed, Embase) and gray literature (conference abstracts) to quantify the prevalence of CVD among RSV-infected adults, and RSV-related hospitalizations, complications, and mortality among adults with CVD. Sixty-two studies were selected for data extraction; most were conducted in the United States and among inpatients. The highest pooled estimates of CVD prevalence were observed among inpatients: 27.5 % (95 % confidence interval: 24.0–31.2) for HF, 22.9 % (17.7–29.0) for IHD, and 44.4 % (38.5–50.5) for non-specified CVD. Adults with CVD were at significantly higher risk of hospitalization following RSV infection compared to those without these comorbidities. Various general, respiratory, and cardiovascular complications attributable to RSV were documented among adults with CVD. RSV-related in-hospital case fatality rates of 7.8–14.8 % (HF), 13.7–20.0 % (IHD), and 2.9–12.5 % (non-specified CVD) were reported. This study shows that adults with CVD bear a significant burden of RSV infection, highlighting the need for effective RSV preventive measures and strategies (i.e., vaccination) targeting this high-risk population.

心血管疾病（CVD）是严重呼吸道合胞病毒（RSV）感染的危险因素，这反过来又增加了心血管并发症的风险。成人心血管疾病患者的呼吸道合胞病毒疾病负担尚不完全清楚，证据仍需通过系统方法加以巩固。从2000年1月1日至2023年11月28日，本系统文献综述记录了≥18 岁CVD成人RSV疾病负担，包括心力衰竭（HF）、缺血性心脏病（IHD）和非特异性CVD。从数据库（PubMed, Embase）和灰色文献（会议摘要）中检索相关出版物，量化rsv感染成人中CVD的患病率，以及与rsv相关的住院、并发症和CVD成人的死亡率。选取62项研究进行数据提取；大多数是在美国和住院病人中进行的。在住院患者中观察到最高的心血管疾病患病率汇总估计：HF为27.5% %(95% %可信区间：24.0-31.2)，IHD为22.9% %(17.7-29.0)，非特定心血管疾病为44.4% %（38.5-50.5）。与没有这些合并症的成年人相比，患有CVD的成年人在RSV感染后住院的风险明显更高。在患有心血管疾病的成人中记录了RSV引起的各种一般、呼吸和心血管并发症。与rsv相关的住院病死率分别为7.8 ~ 14.8 % （HF）、13.7 ~ 20.0 % （IHD）和2.9 ~ 12.5 %（非特定CVD）。这项研究表明，患有心血管疾病的成年人承担着RSV感染的重大负担，强调需要针对这一高危人群采取有效的RSV预防措施和策略（即接种疫苗）。

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引用次数: 0

Left atrial size trajectories and outcome over a 35-year follow-up in patients with hypertrophic cardiomyopathy 肥厚性心肌病患者35年随访的左心房大小轨迹和结果。

IF 7.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases

Pub Date : 2025-09-01 DOI: 10.1016/j.pcad.2025.07.004

Salvatore Di Napoli , Daniela Pacella , Leopoldo Ordine , Grazia Canciello , Felice Borrelli , Lorenzo Moscano , Raffaele Martorano , Roberto Polizzi , Brigida Napolitano , Alessandra Spinelli , Raffaella Lombardi , Giovanni Esposito , Maria Angela Losi

Background

In Hypertrophic cardiomyopathy (HCM) increasing evidence suggests left atrial (LA) remodelling plays a critical role in disease progression. Traditional static LA size measurements, while established as risk markers, do not reflect the dynamic nature of LA changes over time.

Objectives

This study aimed to define long-term LA remodelling trajectories in HCM and assess their prognostic value for predicting atrial fibrillation (AF), sudden cardiac death (SCD), and heart failure (HF) death.

Methods

A cohort of 210 HCM patients with at least 5 LA measurements (36 % women, mean age 45 ± 17 years) was followed over a 35-year period. Group-based trajectory modelling identified distinct longitudinal patterns of LA size. Clinical endpoints included incident AF, SCD, and a composite of heart failure-related death or transplantation. Cox regression analyses compared the predictive value of these trajectories against static baseline LA measurements.

Results

Three LA remodelling trajectories were identified. Over a mean follow-up of 21.8 ± 7.8 years, 73 patients developed AF, 25 experienced SCD, and 9 died from HF. Moderate (Cluster B) and severe (Cluster C) remodelling trajectories were associated with significantly increased AF risk (log-rank p < 0.001), with Cluster C showing a markedly elevated adjusted hazard ratio (aHR 9.30 vs. 5.03 for baseline size). Cluster C was also significantly associated with higher risk of SCD (aHR 3.61, p = 0.031) and HF death (p = 0.028).

Conclusions

Longitudinal LA remodelling patterns offer superior prognostic value over static measurements in HCM, enabling improved risk stratification and personalized care.

背景：在肥厚性心肌病（HCM）中，越来越多的证据表明左心房（LA）重构在疾病进展中起着关键作用。传统的静态LA大小测量虽然被确立为风险标记，但不能反映LA随时间变化的动态性质。目的：本研究旨在确定HCM的长期LA重塑轨迹，并评估其预测心房颤动（AF）、心源性猝死（SCD）和心力衰竭（HF）死亡的预后价值。方法：对210例至少有5项LA测量的HCM患者（36% %女性，平均年龄45 ± 17 岁）进行了35年的随访。基于群的轨迹模型确定了LA大小的不同纵向模式。临床终点包括房颤、SCD和心力衰竭相关死亡或移植的复合。Cox回归分析将这些轨迹的预测值与静态基线LA测量值进行了比较。结果：确定了三种LA重塑轨迹。在平均21.8 ± 7.8 年的随访中，73例患者发生房颤，25例发生SCD， 9例死于心衰。中度（B类）和重度（C类）重塑轨迹与房颤风险显著增加相关（log-rank p ）结论：纵向LA重塑模式在HCM中比静态测量具有更好的预后价值，能够改善风险分层和个性化护理。

{"title":"Left atrial size trajectories and outcome over a 35-year follow-up in patients with hypertrophic cardiomyopathy","authors":"Salvatore Di Napoli , Daniela Pacella , Leopoldo Ordine , Grazia Canciello , Felice Borrelli , Lorenzo Moscano , Raffaele Martorano , Roberto Polizzi , Brigida Napolitano , Alessandra Spinelli , Raffaella Lombardi , Giovanni Esposito , Maria Angela Losi","doi":"10.1016/j.pcad.2025.07.004","DOIUrl":"10.1016/j.pcad.2025.07.004","url":null,"abstract":"<div><h3>Background</h3><div>In Hypertrophic cardiomyopathy (HCM) increasing evidence suggests left atrial (LA) remodelling plays a critical role in disease progression. Traditional static LA size measurements, while established as risk markers, do not reflect the dynamic nature of LA changes over time.</div></div><div><h3>Objectives</h3><div>This study aimed to define long-term LA remodelling trajectories in HCM and assess their prognostic value for predicting atrial fibrillation (AF), sudden cardiac death (SCD), and heart failure (HF) death.</div></div><div><h3>Methods</h3><div>A cohort of 210 HCM patients with at least 5 LA measurements (36 % women, mean age 45 ± 17 years) was followed over a 35-year period. Group-based trajectory modelling identified distinct longitudinal patterns of LA size. Clinical endpoints included incident AF, SCD, and a composite of heart failure-related death or transplantation. Cox regression analyses compared the predictive value of these trajectories against static baseline LA measurements.</div></div><div><h3>Results</h3><div>Three LA remodelling trajectories were identified. Over a mean follow-up of 21.8 ± 7.8 years, 73 patients developed AF, 25 experienced SCD, and 9 died from HF. Moderate (Cluster B) and severe (Cluster C) remodelling trajectories were associated with significantly increased AF risk (log-rank <em>p</em> < 0.001), with Cluster C showing a markedly elevated adjusted hazard ratio (aHR 9.30 vs. 5.03 for baseline size). Cluster C was also significantly associated with higher risk of SCD (aHR 3.61, <em>p</em> = 0.031) and HF death (<em>p</em> = 0.028).</div></div><div><h3>Conclusions</h3><div>Longitudinal LA remodelling patterns offer superior prognostic value over static measurements in HCM, enabling improved risk stratification and personalized care.</div></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"92 ","pages":"Pages 146-150"},"PeriodicalIF":7.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144628314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0