World Journal of Cardiology最新文献

Background: Patients suffering from coronary artery disease (CAD) are experiencing significantly improved outcomes in clinical practice through the use of drug-eluting stents. However, there is still a dearth of real-world long-term data, especially from different patient populations in India, whose clinical presentation is frequently different from trial patient populations. The purpose of this study was to retrospectively assess NeoHexa coronary stent's long-term safety and effectiveness in all-comer patients, covering both ordinary and pandemic-era clinical settings, during an average follow-up duration of five years.

Aim: To investigate long-term safety and effectiveness of NeoHexa sirolimus-eluting stent (SES) in managing CAD among real-world all-comer patient population.

Methods: 740 individuals with CAD who had undergone percutaneous coronary intervention with NeoHexa SES minimum 2 years prior to the study were included in this single center retrospective, observational analysis. The data was extracted from medical records and patients were followed-up telephonically. The primary safety endpoint included cumulative major adverse cardiac event (MACE) at time of follow up (≥ 2 years after implantation). MACE was defined as a composite endpoint consisting of cardiac death, myocardial infarction, and target lesion revascularization (TLR). The primary efficacy endpoint involved sustained relief of angina or angina-equivalent symptoms at two years post- implantation, without the need for TLR. The secondary endpoints included individual components of MACE, all-cause mortality, target vessel revascularization and stent thrombosis.

Results: At a mean follow-up period of 62.17 ± 9.86 months, 32 subjects (4.32%) experienced the key safety endpoint of MACE. This included 13 patients (1.76%) with TLR/target vessel revascularization and 19 patients (2.57%) with cardiac mortality. Additionally, non-cardiac mortality occurred in 35 cases (4.73%). In terms of effectiveness, 673 patients (90.95%) did not require revascularization and remained clinically stable in New York Heart Association functional class I-II.

Conclusion: The study suggests favourable long-term safety and efficacy of NeoHexa SES in a real-world setting with varied clinical presentations.

The management of non-ST-elevation myocardial infarction (NSTEMI) in elderly patients is increasingly common, yet clinical decision-making remains challenging in the presence of frailty. In a large contemporary analysis, Popat et al examined the impact of frailty on outcomes associated with percutaneous coronary intervention (PCI) in patients aged ≥ 75 years hospitalized with NSTEMI. Frailty was assessed using the hospital frailty risk score, an ICD-10-based tool, and categorized as low, intermediate, or high. Using data from the United States National Inpatient Sample (2021-2022), more than 450000 NSTEMI admissions were analyzed. PCI was associated with reduced in-hospital mortality across all frailty categories, supporting its potential benefit even in very elderly patients. However, the magnitude of survival benefit declined progressively with increasing frailty. Higher frailty was also strongly associated with increased procedural complications, longer hospital stays, and greater healthcare costs. These findings suggest that frailty should not be viewed as an absolute contraindication to PCI, but rather as a key modifier in patient-centered decision-making. Despite limitations inherent to retrospective administrative data, this study highlights the importance of frailty-informed strategies in contemporary NSTEMI management.

Background: Hypertension is among the leading causes of cardiovascular diseases, including myocardial infarction (MI), stroke, and heart failure. The thiazide diuretics of chlorthalidone and hydrochlorothiazide are commonly prescribed in the control of blood pressure. Although they are effective, there has been debate regarding their relative efficacy and safety, particularly with respect to cardiovascular events.

Aim: To determine the relative efficacy and safety of hydrochlorothiazide vs chlorthalidone in the treatment of primary hypertension treatment in adults, isolation of their effects on systolic and diastolic blood pressure, MI, stroke, heart failure, and hypokalemia.

Methods: PubMed and Google Scholar databases were searched for comparative studies of hydrochlorothiazide vs chlorthalidone in patients with hypertension. The inclusion criteria were randomized controlled trials, cohort studies, and clinical studies in the English language from 2005 to 2025. Eleven studies were ultimately included for meta-analysis. Statistical analysis was performed using a random-effects model, and heterogeneity was tested by I ² statistics.

Results: Chlorthalidone was associated with greater reductions in systolic blood pressure [mean difference: 5.18 mmHg, 95% confidence interval (CI): 4.28-6.08] and diastolic blood pressure (2.91 mmHg, 95%CI: 1.96-3.87) compared to hydrochlorothiazide. Interestingly, chlorthalidone also demonstrated superior nocturnal blood pressure control (P = 0.0002). In terms of cardiovascular outcomes, chlorthalidone showed a potential significant (P = 0.052) reduction in the risk of MI (relative risk: 1.30, 95%CI: 1.00-1.70); however, there were no differences in stroke or all-cause mortality between the two medications. A safety analysis revealed a significantly lower risk of hypokalemia associated with hydrochlorothiazide (relative risk: 0.52, 95%CI: 0.38-0.72). Both medications had similar safety profiles regarding heart failure and rates of hospitalization.

Conclusion: The present meta-analysis suggests that chlorthalidone is more effective than hydrochlorothiazide in reducing both systolic and diastolic blood pressure, particularly at night. Although both drugs share comparable cardiovascular event safety profiles, chlorthalidone carries a higher risk of inducing hypokalemia. These findings emphasize the need for individualized treatment strategies in the management of hypertension based on the varying efficacy and safety profiles of chlorthalidone and hydrochlorothiazide.

Background: Premature ventricular contractions (PVCs) originating from the left ventricular summit (LVS) could be challenging to ablate due to anatomical reasons.

Aim: To study the role of new irrigation technologies, like the TactiFlex catheter, could facilitate deeper radiofrequency (RF) penetration and thus increase success in the ablative treatment of this PVC subset.

Methods: Three PVCs focus (left bundle branch block morphology, inferior axis on the frontal plane, early R/S transition in V1-V2) were accurately mapped with Ensite X omnipolar technology.

Results: RF was delivered at mitroaortic continuity by TactiFlex catheter (4-9 lesions, max 35 W, 43 °C, 13 mL/minute, max 60 seconds, mean impedance drop 11.9 ± 1.7 ohms) with acute PVCs suppression but early recurrence in all cases. In one case, an anatomical approach in the posteroseptal right ventricular outflow tract was performed without acute success. After 6-10 hours, no PVCs/ventricular arrhythmias have been detected, and no arrhythmia recurrences in all 3 cases at a 180-day follow-up visit. These data were compared with a cohort of 10 patients with LVS PVCs with immediate disappearance treated with the same technology; the only difference, although not statistically significant, was in the greater drop in impedance (13.5 ± 2.1 ohms).

Conclusion: Late PVCs elimination could be due to the porous flexible distal tip design of the TactiFlex catheter that allows deeper RF penetration in the myocardium due to a greater adhesion of the saline irrigation system to tissue. It is reasonable to assume that this new technology makes lesions more transmural, determining a delayed lesion maturation, thus not limited to the duration of energy delivery.

Background: The recent Cardiac Output in Patients with Small Annuli Undergoing Transcatheter Aortic Valve Implantation with Self-Expanding vs Balloon Expandable Valve (COPS-TAVI) study provided some insights into the differences in cardiac output in patients with small aortic annuli undergoing transcatheter aortic valve implantation (TAVI) according to the implanted platform: Balloon-expandable (BEV) vs self-expanding valves (SEV).

Aim: To investigate the understudied role of atrial fibrillation (AF) on cardiac output in patients undergoing TAVI.

Methods: The COPS-TAVI study enrolled consecutive patients with severe aortic stenosis and small annuli who underwent successful TAVI. Cardiac output was measured using echocardiography within 4 weeks following TAVI. Data were analyzed according to the presence of AF and stratified by SEV or BEV.

Results: A total of 138 patients were included in the analysis, of whom 22% had AF. Cardiac output was significantly lower in patients with AF compared to those without it (4.6 L/minute vs 5.3 L/minute, P = 0.02). Consistent with the main study findings, the difference in cardiac output was evident among patients without AF who underwent SEV vs BEV (P < 0.05). On the other hand, there was no difference in cardiac output in patients with AF, irrespective of the implanted platform (P > 0.05). There was no difference in clinical outcomes between the two groups.

Conclusion: Cardiac output, as measured by echocardiography, was larger in patients with small annuli who underwent TAVI procedure with SEV compared to BEV in patients without AF. This observation should be considered during procedural planning.

Frailty has emerged as a critical determinant of clinical outcomes in cardiovascular patients undergoing invasive management. Although percutaneous coronary intervention (PCI) remains the cornerstone of therapy for acute coronary syndromes, its role in elderly and frail patients with non-ST elevation myocardial infarction (NSTEMI) continues to raise uncertainty. Recent evidence underscores the complex interplay between survival benefit, procedural risk, and healthcare utilization in this vulnerable population. In this context, Popat et al applied the hospital frailty risk score to stratify outcomes in elderly patients (≥ 75 years) undergoing PCI. Their analysis provides valuable insights into the prognostic significance of frailty assessment and its potential role in guiding individualized treatment decisions. In this letter to the editor, we reflect on these findings and discuss them in relation to current literature, practice guidelines, and future directions for managing frail elderly patients with NSTEMI.

The pathophysiology of coronary heart disease (CHD) is significantly influenced by oxidative stress and inflammation, which also modify atherosclerosis. A decreased antioxidant defense and an increase in oxidative stress are factors in the development and progression of coronary artery disease. There are many oxidative stress biomarkers in coronary artery disease. However, this article summarised the role of oxidative stress biomarkers such as paraoxonase, nitrotyrosine, glutathione peroxidase, advanced glycation end-products, 8-hydroxydeoxyguanosine, myeloperoxidase, superoxide dismutase, malondialdehyde, isoprostanes, catalase and derivatives of reactive oxidative metabolites in the pathogenesis of CHD. Targeting the causes and consequences of reactive oxygen species by lifestyle changes and pharmacological approaches is part of controlling oxidative stress indicators in CHD.

Background: Severe aortic stenosis is typically treated with transcatheter aortic valve implantation (TAVI) in elderly patients with contraindications for surgery or elderly patients who have a high risk for surgical aortic valve replacement. Currently, there is a paucity of data on the survival outcomes for patients older than 85 years who underwent TAVI.

Aim: To determine survival and predictors of mortality in patients older than 85 years who underwent TAVI.

Methods: A retrospective cohort study was conducted on 64 patients ≥ 85 years of age who underwent TAVI between 2010 and 2023 at the King Abdulaziz Cardiac Center in Riyadh, Saudi Arabia. Baseline demographics, echocardiographic parameters, procedural outcomes, and mortality data were collected and analyzed at the 1-year and 3-year follow-up appointments.

Results: The mean patient age was 88.3 ± 3.6 years, and 81.3% of the patients were male. The most common comorbidities were hypertension (79.7%), diabetes (60.9%), and coronary artery disease (53.1%). The mean left ventricular ejection fraction was 51.1% with a mean transvalvular gradient of 45.1 mmHg. The 1-year and 3-year survival rates were 82% and 63%, respectively. The mean survival duration was 56.3 months. Multivariate analysis identified body mass index ≥ 30 as significant predictor of early mortality (odds ratio: 3.13, 95% confidence interval: 1.01-4.75).

Conclusion: Favorable survival outcomes were observed in patients 85 years or older who underwent TAVI. The mortality risk increased in patients with obesity.

Catecholaminergic polymorphic ventricular tachycardia is a classic example of the successful transfer of genetic cardiology from gene discovery to implementation of precision medicine. This inherited arrhythmia syndrome induces potentially lethal ventricular arrhythmias by catecholaminergic stress in normally structured hearts and is most commonly due to ryanodine receptor 2 (RyR2) mutations in 60%-70% families. Pathophysiology involves gain-of-function mutations forming "leaky" calcium channels with increased sensitivity to catecholaminergic stimulation. Store overload-induced calcium release is a key mechanism whereby mutations reduce thresholds for spontaneous calcium release events. Complex mitochondrial-sarcoplasmic reticulum crosstalk amplifies dysfunction by calcium-induced mitochondrial overload and generation of reactive oxygen species. Modern diagnosis combines next-generation sequencing with functional confirmation using patient-specific induced pluripotent stem cells, allowing for personalized stratification of risk. Male gender, early age of onset, frequent attacks, and central domain mutations are high-risk factors. Exercise testing continues to play a central role in diagnosis and follow-up. Treatment has progressed from empiric β-blocker therapy to mutation-targeted therapy for the condition. β-blockers decrease arrhythmia by 60%-70%, and flecainide adjunct therapy improves success to 80%-90% via direct RyR2 modulation. Carvedilol is more beneficial because of the added alpha-blocking and antioxidant effect. Patients who are refractory are aided by left cardiac sympathetic denervation or implantable cardioverter defibrillators. Upcoming precision medicine includes clustered regularly interspaced short palindromic repeat-associated protein Cas9 gene editing, targeted molecular therapy, and artificial intelligence-based management. RyR2 stabilizers, calmodulin modulators, and mitochondrial protective therapies are promising targeted therapies. Implementation occurs through multidisciplinary care involving genetics, cardiology, and counseling services. Critical challenges are the management of asymptomatic carriers, the definition of exercise limitation, and the validation of biomarkers. Catecholaminergic polymorphic ventricular tachycardia illustrates successful translation of molecular cardiology with a paradigm for inherited arrhythmia syndromes and prevention of sudden cardiac death with mechanistically informed, personalized therapeutic strategies.

Background: Sepsis, a common and severe infectious disease, remains one of the leading causes of mortality among patients, with myocardial injury representing a major contributor to adverse outcomes. Melatonin, an endogenous hormone, is known to regulate oxidative stress and inflammatory responses; however, its specific role in sepsis-induced myocardial injury remains unclear.

Aim: To investigate the protective effects of melatonin on sepsis-induced myocardial injury and to elucidate the underlying mechanisms with a focus on the sirtuin 1/nuclear factor erythroid 2-related factor 2/glutathione peroxidase 4 pathway.

Methods: Male 57BL/6 mice were assigned to four groups: (1) The control group; (2) The lipopolysaccharide (LPS) group (15 mg/kg); (3) The LPS plus ferrostatin-1 group (ferroptosis inhibitor, 5 mg/kg); and (4) The LPS plus melatonin group (10 mg/kg). Cardiac function, myocardial injury, biochemical markers, and protein expression levels were evaluated using echocardiography, hematoxylin and eosin staining, biochemical assay kits, western blotting, and the cell counting kit-8 assay. To further investigate the effects of melatonin in vitro, HL-1 cardiomyocytes were subjected to the same treatment conditions.

Results: Echocardiography and histological evaluation revealed significant impairments in cardiac function and marked myocardial tissue damage in the LPS group, whereas these pathological changes were alleviated in the LPS plus melatonin group. Treatment with melatonin significantly reduced serum levels of brain natriuretic peptide, lactate dehydrogenase, creatine kinase-MB, and cardiac troponin I, while improving myocardial reactive oxygen species and glutathione levels as well as superoxide dismutase activity compared with the LPS group. Protein expression analysis demonstrated an increase in glutathione peroxidase 4 and a decrease in NADPH oxidase 4 and acyl-CoA synthetase long-chain family member 4, consistent with reduced oxidative stress and ferroptosis. In addition, cell viability assays confirmed that melatonin effectively protected HL-1 cardiomyocytes from LPS-induced cytotoxicity.

Conclusion: The findings indicate that melatonin alleviates sepsis-induced myocardial injury by inhibiting ferroptosis through regulation of the sirtuin 1/nuclear factor erythroid 2-related factor 2/glutathione peroxidase 4 pathway, providing evidence supporting the potential use of melatonin in the treatment of sepsis-related myocardial injury.