World Journal of Cardiology最新文献

Background: The electrocardiographic (ECG) presentation, with or without ST-segment elevation, has traditionally been the cornerstone for classifying and managing acute myocardial infarction (AMI). However, up to 20% of non-ST-segment elevation myocardial infarction (NSTEMI) patients may have a completely occluded infarct-related artery, which could have important prognostic implications regardless of ECG findings.

Aim: To determine the prevalence, predictors, and impact of total occlusion of the infarct-related coronary artery on short-term mortality.

Methods: We conducted a prospective, single-center cohort study that included consecutive patients treated for AMI with percutaneous coronary intervention (PCI) at the University Hospital Centre Sestre Milosrdnice in Zagreb, Croatia, between 2011 and 2018. Patients were divided into two groups based on the patency of the infarct-related artery: Those with an occluded coronary artery (OCA) and those with a patent coronary artery (PCA).

Results: Among the 2483 patients (71.6% male) treated with PCI for AMI, 67.9% had an OCA, while 32.1% had a patent artery (PCA). Notably, 35.5% of NSTEMI patients had an OCA. Patients with OCA were younger, had fewer chronic comorbidities, and presented with more severe clinical symptoms. In contrast, patients with PCA were older and exhibited more extensive chronic atherosclerotic disease. Thirty-day mortality was significantly higher in the OCA group (7.29%) compared to the PCA group (3.52%, P < 0.001). OCA was identified as an independent predictor of mortality [hazard ratio (HR) = 3.0367, 95% confidence interval (CI): 1.4543-6.3411]. Other independent predictors included age (HR = 1.0626; 95%CI: 1.0341-1.0919), Global Registry of Acute Coronary Events score (HR = 1.0065; 95%CI: 1.0011-1.0120), and ventricular tachycardia before or during PCI (HR = 3.8458; 95%CI: 1.4600-10.1299). ECG presentation (STEMI vs NSTEMI) was not an independent prognostic factor (HR = 1.0404; 95%CI: 0.5659-1.9128). Chronic statin therapy prior to AMI [odds ratios (OR) = 0.0168, 95%CI: 0.3674-0.9057], older age (OR = 0.0023, 95%CI: 0.9547-0.9900), and lower troponin I values (OR = 1.0000, 95%CI: 1.0000-1.0001) were associated with a lower likelihood of having an OCA.

Conclusion: Culprit-artery occlusion is a strong, independent determinant of short-term mortality. An occlusion-aware perspective refines risk stratification beyond ECG presentation and supports earlier invasive evaluation in NSTEMI patients with clinical/ECG signs of possible occlusion.

Systemic congestion is increasingly recognized as a major contributor to organ dysfunction and adverse outcomes in patients with heart failure and in those at risk of fluid overload. The venous excess ultrasound (VExUS) grading system, introduced in 2020, uses Doppler evaluation of the hepatic, portal, and intrarenal veins to quantify venous congestion at the bedside. While abnormal venous waveforms have been recognized for years, the formalization of VExUS has provided a structured and clinically meaningful framework, generating widespread academic interest with over 500 citations to date. This article blends current evidence with the author's perspective to review the principles, strengths, and limitations of VExUS and to outline the emerging concept of extended VExUS (eVExUS). VExUS has practical limitations when standard windows are inaccessible or unreliable, such as in patients with cirrhosis, advanced kidney disease, or difficult body habitus. The eVExUS approach addresses these challenges by incorporating additional venous Doppler assessments, including the internal jugular, superior vena cava, femoral, and splenic veins, as well as grayscale-based internal jugular measurements to estimate right atrial pressure when inferior vena cava imaging is suboptimal. While eVExUS offers a more adaptable, individualized strategy, its clinical adoption is still in the early stages. Further studies are required to validate eVExUS, link its findings to patient outcomes, and inform the development of tailored imaging protocols for diverse patient populations.

Background: Patient consent discussion is an essential part of preoperative patient preparation. It is the main basis of decision making for the patient. Transcatheter aortic valve implantation (TAVI) has been established as the standard treatment option for symptomatic aortic stenosis-patients. Current guidelines recommend transfemoral TAVI for patients aged 70 years or older, independently of the surgical risk and for patients below 70 years of age if they are at high surgical risk.

Aim: To evaluate beneficial aspects of an explanatory video in addition to conventional medical counseling.

Methods: The study was conducted as a prospective, single-arm, monocentric cohort study. Eligible patients received conventional medical counseling, followed by an educational video. Evaluation of the conventional counseling and the educational video was obtained through a 32-item questionnaire. Two hypotheses were tested: Hypothesis 1: Showing an explanatory video in addition to the standard patient consent discussion improves the mediation of medical facts; and hypothesis 2: Showing an explanatory video in addition to the standard patient consent discussion improves patient satisfaction and confidence.

Results: In total, 66 patients, scheduled for transfemoral TAVI were included, 59% of them were male and 41% female, averaging 81 ± 6.1 years old. Conventional medical counseling by the attending physician was the major criterium for overall patient satisfaction and had more influence on the absence of preprocedural tension than the transfer of additional factual knowledge through the video. Nearly two-thirds (61%) reported that the video enhanced their understanding of the procedure's benefits, while 42% indicated a better understanding of the potential risks and 56% felt that watching the video contributed to decreased preprocedural tension.

Conclusion: Conventional medical counseling was most important for overall patient satisfaction. Educational videos aid in information transfer, in the reduction of preprocedural tension and were strongly sought after by the patients.

Angiogenesis is a central mechanism in the development and progression of cardiovascular diseases. Experimental approaches for studying angiogenesis vary widely, and their translational value depends strongly on model characteristics. We aimed to provide a comparative analysis of contemporary in vitro models used to study angiogenesis and to assess their potential applicability in cardiovascular medicine. Fifty-four publications by domestic and international authors were analyzed. 2D models remain accessible tools for investigating endothelial proliferation, migration, and early angiogenic responses; they are easy to implement and highly reproducible, but lack physiological relevance. 3D models better recapitulate extracellular matrix architecture and cell-cell interactions, providing higher biological fidelity at the cost of increased technical complexity and expense. Microfluidic systems reproduce hemodynamic forces and microenvironmental gradients with the highest degree of physiological relevance, but are time- and resource-intensive. Models based on induced pluripotent stem cells enable patient-specific investigations and disease modeling, although they can be limited by variability and potential instability. No single in vitro platform fully reproduces the complexity of angiogenesis. Model selection should be aligned with specific research objectives. Integrating 3D culture systems, microfluidics, and artificial intelligence-assisted analysis is particularly promising for advancing angiogenesis research in cardiovascular medicine.

Long coronavirus disease (LC) is a condition characterized by a persistent state, with recurrent/remitting or progressive episodes, that may affect one or multiple organ systems following severe acute respiratory syndrome coronavirus 2 infection. The cardiovascular system is particularly impacted by this condition. This review aims to discuss the cardiovascular implications in LC and its potential mechanisms. We offer an updated summary of established and emerging biomarkers with clinical potential for diagnosis, risk stratification, and therapy monitoring. Conventional markers with established clinical roles, such as cardiac troponins, natriuretic peptides (B-type natriuretic peptide/N-terminal pro-B-type natriuretic peptide), D-dimer, and inflammatory markers (e.g., C-reactive protein, interleukin-6), coexist with less established but promising biomarkers, such as growth differentiation factor-15, galectin-3, von Willebrand factor, endothelin-1, and circulating microRNAs. The incomplete understanding of the mechanisms and their diverse clinical manifestations, underscores the urgent need for efficient diagnostic tests and predictive models. In this context, besides the lack of standardization in biomarker testing and the absence of validated longitudinal predictive models, the use of biomarker-based strategies represents a potential tool to improve early detection of high-risk patients, enable personalized follow-up, and support more effective prevention of cardiovascular complications in LC patients in clinical practice.

Background: Obstructive sleep apnea (OSA) is increasingly recognized as a contributor to cardiovascular morbidity, including pulmonary hypertension (PH).

Aim: To assess the prevalence and severity of PH in newly diagnosed OSA patients and evaluate its association with disease severity and quality of life (QoL).

Methods: In this cross-sectional study, 113 patients newly diagnosed with OSA underwent echocardiography to assess pulmonary artery pressures and completed the World Health Organisation Quality of Life Brief Version (WHOQOL-BREF) questionnaire. OSA severity was determined via polysomnography using the apnea-hypopnea index (AHI). Statistical correlations between AHI, right ventricular systolic pressure (RVSP), mean pulmonary artery pressure (MPAP), and QoL domains were analyzed.

Results: PH (defined by MPAP ≥ 20 mmHg) was observed in 71.68% of patients (MPAP ≥ 20 mmHg). Its prevalence increased with age and OSA severity (P < 0.01). The mean RVSP (39.4 mmHg in males vs 34.1 mmHg in females) and MPAP (27.76 mmHg in males vs 24.64 mmHg in females) values were slightly higher in males but the difference was not statistically significant. AHI and oxygen desaturation index positively correlated with RVSP (r = 0.677) and MPAP (r = 0.543). The WHOQOL-BREF scores were significantly lower in PH patients, particularly in physical and psychological domains (P < 0.01).

Conclusion: PH in OSA is strongly linked to disease severity, impairs right ventricular function, and reduces QoL. Findings are limited by the cross-sectional design and reliance on echocardiography instead of right heart catheterization.

With the widespread use of cardiac implantable electronic devices and smartwatches, device-detected atrial fibrillation (AF) also referred to as subclinical AF (SCAF) is becoming increasingly common. The incidence of device-detected AF varies between 30% and 60%, depending on the definition and the device used for detection. Multiple studies, such as EMBRACE, CRYSTAL-AF, and FIND-AF, have confirmed higher detection rates of SCAF following prolonged rhythm monitoring using implantable loop recorders or external loop recorders in patients with cryptogenic stroke. The stroke risk associated with SCAF primarily depends on two factors: The baseline CHA₂DS₂-VASc score and the duration of SCAF episodes. Very-short episodes (< 6 minutes) are likely of uncertain significance, whereas episodes lasting > 24 hours increased the risk of stroke/systemic embolism (SE) more than threefold in the ASSERT study. For episodes lasting between 6 minutes and 24 hours, the stroke risk is lower but varies with the baseline CHA₂DS₂-VASc score. Previous randomized trials of direct oral anticoagulants (DOACs) in patients with cryptogenic stroke-NAVIGATE-ESUS (with rivaroxaban) and RE-SPECT ESUS (using dabigatran)-failed to demonstrate superiority over aspirin. More recently, two dedicated studies in SCAF with DOACs have been published: NOAH-AFNET 6 (with edoxaban) and ARTESIA (with apixaban). NOAH-AFNET 6 was terminated early for futility due to slow enrollment and lower-than-expected event rates. In contrast, apixaban reduced the risk of stroke and SE by 37% in the ARTESIA study, albeit with increased bleeding. These differing results may be attributed to differences in the DOAC used, trial design, and enrolled patient populations. Current ACC/AHA guidelines recommend oral anticoagulation (OAC) for SCAF episodes lasting > 24 hours and a baseline CHA₂DS₂-VASc score > 2. For those with episodes lasting between 6 minutes and 24 hours, a higher CHA₂DS₂-VASc score > 3 points towards a benefit of OAC, while a conservative approach-including control of risk factors (e.g., hypertension, thyroid dysfunction, alcohol intake) and periodic follow-up is warranted for the rest. However, considering the positive ARTESIA results, a reevaluation may be needed. Patients with high CHA₂DS₂-VASc score (> 4) and SCAF > 24 hours duration may be ideal candidates for DOAC therapy. Those with prior stroke and vascular disease also have a higher stroke risk in future and may be attractive candidates for OAC too. For those with high bleeding risk, re-evaluation after optimizing modifiable bleeding risk factors (e.g., concomitant medications, blood pressure control) may help determine eligibility for anticoagulation. Ongoing large-scale DOAC trials will further clarify this contentious issue.

Frailty is a common condition among older adults presenting with acute coronary syndrome and is recognized as a significant determinant of both short- and long-term outcomes. This literature review summarizes the concept of frailty and the assessment tools most relevant in acute care. We synthesize evidence linking frailty to mortality, prolonged hospitalization, and procedural complications, and highlight how heterogeneity among different frailty assessment tools has limited comparisons between studies and the incorporation of guidelines. For healthcare professionals, we propose a pragmatic approach: Rapid screening at first contact using a simple, validated tool; targeted multi-domain assessment for those with a positive result; and clear integration of frailty status into shared decision-making regarding interventional strategies, discharge planning, and transitional care. We identify key gaps, most notably the lack of randomized trials stratified by frailty, limited implementation research on frailty-guided care pathways, and the need to standardize metrics for cardiac testing and registries. Integrating frailty assessment into routine acute coronary syndrome care holds promise for improved individualized risk prediction and more patient-centered management, but will require coordinated research, clearer reporting standards, and feasible clinical workflows.

Kounis syndrome (KS) type III is a rare but life-threatening condition in which an acute allergic, anaphylactic, or anaphylactoid reaction precipitates acute coronary syndrome due to thrombosis or restenosis of a previously implanted coronary stent. The pathophysiological mechanism involves IgE-mediated or non-IgE-mediated mast cell activation, leading to coronary vasospasm, destabilization of atherosclerotic plaques, and intrastent thrombosis. Known triggers include various allergens such as medications (notably antibiotics and nonsteroidal anti-inflammatory drugs), metallic or polymeric stent components, and drugs eluted from the stent surface. A review of relevant clinical cases from PubMed and Scopus (1991-2025; 6 publications meeting the inclusion criteria, reporting 6 cases) showed a mean patient age of 66 ± 11 years, with a male predominance (4/6). Only 3 patients had a history of allergic disease. Clinical manifestations included chest pain (100%), cutaneous rash (2 cases), and ST-segment elevation on electrocardiogram (4 cases). Management included reperfusion therapy, corticosteroids, antihistamines, and dual antiplatelet therapy. Outcomes were generally favorable, although 1 patient died 3 years later due to KS-related complications. KS type III requires urgent recognition and simultaneous treatment of both the allergic reaction and coronary obstruction. In cases of unexplained stent thrombosis or restenosis, KS should be considered in the differential diagnosis.

Xu et al provides crucial regional data for precision cardiovascular medicine in East Asia. This study focuses on the Teochew Han population in China for the first time and reveals the synergistic protective effect of the apolipoprotein E ε2 allele and high copy numbers of kringle IV type 2. This discovery holds significant importance for optimizing regional risk assessment models.