World Journal of Cardiology最新文献

The obesity epidemic continues to challenge global cardiovascular (CV) health, but not all obesity is equal. Emerging evidence underscores that distinct obesity phenotypes-particularly metabolically healthy vs unhealthy profiles-confer differential CV risks. Recent large-scale studies have revealed that even metabolically healthy obesity (MHO) is associated with an increased risk of adverse CV events, particularly in the context of socioeconomic disadvantage. Central is the role of chronic low-grade inflammation, termed "metaflammation", which can persist even in the absence of overt metabolic syndrome and is shaped by both gender and fat distribution. Epicardial and visceral adiposity contribute to this pro-inflammatory state and are strongly associated with conditions such as heart failure and atrial fibrillation. Notably, aging and hormonal changes, particularly in women, may destabilize MHO status, increasing CV vulnerability over time. This overview calls for a paradigm shift in cardiometabolic care, moving beyond anthropometric parameters toward a more refined assessment that incorporate inflammatory biomarkers, fat distribution and sex-specific factors. Recognizing these underlying biological and phenotypic differences enables more accurate CV risk stratification and supports the development of precision-based therapeutic strategies. Ultimately, understanding not just who is at risk, but why, is essential to improving prevention and outcomes across diverse populations facing the burden of obesity.

Atrial fibrillation (AF) is a frequent cardiac arrhythmia in the general population, which is associated with an increased risk of several health issues. It has been demonstrated that hematological variables predict the occurrence and recurrence of AF. This review article specifically only focuses on haemoglobin, hematocrit, platelet count, white blood cells (WBCs), lymphocytes, neutrophils, monocytes, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR) and red blood cells in the pathophysiology of AF. It emphasizes that there is a higher risk of new-onset AF linked with both low and high haemoglobin levels. A quantitative investigation showed that hematocrit is not linked to the development of AF. The predictive significance of platelet count was reported in nonvalvular AF patients. WBCs are consistent inflammatory markers that are associated with postoperative new-onset AF. Inflammation and in particular, leukocyte activation predisposes to AF. Enhanced migratory activity in circulating and local monocytes may play a pivotal role in the pathogenesis of progression in atrial remodeling in AF patients. In particular, the peripheral eosinophil and left atrial diameter may be important in mediating inflammation and atrial remodeling in AF. In nonvalvular AF patients, PLR may be an independent risk factor for left atrial appendage thrombogenic milieu. NLR and MLR changes are associated with early recurrence of AF, and NLR change is related to late recurrence of AF after pulmonary vein isolation. Red blood cell distribution width and left atrial dimension were the only independent risk factors associated with AF.

Background: A key cardiac magnetic resonance (CMR) challenge is breath-holding duration, difficult for cardiac patients.

Aim: To evaluate whether artificial intelligence-assisted compressed sensing CINE (AI-CS-CINE) reduces image acquisition time of CMR compared to conventional CINE (C-CINE).

Methods: Cardio-oncology patients (n = 60) and healthy volunteers (n = 29) underwent sequential C-CINE and AI-CS-CINE with a 1.5-T scanner. Acquisition time, visual image quality assessment, and biventricular metrics (end-diastolic volume, end-systolic volume, stroke volume, ejection fraction, left ventricular mass, and wall thickness) were analyzed and compared between C-CINE and AI-CS-CINE with Bland-Altman analysis, and calculation of intraclass coefficient (ICC).

Results: In 89 participants (58.5 ± 16.8 years, 42 males, 47 females), total AI-CS-CINE acquisition and reconstruction time (37 seconds) was 84% faster than C-CINE (238 seconds). C-CINE required repeats in 23% (20/89) of cases (approximately 8 minutes lost), while AI-CS-CINE only needed one repeat (1%; 2 seconds lost). AI-CS-CINE had slightly lower contrast but preserved structural clarity. Bland-Altman plots and ICC (0.73 ≤ r ≤ 0.98) showed strong agreement for left ventricle (LV) and right ventricle (RV) metrics, including those in the cardiac amyloidosis subgroup (n = 31). AI-CS-CINE enabled faster, easier imaging in patients with claustrophobia, dyspnea, arrhythmias, or restlessness. Motion-artifacted C-CINE images were reliably interpreted from AI-CS-CINE.

Conclusion: AI-CS-CINE accelerated CMR image acquisition and reconstruction, preserved anatomical detail, and diminished impact of patient-related motion. Quantitative AI-CS-CINE metrics agreed closely with C-CINE in cardio-oncology patients, including the cardiac amyloidosis cohort, as well as healthy volunteers regardless of left and right ventricular size and function. AI-CS-CINE significantly enhanced CMR workflow, particularly in challenging cases. The strong analytical concordance underscores reliability and robustness of AI-CS-CINE as a valuable tool.

The integration of wearable technology and remote monitoring (RM) has significantly transformed the early detection, continuous monitoring, and management of cardiac arrhythmias. These conditions, characterized by irregular heart rhythms, arise from various etiological factors, including congenital, structural, immunological, metabolic, and infectious diseases, with atrial fibrillation being the most prevalent type. Diagnosing arrhythmias remains challenging due to variable clinical presentations and episodic symptom manifestations, necessitating individualized management strategies. Recent advances in wearable technology offer scalable, cost-effective solutions for real-time arrhythmia monitoring. These devices are equipped with sophisticated sensors and data analytics that enable early detection and personalized interventions, while empowering patients to actively engage in their healthcare. Integrating RM systems enhances diagnostic accuracy and facilitates timely medical interventions. Despite their potential, regulatory, legal, privacy, security, and infrastructural challenges hinder the widespread adoption of wearable technology and RM. Addressing these barriers requires collaboration among stakeholders and rigorous clinical trials to assess their efficacy and feasibility. Future research should focus on refining wearable technology, improving user experience, and integrating these innovations into existing healthcare frameworks. Overcoming these challenges will maximize the potential of wearable technology and RM, ultimately enhancing the management of cardiac arrhythmias and improving patient outcomes.

Over the last decade, neprilysin inhibition has been established as the cornerstone of therapy in heart failure (HF). Patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) have a high prevalence of HF; the concomitant presence of HF and CKD or ESKD, conventionally termed chronic cardiorenal syndrome, is associated with a higher rate of adverse outcomes, including increased hospitalizations and mortality. The use of this novel class of medications in patients with advanced CKD or ESKD has been limited due to uncertainty about their efficacy and safety. Herein, we provide an overview of the available evidence on the use of neprilysin inhibition in HF and discuss how those concepts would apply to patients with concomitant CKD or ESKD.

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide, hosting numerous serious possible complications such as stroke and heart failure. In the past two decades, managing rhythm control was more successful via pulmonary vein isolation (PVI) ablation, generally performed via transfemoral access. Patients with anatomical variations may necessitate a dose of creativity and evidence-based techniques. To our knowledge, we present the first PVI case in a patient with AF via right internal jugular (IJ) vein access using pulse field ablation.

Case summary: A 76-year-old male with an extensive medical history notable for type 2 diabetes and severe peripheral vascular disease requiring vascular bypass surgery is identified to have paroxysmal AF. Given functional decline and worsening arrhythmia burden refractory to oral antiarrhythmics, an initial PVI ablation was attempted but failed as the catheter could not be advanced secondary to bilateral iliac vein occlusions. This necessitated a novel approach and a subsequent PVI ablation via the right IJ vein was successful without any complications. The success of this case highlights the feasibility of an IJ approach for PVI in patients where traditional access is not possible. This case can be used as a reference for other practitioners who may face similar challenges when attempting to perform PVI for AF or similar procedures requiring access to similar anatomical locations.

Conclusion: The success of this case highlights the feasibility of an IJ approach for PVI when traditional access is impossible.

Background: Acute myocardial infarction (AMI) combined with ventricular septal perforation (VSR) is still a highly fatal condition in the era of reperfusion therapy. The incidence rate has decreased to 0.2%-0.4% due to the popularization of percutaneous coronary intervention. However, the risk is significantly increased for those who fail to undergo revascularization in time, and the mortality rate remains high. The current core contradiction in clinical practice lies in the selection of surgical timing, and the disparity in medical resources significantly affects prognosis. There is an urgent need to optimize the identification of high-risk populations and individualized treatment strategies.

Aim: To investigate the clinical features, determine the prognostic factors, and develop a predictive model for 30-day mortality in patients with acute myocardial infarction complicated by ventricular septal rupture (AMI-VSR) residing in high-altitude regions.

Methods: This study retrospectively analyzed 48 AMI-VSR patients admitted to a Yunnan hospital from 2017 to 2024, with the establishment of survival (n = 30) and mortality (n = 18) groups based on patients' survival status. Risk factors were identified by univariate and multivariate logistic regression analyses. A nomogram model was developed using R software and validated via receiver operating characteristic (ROC) analysis and calibration curves.

Results: Age, uric acid (UA), interleukin-6 (IL-6), and low hemoglobin (Hb) were independent risk factors for 30-day mortality (odds ratios: 1.147, 1.006, 1.034, and 0.941, respectively; P < 0.05). The nomogram demonstrated excellent discrimination (area under the ROC curve = 0.939) and calibration (Hosmer-Lemeshow χ² = 2.268, P = 0.971). In addition, patients' poor outcomes could be synergistically predicted by IL-6 and UA, advanced age, and reduced Hb.

Conclusion: This study highlights age, UA, IL-6, and Hb as critical predictors of mortality in AMI-VSR patients at high altitudes. The validated nomogram provides a practical tool for early risk stratification and tailored interventions, addressing gaps in managing this high-risk population in resource-limited settings.

Transradial access (TRA) has emerged as the preferred vascular access route for coronary angiography and percutaneous coronary interventions due to its superior safety profile compared to transfemoral access. However, its widespread adoption raises concerns regarding structural alterations in the radial artery, which may impact long-term vascular health and future procedural feasibility. TRA is associated with histopathologic changes in the arterial wall, such as intimal injury and hyperplasia, medial remodeling and adventitial inflammation, collectively contributing to radial artery remodeling. Moreover, TRA can induce changes in radial artery lumen diameter driven by an inflammatory response due to arterial puncture and mechanical friction during the procedure. Nonetheless, a more clinically significant consequence is radial artery occlusion, which is influenced by various procedural and patient-related factors. Strategies to minimize remodeling include meticulous pre-procedural ultrasound assessment to ensure appropriate sheath-to-artery size matching, periprocedural pharmacological interventions and implementation of patent hemostasis techniques. This review synthesizes current knowledge regarding the mechanisms, clinical implications, and preventive strategies related to radial artery remodeling following TRA. Further research is needed to elucidate the long-term consequences of radial artery remodeling and to refine preventive strategies for preserving radial artery patency and its suitability for future interventions.

Transcatheter aortic valve replacement (TAVR) has emerged as an established standard of care for patients with severe aortic stenosis (AS), irrespective of their surgical risk. However, despite the continuous advancements over last two decades, there are still significant challenges in field in terms of appropriate selection of patients as well as the valves. While there is no doubt that TAVR has now become the leading mode of treatment for severe AS patients, surgical aortic valve replacement (SAVR) still holds its value for the selective group of patients who are not ideal candidate for the minimally invasive procedure: TAVR. The dilemma is palpable in the clinical field that warrants best approach focusing on the lifetime management of these patients. In the recent metanalysis by Moradi et al, the authors provide a comprehensive insight into TAVR vs SAVR in terms of mortality, procedural complications, and post-procedure adverse events. In this editorial, we shed light on comparative analysis of both modalities to establish a middle ground.

With the rapid advancement and widespread adoption of new artificial intelligence (AI) technologies, personalized medicine and more accurate diagnosis using medical imaging are now possible. Among its many applications, AI has shown remarkable potential in the analysis of electrocardiograms (ECGs), which provide essential insights into the electrical activity of the heart and allowing early detection of ischemic heart disease (IHD). Notably, single-lead ECG (SLECG) analysis has emerged as a key focus in recent research due to its potential for widespread and efficient screening. This editorial focuses on the latest research progress of AI-enabled SLECG utilized in the diagnosis of IHD.