World Journal of Cardiology最新文献

Background: Myocardial ischemia/reperfusion (I/R) is a significant factor that negatively impacts the treatment outcomes of coronary heart disease, particularly acute myocardial infarction. The oxidized form of nicotinamide adenine dinucleotide (NAD) - NAD⁺ is crucial for various cellular functions.

Aim: To explore the effects and mechanisms of NAD⁺ on cell death caused by hypoxia/re-oxygenation (H/R) injury in H9c2 cells.

Methods: Cell viability was assessed using the Cell Counting Kit-8 assay. Apoptosis in H9c2 cells was evaluated through terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling staining. Intracellular reactive oxygen species levels were measured with the fluorescent probe dichloro-dihydrofluorescein diacetate. Intracellular NAD⁺ levels were quantified using a NAD/NAD reduced form assay kit. The impact of NAD⁺ on the expression of NOD-like receptor pyrin domain-containing 3, apoptosis-associated speck-like protein containing a CARD, and caspase-1 was analyzed by reverse transcription polymerase chain reaction and western blotting.

Results: The study demonstrated that NAD⁺ supplementation protects H9c2 cells from H/R induced cell pyroptosis. Mechanistically, external NAD⁺ reduces H/R induced pyroptosis in H9c2 cells by inhibiting the NOD-like receptor pyrin domain-containing 3 inflammasome.

Conclusion: These results indicate that NAD⁺ supplementation may serve as a promising therapeutic strategy for I/R injury.

Background: The choice of priming and volume replacement fluids during cardiopulmonary bypass (CPB) in cardiac surgery impacts hemodynamic stability, coagulation, renal function, and patient outcomes. Hydroxyethyl starch (HES) 130/0.4 and human albumin are commonly used colloids, but their relative safety and efficacy remain debated.

Aim: To compare the outcomes of 6% HES 130/0.4 vs 5% albumin in patients undergoing cardiac surgery with CPB.

Methods: A comprehensive literature search was performed in PubMed, EMBASE, ScienceDirect, and grey literature sources up to August 2025. Randomized controlled trials and controlled observational studies comparing 6% HES 130/0.4 with 5% albumin in patients who underwent cardiac surgery were included. Data extraction and risk of bias assessment followed PRISMA and Cochrane guidelines. Meta-analyses were conducted using RevMan 5.4, applying random-effects models. Heterogeneity was assessed with I ² statistics, and meta-regression explored baseline covariables. Publication bias was evaluated with funnel plots and the Egger's test.

Results: Twelve studies involving 908 patients (455 in the HES group, 453 in the albumin group) were included. No significant differences were observed between the HES and albumin groups for postoperative blood loss [mean difference = 42.4 mL, 95% confidence interval (CI): -90.0 to 174.9; P = 0.53], packed red blood cell transfusion [odds ratio (OR) = 0.78, 95%CI: 0.65-1.10; P = 0.16)], mortality (OR = 1.11, 95%CI: 0.63-1.96; P = 0.80), intensive care unit stay, hospital stay, or postoperative platelet count and creatinine levels. However, HES was associated with a significantly higher risk of acute kidney injury (AKI) (OR = 1.79, 95%CI: 1.08-2.97; P = 0.02), indicating that while many clinical outcomes showed no significant difference, there is a specific safety concern related to renal function with HES use. Meta-regression did not identify baseline factors explaining heterogeneity in bleeding or AKI outcomes (all P > 0.10). No significant publication bias was detected.

Conclusion: The 6% HES 130/0.4 and 5% albumin exhibit similar efficacy for volume management in cardiac surgery with CPB; however, HES is associated with a higher risk of AKI.

This editorial highlights the study by Xu et al on genetic polymorphisms linked to coronary heart disease (CHD) in the Teochew population. This study adjusted odds ratios for confounding factors including age, sex, hypertension, and diabetes. It identifies the apolipoprotein E ε2 allele and higher lipoprotein (a) kringle IV-2 (KIV-2) copy number as protective factors against CHD. The ε2 allele was found at a lower frequency in CHD patients (8.02%) compared to controls (13.29%), and each additional KIV-2 copy reduced CHD risk by approximately 5% (odds ratio = 0.949). Conversely, solute carrier organic anion transporter family member 1B1 polymorphisms showed no significant link to CHD. These findings underscore the importance of population-specific research, particularly for the Teochew population, where CHD is prevalent. They provide a foundation for precision risk stratification and targeted interventions, including lipoprotein (a)-lowering therapies for those with lower KIV-2 copy numbers. Despite limitations, the study emphasizes the need for further research incorporating multi-omics data and lifestyle factors to enhance personalized CHD prevention, moving away from "one-size-fits-all" approaches. This research is essential for leveraging genetic insights into global CHD prevention.

Metabolic dysfunction-associated steatotic liver disease (MASLD) has rapidly become the leading cause of chronic liver disease and cirrhosis worldwide, driven by the global surge in metabolic disorders such as obesity, diabetes, hypertension, and dyslipidemia. In parallel, heart failure with preserved ejection fraction (HFpEF) has surpassed heart failure with reduced ejection fraction (HFrEF) as the predominant form of heart failure, particularly in individuals with metabolic comorbidities. Mounting evidence points to a significant overlap in the pathophysiological underpinnings of MASLD and HFpEF, with metabolic dysfunction serving as a common foundation. This review synthesizes current knowledge on the mechanistic links between MASLD and HFpEF, examining metabolic, inflammatory, and fibrotic pathways. We also explore the clinical implications of this association, including diagnostic considerations and therapeutic targets. Shared risk factors and inflammatory pathways have highlighted a strong bidirectional association between MASLD and cardiovascular diseases, particularly HFpEF. Significantly, the degree of hepatic fibrosis in MASLD correlates with HFpEF prognosis and severity, emphasizing the systemic nature of these conditions. Emerging pharmacological and lifestyle-based interventions aimed at managing both conditions underscore the importance of integrated, multidisciplinary care in improving long-term outcomes.

Drug-coated balloon angioplasty has become one of the important means of interventional treatment for atherosclerotic cardiovascular diseases, and its application in clinical practice is becoming more and more common. Although several expert consensuses and a small number of scattered guideline recommendations have been issued, there is a lack of comprehensive and systematic guideline guidance. However, relevant clinical research and practice are still making continuous progress. This article reviews the clinical research progress of the indications for the treatment of coronary artery stenosis with paclitaxel drug-coated balloons, focusing on introducing its application overview and techniques in in-stent restenosis, bifurcation lesions, new lesions in large and small blood vessels, acute and chronic coronary syndromes and other situations, the management of special complications, and the dual antiplatelet strategy after drug balloon angioplasty, revealing new perspectives on the use of drug-coated balloons in different coronary artery disease scenarios. This article also discusses the cellular and molecular mechanisms related to the anti-atherosclerotic and anti-restenosis effects of paclitaxel, with the hope of providing direct guidance for the daily clinical practice of cardiologists and interventionalists.

Background: Unfractionated heparin (UFH) is routinely used during coronary angiography, but the optimal dosing strategy for diagnostic coronary physiology procedures such as fractional flow reserve or microvascular assessment in stable patients remains unclear. While weight-based dosing is standard in percutaneous coronary intervention, a fixed-dose approach may simplify workflow.

Aim: To compare bleeding and thromboembolic outcomes between fixed-dose and weight-based UFH during diagnostic coronary physiology procedures without percutaneous coronary intervention.

Methods: We conducted a retrospective single-center study of 128 patients undergoing fractional flow reserve or microvascular testing from January 2021 to February 2024. Patients received either fixed-dose (5000 IU) or weight-based (70-100 IU/kg) UFH. The primary outcome was a composite of thromboembolic complications: Radial artery occlusion, stroke, or periprocedural myocardial infarction. Secondary outcomes included bleeding (Bleeding Academic Research Consortium criteria), association with patient characteristics, access site, and length of stay.

Results: Of 128 patients, 78 received fixed-dose and 50 received weight-based UFH. No thromboembolic events occurred in either group. Bleeding (all Bleeding Academic Research Consortium 1-2) occurred in 15% overall, with no significant difference between groups (15% vs 12%, P = 0.47). No significant association between bleeding and patient age, sex, weight, body mass index, access site, antiplatelet, or anticoagulant use. Median hospital stay was 1 day in both groups.

Conclusion: In this exploratory study, a fixed 5000 IU UFH regimen appeared to be a safe and practical alternative to weight-based dosing in diagnostic coronary physiology procedures. Larger prospective studies are warranted to confirm these findings.

Background: Type 2 diabetes mellitus (T2DM) substantially increases the risk of cardiovascular disease, including ischemia with non-obstructive coronary artery disease (INOCA). Coronary computed tomography angiography (CCTA) enables early detection of coronary abnormalities; however, it may fail to identify INOCA due to the absence of overt stenosis. Pericoronary adipose tissue attenuation (PCATa) values derived from CCTA in the proximal segments of the left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA) serve as effective imaging biomarkers for coronary inflammation. However, its clinical use for identifying INOCA in patients with T2DM remains poorly defined.

Aim: To investigate PCATa differences and their diagnostic value for identifying INOCA in patients with T2DM.

Methods: This retrospective study involved 228 T2DM patients underwent CCTA and 120 healthy individuals. The mean PCATa values within the proximal segments of the three major coronary arteries were compared between groups. Further subgroup analysis was performed to assess the differences in PCTAa and clinical characteristics between T2DM patients with and without INOCA. Logistic regression analysis was conducted to identify the independent risk factors for INOCA, and the receiver operating characteristic curves were generated to evaluate the diagnostic performance of each indicator.

Results: Compared with controls, T2DM patients exhibited significantly higher PCATa values in all three major coronary arteries. Among them, those with concomitant INOCA showed further increases compared to those without INOCA (all P < 0.05). Multivariate logistic regression identified age; female sex; elevated glycated hemoglobin; and increased PCATa in the LAD, LCX, and RCA as independent risk factors for INOCA. Receiver operating characteristic analysis showed good diagnostic performance for PCATa [LAD area under the curve (AUC) = 0.809; LCX AUC = 0.777; RCA AUC = 0.758], outperforming traditional clinical indicators (AUC = 0.731). Combining PCATa with clinical parameters yielded the highest diagnostic accuracy (LAD AUC = 0.851; LCX AUC = 0.842; RCA AUC = 0.841).

Conclusion: Elevated proximal PCATa is an independent risk factor for INOCA in T2DM. Combining PCATa with clinical data improves diagnostic performance in this population.

Background: Blunt traumatic aortic injury (BTAI) is a life-threatening injury, commonly associated with high-speed motor vehicle collisions. Historically, open surgical repair was the standard treatment, however with the advancement of endovascular techniques such as thoracic endovascular aortic repair (TEVAR), management strategies shifted towards endovascular repairs. Non-operative management (NOM) strategies are also favored for patients with low-grade injuries and particularly high-grade injuries recently. The Society for Vascular Surgery (SVS) 2011 guidelines recommend that grade I injuries should be managed non-operatively; newer studies also support NOM for grade II injuries.

Aim: To review higher-grade injuries. NOM can be favored for selected patients with grade III injuries.

Methods: A retrospective review of literature to assess NOM in BTAI, using the PubMed, CINHAL, EBSCO, and Google Scholar databases, included articles published in the last 20 years between January 2003 and December 2023. Studies included Cohort studies, case-control studies, and observational studies. Two authors independently screened the titles, abstracts, and performed data extraction. Outcomes were compared by the type of treatment: NOM vs endovascular repair (TEVAR) vs open repair.

Results: We identified 27 studies in our review that met the selection criteria. Most of the studies were based on retrospective analysis of institutional data, and only 16 papers reported BTAI in accordance with SVS reporting standards. A trend of increasing mortality across the BTAI grade was observed. There were heterogeneous results regarding outcomes after non-operative compared with endovascular and surgical repair. For grade I and II BTAI, NOM was associated with lower mortality, reduced rates of unplanned intervention, and resolution of pathology on follow-up. There were reports of NOM of grade III BTAI with reasonable outcomes and a high rate of resolution on follow-up, but data were limited due to very few studies focusing on this subgroup.

Conclusion: This review article provides the most up-to-date literature. Currently literature supporting the NOM for low-grade BTAI (grades I and II) treatment. Current SVS guidelines recommend endovascular repair for grade III BTAI patients; however, a few studies showed that grade III BTAI can be managed non-operatively with active surveillance in a selected group of patients. Literature requires further studies to compare NOM vs TEVAR in higher-grade BTAI population.

Cardiac myxoma (CM) is the most common type of primary cardiac tumor and a major embolic source of cardioembolic stroke. Two potential causative mechanisms are associated with CM-related ischemic stroke (CM-IS): Embolism from detached tumor debris and metastatic infiltration. The risk factors for embolism from CM remain unclear and are widely debated in the literature. CM-IS often initially presents with central nervous system complications. Diagnosis requires a comprehensive assessment of clinical manifestations, imaging findings, and laboratory test results, with histopathological examination required for a definitive diagnosis. Surgical resection of myxoma is the most effective CM-IS treatment, although the optimal timing and approach remain controversial. This review consolidates the current knowledge on CM-IS, identifies critical risk factors for embolic complications, and discusses contemporary treatment strategies, emphasizing the need for individualized management protocols and further research to improve outcomes in affected patients.

Background: Heart failure with preserved ejection fraction (HFpEF) accounts for approximately half of heart failure cases and is associated with high morbidity and mortality. Beta-blockers (BB) and calcium channel blockers (CCB) are commonly used for symptom control and comorbidity management, but their comparative effectiveness and safety remain unclear.

Aim: To compare the effectiveness and safety of BB vs CCB in patients with HFpEF using simulated real-world data and propensity score-matched analyses.

Methods: Simulated data for 4000 HFpEF patients (2000 BB, 2000 CCB) were generated based on distributions extracted from electronic medical records spanning 2014-2023. Inclusion criteria included adults with left ventricular ejection fraction ≥ 50% and initiation of BB or CCB. Effectiveness outcomes encompassed mortality, heart failure hospitalizations, and changes in clinical parameters. Safety outcomes included bradycardia, hypotension, and drug discontinuation. Statistical analyses used t-tests, χ ² tests, Cox proportional hazards models for hazard ratios (HR), and incidence rate ratios (IRR) in R software. Propensity score matching (PSM) was performed to balance baseline characteristics, with outcomes reassessed in the matched cohort.

Results: Baseline characteristics were largely balanced, with minor differences in sex, chronic kidney disease, systolic blood pressure, and left atrial volume index. BB demonstrated lower all-cause mortality (crude HR 0.78, 95%CI: 0.70-0.87, P = 0.003), heart failure hospitalization (crude HR 0.86, 95%CI: 0.77-0.96, P = 0.031), and composite endpoint (crude HR 0.85, 95%CI: 0.79-0.91, P < 0.001) rates compared to CCB. IRR for heart failure hospitalizations and emergency visits favored BB. Safety profiles showed higher symptomatic bradycardia (9.2% vs 4.9%, P < 0.001) and drug discontinuation (11.3% vs 9.3%, P = 0.043) with BB, and higher hypotension (7.2% vs 11.5%, P < 0.001) with CCB. Matched analyses showed all-cause mortality rates of 0.0622 per person-year for BB vs 0.0649 for CCB (HR 0.96, 95%CI: 0.85-1.08), heart failure hospitalization rates of 0.0751 vs 0.0888 (HR 0.84, 95%CI: 0.75-0.94), and IRR for number of heart failure hospitalizations of 1.65 for CCB vs BB (95%CI: 1.51-1.80, P < 0.001).

Conclusion: BB may offer potential advantages in reducing mortality and hospitalizations in HFpEF compared to CCB, with distinct safety considerations. PSM confirmed these trends with reduced confounding. Personalized therapy is recommended, warranting prospective trials for validation.