World Journal of Cardiology最新文献

Diabetes mellitus and atrial fibrillation (AF) are two global epidemics that frequently coexist, with diabetes mellitus contributing to both an increased risk of new-onset AF and a worse prognosis. Pathophysiological mechanisms underlying this relationship include chronic inflammation, oxidative stress, atrial remodeling, autonomic dysfunction, advanced glycation end-products and epicardial adiposity. Management remains challenging; however, recent advances offer promise, including guideline-directed anticoagulation, tailored rate and rhythm control, and particularly, novel antidiabetic therapies, such as sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists, may improve AF outcomes. A comprehensive, individualized approach is essential to mitigate morbidity and mortality in this high-risk population.

Percutaneous coronary intervention (PCI) for coronary and peripheral stenoses has advanced rapidly over the past three decades, driven by a series of innovative techniques since the introduction of the first balloon angioplasty. Significant progress in stent technology, beginning with bare-metal stents and followed by drug-eluting stents, has expanded the scope for successful revascularisation in complex lesions. However, challenges such as late stent thrombosis and in-stent restenosis (ISR) persist. Thus, further improvement in PCI techniques and devices is essential to achieve better patient outcomes. In recent years, drug-coated balloons (DCBs) have emerged as a promising alternative designed to overcome the limitations associated with drug-eluting stents, including the risks of late stent thrombosis, ISR, and the need for prolonged dual antiplatelet therapy. Several DCBs have been evaluated for both coronary and peripheral lesions, showing encouraging results in preclinical and clinical studies. DCBs have demonstrated efficacy in the treatment of ISR and have shown potential in other clinical scenarios, such as small-vessel disease and diffuse lesions. In this review, we present the underlying technology, mechanisms of action, key preclinical findings, emerging clinical indications, recent trial outcomes, and future perspectives of DCBs as they continue to define their role in PCI.

Increased mortality rates in chronic obstructive pulmonary disease (COPD) patients with heart failure (HF) are believed to be driven by various factors, including disparities in access to healthcare services and shifting dynamics of the population characteristics. In this study, we examined the racial and ethnic disparities in the clinical outcomes of HF in COPD patients in the United States, analyzing data from the Nationwide Inpatient Sample database. The database was searched retrospectively from 2016 to 2022 to identify COPD and HF patients by International Classification of Diseases-10 codes. A total of 2445545 individuals were included of which 76% were Whites, 16% were Blacks, 5% Hispanics and 3% others. Whites were significantly older than other populations (P < 0.001), and a significantly higher proportion of Blacks were females compared to other racial groups. Regarding clinical outcomes, Black COPD patients with HF had the lowest mortality rates while it was similar between Whites and Hispanics (P < 0.001). Compared to Whites, the adjusted odds ratio was significantly lower for Blacks, 0.797 [95% confidence interval (CI): 0.783-0.812; P < 0.001] and Hispanics, 0.956 (95%CI: 0.932-0.981; P = 0.001). Other racial groups had significantly higher mortality compared to Whites, with an adjusted odds ratio of 1.131 (95%CI: 1.099-1.164; P < 0.001). Individuals from other racial groups had significantly longer hospital stay, and hospitalization cost adjusted for inflation. Cardiac arrest was the strongest predictor (P < 0.001) for in-hospital mortality in all racial groups.

Background: Aortic adverse remodeling remains a critical complication following thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection (TBAD), significantly impacting long-term survival. Accurate risk prediction is essential for optimized clinical management.

Aim: To develop and validate a logistic regression-based risk prediction model for aortic adverse remodeling following TEVAR in patients with TBAD.

Methods: This retrospective observational cohort study analyzed 140 TBAD patients undergoing TEVAR at a tertiary center (2019-2024). Based on European guidelines, patients were categorized into adverse remodeling (aortic growth rate > 2.9 mm/year, n = 45) and favorable remodeling groups (n = 95). Comprehensive variables (clinical/imaging/surgical) were analyzed using multivariable logistic regression to develop a predictive model. Model performance was assessed via receiver operating characteristic-area under the curve (AUC) and Hosmer-Lemeshow tests.

Results: Multivariable analysis identified several strong independent predictors of negative aortic remodeling. Larger false lumen diameter at the primary entry tear [odds ratio (OR): 1.561, 95%CI: 1.197-2.035; P = 0.001] and patency of the false lumen (OR: 5.639, 95%CI: 4.372-8.181; P = 0.004) were significant risk factors. False lumen involvement extending to the thoracoabdominal aorta was identified as the strongest predictor, significantly increasing the risk of adverse remodeling (OR: 11.751, 95%CI: 9.841-15.612; P = 0.001). Conversely, false lumen involvement confined to the thoracic aorta demonstrated a significant protective effect (OR: 0.925, 95%CI: 0.614-0.831; P = 0.015). The prediction model exhibited excellent discrimination (AUC = 0.968) and calibration (Hosmer-Lemeshow P = 0.824).

Conclusion: This validated risk prediction model identifies aortic adverse remodeling with high accuracy using routinely available clinical parameters. False lumen involvement thoracoabdominal aorta is the strongest predictor (11.751-fold increased risk). The tool enables preoperative risk stratification to guide tailored TEVAR strategies and improve long-term outcomes.

Background: Left ventricular noncompaction (LVNC) is a genetic cardiomyopathy. It is characterized by intensely developed trabeculae in the ventricles with deep intertrabecular lacunae. LVNC manifests as arrhythmias and heart failure with a predisposition for thrombus formation.

Aim: To study predictors of arrhythmic, thromboembolic events and adverse outcomes (death/transplantation) in adult patients with LVNC.

Methods: Adult patients with LVNC were included (n = 125; mean follow-up: 14 months). Electrocardiography, echocardiography, and 24-hour electrocardiography monitoring were performed. Other procedures were conducted for some patients including: Coronary angiography; cardiac magnetic resonance imaging; cardiac computed tomography; genetic testing; myocardial pathological examination; and anti-cardiac antibody level estimation. Primary endpoints were death, heart transplantation, combined endpoint (death + transplantation), and sudden cardiac death. Secondary endpoints were intracardiac thrombosis, embolic events, myocardial infarction, sustained ventricular tachycardia (VT), and implantable cardioverter-defibrillator intervention.

Results: LVNC manifestations included non-sustained VT, thrombosis/embolism, sustained VT, and sudden cardiac death. Non-sustained VT was associated with the New York Heart Association (NYHA) chronic heart failure (CHF) class, poor R-wave progression, superimposed myocarditis, and higher mortality. Thrombosis/embolism was associated with NYHA CHF class ≥ 3, right ventricular end-diastolic diameter ≥ 3 cm, right atrium volume ≥ 67 mL, left ventricle end-diastolic diameter ≥ 6.3 cm, and velocity time integral ≤ 11.2 cm. Sustained VT was associated with premature ventricular contractions (PVCs), low QRS voltage, and atrioventricular block. PVCs > 500/day were predictive of defibrillator intervention. Fatal outcomes were associated with E wave/A wave ratio > 1.9, left ventricle ejection fraction < 35%, NYHA CHF class ≥ 3, VT, and myocarditis.

Conclusion: Frequent PVCs, non-sustained VT, low QRS voltage, and signs of systolic dysfunction on echocardiogram are predictors of life-threatening events in patients with LVNC.

Background: Myocardial infarction (MI) occupies a very high mortality and morbidity rate, and the search for effective pharmacological treatments has far-reaching implications for clinical research.

Aim: To explore the protective effects of Mongolian medicine Agari-5 on rats with MI.

Methods: Sprague-Dawley rats were used, and both the Agari-5 and model groups had their coronary arteries clamped to induce MI. Proteomics was used to research the potential mechanism of action while ELISA, hematoxylin and eosin, and Masson's staining were used to preliminarily investigate the protective impact of Agari-5 on rats with MI.

Results: The current study has shown that Agari-5 might enhance cardiac function indicators, including echocardiography results of rats and creatine kinase, creatine kinase isoenzyme, and lactate dehydrogenase, in rats that had MI. According to the results of pathological staining, Agari-5 may lessen inflammatory cell infiltration and cardiomyocyte fibrosis, among other things. The proteome analysis revealed that there were 60 distinct proteins in total, four of which were associated with the heart. The expression of PSAT1, PDK1, SMAD4, and SDF2 proteins may be linked to the mechanism of their protective effects.

Conclusion: Potential therapeutic effects of Agari-5 for MI and its mechanism of action may be related to PSAT1, PDK1, SMAD4, and SDF2.

Cardiorenal syndrome reflects a complex interplay between cardiac and renal dysfunction, often compounded by fragmented management between cardiology and nephrology. Traditional phrases such as "the heart likes it dry and the kidneys like it wet" oversimplify care and perpetuate misconceptions about diuretic use and fluid management. Emerging evidence points to venous congestion rather than reduced cardiac output as a key driver of worsening renal function and adverse outcomes in heart failure. This article blends current evidence with the authors' perspective and clinical experience to explore the role of point-of-care ultrasound (POCUS) in the hemodynamic assessment of cardiorenal dysfunction, highlighting practical frameworks and tools. Conventional bedside assessment tools are limited, and static markers such as serum creatinine and physical signs can be misleading. POCUS provides a dynamic, physiology-based evaluation by integrating focused cardiac imaging, venous Doppler, lung ultrasound, and abdominal views. Frameworks such as "pump, pipes, and leaks" and scoring systems like venous excess ultrasound enable real-time visualization and quantification of congestion, shifting practice from assumption-based to data-driven care and fostering alignment between specialties. As training opportunities expand and supporting evidence grows, POCUS should be regarded as a core clinical skill in the management of cardiorenal dysfunction, with the potential to improve diagnostic precision and guide targeted therapy.

Cardiovascular disease (CVD) remains the leading cause of mortality worldwide despite major advances in prevention and treatment. The odd-chain saturated fatty acid pentadecanoic acid (C15:0), primarily obtained from dairy fat, has been associated with cardiometabolic benefits. To summarize recent advances in understanding the role of pentadecanoic acid (C15:0) in CVD biology and risk, and to identify knowledge gaps and future research priorities. A narrative review was conducted, drawing on 115 PubMed-indexed studies on odd-chain fatty acids (OCFAs) and cardiovascular outcomes, as well as illustrative mechanistic studies of C15:0. This narrative review synthesized evidence from approximately 115 PubMed-indexed studies on OCFAs and cardiovascular outcomes, along with mechanistic studies of C15:0, identified through targeted searches in PubMed, Scopus, and Web of Science from January 2000 through May 2025.

Background: Limb arterial trauma is a common yet clinically challenging condition often encountered in trauma surgery emergencies. Early accurate diagnosis and effective repair are crucial for patient survival and functional recovery.

Aim: To report a brand new technique to promote the recovery of limb arterial trauma.

Methods: This study retrospectively analyzed data from patients treated for limb arterial trauma at our hospital between 2014 and 2023. A total of 79 patients met the inclusion criteria, including 56 males and 23 females, with an average age of 45 years. All patients underwent surgical repair methods like bare metal support arterial reconstruction. Follow-up evaluations were conducted for at least 36 months postoperatively, documenting surgical outcomes and complications.

Results: Building upon the "end-to-end anastomosis" technique, establishing a "working track" for the two severed ends of the vessel provides crucial technical support for subsequent intravascular stent alignment. Simultaneously, the implantation of bare metal stents (BMS) not only enhances the strength of the connection between severed arteries but also reduces the stent lumen's effective diameter by overlapping, thereby minimizing opportunities for intra-stent blood flow attachment and lowering stent thrombosis formation. This approach maximizes the preservation of arterial supply to organs and essential vascular branches, utilizing intravascular intervention techniques to restore the original anatomical stat. The study revealed that patients with BMS graft achieved more successful limb function recovery postoperatively, compared with patients receiving another surgery.

Conclusion: Bare metal stent support arterial reconstruction could significantly improve upper limb arterial trauma to improve patient quality of life.

Background: Persistent sinus tachycardia affects up to 40% of patients after heart transplantation and is linked with graft dysfunction, impaired diastolic filling, and increased morbidity. Conventional rate-limiting therapies such as beta-blockers and calcium channel blockers are quite often contraindicated due to risks of bradyarrhythmia or hypotension. Ivabradine, a selective I(f) channel inhibitor, reduces heart rate (HR) without negative inotropic or hypotensive effects.

Aim: To evaluate the efficacy and safety of ivabradine in heart transplant recipients.

Methods: A comprehensive search of PubMed, EMBASE, Scopus, Cochrane Library, and Google Scholar was conducted from inception to April 15, 2025. Eligible studies evaluated ivabradine in heart transplant recipient vs placebo or metoprolol, reporting HR, mortality, left ventricular mass (LVM), or safety. Data were independently extracted by two reviewers, and quality was assessed. Review Manager 5.4 performed pooled analyses using random-effects models. Mean differences (MD) or standardized MD (SMD) were calculated for continuous outcomes, and risk ratios for dichotomous outcomes.

Results: Of 415 records identified, four studies comprising 264 patients (126 ivabradine, 138 control) met the inclusion criteria. Ivabradine significantly reduced resting HR compared with controls (MD = -11.06 beats per minute; 95%CI: -19.50 to -2.62; P < 0.00001; I ² = 93%). Sensitivity analysis demonstrated consistent findings (SMD = -6.74; 95%CI: -9.23 to -4.24; I ² = 0%). No significant difference in all-cause mortality was observed (MD = 0.52; 95%CI: 0.17-1.64; P = 0.27; I ² = 85%). Pooled analysis of LVM revealed no significant effect of ivabradine (MD = -3.57 g; 95%CI: -29.21 to 22.08; P = 0.79; I ² = 73%), with sensitivity analysis confirming neutrality. Adverse events were rare and mostly comparable between groups.

Conclusion: Ivabradine reduces HR effectively in heart transplant recipients without added adverse outcomes, supporting its use as safe and well-tolerated alternative when conventional agents are unsuitable. Despite potential clinical benefit, small sample size and heterogeneity the need for larger randomized trials to confirm long-term outcomes and establish ivabradine's role in post-transplant care.