World Journal of Cardiology最新文献

Patients with cardiovascular disease rely on medication to achieve favorable long-term clinical results. Poor adherence has been linked to a relative increase in mortality of 50%-80% as well as higher health care costs. This scoping review thus aimed to explore the evidence of the effects of mobile health care apps on medication adherence in patients with cardiovascular diseases. A comprehensive data search and extraction was done in line with the updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. A total of 10 studies were included for the review. The mean pooled improvement in adherence was found to be 18% and the most effective tool was the digital therapeutics app discussed in Li et al's study. Smartphones and apps enhance coronary artery disease management by promoting medication compliance. Challenges include data security and smartphone usage among the elderly. Tailored apps or voice assistants offer potential solutions.

Background: Glycated hemoglobin (HbA1c) is a well-established biomarker for diagnosing and managing diabetes. However, its prognostic significance in patients without diagnosed diabetes undergoing percutaneous coronary intervention (PCI) remains uncertain. This systematic review and meta-analysis evaluates the association between elevated HbA1c levels in the prediabetic range (≥ 5.7%) and adverse cardiovascular outcomes in this population.

Aim: To investigate the association between elevated HbA1c levels in the prediabetic range and adverse outcomes in patients without diagnosed diabetes undergoing PCI.

Methods: We systematically searched PubMed, EMBASE, and Cochrane Central through April 2025 for studies comparing clinical outcomes in coronary artery disease (CAD) patients without a prior diabetes diagnosis, stratified by HbA1c levels (≥ 5.7% vs < 5.7%). Risk ratios (RR) with 95% confidence intervals (CI) were pooled using a random-effects model. Statistical analysis was performed using R software (version 4.3.2). Primary outcomes were long-term all-cause mortality and major adverse cardiovascular events (MACE); secondary outcomes included short-term mortality and cardiac death.

Results: Ten studies involving 32403 patients (mean age: 60 years; 29% female) were included. Elevated HbA1c levels in patients without diagnosed diabetes were significantly associated with increased risk of long-term all-cause mortality (RR: 1.30; 95%CI: 1.10-1.54; P < 0.01; I ² = 41%) and MACEs (RR: 1.31; 95%CI: 1.01-1.69; P = 0.04; I ² = 61%). Although the risks of short-term all-cause mortality (RR: 1.16; 95%CI: 0.88-1.53; P = 0.29; I ² = 1%) and cardiac mortality (RR: 1.76; 95%CI: 0.85-3.67; P = 0.13; I ² = 94%) were elevated, they did not reach statistical significance. Sensitivity analyses confirmed the robustness of the findings despite moderate to high heterogeneity in some outcomes.

Conclusion: Among CAD patients without diagnosed diabetes, elevated HbA1c levels in the prediabetic range (≥ 5.7%) are independently associated with worse long-term outcomes following PCI. HbA1c may serve as a valuable biomarker for post-PCI risk stratification in this metabolically at-risk group.

Background: Given the clinical challenges posed by drug-eluting stents, drug-coated balloons offer a promising alternative by delivering antiproliferative medications directly to the vessel wall.

Aim: To compare the efficacy of paclitaxel-coated balloon (PCB) angioplasty vs sirolimus-coated balloon (SCB) angioplasty in the treatment of coronary artery disease (CAD), focusing on both in-stent restenosis (ISR) and de-novo lesions (DNL).

Methods: A comprehensive literature search on PubMed, EMBASE, and Cochrane Central from inception to 5^th February 2025. Only randomized controlled trials and observational studies comparing outcomes of PCB vs SCB angioplasty in patients with ISR or DNL were included.

Results: A total of nine studies with 1981 patients (949 in PCB arm and 1032 in SCB arm) were included for further quantitative analysis. The results indicated that both PCB and SCB angioplasty are effective in treating CAD, with PCB showing a greater minimal lumen diameter for DNL [mean difference: -0.11 (95% confidence interval: -0.22 to -0.01, P = 0.03)]. However, the risk of target lesion revascularization and diameter stenosis was identical for both PCB and SCB during the 9-12-month follow-up period.

Conclusion: This meta-analysis highlights that PCB angioplasty may offer superior angiographic outcomes compared to SCB angioplasty, specifically in achieving greater minimal lumen diameter in patients with DNL. These findings suggest that while PCB has certain advantages in terms of tissue retention and immediate efficacy, both PCB and SCB are viable options for treating ISR or DNL in CAD patients. Further large-scale studies are required to conclusively determine the long-term benefits and potential risks associated with each type of drug-coated balloons angioplasty.

Background: In pediatric and adolescent athletes, there is a lack of understanding about the impact of factors such as race on the structural or cardiovascular adaptations in response to exercise which may unnecessarily disqualify athletes from the competitive sport. We hypothesized that race has an impact on cardiac adaptions in non-adult athletes.

Aim: To explore the racial disparity in electrocardiographic (ECG) and echocardiographic (ECHO) parameters in healthy adolescent athletes.

Methods: A comprehensive electronic systematic literature search using MEDLINE database was performed from inception to September 20, 2024. Inclusion criteria included randomized or observational cohort studies that recruited adolescent competitive athletes in any sport discipline and compared between the Black and White races with an age range of 12-18 years.

Results: Of 723 records that were identified by the literature search, seven studies (n = 5036) were included. The mean age was 13.0-18.0 years old with male predominance. Black athletes had significantly longer PR interval [mean difference (MD) = 17.49 millisecond, 95%CI: 11.70-23.29] and shorter QRS complex duration (MD = -7.35 millisecond, 95%CI: -9.17 to -5.53) and corrected QT interval (MD = -4.95 millisecond, 95%CI: -7.69 to -2.22) than the White athletes. Black athletes were approximately four times more likely to have first-degree atrioventricular (AV) block, inverted T wave, ST-segment elevation, and left atrium (LA) enlargement than their White counterparts. In terms of ECHO parameters, Black athletes had significantly greater septal wall thickness (MD = 0.85 mm, 95%CI: 0.62-1.07), posterior wall thickness (MD = 1.07 mm, 95%CI: 0.36-1.78), relative wall thickness (MD = 0.03, 95%CI: 0.001-0.06), maximal wall thickness (MD = 1.05 mm, 95%CI: 0.28-1.83), and LA diameter (MD = 1.64 mm, 95%CI: 0.16-3.12).

Conclusion: Race has an impact on the ECG and ECHO parameters that reflect cardiac adaptations in adolescent athletes. Black athletes tend to have an increased prevalence of distinct ECG changes such as first-degree AV block and T-wave inversions compared with their White counterparts. Despite having thicker septal and posterior walls, the overall prevalence of left ventricular hypertrophy did not differ between the races.

Background: Pulmonary embolism (PE) is a leading cause of cardiovascular mortality. Although anticoagulation is the cornerstone of treatment, aspirin's potential to modulate thromboinflammation and improve outcomes in non-surgical PE patients remains underexplored.

Aim: To assess whether prehospital aspirin use is associated with improved outcomes in patients hospitalized with acute PE.

Methods: We conducted a retrospective case-control study of 323 adult patients admitted with computed tomography-confirmed acute PE from January 2020 to December 2023. Patients were stratified according to documented daily aspirin use for ≥ 7 days prior to hospital admission. Primary outcomes included right ventricular strain, intensive care admission, shock, mechanical ventilation, and in-hospital mortality. Univariate logistic regression was used. A P value < 0.05 was considered significant.

Results: Total of 323 patients, 90 (27.9%) used aspirin prehospital. Aspirin users were older (74.2 ± 14.3 years vs 66.9 ± 16.7 years, P < 0.001) and had more coronary artery disease. Aspirin use was associated with significantly lower rates of right ventricular strain on computed tomography [22.2% vs 34.8%, odds ratio (OR) = 0.536, 95% confidence interval (CI): 0.305-0.944, P = 0.029], Intensive care admission (16.7% vs 28.8%, OR = 0.496, 95%CI: 0.266-0.924, P = 0.025), shock (2.2% vs 9.9%, OR = 0.208, 95%CI: 0.048-0.899, P = 0.021), and in-hospital mortality (3.3% vs 11.6%, OR = 0.260, 95%CI: 0.080-0.889, P = 0.022).

Conclusion: Prehospital aspirin use is associated with reduced severity and mortality in acute PE. These findings support a potential protective role for aspirin and warrant validation in prospective, multicenter trials.

Kataveni et al's meta-analysis offers an important contemporary synthesis of randomized evidence comparing fractional flow reserve-guided percutaneous coronary intervention and coronary artery bypass grafting (CABG) in multivessel coronary artery disease (CAD). The pooled analysis found no significant difference in all-cause mortality or stroke, yet CABG was superior in reducing myocardial infarction, major adverse cardiac events, and repeat revascularization. These results confirm CABG's durability even in the era of physiological lesion assessment and second-generation drug-eluting stents. From a traditional Chinese medicine (TCM) perspective, multivessel CAD corresponds to syndromes such as "heart vessel obstruction" and "Qi and blood stagnation", in which local blockage is compounded by systemic imbalance. While revascularization addresses the structural impediment to blood flow, TCM approaches, including herbal medicine, acupuncture, and lifestyle therapy, aim to improve microcirculation, reduce inflammation, and support recovery, potentially mitigating recurrent ischemic events. This commentary argues that future research should integrate optimal revascularization strategies with rigorously evaluated TCM interventions to address both the anatomical and systemic dimensions of CAD and improve long-term patient outcomes.

SRY-related high-mobility group box 9 (SOX9) is an indispensable transcription factor that regulates multiple developmental pathways related to stem cell differentiation and progenitor cell development. Several studies have investigated the role of SOX9 in chondrogenesis and oncogenesis. Significant research exists describing the role of SOX9 in embryological development of the cardiovascular system. However, there is limited research exploring the roles of SOX9 in development of cardiovascular diseases. In this review we highlight and review the biology and contributions of SOX9 in embryologic cardiac development and shed some light on its participation in the development of myocardial fibrosis, which in turn leads to a wide variety of adverse cardiac outcomes.

Supraventricular tachycardia (SVT) is a frequent cause of emergency presentations. Troponin elevation is common, but its clinical significance remains uncertain and may trigger unnecessary downstream testing. In this mini-review, we aimed to review the prevalence, mechanisms, prognostic relevance, and management of troponin elevation in adult paroxysmal SVT. A narrative review was conducted using PubMed and EMBASE (2000-2025) with MeSH terms related to SVT and troponin. Eligible studies included original research or registry analyses in adults with paroxysmal SVT. Pediatric and atrial fibrillation/flutter cohorts were excluded. Additional data were obtained from reference lists and expert commentaries. Troponin elevation occurs in approximately 30%-50% of adult SVT cases, primarily reflecting a tachycardia-induced supply-demand imbalance or myocardial stretch, rather than plaque rupture. Short-term registry data suggest potential prognostic associations, but long-term outcomes remain inconsistent and are largely determined by comorbidities and underlying coronary artery disease. Troponin-driven management often leads to increased admissions, consultations, and additional testing without a demonstrable benefit. Troponin elevation in SVT is frequent but usually benign. Routine measurement in all patients is not justified. A selective, risk-based approach - focused on ischemic symptoms, electrocardiogram changes, or high-risk clinical features - offers more appropriate, efficient, and patient-centered care.

Background: With rising angiography costs and risks, we explored whether a 5-minute femoral ultrasound can predict patients that actually require angiography.

Aim: To detect associations between atherosclerosis of peripheral arteries and coronary stenosis in patients with coronary heart disease (CHD).

Methods: The study included a total of 218 patients (63 ± 10.9 years of age; 54% male) with CHD subjected to coronary angiography and routine diagnostic assessment, including ultrasound imaging to assess the extent of peripheral atherosclerotic lesions. Receiver operating characteristic analysis and binomial logistic regression were used to detect the associations.

Results: We demonstrated for the first time that the presence of atherosclerotic plaque with ≥ 70% stenosis in femoral arteries was associated with significant coronary stenosis, with 93% sensitivity and 90% specificity, and thus can be used as an additional diagnostic marker for coronary stenosis. The data indicated associations between femoral artery atherosclerosis and atherosclerotic lesions of coronary arteries, with a high correlation coefficient r = 0.8 (P < 0.05). The presence of an atherosclerotic plaque in the femoral arteries with ≥ 30% or ≥ 70% stenosis was associated with a 30- or 70-fold higher odds ratio of coronary stenosis, respectively.

Conclusion: For resource-limited clinics, our findings suggest skipping carotids - femoral ultrasound alone may suffice to rule out severe CHD. Ultrasound imaging femoral artery atherosclerosis provides a simplified approach for patient stratification.