World Journal of Cardiology最新文献

Voltage substrate mapping is a promising tool for the treatment of atrial fibrillation (AF). It is helpful to detect atrial fibrosis, which includes areas with low bipolar voltage, heterogeneous conduction properties, and shortened effective refractory period. The voltage amplitude is typically defined as the maximal peak-to-peak level within a specified time window of interest. Contemporary electroanatomic mapping platforms now enable many thousands of data points to be mapped, so that a geometric model of the atrial endocardium is constructable over a short period of time. This mapping procedure is often done with bipolar electrodes to cancel the far-field signal. The recording site coordinates are projected onto an atrial shell, with interpolation of the voltage data across the shell surface. The amplitude of the recorded bipolar electrogram depicted on the three-dimensional shell provides detailed information for substrate mapping. Wherever there are areas of low peak-to-peak voltage, it is thought to mark the presence of abnormal tissue properties and conduction. However, uncontrolled variables and environmental factors affecting voltage level include the oncoming electrical activation wavefront direction, the catheter incidence angle, the force applied to the catheter, and the region-variable shape and structure of atrial tissue. Techniques and settings to acquire atrial voltage data for AF analysis have not been standardized. Methods to characterize atrial electrograms are also presently limited. These factors affect quality and reproducibility of the mapping results. Herein, voltage substrate mapping and its variables pertaining to AF and radiofrequency ablation are described and discussed, with suggestions for future work efforts.

Colchicine is one of the most widely used drugs in the world. While it is most commonly used in the treatment and prevention of gout, it is also widely used to treat other chronic inflammatory diseases, such as familial Mediterranean fever and Behçet's disease. Regarding cardiovascular disease, an established use of colchicine concerns pericarditis, both acute and chronic, and its effectiveness in this context is supported by multiple studies and robust evidence. Regarding coronary artery disease (CAD), colchicine use has been endorsed in both acute and chronic coronary syndromes (CCS), primarily because of two randomized controlled trials: The COLCOT trial for patients with acute coronary syndromes (ACS) and the LoDoCo2 trial for patients with CCS. Considering this robust evidence, CCS 2024 European Society of Cardiology (ESC) Guidelines recommended 0.5 mg daily colchicine in patients with atherosclerotic CAD to reduce the risk of myocardial infarction, stroke and need for revascularization. However, a few months after the publication of 2024 ESC Guidelines on CCS, the "CLEAR" trial demonstrated that among patients who had experienced an acute myocardial infarction, when initiated shortly after the event and continued for a median of 3 years, colchicine did not reduce the incidence of the composite outcome of death from cardiovascular causes, recurrent myocardial infarction, stroke, or unplanned ischemia-driven coronary revascularization. This result casts doubt on the indication for colchicine use in ACS and weakens evidence that had previously led to the routine use of colchicine in clinical cardiology practice. This review aims to shed light on the current and past scientific evidence underlying the use of colchicine in ACS, CCS and cerebrovascular disease, and thus seeks to provide a quick yet effective tool for cardiologists facing the long-standing issue of reducing residual inflammatory risk in patients with coronary atherosclerotic disease.

Background: Heart failure (HF), especially in patients with preserved ejection fraction and mid-range ejection fraction, remains a significant global health burden. Interatrial shunt devices (IASDs), which allow blood flow from the left to the right atrium, offer a novel treatment approach by reducing left atrial pressure and alleviating symptoms.

Aim: To evaluate the efficacy and safety of IASDs in patients with HF through a systematic review and meta-analysis.

Methods: We performed a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, analyzing studies up to April 2025. Randomized controlled trials and observational studies comparing interatrial shunt therapy with control groups were included. Data on clinical outcomes were analyzed using Review Manager software.

Results: Nine studies involving 1689 patients were included. IASDs significantly improved cardiac output [mean difference (MD): 0.72, 95%CI: 0.13-1.32, P = 0.02], right atrial pressure (RAP) (MD: 0.70, 95%CI: 0.14-1.26, P = 0.01), and 6-minute walk distance (MD: 71.63, 95%CI: 24.13-119.13, P = 0.003). There were no significant differences in major adverse cardiac events, myocardial infarction, ischemic stroke, or new-onset atrial fibrillation. However, all-cause mortality [risk ratio (RR): 1.49, 95%CI: 1.02-2.18, P = 0.04] and cardiovascular death (RR: 1.66, 95%CI: 1.01-2.74, P = 0.05) were significantly higher in the shunt group.

Conclusion: IASDs offer significant short-term improvements in cardiac output, RAP, and exercise capacity in HF patients. However, long-term safety concerns, particularly regarding mortality, necessitate further research and careful patient selection.

Endocrine disorders are increasingly recognized as potentially reversible causes of secondary cardiomyopathies, yet they often remain underdiagnosed in clinical practice. These conditions-including thyroid dysfunction, acromegaly, pheochromocytoma, diabetes mellitus, adrenal disorders, among others-can significantly alter cardiac structure and function through hormonal excess, metabolic remodeling, and neurohumoral activation. Hyperthyroidism may lead to high-output heart failure (HF) and atrial fibrillation, while hypothyroidism is associated with diastolic dysfunction, pericardial effusion, and accelerated atherosclerosis. Acromegaly promotes biventricular hypertrophy and myocardial fibrosis via insulin-like growth factor 1 overproduction. Pheochromocytoma triggers catecholamine-induced cardiomyopathy, resembling Takotsubo syndrome and carrying a high risk of mortality if left untreated. Diabetes induces a distinct phenotype of cardiomyopathy, affecting both systolic and diastolic function through microvascular injury and oxidative stress. Recognizing these endocrine etiologies is crucial, as targeted hormonal therapies-such as antithyroid agents, somatostatin analogs, or adrenalectomy-can reverse or significantly mitigate cardiac dysfunction. Comprehensive endocrine screening in patients with unexplained cardiomyopathy is therefore essential. This review synthesizes current knowledge on the pathophysiological mechanisms, clinical manifestations, and therapeutic strategies for endocrine cardiomyopathies and proposes a diagnostic algorithm for early recognition. Emerging biomarkers, such as galectin-3 in diabetic heart disease, may further enhance diagnostic accuracy and risk stratification. The interplay between endocrine and cardiovascular systems offers a unique opportunity for early intervention, potentially preventing progression to irreversible HF.

Background: Descending thoracic aortic aneurysms are dangerous and have to be treated quickly. The primary treatment methods are thoracic endovascular aortic repair (TEVAR) and open surgical repair (OSR). The comparative effectiveness and safety of TEVAR and OSR were evaluated in this meta-analysis, focusing on perioperative and long-term outcomes.

Aim: To compare and contrast the efficacy and safety of TEVAR vs OSR in the treatment of descending thoracic aortic aneurysms. This study aims to assess both perioperative and long-term outcomes through a systematic review and meta-analysis.

Methods: A comprehensive search of PubMed, EMBASE, and Cochrane was conducted from inception to January 2025. Baseline characteristics and outcomes were evaluated. Odds ratios (OR) for dichotomous data and mean differences for continuous data with 95% confidence intervals (CI) were analyzed using random-effects models.

Results: A meta-analysis of 21 studies involving 29465 patients (8261 TEVAR; 21204 OR) showed TEVAR associated with lower operative mortality (OR = 0.60, 95%CI: 0.42-0.85, P = 0.004), shorter intensive care unit (-2.94 days, 95%CI: -4.76 to -1.12, P = 0.002) and hospital stays (-7.35 days, 95%CI: -10.54 to -4.17, P < 0.00001), and reduced rates of paraplegia (OR = 0.44, 95%CI: 0.27-0.73, P = 0.002), spinal ischemia (OR = 0.30, 95%CI: 0.16-0.56, P = 0.0002), renal failure (OR = 0.29, 95%CI: 0.14-0.61, P = 0.001), and wound infections (OR = 0.28, 95%CI: 0.13-0.61, P = 0.001). However, TEVAR had higher rates of vascular complications. No significant differences were noted in 1-year and 5-year mortality rates, the rate of non-elective surgery, neurological complications, or stroke rates.

Conclusion: Compared to EVAR, TEVAR revealed lower operative mortality and better perioperative outcomes across all indicators, including hospital and intensive care unit stays, as well as fewer complications, except for those related to vascular problems. Mortality results were also similar in the long run; consequently, more research is required concerning the long-term durability.

Background: Non-ST-elevation myocardial infarction (NSTEMI) is a prevalent acute coronary syndrome among the elderly, a population often underrepresented in clinical trials. Frailty, a marker of physiologic vulnerability, may influence the risks and benefits of percutaneous coronary intervention (PCI) in these patients.

Aim: To evaluate the impact of frailty status on in-hospital outcomes among patients aged ≥ 75 years with NSTEMI undergoing PCI.

Methods: We conducted a retrospective cohort study using the 2021-2022 National Inpatient Sample to evaluate the impact of frailty on in-hospital outcomes among NSTEMI patients aged ≥ 75 years undergoing PCI. Patients were stratified into three frailty categories using the Hospital Frailty Risk Score. Multivariable logistic and generalized linear models with interaction terms assessed the association between frailty and clinical outcomes.

Results: Among 456690 NSTEMI admissions, 37.95%, 50.71%, and 11.34% were categorized as low, intermediate, and high frailty, respectively. PCI use declined with increasing frailty (35.0% in low vs 7.5% in high; P < 0.001). Adjusted mortality was lower with PCI across all frailty levels [odds ratios (OR): 0.27 (low), 0.37 (intermediate), 0.43 (high); all P < 0.001]. However, the mortality benefit was attenuated with increasing frailty (interaction OR: 1.56 and 1.83 for intermediate and high vs low frailty; P < 0.001). Frailty was independently associated with higher odds of complications, including acute kidney injury, respiratory failure, delirium, and bleeding. PCI was associated with shorter hospital stays in low (-0.90 days) but longer in the high-frail category (+2.47 days; P < 0.001), and increasing frailty correlated with significantly higher hospital charges.

Conclusion: In elderly NSTEMI patients, PCI conferred a survival benefit across all frailty strata, although with a diminishing magnitude as frailty increased. Frailty correlated with increased complications and healthcare resource utilization.

The heart and brain are functionally synchronized through the heart-brain axis, also known as the neurocardiac axis. Astrocytes are the predominant subpopulation of glial cells in the central nervous system that play an integral role in maintaining homeostasis, neurovascular coupling, and synaptic transmission. Radial astroglia are recognized as a potential source for the generation of new neurons in the brain, a process known as neurogenesis, accounting for neuroplasticity. While brain-resident astrocytes have been extensively studied, increasing experimental evidence has demonstrated the presence of astroglial-like cells in various organs, including the heart. The existence of astrocyte-like cells in the heart, known as cardiac nexus glia, is recognized as an emerging key modulator of cardiac function and blood flow. Similar to astrocytes, cardiac nexus glia can also release different gliotransmitters, including brain-derived neurotrophic factor, thereby modulating neurocardiac interactions. This review delves into the mechanistic insights of the cardiac nexus glia and emphasizes a hypothesis that these glial cells may possess the multipotent capacity to generate neurons, astrocytes, and oligodendrocytes, suggesting that peripheral neurogenesis could occur in the heart. As astrocytes are vital for neuroplasticity, the regulation of cardiac nexus glia may support heart-brain communication, while their dysfunction could lead to neurocardiac disorders.

Heart failure (HF) is characterized by unbalanced oxygen demand and supply and impaired exercise capacity, which substantially affects the quality of life and prognosis of patients with HF. Cardiac rehabilitation is an effective intervention for improving exercise intolerance in patients with cardiovascular diseases, including HF. However, cardiac rehabilitation is not always accessible to these patients because a restricted number of hospitals offer cardiac rehabilitation, and access to these hospitals is limited to those who require rehabilitation. Although pharmacological interventions may help improve exercise capacity in patients with HF, evidence for this intervention is scarce. This mini-review summarizes the available research on the effects of pharmacological therapies on improving exercise capacity.

Background: Postoperative complications such as atrial fibrillation and pericardial effusion are frequent after coronary artery bypass grafting (CABG), contributing to increased morbidity and prolonged hospital stays. Posterior pericardiotomy (PP), a surgical technique involving incision of the posterior pericardium to allow drainage, has been suggested as a preventive measure. However, its overall efficacy and safety profile, including potential risks like pleural effusion, require comprehensive evaluation amid varying study qualities. We hypothesized that PP reduces key post-CABG complications compared to standard care.

Aim: To determine the efficacy of PP in reducing postoperative complications following CABG.

Methods: This systematic review and meta-analysis included randomized controlled trials (RCTs) from PubMed, Cochrane, ClinicalTrials.gov, and Ovid, comparing PP vs no PP in adult CABG patients. Studies were conducted in tertiary care hospital settings. Twenty RCTs with 5331 participants were selected based on predefined inclusion criteria. The intervention involved intraoperative PP. Primary outcome was postoperative atrial fibrillation (POAF); secondary outcomes included effusions, tamponade, hospital/intensive care unit stay, and bleeding revisions. Risk ratios (RRs), mean differences, and 95% confidence intervals (CIs) were calculated using random-effects models; heterogeneity assessed via I ² statistic.

Results: Twenty RCTs analyzed 5331 patients (2665 with PP vs 2666 without). PP significantly lowered POAF (10% vs 21%; RR = 0.48, 95%CI: 0.36-0.65, P < 0.00001; I ² = 70%), cardiac tamponade (0.5% vs 3%; RR = 0.16, 95%CI: 0.08-0.34, P < 0.00001; I ² = 0%), early pericardial effusion (2% vs 6%; RR = 0.31, 95%CI: 0.14-0.68, P = 0.004; I ² = 96%), and late pericardial effusion (1% vs 9%; RR = 0.11, 95%CI: 0.05-0.21, P < 0.00001; I ² = 0%). Hospital stay decreased (mean difference = -1.23 days, 95%CI: -1.87 to -0.59, P = 0.0002; I ² = 85%). Pleural effusion risk increased (25% vs 17%; RR = 1.46, 95%CI: 1.21-1.76, P < 0.0001; I ² = 0%). No significant effects on mortality (RR = 0.92, 95%CI: 0.48-1.76, P = 0.80; I ² = 0%), intensive care unit stay, or bleeding revisions.

Conclusion: PP effectively reduces POAF, pericardial effusions, tamponade, and hospital stay in CABG patients, though it increases pleural effusion risk and shows heterogeneity in some outcomes.

Pulmonary embolism (PE) ranks as the third leading cause of cardiovascular-related deaths in Western nations. Patients classified as high-risk (HR)-those exhibiting hemodynamic instability-require immediate interventions to restore blood flow. While intermediate-HR (IHR) individuals remain hemodynamically stable, they face a significant chance of clinical decline and thus need close and continuous observation. Effective risk assessment, mortality prediction, and therapeutic decision-making in these patients rely on a combination of clinical evaluation and imaging studies. Catheter-directed therapy (CDT) has emerged as a promising option, offering the ability to alleviate clot burden and reduce strain on the right ventricle, all while posing a lower risk of major bleeding compared to systemic thrombolysis. The growing adoption of CDT reflects its increasing relevance in PE treatment, especially when managed by specialized PE response teams that ensure individualized, multidisciplinary care. As clinical practices evolve, further studies and robust clinical trials are necessary to clearly define CDT's role in lowering the risks of complications and death among IHR PE patients. This article explores the current understanding and future direction of managing PE, focusing in the role of catheter-based interventions.