World Journal of Cardiology最新文献

Background: The use of sodium-glucose cotransporter 2 (SGLT2) inhibitor in heart failure (HF) patients is increasing significantly, regardless of whether they have a history of diabetes. The effects of SGLT2 inhibitor on HF are likely mediated through multiple mechanisms, including suppression of the renin-angiotensin-aldosterone system (RAAS), reduction in oxidative stress leading to enhanced myocardial efficiency, and attenuation of adverse cardiac remodeling by preventing fibrosis. These pathways are fundamental to reducing mortality, improving patients' quality of life, and alleviating the burden on the United States healthcare system by decreasing HF-related hospitalizations.

Aim: To evaluate SGLT2 inhibitor effects on HF, focusing on hospitalization for HF (HHF), cardiovascular (CV) deaths, and all-cause mortality.

Methods: A comprehensive search was conducted in PubMed for randomized controlled trials (RCTs) evaluating the effects of SGLT2 inhibitor in HF patients compared to placebo, covering the period from January 1, 2014, to January 1, 2025. The primary outcomes assessed were HHF, CV deaths, and all-cause mortality. RevMan Web 5.4.1 was used to assess the risk of bias heterogeneity and to perform the statistical analyses. A random-effects model was employed for all statistical evaluations.

Results: A total of nine RCTs were included in this analysis: DELIVER, DECLARE-TIMI 58, DAPA-HF, EMPA-REG OUTCOME, EMPEROR-Reduced, EMPEROR-Preserved, SOLOIST-WHF, EMPULSE, and VERTIS-CV. For HHF, eight trials (excluding the SOLOIST-WHF; n = 25906) were pooled, while CV deaths were assessed using data from eight trials (excluding the EMPULSE; n = 26598). Compared to placebo, SGLT2 inhibitor significantly reduced the risk of HHF (relative risk: 0.74; 95%CI: 0.71-0.77; P < 0.00001) and CV death (odds ratio: 0.88; 95%CI: 0.83-0.92; P = 0.0006). All nine trials (n = 27128) were included in the analysis of all-cause mortality. SGLT2 inhibitor were associated with a statistically significant reduction in all-cause mortality compared to placebo (OR: 0.91; 95%CI: 0.84-0.98; P = 0.02).

Conclusion: These results suggest that SGLT2 inhibitor significantly reduce the risk of hospitalization for HF, CV deaths, and all-cause mortality.

Vasospastic angina (VSA) is a distinct endotype of ischemia with non-obstructive coronary arteries characterized by transient coronary artery spasm and myocardial ischemia in the absence of significant fixed stenosis. It is an underdiagnosed and often challenging condition that can lead to recurrent angina, myocardial infarction, and sudden cardiac death. VSA arises from a multifactorial interplay of endothelial dysfunction, vascular smooth muscle hyperreactivity, inflammation, and autonomic dysregulation. While calcium channel blockers and nitrates remain the mainstay of therapy, there is a growing body of evidence in the use of novel and emerging treatments including Rho-kinase inhibitors, endothelin receptor antagonists, and anti-inflammatory agents for refractory cases. Diagnostic evaluation relies on clinical features and, when necessary, invasive coronary pharmacological provocation testing. This narrative review examines the current understanding of VSA, discusses current international guideline-based diagnostic and therapeutic strategies, and highlights novel and investigational approaches that may broaden the treatment armamentarium against it.

Background: Peripheral artery disease (PAD) affects millions globally, with a 5.6% prevalence in 2015 impacting 236 million adults, rising above 10% in those over 60 due to factors like diabetes and smoking. Post-revascularization, single antiplatelet therapy (SAPT) is standard, but dual antiplatelet therapy (DAPT) may improve outcomes, though duration and bleeding risks are unclear. The 2024 American College of Cardiology/American Heart Association guidelines endorse short-term DAPT, yet evidence gaps remain in comparative efficacy and safety. We hypothesized that DAPT reduces cardiovascular events and reinterventions vs SAPT without significantly elevating bleeding in PAD patients' post-lower extremity revascularization.

Aim: To evaluate the efficacy and safety of DAPT vs SAPT in PAD patients' post-revascularization.

Methods: This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching PubMed, EMBASE, and ScienceDirect up to July 2025. Included were randomized controlled trials (RCTs) and cohort studies from various global settings (e.g., hospitals, tertiary care) comparing DAPT (aspirin plus P2Y12 inhibitor for > 1 month) to SAPT in symptomatic PAD patients undergoing endovascular or surgical revascularization (n up to 28244 participants selected via eligibility criteria). Data were pooled using random-effects models for risk ratio (RR) with 95%CI; heterogeneity was assessed via the I² statistic. Quality appraisal used Risk of Bias in Non-randomized Studies of Interventions for cohorts and Risk of Bias 2.0 for RCTs; certainty was evaluated via Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results: Twelve studies (3 RCTs, 9 cohorts, conducted 2010-2025 with follow-ups of 6 months to 5 years) were included. DAPT showed no significant difference but a trend toward reduced all-cause mortality (RR: 0.52, 95%CI: 0.27-1.01, P = 0.05, DAPT of 298/9545 events vs SAPT of 165/566 events) or stroke (RR: 0.72, 95%CI: 0.30-1.72, P = 0.46, DAPT of 16/3729 events vs SAPT of 41/7673 events) vs SAPT. DAPT significantly reduced cardiac mortality (RR: 0.46, 95%CI: 0.27-0.80, P = 0.006, DAPT of 78/2903 events vs SAPT of 171/1465 events, risk difference: -5.4%), myocardial infarction (RR: 0.82, 95%CI: 0.71-0.94, P = 0.004, DAPT of 233/7704 events vs SAPT of 262/9130 events, risk difference: -1.8%), and major reintervention (RR: 0.58, 95%CI: 0.35-0.98, P = 0.04, DAPT of 803/205 events vs SAPT of 1197/4 events, risk difference: -42%). Bleeding showed no difference (RR: 1.12, 95%CI: 0.42-3.03, P = 0.82, DAPT of 195/2775 events vs SAPT of 202/8234 events). Heterogeneity was high (I ² = 59%-97%). Quality revealed mo

The innovative study by Zhang et al published in the World Journal of Cardiology focused on predicting 30-day mortality in patients with acute myocardial infarction complicated by ventricular septal rupture at high altitudes. Based on a retrospective analysis of 48 patients from Yunnan Province, China, the authors identified four independent predictors of mortality: Age; Elevated uric acid levels; Interleukin-6 and decreased hemoglobin. Integrating these factors into a nomogram demonstrated high predictive accuracy (area under the curve = 0.939). This model addressed the critical challenge of risk stratification in the resource-limited settings typical of high-altitude areas. This editorial underscored the practical value of the nomogram for timely identification of candidates for intensive therapy and surgical intervention while emphasizing the need for model validation in multicenter cohorts to optimize the management of these patients.

Obstructive sleep apnea (OSA) and coronary artery disease (CAD) frequently coexist, forming a bidirectional pathophysiological loop that amplifies cardiovascular risk. Intermittent hypoxemia in OSA patients promotes endothelial dysfunction, systemic inflammation, oxidative stress, and sympathetic activation, thereby accelerating atherogenesis, whereas myocardial ischemia and ventricular dysfunction in CAD patients can further destabilize upper-airway patency and exacerbate OSA. Continuous positive airway pressure (CPAP) is the standard therapy for OSA and reliably restores sleep architecture; however, large randomized trials have reported inconsistent effects on major adverse cardiovascular events, particularly in patients with established CAD. This mini review synthesizes contemporary data on CPAP across diverse OSA-CAD clinical scenarios, delineates patient phenotypes most likely to achieve cardiovascular benefit and identifies contexts in which CPAP provides limited protection. On the basis of these findings, we propose pragmatic recommendations for patient selection, adherence monitoring and optimization of CPAP therapy and highlight key research priorities, including extended follow-up, adherence-enhancing strategies and multimodal interventions. Clarifying the circumstances under which CPAP is cardioprotective will enable more precise management of patients with OSA, with or without concomitant CAD.

Background: Subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation requires effective anesthesia. General anesthesia (GA) carries risks like hemodynamic instability, while ultrasound-guided intercostal nerve block (US-ICNB) may offer better pain control. This study hypothesized US-ICNB is superior in perioperative safety and pain management.

Aim: To compare perioperative outcomes of GA and US-ICNB in S-ICD implantation.

Methods: This retrospective single-center study included 64 patients who received S-ICD implantation between February 2021 and December 2024. They were divided into GA and US-ICNB groups based on anesthesia type. Demographic data, perioperative parameters (operation time, pain scores, analgesic usage), and postoperative outcomes (complications, defibrillation events) were collected and analyzed. Statistical tests were used to compare the two groups.

Results: This study included 64 patients (20 in the GA group and 44 in the US-ICNB group). Baseline left ventricular ejection fraction was significantly lower in the US-ICNB group (39.20% ± 12.00% vs 56.20% ± 11.50% in GA, P < 0.001), while American Society of Anesthesiologists scores and comorbidities were comparable. US-ICNB showed superior pain control, with significantly lower numeric rating scale scores at 6-48 hours (P < 0.001) and fewer patients requiring analgesics (P = 0.02). The US-ICNB group had shorter operation times (P < 0.001), total hospital stays (P < 0.001), and later first analgesia times (P < 0.001). No anesthesia-related complications occurred in either group.

Conclusion: Both anesthetic methods were safe in the short term. However, US-ICNB was superior in reducing operation and hospital stay times and alleviating peri-operative pain. It has high safety in S-ICD implantation and deserves further clinical promotion, though large-scale, multi-center, randomized controlled trials are needed to confirm these findings.

Acute myocardial infarction (AMI) remains a leading global cause of morbidity and mortality, with high risk of recurrent adverse cardiovascular events. Conventional diagnostic markers often lack the sensitivity needed for early detection and prognostic stratification. Recent advances highlight the role of microRNAs (miRNAs) and their genetic polymorphisms in regulating inflammation, fibrosis, and endothelial function in atherosclerotic disease. This review summarizes evidence on circulating miRNA expression and miRNA-related single nucleotide polymorphisms as biomarkers in AMI. Literature from PubMed, Scopus, and Web of Science was evaluated, focusing on pathways involving NF-κB, interleukin-1 receptor/toll-like receptors, and JAK/STAT signaling. Circulating miRNAs such as miR-150, miR-208, miR-26a, and miR-483-5p demonstrate strong diagnostic accuracy, while polymorphisms, particularly rs2910164 in miR-146a, are consistently associated with AMI susceptibility and adverse outcomes. These findings suggest that miRNAs and their variants may serve as non-invasive tools for diagnosis and risk prediction, supporting future integration into precision cardiovascular medicine.

Rheumatoid arthritis (RA) significantly increases the risk of cardiovascular diseases (CVD), including myocardial infarction (MI), stroke, and heart failure (HF). This association is linked to chronic inflammation, endothelial dysfunction, and accelerated atherosclerosis. Patients with RA have a 1.5-2 times higher risk of CVD compared to the general population, and cardiovascular mortality reaches 40%-50%. However, basic anti-inflammatory drugs such as methotrexate reduce the rate of cardiovascular events by 20%-30% due to suppression of systemic inflammation. Biological medications also demonstrate a cardioprotective effect, reducing the risk of MI by 20%-40%, although some (e.g., tumor necrosis factor α inhibitors) may increase the risk of HF in predisposed patients. Janus kinase inhibitors are associated with an increased risk of thrombosis and cardiovascular events, particularly in patients with pre-existing risk factors. Therefore, optimal control of inflammation in RA can reduce cardiovascular risk; however, drug selection should consider individual safety profiles. Regular monitoring of cardiovascular risk factors and a multidisciplinary approach are key to managing patients with RA and minimizing complications.

Background: Optical coherence tomography (OCT) offers detailed cross-sectional imaging during percutaneous coronary intervention (PCI), aiding in anatomically complex coronary lesions. Despite its advantages, evidence on the clinical effectiveness of OCT-guided PCI remains limited.

Aim: To compare clinical outcomes of OCT-guided vs angiography-guided PCI in patients with complex lesions.

Methods: Major databases were systematically searched for randomized controlled trials (RCTs) comparing OCT-guided and angiography-guided PCI in complex lesions. Primary outcomes included major adverse cardiovascular events (MACE) and target vessel failure (TVF); secondary outcomes included mortality, myocardial infarction (MI), and other procedural outcomes. A random-effects model was used to pool risk ratio (RR), with 95%CI. Statistical analysis was conducted in R software (v4.4.1), with significance set at P < 0.05.

Results: Five RCTs (5737 patients) showed OCT-guided PCI significantly reduced MACE (RR: 0.63, 95%CI: 0.52-0.77, P < 0.01), TVF (RR: 0.68, 95%CI: 0.56-0.83, P < 0.01), all-cause (RR: 0.58, 95%CI: 0.38-0.87, P < 0.01) and cardiac mortality (RR: 0.43, 95%CI: 0.24-0.76, P < 0.01), target-lesion revascularization (RR: 0.53, 95%CI: 0.33-0.84, P < 0.01), stent thrombosis (RR: 0.52, 95%CI: 0.31-0.86, P = 0.01), and target-vessel MI (RR: 0.64, 95%CI: 0.42-0.97, P = 0.04) vs angiography-guided PCI. Periprocedural MI, any revascularization, target-vessel revascularization, and contrast-associated kidney injury were similar between groups.

Conclusion: OCT-guided PCI improves outcomes in complex lesions by reducing MACE, TVF, mortality, stent thrombosis, and target-vessel MI. These findings highlight the need for further large-scale RCTs to confirm its benefits.

Background: Stable angina pectoris, a clinical manifestation of coronary artery disease (CAD), is commonly evaluated using non-invasive diagnostic tools. Traditionally, stress testing modalities such as exercise electrocardiography (ECG), myocardial perfusion imaging (MPI), and stress echocardiography have been the first-line strategies. However, coronary computed tomography angiography (CCTA), an anatomic imaging modality, is increasingly used for its ability to directly visualize coronary artery stenoses and plaque burden. Despite growing adoption, the comparative effectiveness of CCTA and stress testing in terms of diagnostic accuracy, prognostic value, and clinical outcomes in stable angina remains an area of active debate.

Aim: To compare the diagnostic and prognostic performance of CCTA with various forms of stress testing in adult patients presenting with suspected or confirmed stable angina.

Methods: A comprehensive literature search was performed across PubMed, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials in accordance with the PRISMA guidelines. Only randomized controlled trials (RCT) published in English within the last 15 years were included. Studies involving adult patients (≥ 18 years) with stable angina or low-risk chest pain were selected. The intervention was CCTA, and the comparators included ECG, MPI, and stress echocardiography. Data were extracted using a standardized process, and study quality was assessed using the Cochrane Risk of Bias 2.0 tool. Due to heterogeneity in outcome measures and modalities, narrative synthesis was employed.

Results: Five high-quality RCTs encompassing a total of 5551 patients were included. CCTA demonstrated superior diagnostic accuracy and prognostic capability across multiple studies. It was more effective in predicting major adverse cardiac events, including myocardial infarction and cardiac death, and was associated with fewer unnecessary invasive coronary angiographies and better event-free survival. Studies also reported improved revascularization rates in patients evaluated with CCTA, particularly within tiered diagnostic protocols. Stress testing, while useful, showed limitations in sensitivity and downstream clinical decision-making.

Conclusion: CCTA offers a diagnostically superior and clinically impactful strategy for the initial evaluation of patients with stable angina, especially those with intermediate pretest probability of CAD. Compared to conventional stress testing, it enhances risk stratification, reduces unnecessary procedures, and may improve long-term outcomes. These findings support its broader integration into diagnostic pathways for stable angina.