World Journal of Cardiology最新文献

Background: Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are well-established treatments for multivessel coronary artery disease (CAD), a condition where multiple heart arteries are narrowed. A newer approach, fractional flow reserve (FFR)-guided PCI, uses a specialized measurement to select which artery blockages to treat, aiming to enhance patient outcomes. Despite its adoption, the comparative effectiveness of FFR-guided PCI vs CABG remains unclear, particularly regarding key health outcomes such as survival, heart-related complications, and the need for further procedures.

Aim: To evaluate the safety and effectiveness of FFR -guided PCI compared to CABG in patients with multivessel CAD.

Methods: This meta-analysis followed standard reporting guidelines and included randomized controlled trials (RCTs) comparing FFR-guided PCI with CABG in patients with multivessel CAD. We searched medical databases, including PubMed, EMBASE, ScienceDirect, and ClinicalTrials.gov, from their start to May 2025. We calculated combined risk ratios (RRs) with 95% confidence intervals (95%CIs) to analyze the data.

Results: Three RCTs were analyzed. There was no notable difference in all-cause mortality between FFR-guided PCI and CABG (RR = 1.01, 95%CI: 0.78-1.31, P = 0.93). However, FFR-guided PCI showed higher rates of major adverse cardiac events (MACEs; RR = 1.30, 95%CI: 1.11-1.52, P = 0.001), myocardial infarction (RR = 1.49, 95%CI: 1.11-2.01, P = 0.009), and repeat revascularization (RR = 2.25, 95%CI: 1.78-2.85, P < 0.00001). Stroke rates were comparable between the two treatments (RR = 0.80, 95%CI: 0.54-1.20, P = 0.28).

Conclusion: FFR-guided PCI and CABG have similar rates of all-cause mortality and stroke in patients with multivessel CAD. However, CABG results in fewer MACEs, myocardial infarctions, and repeat procedures.

Background: Postoperative atrial fibrillation (POAF) is a complication after cardiac surgeries associated with increased morbidity and hospital stay. Surgical cardiac denervation, which reduces autonomic input to the heart, has been proposed as a good preventive against POAF. However, evidence on its effectiveness remains inconsistent.

Aim: To evaluate the impact of surgical cardiac denervation on the incidence of POAF and related clinical outcomes.

Methods: This meta-analysis adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search was conducted across PubMed, Cochrane, ScienceDirect, and EMBASE up to April 2025 using a preformed search strategy using Medical Subject Headings terms and free-text keywords. Risk of bias assessment was done via Risk of Bias 2.0 and Risk Of Bias In Non-randomized Studies - of Interventions tools. Study analysis was performed using Review Manager version 5.4, with heterogeneity assessed via I ² values and appropriate fixed- or random-effects models applied.

Results: Five studies (N = 1266) were included, with 627 patients undergoing cardiac denervation and 639 serving as controls. Denervation did not significantly reduce overall POAF [odds ratio = 0.71; 95% confidence interval (CI): 0.32-1.58; P = 0.40; I ² = 83%], but was associated with a significant reduction in persistent atrial fibrillation (odds ratio = 0.19; 95%CI: 0.10-0.36; P < 0.00001; I ² = 0%). Among secondary outcomes, only postoperative serum magnesium levels significantly reduced the denervation group (mean difference: -0.07 mmol/L; 95%CI: -0.08 to -0.06; P < 0.00001). Other outcomes, such as reoperation for bleeding, stroke/transient ischemic attack, length of hospital stay, 30-day mortality, and postoperative drainage, did not show any significant difference.

Conclusion: Surgical cardiac denervation does not significantly reduce overall POAF but does lower the incidence of persistent atrial fibrillation. It is also shown to decrease serum magnesium levels. Other outcomes, such as stroke, reoperation, and hospital stay, showed no significant differences.

Background: Coronary heart disease (CHD) is a prominent cause of mortality and disability worldwide. Like most complex diseases, the risk of CHD in individuals is regulated by the interaction between genetic factors and lifestyle. APOE and SLCO1B1 genetic polymorphisms and LPA KIV-2 copy number variation may influence the development and progression of CHD. Clarifying gene polymorphisms can guide clinical precision and prevention, thereby improving treatment outcomes.

Aim: To investigate the influence of APOE and SLCO1B1 gene polymorphisms, as well as LPA KIV-2 copy number variation on CHD in the Teochew population.

Methods: A total of 324 patients with CHD and 143 control participants were involved in this study. Single nucleotide polymorphisms rs429358 and rs7412 in the APOE gene, and rs2306283 and rs4149056 in the SLCO1B1 gene were analyzed via high-resolution melting curve analysis. Additionally, PCR was performed to detect KIV-2 copy number variations. Clinical risk factors and potential effects on CHD patients were subsequently assessed.

Results: In the CHD group, the frequencies of APOE allele ε2, ε3, ε4 were 8.02%, 82.97%, and 9.10%, respectively. Compared to the control groups (13.29%, 79.37%, and 7.34%, respectively), the ε2 allele frequency showed a significant difference (8.02% vs 13.29%, P = 0.012). SLCO1B1 allele frequencies in the CHD group were not significantly different from those in the control group (*1a: 26.69% vs 25.52%, *1b: 61.17% vs 65.38%, *5: 0.15% vs 0.35%, *15: 11.83% vs 8.74%). The number of copies of the KIV-2 gene was significantly lower in the CHD group when compared to controls (23.35 ± 8.78 vs 27.21 ± 9.48; P < 0.01). Logistic regression analysis revealed that sex, age, hypertension, diabetes, smoking, the ε2 allele and KIV-2 copy number were factors influencing the presence of CHD.

Conclusion: In the Teochew population, the APOE ε2 allele and a higher KIV-2 copy number were associated with a reduced risk of CHD. In contrast, the APOE ε4 allele and SLCO1B1 gene were not associated with CHD.

Together, the heart and lung sound comprise the thoracic cavity sound, which provides informative details that reflect patient conditions, particularly heart failure (HF) patients. However, due to the limitations of human hearing, a limited amount of information can be auscultated from thoracic cavity sounds. With the aid of artificial intelligence-machine learning, these features can be analyzed and aid in the care of HF patients. Machine learning of thoracic cavity sound data involves sound data pre-processing by denoising, resampling, segmentation, and normalization. Afterwards, the most crucial step is feature extraction and selection where relevant features are selected to train the model. The next step is classification and model performance evaluation. This review summarizes the currently available studies that utilized different machine learning models, different feature extraction and selection methods, and different classifiers to generate the desired output. Most studies have analyzed the heart sound component of thoracic cavity sound to distinguish between normal and HF patients. Additionally, some studies have aimed to classify HF patients based on thoracic cavity sounds in their entirety, while others have focused on risk stratification and prognostic evaluation of HF patients using thoracic cavity sounds. Overall, the results from these studies demonstrate a promisingly high level of accuracy. Therefore, future prospective studies should incorporate these machine learning models to expedite their integration into daily clinical practice for managing HF patients.

Background: Obese patients (body mass index ≥ 30 kg/m²) undergoing isolated aortic valve replacement (AVR) face increased surgical risks due to comorbidities. Partial upper sternotomy (PUS), a minimally invasive approach, may reduce complications compared to full median sternotomy (FMS). We hypothesize that PUS improves outcomes over FMS in obese patients undergoing AVR.

Aim: To compare the efficacy and safety of PUS vs FMS in obese patients undergoing isolated AVR.

Methods: This systematic review and meta-analysis followed PRISMA guidelines, searching PubMed, EMBASE, and Cochrane databases for observational studies comparing PUS vs FMS in obese patients undergoing AVR. Outcomes were analyzed using odds ratios (OR), mean differences (MD), 95% confidence intervals (CI), I² statistic, and Newcastle-Ottawa Scale was used for quality assessment.

Results: Four observational studies involving 677 patients were analyzed. PUS reduced intensive care unit stay (MD -2.67 days, 95%CI: -4.43 to -0.90, P = 0.003, I² = 78%) but increased cardiopulmonary bypass time (MD 5.62 minutes, 95%CI: -0.36 to 11.59, I² = 55%). No differences were observed in renal failure (OR 1.13, 95%CI: 0.63-2.94, I² = 0%), atrial fibrillation (OR 0.81, 95%CI: 0.43-1.54, I² = 30%), reexploration (OR 1.09, 95%CI: 0.48-2.47, I² = 0%), postoperative bleeding (OR 1.48, 95%CI: 0.53-4.15, I² = 60%), wound infection (OR 1.23, 95%CI: 0.70-2.14, I² = 0%), hospital stay (MD 0.51 days, 95%CI: -4.13 to 5.15, I² = 90%), or cross-clamp time (MD 4.03 minutes, 95%CI: -0.75 to 8.80, I² = 50%).

Conclusion: PUS is safe and effective for obese patients undergoing AVR, reducing intensive care unit stay and enhancing recovery, provided surgical expertise is available.

[This retracts the article on p. 522 in vol. 16, PMID: 39351334.].

The prevalence of cardiometabolic syndrome (CMS) and increasing mortality rate play a significant role in the global increase of cardiovascular disease (CVD) in developing countries. A group of metabolic syndromes that are risk factors for CVDs are referred to as the CMS. Although the exact mechanism(s) behind the development of the CMS are not known, but multi-organ insulin resistance, a prevalent characteristic of the syndrome, is probably one of them. The two most prevalent dental diseases i.e. periodontitis (PD) and dental caries have been related to several systemic diseases and disorders, such as CMS. Age, alcohol consumption, being obese, possessing diabetes, as well as smoking are risk factors for periodontal diseases, while both CVD and periodontal diseases are linked to systemic inflammation. It has a multifactorial aetiology and is associated with many systemic diseases. When bacteria and their products attack the periodontal tissues, the tissue raises an immune-inflammatory response against the pathogens. This acute phase response is a result of the pathogen's systemic attack and contributes to the overall inflammatory burden of the system. CVD and PD are both diseases associated with systemic inflammation and may be related as they share many common risk factors. Hence, the correlation between these conditions might also have an impact on how dentistry and medicine are practised, thus helping to build a working relationship between the dentist and the physician.

The concept of metabolically healthy obesity (MHO) has attracted growing attention, but its clinical relevance and association with future cardiovascular risk remain unclear. Estrogen deficiency, which signifies the menopause phase, contributes to altered body composition and unfavorable metabolic processes. In this Editorial, we comment on the recent retrospective study by Pingili et al, which used a United States national in-patient population and observed significantly elevated odds of major adverse cardiac and cerebrovascular events in postmenopausal women with MHO compared with their age-matched non-obese counterparts. Of note, disproportionately greater risks were particularly observed among Black patients. These findings along with previous literature data call into question the seemingly benign profile of the MHO state. Obese individuals who appear metabolically healthy present an elevated cardiovascular risk which may be exacerbated in older female populations. These findings emphasize the need for vigilance and improved approaches of risk stratification which would translate into the early application of preventive measures.

Background: Peripheral endovascular intervention (PEVI) is performed using radiation. Radiation has deleterious health consequences for patients and operators.

Aim: To investigate the gender radiation disparities and procedural outcomes in PEVI.

Methods: A prospective observational study was performed in 186 consecutive patients (65 ± 12 years) at an academic medical center from January 2019 to April 2020 (mean follow-up of 3.9 ± 3.6 months) comparing the gender radiation disparity and outcomes of PEVI (n = 147 underwent intervention, 79.0%). Groups were divided into women (n = 99, 53.2%) and men (n = 87, 48.4%). Primary endpoints included air kerma, dose area product (DAP), fluoroscopy time, and contrast use. Secondary endpoints included all-cause mortality, acute myocardial infarction, acute kidney injury, stroke, repeat revascularization, major adverse limb event, and the composite of complications.

Results: Men showed increased DAP compared with women (15221.2 ± 25858.5 µGy × m² vs 9251.7 ± 9555.3 µGy × m², P = 0.047), but no significant difference in air kerma or any other primary endpoints. In the secondary endpoints, no significant difference was found between gender.

Conclusion: Men had increased DAP indicating more radiation absorption in the exposed area. Gender outcomes showed no difference in complications. Thus, PEVI can be safely performed in men or women.

Background: Extracorporeal membrane oxygenation (ECMO) is mainly applied to patients with significant cardiorespiratory failure who do not respond to existing conventional treatments. Patients that are supported with veno-arterial ECMO (VA-ECMO) are considered very-high risk patients to participate in any type of physical therapy (PT) or mobilization. However, cumulative evidence suggests that early mobilization of critically ill patients is feasible, safe, and efficient under certain circumstances.

Aim: To summarize the existing evidence on the impact of early mobilization and physiotherapy on VA-ECMO patients.

Methods: This is a scoping review that used systematic electronic literature searches (from inception until January 2025) on MEDLINE (PubMed), PEDro, DynaMed, CINAHL, Scopus, Science direct and Hellenic Academic Libraries. Snowball searching method was also applied. Eligible studies included those reporting patients on VA-ECMO who participated in early mobilization or PT, published in English and utilized any primary evidence study design. Studies on children, animals and patients placed on any other ECMO, secondary evidence, and 'grey' literature were excluded.

Results: A total of 316 articles were retrieved and 13 were included in the study. Of those, 1 study was a randomized control trial, 4 retrospective studies, 4 retrospective cohort studies, 1 case series and 3 case reports. The sample size of the included studies ranged from 1 to 104 VA-ECMO patients, who were ambulated or received PT interventions, and mobilization frequency ranged from 2 per day to 4 per week. Mobilization of VA-ECMO patients seems to be safe regardless the cannula's position. PT and early mobilization were associated with better weaning from mechanical ventilation, gradual reduction of inotropes and functional capacity improvement after ECMO discharge.

Conclusion: Early mobilization in VA-ECMO seems to be safe and can potentially help reduce vasoconstrictors and speed up rehabilitation times. High quality research on early mobilization in VA-ECMO patients is warranted.