World Journal of Cardiology最新文献

Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disease, mostly inherited in an autosomal dominant manner. It is a global heart disease with complex clinical phenotypes and gene expression. The prevalence rate in the population is 1:500-1:200. This article mainly introduces the diagnostic criteria, pathological manifestations, and genetic basis of HCM, which is the leading cause of sudden death in adolescents and athletes due to exercise, with 60%-70% showing familial clustering. It also discusses the latest progress in the relationship between different genotypes and clinical phenotypes of HCM patients.

Background: Cardiac myxoma, a benign intracardiac tumor, is traditionally excised via conventional sternotomy, which is invasive and associated with longer recovery times. Minimally invasive robotic surgery has emerged as a potential alternative, offering reduced trauma and faster recovery. This meta-analysis compares the efficacy and safety of robotic surgery vs conventional sternotomy for cardiac myxoma excision. We hypothesized that robotic surgery would provide comparable safety outcomes with improved postoperative recovery, such as shorter hospital stays and reduced transfusion rates, despite potentially longer operative times.

Aim: To assess robotic surgery vs sternotomy for cardiac myxoma regarding operative times, hospital stay, transfusions, and complications.

Methods: A systematic review was performed using EMBASE, OVID, Scopus, PubMed, Cochrane, and ScienceDirect databases to identify studies comparing robotic surgery and sternotomy for cardiac myxoma excision. Continuous outcomes were analyzed using mean differences (MDs), and categorical outcomes with odds ratios (ORs) and 95% confidence intervals (95%CIs). A random-effects model was used to pool data, accounting for study heterogeneity.

Results: Six studies involving 425 patients (180 robotic, 245 conventional) were included. Robotic surgery significantly increased cross-clamp time (MD = 12.03 minutes, 95%CI: 2.14-21.92, P = 0.02) and cardiopulmonary bypass time (MD = 28.37 minutes, 95%CI: 11.85-44.89, P = 0.001). It reduced hospital stay (MD = -1.86 days, 95%CI: -2.45 to -1.27, P < 0.00001) and blood transfusion requirements (OR = 0.30, 95%CI: 0.13-0.69, P = 0.007). No significant differences were observed in atrial arrhythmia (OR = 0.55, 95%CI: 0.27-1.12) or ventilation time (MD = -1.72 hours, 95%CI: -5.27 to 1.83, P = 0.34).

Conclusion: Robotic surgery for cardiac myxoma excision prolongs operative times but shortens hospital stays and reduces transfusion needs, suggesting enhanced recovery without compromising safety.

Background: Data on adsorptive extracorporeal membrane oxygenation (ECMO) (combined with HA380 hemoperfusion column) on the inflammatory factors in patients with cardiogenic shock (CS) remains limited.

Aim: To investigate the effects of adsorptive ECMO on the inflammatory factors in patients with CS.

Methods: A retrospective analysis was performed on 81 patients with CS caused by acute myocardial infarction, fulminant myocarditis, or cardiac surgery who required venoarterial ECMO support at TEDA International Cardiovascular Hospital from December 2020 to December 2024. Patients were divided into the conventional ECMO group (42 cases) and the adsorptive ECMO group (ECMO combined with hemoperfusion, 39 cases). The adsorptive ECMO group received 2 columns of HA380 initiation on the first day (the first column connected within 2 hours of ECMO and the second after 12 hours of ECMO), followed by 1 column each day, with each column used for 4-6 hours, totaling 24-30 hours of treatment. Baseline data were compared between the two groups: Inflammatory factor levels (at 0, 6, 12, 24, 48, and 72 hours after ECMO or hemoperfusion initiation); ECMO support duration; successful weaning rate; continuous renal replacement therapy (CRRT) utilization; Sequential Organ Failure Assessment (SOFA) score; Vasoactive-Inotropic Score (VIS); systemic inflammatory response syndrome (SIRS) incidence; and in-hospital survival and 30-/90-day survival after discharge.

Results: The adsorptive ECMO group showed significantly lower levels of C-reactive protein, interleukin (IL)-6, tumor necrosis factor (TNF)-α, and lactate from 6 to 72 hours compared with the conventional ECMO group (all P < 0.05), with IL-6 decreasing by 94.4% and tumour necrosis factor alpha by 70.1% from baseline at 72 hours. The adsorptive ECMO group had a significantly shorter ECMO duration [114.0 (75.0-139.0) hours vs 135.0 (73.0-199.3) hours, P = 0.032]; higher successful weaning rate (66.7% vs 42.9%, P = 0.032); a trend toward lower CRRT utilization (54.8% vs 38.5%, P = 0.070); lower post-weaning SOFA score [7 (6-8) vs 9 (8-10), P < 0.001]; significantly reduced VIS (8.4 ± 1.3 vs 9.8 ± 1.6, P < 0.001); and a trend toward lower SIRS incidence (10.3% vs 26.2%, P = 0.065). There were no significant differences in complications, in-hospital survival (64.1% vs 52.4%, P = 0.285); or 30-/90-day survival between the two groups (all P > 0.05).

Conclusion: Adsorptive ECMO efficiently clears IL-6 and TNF-α, significantly improving ECMO weaning success rate and hemodynamics. However, it has no significant impact on survival, and its efficacy requires validation through prospective studies.

Cardiovascular disease remains the leading global cause of mortality, projected to increase by 73.4% from 2025 to 2050 despite declining age-standardized rates. Contemporary interventions, such as percutaneous coronary intervention and statins, reduce major adverse cardiovascular events (MACE) by 25%-30%, yet a 20% five-year MACE risk persists in high-risk cohorts. These approaches, historically focused on luminal stenosis, fail to address systemic atherogenesis drivers like endothelial dysfunction and inflammation. Specifically, dietary linoleic acid restriction (< 5 g/day) reduces oxidized low-density lipoprotein by approximately 15% by limiting peroxidation-prone bisallylic bonds, mitigating arterial inflammation, a key atherogenic trigger. Enhanced external counterpulsation, through pulsatile shear stress, enhances nitric oxide-mediated coronary perfusion, alleviating angina in approximately 70% of refractory cases unresponsive to revascularization. Nanoparticle-facilitated chelation targets atherosclerotic plaques with precision, reducing calcium content by up to 30% in preclinical models, offering a novel avenue for lesion reversal. These innovations collectively address residual risk by tackling root causes, oxidative stress, endothelial dysfunction, and plaque instability, potentially halving MACE rates with widespread adoption. Despite promising preliminary data, gaps remain in long-term safety and scalability. Robust clinical trials are needed to validate these approaches, which collectively aim to transform cardiovascular disease management by prioritizing prevention and vascular restoration, potentially reducing coronary events to a public health rarity.

Background: Sex disparities in clinical outcomes following thoracic endovascular aortic repair (TEVAR) for acute complicated type B aortic dissection (TBAD) are not well understood.

Aim: To evaluates the impact of sex on primary and secondary outcomes by comparing male and female cohorts undergoing TEVAR.

Methods: A systematic search of PubMed, EMBASE, Cochrane Library, and ScienceDirect identified five studies involving 2572 patients (1153 males and 1419 females). The primary outcome was hospital mortality. Secondary outcomes included reintervention rates, acute kidney injury (AKI), ischemic stroke, limb ischemia, and spinal cord ischemia. Odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model. Heterogeneity was assessed using the I² statistic.

Results: The primary outcome showed no significant difference between males and females for hospital mortality (OR: 1.13, 95%CI: 0.81-1.59, P = 0.47, I ² = 0). Among secondary outcomes, males had a significantly higher risk of AKI (OR: 1.55, 95%CI: 1.21-2.00, P = 0.0006, I² = 0). No differences were observed for reintervention rates, ischemic stroke, limb ischemia, or spinal cord ischemia.

Conclusion: Male patients undergoing TEVAR for complicated TBAD are at increased risk of AKI but show comparable outcomes to females for mortality, ischemic events, reintervention, and other complications. Future research should explore mechanisms and strategies to optimize outcomes.

Mesenchymal stem cells (MSCs) possess unique properties such as immunomodulation, paracrine actions, multilineage differentiation, and self-renewal. Therefore, MSC-based cell therapy is an innovative approach to treating various degenerative illnesses, including cardiovascular diseases. However, several challenges, including low transplant survival rates, low migration to the ischemic myocardium, and poor tissue retention, restrict the application of MSCs in clinical settings. These undesirable cell therapy outcomes mainly originated due to the overproduction of reactive oxygen species (ROS) in the injured heart. MSCs' stress-coping capacity can be enhanced by preconditioning them under conditions similar to the microenvironment of wounded tissues. Hydrogen peroxide (H₂O₂) is a ROS that has been shown to activate protective cellular mechanisms such as survival, proliferation, migration, paracrine effects, and differentiation at sublethal doses. These processes are induced via phosphatidylinositol 3-kinase/protein kinase B, p38 mitogen-activated protein kinases, c-Jun N-terminal kinase, Janus kinase/signal transducer and activator of the transcription, Notch1, and Wnt signaling pathways. H₂O₂ preconditioning could lead to many clinical benefits, including ischemic injury reduction, enhanced survival of cellular transplants, and tissue regeneration. In this review, we present an overview of stem cell preconditioning methods and the biological functions activated by H₂O₂ preconditioning. Furthermore, this review explores the molecular mechanisms underlying the protective cellular functions stimulated under H₂O₂ preconditioning.

The ground-breaking development of the incretin agonists by manipulation of the incretin system, including the gut hormones glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), as well as the pancreatic hormone glucagon, has led to the emergence of promising pharmacotherapy for metabolic health. The GLP-1 receptor agonists (GLP-1RAs), namely liraglutide, dulaglutide, albiglutide, exenatide, and semaglutide, have been found to have beneficial effects on glycated hemoglobin, weight, lipid profile, and liver fat and thereby improving cardiometabolic health. Other drugs of the same group in development include Orforglipron, which has a high weight loss efficacy (-15% weight reduction). Long-acting GLP-1RAs in trials are Ecnoglutide, Efpeglenatide, TG103, and Visepegenatide. Many of these have cardiovascular benefits in terms of reduction in MACE (Non-fatal MI, Non-fatal stroke, and mortality). Tirzepatide is a dual GIP/GLP-1RA, the first drug of the group to be approved for diabetes and obesity with remarkably lower gastrointestinal side effects compared to GLP-1 monoagonists. The dual GLP-1/glucagon co-agonists cause tremendous weight loss due to the synergistic action. Most drugs in this class are long-acting and developed for once-weekly administration. The revolutionary triple agonists at the GLP-1, GIP, and Glucagon receptors have demonstrated the highest achievable weight loss with pharmacotherapy. Retatrutide and Efocipegtrutide belong to this novel group of drugs. The newer drugs in the broad category of incretin co-agonists include the GLP-1/amylin receptor agonist like CagriSema and Amycretin, oral GLP-1 agonists other than semaglutide, and the peptide YY/GLP-1 receptor dual agonists. The profound biochemical and weight loss outcomes associated with incretin co-/poly-agonists are expected to translate into outstanding cardiometabolic benefits, the theme of this evidence review.

Background: Pheochromocytoma, a rare catecholamine-secreting tumor, typically presents with the classic triad of headache, palpitations, and diaphoresis, often accompanied by cardiovascular manifestations. While vomiting occurs in approximately 34.5% of cases, it is rarely the predominant and persistent presenting symptom. Pheochromocytoma-induced cardiomyopathy leading to heart failure is a recognized but uncommon complication. Due to its heterogeneous presentations, misdiagnosis and diagnostic delay are frequent.

Case summary: A 53-year-old female presented predominantly with persistent and refractory vomiting as her chief complaint, accompanied by signs of acute heart failure [left ventricular ejection fraction (LVEF) 30%]. Initial evaluation at a primary hospital, including coronary angiography (revealing only mild stenosis), led to a misdiagnosis of coronary artery disease. Despite standard anti-thrombotic, anti-heart failure, and anti-emetic therapy, her vomiting persisted and heart failure did not resolve. Subsequent hospitalization revealed dramatic paroxysmal hypertension (202/129 mmHg to 97/51 mmHg) and fever. Significantly elevated plasma metanephrines and normetanephrine, combined with abdominal computed tomography and magnetic resonance imaging, confirmed a right adrenal pheochromocytoma. This diagnosis was significantly delayed due to the atypical prominence of gastrointestinal symptoms masking the underlying endocrine crisis.

Conclusion: This case highlights a highly atypical presentation of pheochromocytoma dominated by refractory vomiting and complicated by acute catecholamine-induced cardiomyopathy. It emphatically underscores that pheochromocytoma must be considered in the differential diagnosis for patients presenting with unexplained, treatment-resistant vomiting, particularly when co-existing with acute heart failure. The presence of labile hypertension, even if not initially evident, provides a crucial diagnostic clue. Prompt biochemical screening (catecholamine metabolites) and adrenal imaging are essential to prevent diagnostic delay and enable timely, life-saving surgical intervention.

Background: The integration of sophisticated large language models (LLMs) into healthcare has recently garnered significant attention due to their ability to leverage deep learning techniques to process vast datasets and generate contextually accurate, human-like responses. These models have been previously applied in medical diagnostics, such as in the evaluation of oral lesions. Given the high rate of missed diagnoses in pericarditis, LLMs may support clinicians in generating differential diagnoses-particularly in atypical cases where risk stratification and early identification are critical to preventing serious complications such as constrictive pericarditis and pericardial tamponade.

Aim: To compare the accuracy of LLMs in assisting the diagnosis of pericarditis as risk stratification tools.

Methods: A PubMed search was conducted using the keyword "pericarditis", applying filters for "case reports". Data from relevant cases were extracted. Inclusion criteria consisted of English-language reports involving patients aged 18 years or older with a confirmed diagnosis of acute pericarditis. The diagnostic capabilities of ChatGPT o1 and DeepThink-R1 were assessed by evaluating whether pericarditis was included in the top three differential diagnoses and as the sole provisional diagnosis. Each case was classified as either "yes" or "no" for inclusion.

Results: From the initial search, 220 studies were identified, of which 16 case reports met the inclusion criteria. In assessing risk stratification for acute pericarditis, ChatGPT o1 correctly identified the condition in 10 of 16 cases (62.5%) in the differential diagnosis and in 8 of 16 cases (50.0%) as the provisional diagnosis. DeepThink-R1 identified it in 8 of 16 cases (50.0%) and 6 of 16 cases (37.5%), respectively. ChatGPT o1 demonstrated higher accuracy than DeepThink-R1 in identifying pericarditis.

Conclusion: Further research with larger sample sizes and optimized prompt engineering is warranted to improve diagnostic accuracy, particularly in atypical presentations.

Elevated lipoprotein(a) [Lp(a)] is a major independent risk factor for atherosclerotic cardiovascular disease (ASCVD), with limited response to traditional lipid-lowering therapies. Lepodisiran, a novel N-acetylgalactosamine-conjugated small interfering RNA, targets hepatic LPA message RNA to reduce apolipoprotein(a) production. Early-phase trials demonstrated > 90% sustained Lp(a) reduction with excellent safety and tolerability. The phase 2 ALPACA trial confirmed durable effects lasting up to one year after biannual dosing. Compared to other therapies, lepodisiran offers longer duration, high efficacy, and minimal side effects. Ongoing phase 3 studies aim to determine its impact on cardiovascular outcomes, potentially establishing a new standard in precise ASCVD risk management.