JRSM Cardiovascular Disease最新文献

Background: Acute kidney injury (AKI) is increasingly associated with heart failure (HF), contributing to higher morbidity and mortality. Nonetheless, mortality remains under-explored. This study examines trends in AKI-related HF mortality trends among American adults.

Methods: We sourced data from 1999 to 2023 from the CDC WONDER multiple cause-of-death database for AKI-related HF mortality in adults aged ≥ over 25. We calculated age-adjusted mortality rates (AAMRs) per 1,000,000 persons for year and sex from 1999 to 2023 and from 1999 to 2020 for ethnicity, census region, and urbanization status, analyzing annual percent change across these stratifications.

Results: From 1999 to 2023, 284,599 AKI-related HF deaths occurred, with AAMR rising from 34.42 to 86.53. Between 1999 (34.42) and 2010 (50.5), the AAMRs increased modestly, followed by relative stability until 2019 (46.93); the steepest increase occurred between 2020 (51.52) and 2022 (91.59), with a modest decline observed in 2023 (86.53). Men consistently had higher AAMRs than women. Male AAMRs increased from 43.45 to 108.3, while female rates rose from 29.12 to 69.79. Non-Hispanic (NH) Blacks had the highest AAMR (54.18), followed by NH American Indian/Alaska Natives (52.49), NH Whites (45.74), Hispanics/Latinos (33.38), and NH Asians/Pacific Islanders (26.53). The Midwest had the highest AAMR (49.66), followed by the South (46.24), West (42.85), and Northeast (41.09). Rural areas showed higher AAMRs (56.81) than urban (42.91). North Dakota reported the highest AAMR (69.29), while Florida had the lowest (24.38).

Conclusion: While overall AAMRs were higher in 2023 compared to 1999, the sharpest rise was seen post-2020 after a period of relative stability from 2010 to 2019. AKI-related HF mortality remains disproportionately high among men, NH Blacks, and residents of the Midwestern and rural United States, highlighting the necessity of focused initiatives to address inequities and lower mortality.

Objective: Improved aortic surgery outcomes are linked to a broader comprehension of the pathogenesis of thromboembolic complications. This study aims to evaluate the involvement of cholesterol microcrystals and neutrophil extracellular traps (NETs) in postoperative thrombotic complications following open aortic surgery.

Methods: Aortic blood smears were examined precisely to identify the presence of cholesterol microcrystals (CMs) using polarized light microscopy, Coherent Anti-Stokes Raman spectroscopy (CARS), and fluorescence microscopy to detect NETs. The data obtained, including CMs quantity, perimeter, and NETs quantity, were evaluated as possible predictors of the postoperative complication rate.

Results: Fifty-five patients (85%) had an uneventful postoperative period, while 10 patients (15%) experienced early postoperative complications, there was a statistically significant positive correlation between the average perimeter of the CMs and the number of NETs in the blood smears in patients who experienced a complicated postoperative period (rho = 0.67; p = .03).

Conclusion: In some cases, complications in the early postoperative period after aortae surgery may be caused by CMs embolism (CE) of the distal vascular bed, accompanied by NETs-mediated thrombosis. The protocol for assessing arterial blood allows for the identification and evaluation of CMs and NETs characteristics as predictors of perioperative thromboembolic complications.

Objective: Carotid artery intima-media thickness (CIMT) is a non-invasive marker of subclinical atherosclerosis and a predictor of coronary heart disease (CHD). This study aimed (1) to recalibrate the Framingham Risk Score (FRS) using Sri Lankan population data and (2) to evaluate the association between the recalibrated FRS models and carotid artery CIMT measurements.

Design setting and participants: A sample of 356 participants aged 40-74 with no CHD history was selected from a tertiary hospital in Sri Lanka. The first published FRS equation, β-coefficients, 10-year CHD-free survival rates (separately for all ages (model 1) and for 40-74 years (model 2)), and local risk factor prevalence were used for recalibration. CIMT was measured in mm by ultrasonography, and a composite CIMT score was derived.

Main outcome measure: Association between recalibrated FRS models and CIMT.

Results: The mean age of the sample was 58.7 ± 10.1 years (52.5% male). The original FRS (oFRS) categorised more participants into higher 10-year-CHD risk groups than the recalibrated FRS (rFRS) models. Among males, 30.5% and among females, 68.0% had consistent classifications across all models. CIMT-values differed significantly by risk category for both oFRS and rFRS models (P<.05), with rFRS models showing higher CIMT-values. The composite carotid scores (ACA-CIMT and ACA-Max) were positively correlated with all FRS models (P=.001). CIMT values were higher in recalibrated models, with model 1 showing higher values than model 2 in males.

Conclusions: The recalibrated FRS models provided lower overall CHD risk estimates while maintaining stronger associations with CIMT than the original FRS, supporting their improved applicability for CHD risk prediction in the Sri Lankan population.

Arrhythmias are common during pregnancy and, although most are benign, they are associated with increased rates of maternal and fetal morbidity and mortality. The most frequent arrhythmias during pregnancy are sinus tachycardia and premature atrial complexes or ventricular complexes, which are often benign and resolve post-partum. However, tachyarrhythmias such as supraventricular tachycardia, atrial fibrillation and ventricular tachycardia are also more prevalent in pregnancy and require careful management, as they are associated with adverse maternal and fetal outcomes. A systematic approach to diagnosis is essential to identify the women with benign conditions and those with serious pathology. This involves thorough history taking, including past medical and family history, physical examination, and consideration of additional investigations such as electrocardiograms. The key diagnostic test is often a heart rhythm recording at the time of symptoms. When an arrhythmia has been identified, management strategies must balance maternal health with fetal safety. Beta-blockers, the first-line pharmacological treatment for many symptomatic arrhythmias, are not teratogenic but are associated with fetal growth restriction. Adenosine, flecainide, calcium channel blockers, digoxin and sotalol can also be safely used. Electrical cardioversion is safe at all stages of pregnancy and should not be delayed in emergencies. Procedures, such as the implantation of cardiac devices or ablations, can also be performed during pregnancy. Arrhythmias during pregnancy require individualised and multidisciplinary management plans to ensure optimal outcomes for both mother and fetus. This narrative review discusses the diagnosis and management of arrhythmias in pregnancy, including diagnostic work-up, pharmacological therapy, cardiac devices and electrophysiological procedures.

Atrial fibrillation (AF) is a clinically heterogeneous syndrome where traditional 'one-size-fits-all' management strategies are often suboptimal. This review synthesizes the contemporary application of machine learning (ML) and deep learning (DL) in identifying distinct clinical AF phenotypes to advance personalized treatment. We provide a comprehensive overview of over a dozen key phenotyping studies, highlighting the consistent identification of core patient subgroups across diverse international cohorts, including low-risk/younger, atherosclerotic/high-cardiovascular-risk, and elderly/multi-morbid phenotypes. A detailed comparative summary of these studies, their methodologies, and their prognostic findings is presented. Our review also illustrates how these data-driven phenotypes are being leveraged to guide personalized therapy. We detail specific ML applications in optimizing medication selection and dosing, particularly for anticoagulants, and in advancing catheter ablation strategies. Key innovations in ablation include AI-guided anatomical mapping, in silico simulation with 'cardiac digital twins' to test lesion sets pre-procedurally, and the identification of non-invasive predictors for procedural success. Finally, we discuss how phenotyping informs tailored lifestyle and risk factor management. While ML-driven phenotyping demonstrates powerful prognostic value, challenges in prospective validation, clinical integration, and model interpretability remain. This review concludes that a phenotype-guided approach holds transformative potential to move AF management towards a new era of precision medicine, improving outcomes by tailoring interventions to an individual's unique clinical profile.

Pro-adrenomedullin (proADM) involved in cardiovascular hemostasis, has shown promise as a prognostic biomarker in heart failure (HF). However, it's precise role in predicting HF outcomes has yet to be defined. We conducted a systematic review and meta-analysis to determine whether proADM can effectively predict outcomes in patients with HF. We systemtically searched Pubmed, Cochrane, Web of Science, and Scopus for studies on proADM levels in adults (≥18 years) diagnosed with HF. Cohort studies, case-control studies, and randomized controlled trials were considered. The primary outcomes were mortality and hospitalization, with the risk of bias assessed using the QUIPs tool. A random effects meta-analysis was conducted to report pooled hazard ratio (HR) and 95% confidence intervals. Our search identified 956 studies, of which 25 met the inclusion criteria after full-text screening, encompassing a total of 13,915 patients. ProADM emerged as a robust predictor of mortality (HR = 2.46, 95% CI [2.02-3.01]) and combined mortality/hospitalization (HR = 2.96, 95% CI [2.17-4.04]). Notably, each 1-log-unit (nmol/L) increase in proADM was associated with a 196% higher risk of mortality or hospitalization and a 146% higher risk of mortality. ProADM shows significant potential as a prognostic biomarker for HF, with elevated levels linked to a higher risk of mortality and hospitalization. Future research should focus on integrating proADM into risk assessment tools for predicting worsening HF events, as this could influence management guidelines and reshape our approach to treating HF patients.

Objectives: Myocarditis may lead to persistent myocardial impairment. We evaluated whether admission troponin I and inflammatory biomarkers predict one-year myocardial impairment using global longitudinal strain (GLS) as the reference outcome.

Design: Prospective, single-center cohort study (2013-2023); approved by the Kaplan Medical Center Institutional Review Board (KMC-10-0068).

Setting: Kaplan Medical Center, Israel.

Participants: A total of 115 patients were admitted with myocarditis, defined by ESC criteria.

Main outcome measures: Admission biomarkers included troponin I (pg/mL), white blood cells (WBC; × 10⁹/L), C-reactive protein (CRP; mg/L), and erythrocyte sedimentation rate (ESR; mm/h). One-year myocardial function was assessed by speckle-tracking echocardiography. Impairment was defined as GLS > -19.5%. Predictive performance was evaluated with Firth logistic regression and ROC analysis.

Results: Myocardial impairment occurred in 22.6% (26/115). Median troponin I was higher in impaired versus non-impaired patients (11,517 vs 5918 pg/mL; p < 0.001). WBC was elevated (12.79 vs 9.90 × 10⁹/L; p < 0.001), with higher CRP (11.44 vs 9.05 mg/L; p = 0.031) and ESR (36 vs 21 mm/h; p = 0.04). In multivariable models, troponin I (coefficient 0.000526; p < 0.001), WBC (0.273; p = 0.001), CRP (0.065; p = 0.031), and LV E/E' lateral (0.347; p = 0.009) remained independent predictors, while ESR trended (0.0178; p = 0.057). Discrimination was strongest for troponin I (AUC 0.930, 95% CI 0.726-0.933), followed by WBC (0.756), CRP (0.756), and ESR (0.723).

Conclusions: Admission troponin I provides the strongest predictive value for one-year myocardial impairment in myocarditis, with complementary contributions from WBC, CRP, and LV E/E'. These accessible measures support early risk stratification where advanced imaging is limited.

Background & aim: Previous studies link marital status to mortality across diverse populations. This study examines how sex influences its association with all-cause, cardiovascular disease (CVD), and cancer mortality.

Method: The search was conducted through PubMed, Scopus, and Google Scholar databases and included related articles up to September 16, 2025. The titles, abstracts, and full texts of the included articles were reviewed, and data were extracted and analyzed.

Result: Twelve cohort studies (1,785,857 individuals) were analyzed. Unmarried status was significantly associated with an increased risk of all-cause, CVD, and cancer mortality. Specifically, single individuals showed a higher risk of all-cause (hazard ratio [HR]: 1.55, 95% CI: 1.37-1.74), cancer (HR: 1.14, 95% CI: 1.07-1.22), and CVD mortality (HR: 1.52, 95% CI: 1.28-1.84). Divorced individuals had an increased risk of all-cause (HR: 1.39, 95% CI: 1.12-1.66) and CVD mortality (HR: 1.27, 95% CI: 1.02-1.52). Widowed individuals showed a higher risk of all-cause (HR: 1.43, 95% CI: 1.11-1.74), cancer (HR: 1.13, 95% CI: 1.03-1.23), and CVD mortality (HR: 1.67, 95% CI: 1.23-2.10).

Conclusion: Unmarried status is significantly associated with an increased risk of all-cause, cancer, and CVD mortality. The association between marital status and mortality differs by sex and geographic region. For instance, the link between divorced status and all-cause mortality is significantly stronger in men, while the association between single status and cancer mortality is significantly stronger in women. These findings highlight the importance of considering sex and regional differences in public health interventions.

Background: Timely fibrinolysis remains the cornerstone of reperfusion for ST-elevation myocardial infarction (STEMI) in settings without reliable access to primary percutaneous coronary intervention (PCI). International guidelines recommend a door-to-needle time (DTNT) of 30 min or less.

Aim: We conducted the first continent-wide meta-analysis to quantify real-world DTNTs and adherence to guideline benchmarks in African hospitals.

Methods: We systematically searched PubMed/MEDLINE, Scopus, and Web of Science through July 2, 2025, for studies reporting DTNT for adult STEMI patients treated with thrombolysis in Africa. Pooled mean DTNT was estimated via random-effects meta-analysis with restricted maximum likelihood and Knapp-Hartung adjustment. Heterogeneity was assessed by Cochran's Q and I ², and sensitivity analyses evaluated robustness.

Results: Across 12 eligible studies encompassing a total of 2193 STEMI patients, about 1261 individuals (57.5%) received thrombolytic therapy. Among the 11 studies reporting mean reperfusion times (1011 patients), the overall pooled mean DTNT was 74.8 min (95% confidence interval: 44.4-105.2; I ² = 99.4%), substantially exceeding the recommended benchmark. Notably, only 36.3% of thrombolyzed patients achieved a DTNT of ≤30 min. Furthermore, none of the included study cohorts reported an overall mean DTNT within 30 min.

Conclusion: African STEMI patients experience door-to-needle delays more than twice the guideline target, with fewer than 4 in 10 receiving timely fibrinolysis. In such settings lacking widespread PCI, implementation of standardized reperfusion protocols, optimized in-hospital workflows, and targeted quality-improvement initiatives is urgently needed to accelerate fibrinolysis, maximize myocardial salvage, and reduce adverse cardiovascular outcomes.

Background: Dilated cardiomyopathy is defined by left ventricular dilatation and systolic dysfunction and may rarely be complicated by left ventricular thrombi, which carry a significant risk of systemic embolization.

Case presentation: A 77-year-old woman with dyslipidemia and depression presented with progressive dyspnea (NYHA IV) and palpitations. Transthoracic echocardiography revealed severe biventricular dysfunction (left ventricular ejection fraction 24%) and multiple partially mobile thrombi in the left ventricular. Coronary angiography excluded obstructive coronary artery disease, and cardiac magnetic resonance confirmed severe left ventricular dilatation, diffuse hypokinesia, extensive fibrosis, and thrombotic appositions. Secondary causes of dilated cardiomyopathy and thrombophilia were excluded; genetic testing revealed a heterozygous BAG3 variant.

Management: The patient was treated with intravenous diuretics, non-invasive ventilation, unfractionated heparin followed by apixaban, and guideline-directed medical therapy for heart failure, including a beta-blocker, angiotensin receptor-neprilysin inhibitor, MRA, and SGLT2 inhibitor. Serial imaging at 7 days showed a reduction of thrombotic burden, with complete resolution confirmed at 2-month follow-up.

Outcome: At 4-month follow-up, the patient was asymptomatic (NYHA I-II) with improved left ventricular ejection fraction (35%) and no documented arrhythmias. Given functional recovery and absence of significant conduction delay, device implantation was not indicated.

Conclusion: This case highlights the importance of early recognition and prompt anticoagulation in dilated cardiomyopathy complicated by left ventricular thrombi. A structured diagnostic and therapeutic strategy-integrating multimodality imaging, exclusion of secondary causes, and genetic assessment-can lead to complete thrombus resolution and favorable remodeling.