IJC Heart and Vasculature最新文献_第7页

Individualized paced deep breathing training with autonomic nervous function as rehab targets in patients with chronic heart failure: a randomized clinical trial 以自主神经功能为康复目标的个体化节奏深呼吸训练在慢性心力衰竭患者中的应用：一项随机临床试验

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-10-16 DOI: 10.1016/j.ijcha.2025.101800

Xiaoling Liu , Ziwei Shan , Ting Shen , Megan Lo , Lin Luo , Qifan Sun , Lemin Wang , Guanghe Li , Yumei Jiang , Dejie Li , Mengyi Zhan , Liang Zheng , Jiankang Wu , Yuqin Shen

Background

The autonomic imbalance and low vagal tone are common characteristic among patients with chronic heart failure (CHF). It is hypothesized that CHF rehabilitation programs targeting autonomic nerves system (ANS) function may offer greater efficacy for CHF management. This trial represents the first attempt to investigate such an approach.

Methods

This is a randomized controlled trial aimed to examine the effectiveness of individualized paced deep breathing training (IBT) in CHF patients, with ANS measures as rehabilitation targets. Patients in the IBT group received an additional 4-week program of IBT alongside their standard rehabilitation care. The cardiopulmonary resonance index (CRI), 6-Minute Walking Distance (6MWD) and the Minnesota Quality of Life Score Questionnaire (MLHFQ) were assessed at baseline (T1) and after 4 weeks (T2).

Results

All 38 participants completed the trial successfully. Participants in the IBT group showed significant improvements in CRI, including enhancements in respiratory stability (RS), cardiopulmonary resonance amplitude (CRA), cardiopulmonary resonance factor (CRF), cardiopulmonary coupling coefficient (CPC), and the Spearman’s Rank Correlation Coefficient between Respiratory Rate and Heart Rate (CRS). Further, improvements in both 6MWD and MLHFQ scores were observed. [Multiple linear regression analysis results showed correlations between RS and white blood cell (r = 0.924), CRF and procalcitonin (r = 0.733) and serum creatinine (r = 0.494), as well as CRS and glycosylated hemoglobin (r = 0.819)].

Conclusions

These findings demonstrate that IBT is a feasible and effective rehabilitation approach for CHF patients with ANS measures as target. The IBT program here also showed therapist efficiency and good patients compliance.

背景：自主神经失衡和迷走神经张力低是慢性心力衰竭（CHF）患者的共同特征。假设针对自主神经系统（ANS）功能的CHF康复计划可能对CHF管理提供更大的疗效。这项试验是对这种方法进行研究的首次尝试。方法本研究是一项随机对照试验，旨在研究个体化有节奏深呼吸训练（IBT）在CHF患者中的有效性，以ANS措施为康复目标。IBT组患者在接受标准康复治疗的同时，还接受了额外的4周IBT治疗。分别在基线（T1）和4周后（T2）评估心肺共振指数（CRI）、6分钟步行距离（6MWD）和明尼苏达州生活质量评分问卷（MLHFQ）。结果38例受试者均成功完成试验。IBT组患者的CRI有显著改善，包括呼吸稳定性（RS）、心肺共振幅度（CRA）、心肺共振因子（CRF）、心肺耦合系数（CPC）和呼吸速率与心率（CRS）之间的Spearman秩相关系数的增强。此外，观察到6MWD和MLHFQ评分均有改善。[多元线性回归分析结果显示，RS与白细胞（r = 0.924）、CRF与降钙素原（r = 0.733）、血清肌酐（r = 0.494）、CRS与糖化血红蛋白（r = 0.819）呈正相关]。结论以ANS措施为目标，IBT是一种可行、有效的CHF患者康复方法。这里的IBT项目也显示出治疗师的效率和良好的患者依从性。

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引用次数: 0

Modified body mass index as a novel prognostic indicator of in-hospital mortality after off-pump coronary artery bypass grafting: A nationwide multicenter cohort study 改良体重指数作为非体外循环冠状动脉旁路移植术后住院死亡率的新预后指标：一项全国多中心队列研究

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-10-15 DOI: 10.1016/j.ijcha.2025.101823

Shipan Wang , Yilin Li , Hao Han , Tianxu Han , Zhiran Yang , Youjin Li , Haiping Yang , Hongli Li , Gang Liu , Minjia Zhu , Jian Huang , Qingwu Zhao , Jihong Liu , Haibin Li , Shuaitong Zhang , Yuan Xue , Hongjia Zhang , Haiyang Li

Background

Malnutrition is a prevalent yet underrecognized comorbidity in coronary artery bypass grafting (CABG) patients. Modified BMI (mBMI), defined as albumin × BMI, has been proposed as a more accurate indicator of nutritional risk. This study examined the association between preoperative mBMI and in-hospital outcomes following Off-pump CABG (OPCABG).

Methods

This retrospective cohort study included patients with coronary artery disease who underwent isolated OPCABG at eight cardiac centers. Patients were stratified into tertiles based on preoperative mBMI values. The primary endpoint was in-hospital mortality. Logistic regression and restricted cubic spline models were used to evaluate the association between mBMI and outcomes. Subgroup analyses were performed based on clinical characteristics including sex, age, renal function, and comorbidity burden.

Results

Among 6,667 patients, the lowest mBMI tertile had higher in-hospital mortality (2.52 % vs 1.53 % vs 1.17 %), cerebral infarction (2.48 % vs 2.34 % vs 1.39 %), and dialysis rates (1.04 % vs 0.54 % vs 0.36 %) compared to higher tertiles (all P < 0.05). Restricted cubic spline analysis revealed an inverse association between mBMI and the odds of in-hospital mortality, with the lowest risk observed around mBMI 1300–1350. Subgroup analyses demonstrated this relationship was particularly significant among females, patients with eGFR ≤ 90, and those with ASA score > 3 (P for association = 0.023, 0.013, and 0.049, respectively).

Conclusion

Lower mBMI is associated with an increased risk of in-hospital mortality and multiple adverse outcomes in patients undergoing OPCABG, particularly among females and those with renal impairment or systemic comorbidities.

Trial registration: Chinese Clinical Trial Registry: Chictr2400085741.

背景：营养不良是冠状动脉旁路移植术（CABG）患者普遍存在但尚未得到充分认识的合并症。修正BMI (mBMI)，定义为白蛋白× BMI，被认为是更准确的营养风险指标。本研究探讨了术前mBMI与非体外循环冠状动脉搭桥（OPCABG）后住院预后之间的关系。方法本回顾性队列研究纳入了在8个心脏中心行孤立性冠状动脉冠脉搭桥术的冠心病患者。根据术前mBMI值将患者分层。主要终点是住院死亡率。使用Logistic回归和受限三次样条模型来评估mBMI与预后之间的关系。根据临床特征进行亚组分析，包括性别、年龄、肾功能和合并症负担。结果在6667例患者中，最低mBMI组的住院死亡率（2.52% vs 1.53% vs 1.17%）、脑梗死（2.48% vs 2.34% vs 1.39%）和透析率（1.04% vs 0.54% vs 0.36%）均高于较高mBMI组（P均为0.05）。限制性三次样条分析显示mBMI与住院死亡率之间呈负相关，在mBMI 1300-1350附近观察到最低风险。亚组分析显示，这种关系在女性、eGFR≤90的患者和ASA评分为>； 3的患者中尤为显著（相关性P分别为0.023、0.013和0.049）。结论：较低的mBMI与OPCABG患者住院死亡率和多种不良结局的风险增加有关，特别是在女性和肾脏损害或全身性合并症患者中。试验注册：中国临床试验注册中心：Chictr2400085741。

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引用次数: 0

Peri-procedural respiratory complications in patients undergoing pulmonary vein isolation under procedural sedation and analgesia: Incidence and predictive factors 术中镇静镇痛下肺静脉隔离患者术中呼吸并发症的发生率及预测因素

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-10-14 DOI: 10.1016/j.ijcha.2025.101822

Marloes Homberg , Konstanze Betz , Sander M.J. van Kuijk , Justin Luermans , E.A. Joosten , Wolfgang Buhre , Ulrich Schotten , Kevin Vernooy , Dominik Linz , Esther Bouman

Background and Objectives

Catheter ablation (CA) in patients with atrial fibrillation (AF) can be performed under procedural sedation and analgesia (PSA). Risk factors for respiratory complications during PSA are unclear. We aimed to determine the incidence and severity of respiratory complications during PSA and identify predictive factors for development of per-procedural respiratory complications.

Methods

Patients with AF receiving PSA in the MUMC⁺ for CA were included. Respiratory complications were defined as the need of an oral/nasal airway, a non-rebreathing mask, high flow oxygen, a hypoxemic event or conversion to general anaesthesia.

Results

In total 232 procedures (42.2 % cryoballoon ablation; 57.3 % RF ablation) were performed. Most patients were male (62.1 %), with a mean age of 64 ± 9.3 (mean ± SD), an activity level ≥ 4 METS (94.8 %) and paroxysmal AF (68.5 %). Respiratory complications occurred in 42.2 %. A multiple logistic regression model including sedation duration, age > 50 years, neck circumference > 40 cm, visceral fat percentage, self-reported tiredness, apnoea hypopnoea index (AHI), medical background of diagnosed sleep apnoea (OSAS) and chronic obstructive pulmonary disease (COPD) identified patients at risk with an AUROC 0.72, 95 % CI: 0.65–0.78.

Conclusion

In patients with AF undergoing CA under PSA, per-procedural respiratory complications occur in 42.2 % of the cases. Duration of the PSA, a neck circumference > 40 cm, visceral fat percentage, tiredness, AHI, OSAS and COPD may help to identify patients at risk for per-procedural respiratory complications. Although age > 50 years is a recognized risk factor, this cut-off had limited discriminative value in our cohort, as most patients were older than 50.

背景与目的心房颤动（AF）患者的导管消融（CA）可以在程序性镇静镇痛（PSA）下进行。PSA期间呼吸系统并发症的危险因素尚不清楚。我们的目的是确定PSA期间呼吸并发症的发生率和严重程度，并确定手术前呼吸并发症发生的预测因素。方法纳入在CA的MUMC+中接受PSA的AF患者。呼吸并发症定义为需要口/鼻气道，非再呼吸面罩，高流量氧气，低氧事件或转换为全身麻醉。结果共行232例手术，其中低温球囊消融占42.2%，射频消融占57.3%。大多数患者为男性（62.1%），平均年龄为64±9.3 (mean±SD)，活动水平≥4 METS(94.8%)，阵发性房颤（68.5%）。呼吸道并发症发生率为42.2%。包括镇静时间、年龄（50岁）、颈围（40厘米）、内脏脂肪百分比、自我报告的疲倦程度、呼吸暂停低通气指数（AHI）、诊断为睡眠呼吸暂停（OSAS）和慢性阻塞性肺疾病（COPD）的医学背景在内的多元logistic回归模型确定了患者的AUROC为0.72,95% CI为0.65-0.78。结论在PSA下行CA的房颤患者中，42.2%的患者出现术中呼吸系统并发症。PSA持续时间、颈围40厘米、内脏脂肪百分比、疲劳程度、AHI、OSAS和COPD可能有助于识别有手术前呼吸系统并发症风险的患者。虽然年龄50岁是公认的危险因素，但由于大多数患者年龄超过50岁，这一截止值在我们的队列中具有有限的判别价值。

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引用次数: 0

Recent highlights from the International Journal of Cardiology Heart & Vasculature: Stroke prevention and rhythm control in patients with atrial fibrillation 国际心脏病学杂志心脏与脉管系统的最新亮点：房颤患者的卒中预防和节律控制

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-10-11 DOI: 10.1016/j.ijcha.2025.101816

Dominik Linz , Dobromir Dobrev

引用次数: 0

Role of miR-21-5p in the pathogenesis of abdominal aortic aneurysm regarding the Th17 pathway miR-21-5p在腹主动脉瘤Th17通路发病中的作用

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-10-09 DOI: 10.1016/j.ijcha.2025.101821

Dorota Studzińska , Sabina Lichołai , Kamil Polok , Hanna Plutecka , Piotr Kica , Piotr Grazda , Maciej Chwała , Marek Sanak , Wojciech Szczeklik

Background and aims

The interplay between Th17-related immune activity and miRNA-driven regulation in abdominal aortic aneurysm (AAA) pathogenesis remains poorly understood. In this prospective study, we aimed to assess the potential role of miR-21-5p corresponding to the Th17 pathway disturbances in the development of AAA.

Methods

Biological samples were collected from patients with true infrarenal AAA, undergoing elective open abdominal aortic surgery, and patients with peripheral arterial disease (PAD) without concomitant aneurysms on the day of hospital admission for surgery. A fragment of aneurysmal abdominal aortic tissue was collected from patients intraoperatively. Total RNA was extracted from the samples, and the expression level of miR-21-5p and selected markers associated with Th17 pathway were assessed using quantitative real-time PCR (RT-qPCR) and Luminex assays, respectively. Moreover, we performed an in vitro model using human endothelial cells, transfected with a synthetic miR-21-5p mimic.

Results

We included 60 patients (30 in the study group and 30 in the control group, selected based on the propensity score matching method). Circulating miR-21-5p levels were significantly higher in AAA patients compared to controls. miR-21-5p downregulates genes involved in endothelial development, regulation of vascular permeability, or endothelial cell response to growth factors. We demonstrated that the Th17 circulating mediators were higher among AAA patients compared to controls, and were higher in the middle part of the aneurysmal aorta when compared to its upper pole.

Conclusion

Our study showed that, regarding AAA pathogenesis, endothelial dysfunction followed by inflammation could be mediated by an increased level of miR-21-5p.

背景与目的在腹主动脉瘤（AAA）发病机制中，th17相关免疫活性与mirna驱动调控之间的相互作用尚不清楚。在这项前瞻性研究中，我们旨在评估Th17通路紊乱对应的miR-21-5p在AAA发展中的潜在作用。方法在住院当天收集真肾下AAA患者、择期腹主动脉开腹手术患者和未伴有动脉瘤的外周动脉疾病（PAD）患者的生物学样本。术中收集患者腹主动脉动脉瘤组织碎片。从样本中提取总RNA，分别使用实时荧光定量PCR （RT-qPCR）和Luminex检测方法评估miR-21-5p和Th17通路相关标记物的表达水平。此外，我们使用人内皮细胞进行了体外模型，转染了合成的miR-21-5p模拟物。结果纳入60例患者，其中研究组30例，对照组30例，采用倾向评分匹配法。与对照组相比，AAA患者的循环miR-21-5p水平显著升高。miR-21-5p下调参与内皮发育、血管通透性调节或内皮细胞对生长因子反应的基因。我们发现，AAA患者的Th17循环介质含量高于对照组，动脉瘤主动脉中部的Th17循环介质含量高于上极。结论我们的研究表明，在AAA的发病机制中，miR-21-5p水平升高可能介导内皮功能障碍随后的炎症。

{"title":"Role of miR-21-5p in the pathogenesis of abdominal aortic aneurysm regarding the Th17 pathway","authors":"Dorota Studzińska , Sabina Lichołai , Kamil Polok , Hanna Plutecka , Piotr Kica , Piotr Grazda , Maciej Chwała , Marek Sanak , Wojciech Szczeklik","doi":"10.1016/j.ijcha.2025.101821","DOIUrl":"10.1016/j.ijcha.2025.101821","url":null,"abstract":"<div><h3>Background and aims</h3><div>The interplay between Th17-related immune activity and miRNA-driven regulation in abdominal aortic aneurysm (AAA) pathogenesis remains poorly understood. In this prospective study, we aimed to assess the potential role of miR-21-5p corresponding to the Th17 pathway disturbances in the development of AAA.</div></div><div><h3>Methods</h3><div>Biological samples were collected from patients with true infrarenal AAA, undergoing elective open abdominal aortic surgery, and patients with peripheral arterial disease (PAD) without concomitant aneurysms on the day of hospital admission for surgery. A fragment of aneurysmal abdominal aortic tissue was collected from patients intraoperatively. Total RNA was extracted from the samples, and the expression level of miR-21-5p and selected markers associated with Th17 pathway were assessed using quantitative real-time PCR (RT-qPCR) and Luminex assays, respectively. Moreover, we performed an in vitro model using human endothelial cells, transfected with a synthetic miR-21-5p mimic.</div></div><div><h3>Results</h3><div>We included 60 patients (30 in the study group and 30 in the control group, selected based on the propensity score matching method). Circulating miR-21-5p levels were significantly higher in AAA patients compared to controls. miR-21-5p downregulates genes involved in endothelial development, regulation of vascular permeability, or endothelial cell response to growth factors. We demonstrated that the Th17 circulating mediators were higher among AAA patients compared to controls, and were higher in the middle part of the aneurysmal aorta when compared to its upper pole.</div></div><div><h3>Conclusion</h3><div>Our study showed that, regarding AAA pathogenesis, endothelial dysfunction followed by inflammation could be mediated by an increased level of miR-21-5p.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101821"},"PeriodicalIF":2.5,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Increased dipeptidyl peptidase 4 in patients with concomitant transthyretin cardiac amyloidosis and severe aortic stenosis 二肽基肽酶4在合并转甲状腺素型心脏淀粉样变性和严重主动脉瓣狭窄患者中的升高

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-10-08 DOI: 10.1016/j.ijcha.2025.101820

Margrethe Flesvig Holt , Annika E. Michelsen , August Flø , Kristoffer Russell , Jan Otto Beitnes , Sophie Foss Kløve , Anders Hodt , Lars Gullestad , Pål Aukrust , Einar Gude , Kaspar Broch , Thor Ueland

Background

Due to overlapping symptoms and signs, it can be challenging to diagnose transthyretin amyloid cardiomyopathy (ATTR-CM) in the setting of concomitant aortic stenosis. Biomarkers may discriminate between heart failure with ATTR-CM and heart failure without ATTR-CM, but it is not known if these markers can differentiate between AS with and AS without concomitant ATTR-CM.

Methods

In 9 patients with ATTR-CM and AS, 161 patients with lone AS, and 23 healthy controls, we measured 8 plasma proteins previously identified by proteomic analysis as potential candidates for diagnosing ATTR-CM. We assessed differences between groups and association with indices of heart failure and AS severity.

Results

Plasma levels of dipeptidyl peptidase 4 (DPP4) were significantly higher in patients with AS and ATTR-CM than in patients with lone AS and in healthy controls. Lower levels of DPP4 were also associated with worse left ventricular function, higher New York Heart Association functional class, and low-flow, low-gradient aortic stenosis.

Conclusions

Our findings suggest that DPP4 may be a marker of ATTR-CM in patients with severe AS. In all AS patients, those with and without coexisting ATTR-CM, high DPP4 levels were asociated with better cardiac function.

背景：由于症状和体征重叠，在合并主动脉狭窄的情况下诊断转甲状腺素淀粉样心肌病（atr - cm）可能具有挑战性。生物标志物可以区分合并atr - cm的心力衰竭和不合并atr - cm的心力衰竭，但尚不清楚这些标志物是否可以区分合并atr - cm的AS和不合并atr - cm的AS。方法在9例atr - cm合并AS患者、161例单独AS患者和23例健康对照中，检测了8种先前通过蛋白质组学分析确定的可能用于诊断atr - cm的血浆蛋白。我们评估了各组之间的差异以及与心力衰竭和AS严重程度指标的关联。结果AS合并atr - cm患者血浆二肽基肽酶4 （DPP4）水平明显高于单纯AS患者和健康对照组。较低水平的DPP4也与较差的左心室功能、较高的纽约心脏协会功能等级和低流量、低梯度主动脉瓣狭窄相关。结论DPP4可能是重度AS患者atr - cm的标志物。在所有AS患者中，无论是否伴有atr - cm，高DPP4水平与更好的心功能相关。

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引用次数: 0

Left atrial appendage thrombi despite oral anticoagulation in transthyretin amyloid cardiomyopathy patients undergoing electrical cardioversion for atrial fibrillation or − flutter 经甲状腺蛋白淀粉样心肌病患者因房颤或心房扑动而接受电转复的左心房附件血栓，尽管口服抗凝

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-10-08 DOI: 10.1016/j.ijcha.2025.101790

Michael Poledniczek , Christina Kronberger , Bernhard Gregshammer, Luca List, Robin Willixhofer, Nikita Ermolaev, Franz Duca, René Rettl, Christina Binder, Luciana Camuz Ligios, Christian Nitsche, Mahshid Eslami, Senta Graf, Stefan Kastl, Johannes Kastner, Roza Badr Eslam, Christian Hengstenberg, Andreas Kammerlander, Jutta Bergler-Klein

Background

Patients with cardiac amyloidosis undergoing direct current electrical cardioversion (DCCV) are at risk of left atrial appendage thrombus (LAAT). We investigated LAAT formation rates, success rates, and long-term recurrence rates in transthyretin amyloid cardiomyopathy (ATTR-CM) patients.

Methods

ATTR-CM patients scheduled to undergo DCCV were included in the study. LAAT exclusion was performed utilizing transesophageal echocardiography or computed tomography.

Results

A total of 62 (1.35 per patient) DCCVs were recorded among 46 patients (77 ± 6.5 years, 89 % male) with ATTR-CM. In 39 DCCVs, LAAT exclusion was performed (62.9 %). In total, 10 DCCVs (16.1 %) were canceled due to (I) spontaneous conversion to sinus rhythm (n = 2, 5.1 %) or (II) definitive/suspected LAAT (n = 8, 20.5 %). Of these, five patients with LAAT had been receiving sufficient doses of oral anticoagulants for more than three weeks prior to DCCV. The immediate success rate was 92.3 %, and 3-month rhythm control was achieved in 27 (62.8 %) procedures. Notably, one stroke event was recorded two months following DCCV.

Conclusion

A high rate of left atrial appendage thrombus was observed in ATTR-CM, leading to DCCV cancellation in 20.5% of patients. Despite a high immediate success rate (92.3%), sustained sinus rhythm control was achieved in only 62.8% following DCCV. These findings advise using TEE or CT prior to DCCV to exclude LAAT in ATTR-CM patients, even in those with oral anticoagulation.

背景：心脏淀粉样变性患者行直流电转复术（DCCV）有左房附件血栓（LAAT）的危险。我们研究了转甲状腺素淀粉样心肌病（atr - cm）患者的LAAT形成率、成功率和长期复发率。方法纳入计划行DCCV的sattr - cm患者。利用经食管超声心动图或计算机断层扫描进行LAAT排除。结果46例atr - cm患者（77±6.5岁，男性89%）共发生62例（1.35例/例）dccv。在39例dccv中，LAAT排除（62.9%）。总共有10例dccv（16.1%）由于(I)自发转化为窦性心律（n = 2,5.1%）或（II）明确/疑似LAAT （n = 8,20.5%）而取消。其中，5例LAAT患者在DCCV前已接受足量口服抗凝剂治疗超过3周。即刻成功率为92.3%，27例（62.8%）手术实现3个月节律控制。值得注意的是，DCCV后两个月记录了一次中风事件。结论atr - cm患者左心耳血栓发生率高，导致20.5%的患者DCCV取消。尽管即时成功率很高（92.3%），但DCCV后持续窦性心律控制仅为62.8%。这些发现建议在DCCV之前使用TEE或CT来排除atr - cm患者的LAAT，即使是口服抗凝的患者。

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引用次数: 0

Protocol for a prospective, multicenter, randomized, controlled trial comparing pulsed field ablation vs. cryoballoon ablation in patients with persistent atrial fibrillation (PEACE trial) 一项前瞻性、多中心、随机、对照试验，比较脉冲场消融与低温球囊消融治疗持续性房颤的方案（PEACE试验）

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-10-07 DOI: 10.1016/j.ijcha.2025.101819

Hidehira Fukaya , Jun Oikawa , Tomoharu Yoshizawa , Akira Satoh , Wataru Shinkai , Megumi Toraiwa , Sho Ogiso , Daiki Saito , Gen Matsuura , Shuhei Kobayashi , Yuki Arakawa , Hironori Nakamura , Naruya Ishizue , Jun Kishihara , Junya Ako

Background

Catheter ablation has become a standard treatment for atrial fibrillation (AF). However, evidence regarding the efficacy and safety of pulsed field ablation (PFA) in patients with persistent AF (PeAF) remains limited. The PEACE trial aims to evaluate the efficacy and safety of PFA compared to cryoballoon ablation (CBA) in PeAF.

Methods

This prospective, multicenter, open-label, randomized controlled, non-inferiority trial (NCT07064616, UMIN000057896) will enroll 300 patients with PeAF, randomly assigned (1:1) to undergo either PFA using the PulseSelect™ or cryoballoon ablation (CBA) using the Arctic Front Advance™. The primary efficacy endpoint is atrial tachyarrhythmia recurrence within 12 months. The primary safety endpoint is procedure-related complications within 30 days. Secondary outcomes include early recurrence, changes in LA diameter, natriuretic peptide levels, and patient-reported symptoms.

Expected results

We hypothesize that PFA will be non-inferior to CBA in terms of efficacy and safety.

Conclusions

The PEACE trial will provide essential data regarding the efficacy and safety of PFA compared to CBA in patients with PeAF, potentially informing future clinical practice.

背景：导管消融已成为房颤（AF）的标准治疗方法。然而，关于脉冲场消融（PFA）治疗持续性房颤（PeAF）的有效性和安全性的证据仍然有限。PEACE试验旨在评估PFA与低温球囊消融（CBA）在PeAF中的疗效和安全性。方法：这项前瞻性、多中心、开放标签、随机对照、非效性试验（NCT07064616, UMIN000057896）将招募300名PeAF患者，随机分配（1:1）接受使用PulseSelect™的PFA或使用Arctic Front Advance™的冷冻球球消融（CBA）。主要疗效终点为12个月内房性心动过速复发。主要安全终点是30天内手术相关并发症。次要结局包括早期复发、LA直径改变、利钠肽水平和患者报告的症状。预期结果我们假设PFA在疗效和安全性方面不逊于CBA。PEACE试验将提供关于PFA与CBA在PeAF患者中的疗效和安全性的基本数据，可能为未来的临床实践提供信息。

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引用次数: 0

Development and external validation of a nomogram to predict the need for electrical cardioversion during radiofrequency ablation in patients with atrial fibrillation 开发和外部验证的nomogram预测心房颤动患者在射频消融期间是否需要电复律

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-10-06 DOI: 10.1016/j.ijcha.2025.101817

Yahui Li , Xindi Yue , Yidan Chen , Xuhui Liu , Xujie Wang , Ru Sun , Haojiang Li , Qingqing Li , Nianfang Luo , Feng Wang , Ling Zhou , Chunxia Zhao

Objectives

To identify predictors of intraoperative electrical cardioversion and develop a predictive model for patients undergoing radiofrequency ablation for atrial fibrillation (AF).

Methods

We retrospectively analyzed data from 1,348 patients with AF who underwent radiofrequency catheter ablation at Tongji Hospital between January 2018 and December 2023. Clinical, echocardiographic, and CT imaging data were collected. The Boruta algorithm and multivariable logistic regression were used to identify predictors and construct a nomogram. Model performance was assessed using the area under the ROC curve (AUC), calibration plots, and decision curve analysis (DCA). External validation was performed on 121 patients treated at Hubei No. 3 People’s Hospital of Jianghan University from June 2023 to February 2025.

Results

Patients were divided into training and validation sets (7:3 ratio). Five independent predictors were identified: AF type (OR = 13.63), valvular regurgitation (OR = 3.25), BMI (OR = 1.06), left atrial diameter (OR = 1.74), and systolic blood pressure (OR = 0.96). The nomogram showed excellent discriminative ability with AUCs of 0.881 (training), 0.879 (internal validation), and 0.866 (external validation). Calibration curves demonstrated good agreement between predicted and actual outcomes. DCA confirmed the model’s clinical utility.

Conclusions

The proposed nomogram accurately predicts the need for intraoperative electrical cardioversion during AF ablation and may aid in individualized procedural planning.

目的确定术中电转复的预测因素，并建立心房颤动（AF）射频消融患者的预测模型。方法回顾性分析2018年1月至2023年12月在同济医院接受射频导管消融治疗的1348例房颤动患者的资料。收集临床、超声心动图和CT影像资料。使用Boruta算法和多变量逻辑回归来识别预测因子并构建模态图。采用ROC曲线下面积（AUC）、校正图和决策曲线分析（DCA）来评估模型的性能。对2023年6月至2025年2月在江汉大学湖北省第三人民医院就诊的121例患者进行外部验证。结果将患者分为训练组和验证组（比例为7:3）。确定了5个独立预测因素：房颤类型（OR = 13.63）、瓣膜反流（OR = 3.25）、BMI （OR = 1.06）、左房内径（OR = 1.74）和收缩压（OR = 0.96）。模态图的auc分别为0.881（训练）、0.879（内部验证）和0.866（外部验证）。校正曲线显示预测结果与实际结果吻合良好。DCA证实了该模型的临床实用性。结论所建立的心电图准确预测心房颤动消融术中是否需要电复律，有助于个体化手术计划。

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引用次数: 0

Cardamonin attenuates angiotensin II-induced abdominal aortic aneurysms through activation of the Nrf2/HO-1 pathway 小豆蔻素通过激活Nrf2/HO-1通路减轻血管紧张素ii诱导的腹主动脉瘤

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-10-06 DOI: 10.1016/j.ijcha.2025.101815

Hsiao-Ya Tsai , Yu-Juei Hsu , Chih-Yuan Lin , Po-Hsun Huang , Chin-Wang Hsu , Shih-Hung Tsai

Background

Cardamonin is a natural chalcone compound. It has been shown to have various pharmacological properties. Cardamonin can activate the Nrf2 signaling pathway. Abdominal aortic aneurysm (AAA) is a complex degenerative aortic disease. Ruptured AAAs continue to be among the leading causes of sudden death in elderly individuals. No medical therapy has proven clinical benefits for preventing AAA progression. Therefore, an adjunctive medical therapy is essential to address this unmet clinical need.

Methods

Human aortic smooth muscle cells (HASMCs) were used to determine the molecular mechanism of cardamonin. A murine model of angiotensin II (AngII)-induced AAA was used to assess the therapeutic effects of cardamonin on AAA growth in apolipoprotein E knockout (ApoE KO) mice in vivo. Immunoblotting, senescence assays, and reactive oxygen species (ROS) production assays were used to determine the protective effects of cardamonin in vivo and in vitro.

Results

Cardamonin induced Nrf2 translocation from the cytosol to the nuclear compartment in HASMCs. Cardamonin reduced AngII-induced ROS production and matrix metalloproteinases (MMPs) overexpression through activation of the Nrf2/heme oxygenase-1 (HO-1) antioxidant pathway in HASMCs. Silencing HO-1 attenuated the anti-ROS effects of cardamonin and abolished the protective effects of cardamonin in AngII-challenged HASMCs. Cardamonin (20 mg/kg/day) reduced AngII-induced AAA in vivo. Cardamonin also reduced the overexpression of MMPs and the production of ROS and attenuated elastin degradation in aortic tissues.

Conclusion

Cardamonin inhibits the progression of AngII-induced AAA through Nrf2/HO-1-mediated antioxidant and anti-inflammatory pathways. Cardamonin could have the potential to be an adjunctive therapy for small AAAs.

小豆蔻素是一种天然查尔酮化合物。它已被证明具有多种药理特性。小豆蔻素可以激活Nrf2信号通路。腹主动脉瘤（AAA）是一种复杂的退行性主动脉疾病。AAAs破裂仍然是老年人猝死的主要原因之一。没有任何药物治疗被证实对预防AAA进展有临床益处。因此，辅助医学治疗对于解决这一未满足的临床需求至关重要。方法采用人主动脉平滑肌细胞（HASMCs）研究小豆蔻素的分子机制。采用血管紧张素II （AngII）诱导的小鼠AAA模型，在体内评估小豆蔻素对载脂蛋白E敲除（ApoE KO）小鼠AAA生长的治疗作用。采用免疫印迹、衰老测定和活性氧（ROS）产生测定来确定小豆蔻素在体内和体外的保护作用。结果scardamonin诱导Nrf2从HASMCs细胞质转移到核室。小豆蔻素通过激活Nrf2/血红素氧化酶-1 （HO-1）抗氧化途径，降低血管内皮细胞诱导的ROS生成和基质金属蛋白酶（MMPs）的过度表达。沉默HO-1可减弱小豆蔻素的抗ros作用，并消除小豆蔻素在血管损伤的HASMCs中的保护作用。小豆蔻素（20 mg/kg/day）在体内降低血管损伤诱导的AAA。小豆蔻素还能降低主动脉组织中MMPs的过表达和ROS的产生，并减弱弹性蛋白的降解。结论小豆蔻素通过Nrf2/ ho -1介导的抗氧化和抗炎途径抑制血管内皮细胞诱导的AAA的进展。小豆蔻素有可能成为小型AAAs的辅助治疗方法。

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引用次数: 0