Current Problems in Cardiology最新文献

Time to adopt a new standard method for assessing cardiac function in chemotherapy-induced cardiotoxicity in breast cancer? A systematic review and meta-analysis 是时候采用一种新的标准方法来评估乳腺癌化疗引起的心脏毒性心功能了？系统回顾和荟萃分析。

IF 3.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2026-05-01 Epub Date: 2026-01-28 DOI: 10.1016/j.cpcardiol.2026.103289

Bruno Gama Linhares , Diego Gama Linhares , Rodrigo Gomes de Souza Vale , Daniel Moreira Gonçalves

Background

Anthracycline-induced cardiotoxicity is a major cause of morbidity in breast cancer survivors. Although left ventricular ejection fraction (LVEF) is the gold standard for monitoring cardiac function, it is often considered a late and insensitive marker of myocardial damage. New methods have emerged: global longitudinal strain (GLS) and cardiac magnetic resonance (CMR) derived parameters as potentially superior tools for detecting subclinical dysfunction. This study aimed to systematically compare the diagnostic accuracy and temporal sensitivity of GLS, LVEF, and CMR índices in the early detection of chemotherapy-induced cardiotoxicity.

Methods

A systematic review and meta-analysis of clinical studies was conducted to evaluate the outcomes and technical accuracy of the main methods for assessing cardiac function in breast cancer patients undergoing chemotherapy, using the PubMed, Web of Science, and Scopus databases. Twenty-nine studies were included in the systematic review and meta-analysis.

Results

The meta-analysis revealed a distinct temporal dissociation between methods. GLS detected a significant absolute reduction of 1.81% (95% CI: 1.14 – 2.49; z = 5.25, p < .001) as early as 1–3 months after treatment initiation. In contrast, LVEF showed a significant reduction of 3.59% only at mid-term follow-up (4–6 months), typically remaining within the range of clinical normality (>50%). The HSROC analysis for GLS (10 studies) demonstrated robust diagnostic performance, with an Area Under the Curve (AUC) of 0.818, a pooled sensitivity of 74.6% (95% CI: 64.8%–82.4%), and a specificity of 76.3% (95% CI: 68.2%–82.9%).

Conclusion

Comparative analysis of data from our meta-analyses supports the recommendation of Global Longitudinal Strain (GLS) as the preferred method for screening for cardiotoxicity, over isolated assessment by Left Ventricular Ejection Fraction (LVEF).

背景：蒽环类药物引起的心脏毒性是乳腺癌幸存者发病的主要原因。虽然左室射血分数（LVEF）是监测心功能的金标准，但它通常被认为是心肌损伤的一个晚期和不敏感的标志物。新的方法已经出现：全局纵向应变（GLS）和心脏磁共振（CMR）衍生参数作为检测亚临床功能障碍的潜在优越工具。本研究旨在系统比较GLS、LVEF和CMR índices在化疗引起的心脏毒性早期检测中的诊断准确性和时间敏感性。方法：使用PubMed、Web of Science和Scopus数据库，对临床研究进行系统回顾和荟萃分析，以评估评估乳腺癌化疗患者心功能的主要方法的结果和技术准确性。29项研究被纳入系统评价和荟萃分析。结果：荟萃分析揭示了不同方法之间明显的时间分离。GLS检测到早在治疗开始后1-3个月，绝对降低1.81% （95% CI: 1.14 - 2.49; z = 5.25,p < .001）。相比之下，LVEF仅在中期随访（4-6个月）时显着下降3.59%，通常保持在临床正常范围内（约50%）。对GLS的HSROC分析（10项研究）显示出可靠的诊断性能，曲线下面积（AUC）为0.818，合并敏感性为74.6% (95% CI: 64.8%-82.4%)，特异性为76.3% （95% CI: 68.2%-82.9%）。结论：我们荟萃分析数据的比较分析支持全局纵向应变（GLS）作为筛选心脏毒性的首选方法，而不是左心室射血分数（LVEF）单独评估。

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引用次数: 0

Takotsubo syndrome-2024: Changing trends in diagnosis and management of patients reported in the world literature Takotsubo综合征-2024：世界文献报道的患者诊断和管理的变化趋势。

IF 3.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2026-05-01 Epub Date: 2026-02-02 DOI: 10.1016/j.cpcardiol.2026.103269

John E. Madias MD, FACC, FAHA

Background

Increasing recognition of takotsubo syndrome (TTS) is being realized since its formal description in 1990/1991 with information provided in case reports, patient series, and multinational registries. The present study aimed at gathering all the patient reports published in the world literature in 2024 to evaluate possible changes in the diagnosis and management of TTS, as compared with TTS registries.

Methods

All the patients with TTS and granular data published in PubMed in response to the MeSH term “takotsubo” in 2024 were scrutinized with data tabulated pertaining to 85+ variables, and compared with the corresponding data deriving from the latest published reports of the InterTak, RETAKO, and GEIST TTS registries.

Results

The present study comprised 246 patients aged 58.2 ± 20.3, with 41 (16.7%) being male, reported from 51 countries, and were characterized by comparison with the 8,288 patients from the 3 registries, by lower rates of risk factors for CAD and cancer, very high comorbidity burden (86.2%), “physical stress”-triggered TTS (69.5% vs. 47.5%, 28.%, 35.5%, for the 3 registries, correspondingly, P = 0.00001), and higher rates of cardiogenic shock (20.7% vs 8.5%, 10.5%, and 8.1%, P = 0.00001), in-hospital mortality (6.9% vs 5.5%, 2.3%, P = 0.00001), and recurrence of TTS (7.3% vs 3.2%, P = 0.02).

Conclusions

The patients with TTS published in the world literature in 2024 comprise a younger group revealing lower risks for CAD and cancer, and higher rates of comorbidity, “physical stress”-triggered TTS, in-hospital complications, mortality, and TTS recurrence, as compared to patients published heretofore.

背景：自1990/1991年正式描述takotsubo综合征（TTS）以来，通过病例报告、患者系列和跨国登记提供的信息，人们对其的认识正在不断提高。本研究旨在收集2024年世界文献中发表的所有患者报告，以评估与TTS登记相比，TTS诊断和管理可能发生的变化。方法：对所有TTS患者和2024年发表在PubMed上的针对MeSH术语“takotsubo”的颗粒数据进行审查，数据表涉及85多个变量，并与InterTak、RETAKO和GEIST TTS注册中心最新发表的报告中的相应数据进行比较。结果：本研究纳入了来自51个国家的246例患者，年龄为58.2±20.3岁，其中41例（16.7%）为男性，与来自3个登记处的8288例患者相比，其特点是CAD和癌症危险因素发生率较低，合并症负担非常高（86.2%），“身体压力”引发的TTS（69.5%对47.5%,28）。相应的，P = 0.00001)，心源性休克（20.7% vs 8.5%， 10.5%和8.1%,P = 0.00001），住院死亡率（6.9% vs 5.5%, 2.3%, P = 0.00001）和TTS复发率（7.3% vs 3.2%, P = 0.02）较高。结论：与迄今为止发表的患者相比，2024年世界文献中发表的TTS患者包括一个更年轻的群体，他们患CAD和癌症的风险更低，合并症、“身体压力”引发的TTS、住院并发症、死亡率和TTS复发率更高。

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引用次数: 0

Urinary sodium-guided diuretic therapy in acute decompensated heart failure: A grade assessed systematic review and meta-analysis with trial sequential analysis 尿钠引导利尿剂治疗急性失代偿性心力衰竭：分级评估系统评价和荟萃分析与试验序贯分析。

IF 3.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2026-05-01 Epub Date: 2026-01-20 DOI: 10.1016/j.cpcardiol.2026.103272

Ali Saad Al-Shammari , Khadeeja Ali Hamzah , Mahyar Masanabadi , Maryam Asif , Mehak Budhiraja , Nimra Shafi , Belal Mohamed Hamed , Yousif Hameed Kurmasha , Mohammedsadeq A. Shweliya , Yasar Sattar

Background

Diuretic resistance remains a major challenge in acute decompensated heart failure (ADHF). Urinary sodium (UNa) concentration provides an early marker of loop diuretic responsiveness, yet its clinical utility remains uncertain.

Methods

We conducted a systematic review and meta-analysis (PROSPERO ID: CRD420251175306). PubMed, Embase, Scopus, and CENTRAL were searched from database inception to October 1, 2025, for studies evaluating UNa-guided diuretic titration in hospitalized ADHF patients. Primary outcomes were 24- and 48 h diuresis and natriuresis; secondary outcomes included congestion relief, renal function, length of stay, rehospitalization, and mortality. Data were pooled using random-effects models. Heterogeneity was assessed using I² and χ² statistics. Analyses were performed with the R software (version 4.4.3, meta package). Certainty of evidence was rated using the GRADE framework.

Results

Five studies were included (three RCTs, two observational cohorts). UNa-guided therapy significantly increased 24- and 48 h diuresis (MD = 0.59,95%CI [0.30-0.87] L; MD = 0.70 [0.37-1.03] L) and natriuresis (MD = 88 [52-124] mmol; MD = 138 [69-206] mmol; all P < 0.001). No significant differences were observed in mortality (RR = 0.99 [0.60-1.63]), rehospitalization (RR = 0.90 [0.57-1.41]), renal dysfunction, or length of stay. Safety outcomes, including hypotension, hypokalemia, and renal worsening, were similar (all P > 0.05). Certainty of evidence was moderate for natriuresis/diuresis and low for clinical outcomes.

Conclusions

UNa-guided diuretic therapy enhances short-term natriuresis and diuresis without increasing adverse events but shows no proven impact on mortality, rehospitalization, or renal outcomes. Larger studies are needed to confirm its long-term benefit and feasibility.

背景：利尿剂抵抗仍然是急性失代偿性心力衰竭（ADHF）的主要挑战。尿钠（UNa）浓度提供了利尿剂循环反应的早期标志，但其临床应用仍不确定。方法：我们进行了系统评价和荟萃分析（PROSPERO ID: CRD420251175306）。检索PubMed、Embase、Scopus和CENTRAL数据库，从数据库建立到2025年10月1日，以评估una引导的住院ADHF患者利尿剂滴定的研究。主要结局为24小时和48小时利尿和尿钠；次要结局包括充血缓解、肾功能、住院时间、再住院和死亡率。使用随机效应模型汇总数据。采用I²和χ²统计量评估异质性。使用R软件（版本4.4.3，meta包）进行分析。使用GRADE框架对证据的确定性进行评级。结果：纳入5项研究（3项随机对照试验，2项观察性队列）。ua引导治疗可显著提高24小时和48小时利尿（MD = 0.59,95%CI [0.30-0.87] L; MD = 0.70 [0.37-1.03]L）和钠尿（MD = 88 [52-124]mmol; MD = 138 [69-206]mmol， P均< 0.001）。两组患者的死亡率（RR = 0.99[0.60-1.63]）、再住院率（RR = 0.90[0.57-1.41]）、肾功能不全、住院时间均无显著差异。安全性结果，包括低血压、低钾血症和肾脏恶化，相似（均P < 0.05）。钠尿/利尿的证据确定性中等，临床结果的证据确定性较低。结论：una引导的利尿剂治疗可以增强短期尿钠和利尿，而不会增加不良事件，但对死亡率、再住院或肾脏预后没有证实的影响。需要更大规模的研究来证实其长期效益和可行性。

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引用次数: 0

Association of pre-hospital shock team implementation with outcomes in ST-segment elevation myocardial infarction patients 院前休克小组实施与st段抬高型心肌梗死患者预后的关系

IF 3.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2026-05-01 Epub Date: 2026-01-20 DOI: 10.1016/j.cpcardiol.2026.103274

Abdulrahman Arabi, Mhd Baraa Habib, Mohamed Salah Abdelghani, Osamah AlAmeen, Mohammad Al-Hijji, Awad Alqahtani, Salah Eddin Arafa, Ihsan Rafie, Jassim M.S. Al Suwaidi

Background

Cardiogenic shock (CS) complicating ST-segment elevation myocardial infarction (STEMI) is associated with high mortality rates. While in-hospital shock teams have shown benefits, the impact of pre-hospital shock team activation remains underexplored.

Methods

In July 2022, our high-volume primary percutaneous coronary intervention (PPCI) center serving the entire state population implemented a pre-hospital shock team. This multidisciplinary team comprises an emergency department physician, cardiac intensivist, interventional cardiologist, cardiac anesthesiologist, and extracorporeal membrane oxygenation (ECMO) specialists. Activation criteria include hypotension, tachycardia or bradycardia, acute heart failure, significant ST-elevation, ventricular arrhythmias, or elevated lactic acid levels. We compared mortality rates 18 months before and after implementation.

Results

Before implementation, 1,605 STEMI patients were admitted, compared to 1,735 after implementation. Of these, 217 (12%) met shock team activation criteria. Early Hospital mortality (in ED and in Cath lab) and Overall-hospital mortality rates significantly declined following implementation (1.2% vs. 0.3%, p = 0.03; and 2.1% vs. 3.3%, p = 0.02, respectively).

Conclusion

This study suggests that pre-hospital shock team implementation is associated with a significant reduction in STEMI mortality.

背景：心源性休克（CS）合并st段抬高型心肌梗死（STEMI）与高死亡率相关。虽然院内休克小组已显示出益处，但院前休克小组激活的影响仍未得到充分探讨。方法：2022年7月，我们为全州人口服务的大容量初级经皮冠状动脉介入治疗（PPCI）中心实施了院前休克小组。这个多学科团队包括急诊科医师、心脏强化医师、介入性心脏病专家、心脏麻醉师和体外膜氧合（ECMO）专家。激活标准包括低血压、心动过速或心动过缓、急性心力衰竭、明显st段抬高、室性心律失常或乳酸水平升高。我们比较了实施前后18个月的死亡率。结果：实施前，1605例STEMI患者入院，而实施后为1735例。其中，217人（12%）达到了突击队的激活标准。实施后，医院早期死亡率（急诊科和导管室）和医院整体死亡率显著下降（分别为1.2%对0.3%,p=0.03； 2.1%对3.3%,p=0.02）。结论：本研究表明院前休克小组实施与显著降低STEMI死亡率相关。

{"title":"Association of pre-hospital shock team implementation with outcomes in ST-segment elevation myocardial infarction patients","authors":"Abdulrahman Arabi, Mhd Baraa Habib, Mohamed Salah Abdelghani, Osamah AlAmeen, Mohammad Al-Hijji, Awad Alqahtani, Salah Eddin Arafa, Ihsan Rafie, Jassim M.S. Al Suwaidi","doi":"10.1016/j.cpcardiol.2026.103274","DOIUrl":"10.1016/j.cpcardiol.2026.103274","url":null,"abstract":"<div><h3>Background</h3><div>Cardiogenic shock (CS) complicating ST-segment elevation myocardial infarction (STEMI) is associated with high mortality rates. While in-hospital shock teams have shown benefits, the impact of pre-hospital shock team activation remains underexplored.</div></div><div><h3>Methods</h3><div>In July 2022, our high-volume primary percutaneous coronary intervention (PPCI) center serving the entire state population implemented a pre-hospital shock team. This multidisciplinary team comprises an emergency department physician, cardiac intensivist, interventional cardiologist, cardiac anesthesiologist, and extracorporeal membrane oxygenation (ECMO) specialists. Activation criteria include hypotension, tachycardia or bradycardia, acute heart failure, significant ST-elevation, ventricular arrhythmias, or elevated lactic acid levels. We compared mortality rates 18 months before and after implementation.</div></div><div><h3>Results</h3><div>Before implementation, 1,605 STEMI patients were admitted, compared to 1,735 after implementation. Of these, 217 (12%) met shock team activation criteria. Early Hospital mortality (in ED and in Cath lab) and Overall-hospital mortality rates significantly declined following implementation (1.2% vs. 0.3%, <em>p</em> = 0.03; and 2.1% vs. 3.3%, <em>p</em> = 0.02, respectively).</div></div><div><h3>Conclusion</h3><div>This study suggests that pre-hospital shock team implementation is associated with a significant reduction in STEMI mortality.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"51 5","pages":"Article 103274"},"PeriodicalIF":3.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Fabry disease cardiomyopathy: A practical guide for cardiologists 法布里病心肌病：心脏病专家的实用指南。

IF 3.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2026-04-01 Epub Date: 2026-01-14 DOI: 10.1016/j.cpcardiol.2026.103266

Tala Al Saleh MD , Yusuf Kamran Qadeer MD , Bing Yue MD , Maurizio Pieroni MD, PhD , Karim El Hachem MD , Fabiano de Oliveira Poswar MD, MSc, PhD , Roberto Giugliani MD , Irfan Vardarli MD , Eric Wallace MD , Chayakrit Krittanawong MD, FACC

Fabry disease (FD) is an X-linked lysosomal storage disease that results in the accumulation of glycosphingolipids, such as globotriaosylceramide (Gb3) in a variety of cells. FD most prominently involves cardiac, nervous, and renal tissue, with cardiac complications representing the most common cause of death. Fabry disease has a prevalence ranging between 1:8454 to 1:117,000 among men. The higher prevalence included patients with the A143T mutation, which was shown to be a non-disease causing variant. Due to its rarity, and wide array of phenotypic presentations, especially in women, FD is often misdiagnosed. Advances in echocardiographic techniques and magnetic resonance imaging can play a crucial role in raising suspicion for Fabry disease and identifying early Fabry cardiomyopathy. Identification of end-organ involvement can, in turn, permit treatment initiation in patients who did not previously qualify for advanced therapies and in screened family members who are still too early in the disease process to manifest specific symptoms.

法布里病（FD）是一种x连锁溶酶体贮积性疾病，导致鞘糖脂积累，如globotriaosylceramide （Gb3）在多种细胞中。FD主要累及心脏、神经和肾脏组织，心脏并发症是最常见的死亡原因。法布里病在男性中的患病率在1:8454至1:11 17000之间。较高的患病率包括携带A143T突变的患者，这被证明是一种非致病变异。由于其罕见性和广泛的表型表现，特别是在女性中，FD经常被误诊。超声心动图技术和磁共振成像技术的进步可以在提高对法布里病的怀疑和识别早期法布里心肌病方面发挥关键作用。确定终末器官受累，反过来可以允许以前不符合先进治疗条件的患者和筛查的家庭成员开始治疗，这些家庭成员仍处于疾病过程的早期，未表现出特定症状。

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引用次数: 0

Ocular manifestations of transthyretin amyloidosis and their diagnostic value in cardiology: A comprehensive review 甲状腺转蛋白淀粉样变的眼部表现及其在心脏病学中的诊断价值：综述。

IF 3.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2026-04-01 Epub Date: 2026-01-19 DOI: 10.1016/j.cpcardiol.2026.103263

Yongda Zhu, Shun Gao Prof, Qingquan Liu, Chunjian Shen Dr.

Background

Transthyretin cardiac amyloidosis (ATTR-CM) is an increasingly recognized cause of heart failure with preserved ejection fraction (HFpEF); however, early diagnosis remains challenging.

Objective

From the perspective of cardiovascular physicians, this review systematically elucidates the ocular manifestations of ATTR, explores their clinical significance as early diagnostic clues, and proposes an integrated diagnostic pathway incorporating ophthalmologic assessment.

Content

This article focuses on the pathophysiological mechanisms and recognition criteria of characteristic ocular signs, including vitreous amyloidosis and secondary glaucoma, and constructs a multidisciplinary diagnostic workflow integrating cardiac imaging, ophthalmologic "red flags," and molecular diagnostic techniques.

Conclusions

Incorporating ocular manifestations into routine cardiovascular history-taking and systematic evaluation holds significant clinical value for improving early ATTR-CM diagnosis rates and patient outcomes. Active promotion of cardiovascular-ophthalmology-neurology multidisciplinary collaboration is warranted.

背景：转甲状腺素型心脏淀粉样变性（atr - cm）是一种越来越被认为是具有保留射血分数（HFpEF）的心力衰竭的原因；然而，早期诊断仍然具有挑战性。目的：本文从心血管内科医生的角度，系统阐述ATTR的眼部表现，探讨其作为早期诊断线索的临床意义，提出结合眼科评估的综合诊断途径。内容：本文重点探讨玻璃体淀粉样变性、继发性青光眼等特征性眼部体征的病理生理机制和识别标准，构建集心脏影像学、眼科“危险信号”和分子诊断技术为一体的多学科诊断流程。结论：将眼部表现纳入常规心血管病史和系统评估，对提高atr - cm早期诊断率和患者转归具有重要的临床价值。积极促进心血管-眼科-神经病学多学科合作是必要的。

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引用次数: 0

Incidence, characteristics and long-term outcomes of peripartum cardiomyopathy: Insights from the Bergen peripartum cardiomyopathy study 围产期心肌病的发生率、特征和长期预后：来自卑尔根围产期心肌病研究的见解。

IF 3.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2026-04-01 Epub Date: 2026-01-21 DOI: 10.1016/j.cpcardiol.2026.103276

Vasiliki Kitsou MD, PhD , Håvard Dingen MD , Torbjørn Lunde MD , Britt Engan MD, PhD , Ferenc Macsali MD, PhD , Sahrai Saeed MD, PhD, FESC

Background

Peripartum cardiomyopathy (PPCM) is a rare but potentially fatal condition characterized by heart failure occurring at the end of pregnancy or within the first months after delivery in women without prior history of structural heart disease. This single-center case-control study aimed to describe the incidence, clinical profile, echocardiographic findings and outcomes of PPCM in a West-Norwegian population.

Methods

Between 2011 and 2023, a total of 15 cases of PPCM were identified at Haukeland University Hospital. The Bergen Birth Registry was used to determine the total number of births in the same period, and to recruit 30 age-matched healthy controls. Clinical characteristics, echocardiographic data, and outcomes were collected.

Results

The incidence rate of PPCM was 1 in 4,182 births. Risk factors included higher pre-pregnancy body mass index (BMI) (OR 1.25) and elevated systolic blood pressure at presentation (OR 1.11). The prevalence of pre-eclampsia and primiparity was significantly higher in PPCM patients compared to controls (p < 0.01). Mean left ventricular (LV) ejection fraction increased from 35% at presentation to 58% at the 6-month follow-up (p < 0.001). There were no maternal or neonatal mortalities. Three patients required ICU treatment, but none experienced major cardiovascular events.

Conclusions

The incidence of PPCM in this West-Norwegian study was relatively low. Higher pre-pregnancy BMI and elevated systolic blood pressure, both important modifiable cardiovascular risk factors, were identified as predictors of PPCM. All patients experienced successful clinical and LV function recovery. Future large collaborative studies are necessary to provide a reliable description of incidence and outcomes nationwide.

背景：围产期心肌病（PPCM）是一种罕见但具有潜在致命性的疾病，其特征是无结构性心脏病病史的妇女在妊娠末期或分娩后第一个月内发生心力衰竭。本单中心病例对照研究旨在描述挪威西部人群PPCM的发病率、临床特征、超声心动图结果和结局。方法：选取2011 - 2023年在新西兰豪克兰大学医院确诊的PPCM患者15例。使用卑尔根出生登记处来确定同一时期的出生总数，并招募30名年龄匹配的健康对照。收集临床特征、超声心动图数据和结果。结果：4182例新生儿中PPCM发生率为1例。危险因素包括较高的孕前体重指数（BMI）（OR 1.25）和分娩时收缩压升高（OR 1.11）。与对照组相比，PPCM患者先兆子痫和初产的患病率明显更高(结论：在挪威西部的这项研究中，PPCM的发病率相对较低。较高的孕前BMI和收缩压升高，这两个重要的可改变的心血管危险因素，被确定为PPCM的预测因素。所有患者临床和左室功能均恢复成功。未来的大型合作研究是必要的，以提供全国发病率和结果的可靠描述。

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引用次数: 0

NRF2-mediated anti-ferroptotic pathways in diabetic cardiomyopathy: Mechanistic insights, therapeutic advances, and challenges in cardiovascular protection 糖尿病性心肌病中nrf2介导的抗紧铁途径：机制见解、治疗进展和心血管保护的挑战。

IF 3.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2026-04-01 Epub Date: 2025-12-18 DOI: 10.1016/j.cpcardiol.2025.103251

Shahid Ullah Khan Phd , Mustafa H. Halawi , Mazen Almehmadi , Essam H. Ibrahim , Ramadan Taha , Khalid M. Alsyaad , Ahmed Ezzat Ahmed , Amin A. Al-Doaiss , William Thornbury

Diabetic cardiomyopathy (DCM) remains a major contributor to cardiovascular morbidity and mortality, yet its underlying mechanisms extend beyond hyperglycemia-induced metabolic stress. Emerging evidence identifies ferroptosis, a regulated, iron-dependent lipid peroxidation process, as a central driver of diabetic myocardial injury. This review synthesizes molecular insights demonstrating how chronic hyperglycemia, oxidative stress, and mitochondrial dysfunction create a uniquely ferroptosis-prone cardiac environment. Particular emphasis is placed on the NRF2 signaling network, which orchestrates antioxidant defense through the HO-1 pathway and the SLC7A11-GSH-GPX4 axis. Diabetic impairment of AMPK/AKT-dependent NRF2 activation compromises these protective systems, accelerating lipid peroxidation, mitochondrial damage, inflammation, and cardiomyocyte death. We further evaluate emerging pharmacologic and natural NRF2 activators, including sulforaphane, curcumin, dexmedetomidine, canagliflozin, and 6-gingerol, demonstrating consistent cardioprotective, anti-ferroptotic benefits in preclinical models. Despite encouraging progress, concerns regarding long-term NRF2 overstimulation, metabolic reprogramming, and oncogenic risk underscore the need for carefully optimized therapeutic strategies. By integrating mechanistic advances with translational challenges, this review highlights NRF2-ferroptosis modulation as a promising frontier for targeted DCM therapy and future precision cardiology.

糖尿病性心肌病（DCM）仍然是心血管疾病发病率和死亡率的主要原因，但其潜在机制超出了高血糖诱导的代谢应激。新出现的证据表明，铁下垂是一种受调节的铁依赖性脂质过氧化过程，是糖尿病心肌损伤的主要驱动因素。这篇综述综合了慢性高血糖、氧化应激和线粒体功能障碍如何创造一个独特的易发生铁中毒的心脏环境的分子见解。特别强调的是NRF2信号网络，它通过HO-1途径和SLC7A11-GSH-GPX4轴协调抗氧化防御。糖尿病AMPK/ akt依赖性NRF2激活损害这些保护系统，加速脂质过氧化、线粒体损伤、炎症和心肌细胞死亡。我们进一步评估了新出现的药理学和天然NRF2激活剂，包括萝卜硫素、姜黄素、右美托咪定、卡格列净和6-姜酚，在临床前模型中显示出一致的心脏保护和抗铁沉益处。尽管取得了令人鼓舞的进展，但对NRF2长期过度刺激、代谢重编程和致癌风险的担忧强调了仔细优化治疗策略的必要性。通过整合机制进展和翻译挑战，本综述强调nrf2 -铁下垂调节是靶向DCM治疗和未来精确心脏病学的一个有前途的前沿。

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引用次数: 0

National burden and future projections of hypertensive heart disease in China: a GBD 2021 analysis 中国高血压心脏病的国家负担和未来预测：GBD 2021分析

IF 3.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2026-04-01 Epub Date: 2026-01-20 DOI: 10.1016/j.cpcardiol.2026.103273

Rui Wu , Xinlian Zhong

Background

Hypertensive heart disease (HHD) remains a critical public health challenge, with increasing prevalence globally, especially in China. Research indicates that the HHD in Chin remain underexplored.

Methods

Epidemiological data were sourced from the GBD 2021. Joinpoint analysis and decomposition analysis, have been applied to investigate the evolving patterns of the disease. Additionally, frontier analysis was utilized to estimate potential reductions in the burden of disease based on the sociodemographic index (SDI) across different stages, whereas autoregressive integrated moving average (ARIMA) models were employed to project the disease burden.

Results

In 2021, there were 3,912,158 prevalent cases of HHD in China, with 328,119 deaths cases and 5,589,287 disability-adjusted life years (DALYs). Analysis of the trends from 1990 to 2021 revealed increases in the number of prevalence, mortality, and DALYs. The contributions of age, period, and cohort to the disease burden varied. Frontier analysis indicated that although the Chinese SDI has improved, the disease burden trends remain inconsistent, with considerable room for reducing the age-standardized prevalence rate (ASPR). ARIMA projections suggest that while the ASPR will continue to rise, the age-standardized DALYs rate (ASDR) will decline over the next three decades.

Conclusions

This study highlights the increasing burden of HHD in China, which is largely influenced by aging and population growth. The projected trends indicate a further rise in the ASPR, stressing the need for focused interventions in prevention and early diagnosis and increasing access to healthcare.

背景：高血压性心脏病（HHD）仍然是一个重大的公共卫生挑战，在全球范围内，特别是在中国，患病率不断上升。研究表明，中国的HHD尚未得到充分开发。方法：流行病学数据来源于GBD 2021。结合点分析和分解分析已被应用于研究疾病的演变模式。此外，基于不同阶段的社会人口指数（SDI），采用前沿分析来估计疾病负担的潜在减少，而采用自回归综合移动平均（ARIMA）模型来预测疾病负担。结果：2021年，中国HHD患病率为3912158例，死亡病例328119例，残疾调整生命年（DALYs）为5589287年。对1990年至2021年趋势的分析显示，患病率、死亡率和伤残调整生命年的数量有所增加。年龄、时期和队列对疾病负担的贡献各不相同。前沿分析表明，尽管中国SDI有所改善，但疾病负担趋势仍不一致，年龄标准化患病率（ASPR）仍有很大的降低空间。ARIMA的预测表明，虽然ASPR将继续上升，但年龄标准化的DALYs率（ASDR）将在未来30年下降。结论：本研究强调了中国HHD负担的增加，这在很大程度上受老龄化和人口增长的影响。预测的趋势表明，ASPR将进一步上升，强调需要在预防和早期诊断方面采取重点干预措施，并增加获得保健的机会。

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引用次数: 0

Novel electrocardiographic criteria to determine the electrical position of the heart in baseline rhythm and in Post-TAVR left bundle branch block 确定基线心律和tavr后左束支传导阻滞时心脏电位置的新心电图标准。

IF 3.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2026-04-01 Epub Date: 2026-01-16 DOI: 10.1016/j.cpcardiol.2026.103271

Rogelio Robledo-Nolasco M.D. , Elias Noel Andrade-Cuellar M.D. , Juan Carlos Solis-Gómez M.D, M.Sc. , Saul Yair Guillot-Castillo M.D. , Jose Javier Ik Yahalcab Zamora-Diaz M.D., M.Sc. , Ivan Alejandro Elizalde-Uribe M.D. , Rocio Aceves-Millan M.D. , Andrea Paulina Maldonado-Tenesaca M.D. , Maria Alejandra Monroy-Jimenez M.D. , Kevin Josué Acevedo-Gómez M.D. , Freddy Javier Medina-Santos M.D.

Background

Left bundle branch block (LBBB) is a frequent complication after transcatheter aortic valve replacement (TAVR), altering ventricular activation and challenging ECG interpretation. This study sought to establish novel electrocardiographic criteria to define the electrical position of the heart (EPH) before and after LBBB post-TAVR.

Methods

In this single-center, retrospective study, 439 TAVR patients (2018–2023) were screened; 74 developed new LBBB. Patients with pre- and post-TAVR ECGs, without pacemaker, infiltrative disease, or baseline conduction disorders, were included. ECGs were analyzed for QRS duration, electrical axes (AQRS, AT), and patterns of concordance/discordance in leads II/III and aVL/aVF. EPH was categorized as intermediate (IEP), horizontal (HEP), or vertical (VEP) by AQRS. Morphology in leads I, aVL, V5, and V6 was also assessed.

Results

Among 74 patients with LBBB, 36 (48.6%) had IEP, 32 (43.2%) HEP, and 6 (8.1%) VEP. In patients without LBBB, AQRS averaged 50°±15° in IEP and –10°±20° in HEP (p < 0.0001). With LBBB, AQRS shifted to –20°±25° in IEP and –60°±30° in HEP (p < 0.0001). Positive concordance in II/III and aVL/aVF identified IEP, whereas positive discordance indicated HEP. In LBBB, negative concordance in II/III with positive discordance in aVL/aVF defined HEP, while positive discordance in II/III with positive concordance in aVL/aVF characterized IEP.

Conclusion

Novel ECG criteria enable reliable classification of cardiac electrical position in both baseline and post-TAVR LBBB. Leftward axis deviation with LBBB often reflects intrinsic EPH rather than new pathology, enhancing interpretation and clinical decision-making.

背景：左束分支阻滞（LBBB）是经导管主动脉瓣置换术（TAVR）后常见的并发症，它改变了心室激活，并对心电图解释提出了挑战。本研究旨在建立新的心电图标准，以确定tavr后LBBB前后的心脏电位置（EPH）。方法：在这项单中心回顾性研究中，筛选了439例TAVR患者（2018-2023）；74人发展了新的LBBB。包括tavr前后心电图无起搏器、浸润性疾病或基线传导障碍的患者。分析心电图QRS持续时间、电轴（AQRS、AT）、导联II/III和aVL/aVF的一致/不一致模式。AQRS将EPH分为中间型（IEP）、水平型（HEP）和垂直型（VEP）。同时评估导联I、aVL、V5和V6的形态学。结果：74例LBBB患者中，IEP 36例（48.6%），HEP 32例（43.2%），VEP 6例（8.1%）。在没有LBBB的患者中，IEP患者的AQRS平均为50°±15°，HEP患者的AQRS平均为-10°±20°。结论：新的ECG标准能够可靠地分类基线和tavr后LBBB患者的心电位置。左轴偏离与LBBB通常反映内在EPH，而不是新的病理，加强解释和临床决策。

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引用次数: 0