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Social vulnerability and mortality attributable to non-optimal temperature in the United States: A county-level ecological analysis 美国非最适温度导致的社会脆弱性和死亡率：一个县级生态分析。
IF 3.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Current Problems in Cardiology
Pub Date : 2026-01-11 DOI: 10.1016/j.cpcardiol.2026.103260
Pedro Rafael Vieira de Oliveira Salerno MD , Ricardo J. Estrada-Mendizabal MD , Zhuo Chen PhD , Jean-Eudes Dazard PhD , Khurram Nasir MD , Weeberb Requia PhD , Robert D. Brook MD , Sanjay Rajagopalan MD , Sadeer Al-Kindi MD , Salil V Deo MD

Objectives

To quantify county-level mortality attributable to non-optimal temperature in the United States and examine whether social vulnerability modifies this relationship.

Study design

Ecological time-series analysis from 2000–2020.

Methods

We analyzed 1,514 counties representing 91.2% of the 2010 U.S. adult population (ages 25–84), including 33,395,241 deaths (after imputation: 33,421,054) which were linked to monthly mean temperature. A two-stage modeling framework was used. First, quasi-Poisson models with natural cubic splines estimated county-specific non-linear temperature–mortality associations, with population offsets and spline-based control for seasonality. Second, coefficients and variances were pooled using random-effects multivariate meta-analysis to identify the minimum mortality temperature (MMT) and percentile (MMP). Effect modification was assessed by incorporating Social Vulnerability Index (SVI) quartiles into a multivariate meta-regression. Attributable deaths were estimated using 5,000 Monte Carlo draws and classified as heat-related (above MMT) or cold-related (below MMT); crude rates were expressed per 100,000 person-years.

Results

The pooled MMT was 22.7 °C (95% CI: 22.2–23.2), corresponding to the 78.4th percentile (95% CI: 76.1–80.8). Nationally, an estimated 72,361 (95% CI: 68,837–76,153) cold-attributable and 6,129 (95% CI: 5,309–7,227) heat-attributable deaths occurred annually, equivalent to 40.1 and 3.4 per 100,000 person-years. More socially vulnerable counties had higher MMTs [SVI Q4: 23.9 °C vs Q1: 21.0 °C] and higher heat- (2.0 vs 0.7) and cold-related mortality rates (40.9 vs 28.0).

Conclusions

Cold accounted for most temperature-related deaths in the U.S., and social vulnerability intensified both cold- and heat-related mortality. These findings support geographically targeted, vulnerability-responsive public health strategies.
目的：量化美国非最佳温度导致的县一级死亡率，并检查社会脆弱性是否改变了这种关系。研究设计：2000-2020年生态时间序列分析。方法：我们分析了1514个县，占2010年美国成年人口（25-84岁）的91.2%，包括33,395,241例与月平均温度相关的死亡（经估算后：33,421,054例）。采用两阶段建模框架。首先，采用自然三次样条拟泊松模型，利用种群偏移量和基于样条的季节性控制，估计了特定国家的非线性温度-死亡率关联。其次，采用随机效应多变量荟萃分析合并系数和方差，确定最低死亡温度（MMT）和百分位数（MMP）。通过将社会脆弱性指数（SVI）四分位数纳入多元元回归来评估效果修改。使用5000张蒙特卡罗图估计归因死亡，并将其分类为热相关（高于MMT）或冷相关（低于MMT）；粗率表示为每10万人年。结果：合并MMT为22.7°C (95% CI: 22.2-23.2)，对应于78.4百分位（95% CI: 76.1-80.8）。在全国范围内，每年估计有72,361例（95% CI: 68,837-76,153）例因冷导致的死亡和6129例（95% CI: 5,309-7,227）例因热导致的死亡，相当于每10万人年40.1例和3.4例。社会脆弱的县有更高的mmt [SVI Q4: 23.9°C vs Q1: 21.0°C]和更高的热（2.0 vs 0.7）和冷相关死亡率（40.9 vs 28.0）。结论：在美国，寒冷导致了大多数与温度相关的死亡，而社会脆弱性加剧了与寒冷和炎热相关的死亡率。这些研究结果支持有地理针对性、针对脆弱性的公共卫生战略。
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引用次数: 0
Coronary artery calcium clinical utilization: An update 冠状动脉钙的临床应用：最新进展
IF 3.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Current Problems in Cardiology
Pub Date : 2026-01-10 DOI: 10.1016/j.cpcardiol.2026.103258
Ibrahim Mortada MD, MS , Esosa Odigie-Okon MD, MSc , Afaq Motiwala MD , Joseph Allencherril MD , Abdul Qadeer MBBS , Diann Gaalema PhD , Amer Abdulla MD , Thomas Blackwell MD , Hani Jneid MD
Coronary artery disease (CAD) remains a leading cause of mortality and morbidity worldwide. Coronary artery calcification (CAC) is a well-established marker of atherosclerotic burden, and its quantification provides an objective measure of subclinical coronary atherosclerosis that can refine cardiovascular risk stratification and guide decisions regarding risk factor modification and lipid-lowering therapies. There is extensive data supporting the role of CAC scoring as an adjunct risk refinement tool, and it has been incorporated into multiple primary prevention guidelines. In addition to the Agatston method, CAC can also be quantified using non-gated computed tomography (CT) scans which are simple and widely available from non-cardiac screening strategies, including those obtained routinely for lung cancer screening. The integration of artificial intelligence and automated CAC assessment in non-gated studies is further expanding its application for risk stratification to a much larger population. This review summarizes the current tools, evidence and guidelines supporting the use of CAC to help risk stratify, optimize lipid lowering therapy, and potentially improve patient outcomes.
冠状动脉疾病（CAD）仍然是世界范围内死亡率和发病率的主要原因。冠状动脉钙化（CAC）是一种公认的动脉粥样硬化负担标志物，其量化提供了亚临床冠状动脉粥样硬化的客观测量，可以细化心血管危险分层，指导有关危险因素调整和降脂治疗的决策。有大量数据支持CAC评分作为辅助风险细化工具的作用，它已被纳入多个一级预防指南。除了Agatston方法，还可以使用非门控计算机断层扫描（CT）对CAC进行量化，这种方法简单且广泛应用于非心脏筛查策略，包括肺癌筛查常规方法。人工智能和自动化CAC评估在非门控研究中的整合进一步扩大了其在风险分层中的应用范围。这篇综述总结了目前支持使用CAC的工具、证据和指南，以帮助风险分层、优化降脂治疗，并可能改善患者的预后。
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引用次数: 0
Balancing hope and heart: An umbrella review of cardiotoxicity in immune checkpoint inhibitor cancer therapies 平衡希望和心脏：免疫检查点抑制剂癌症治疗中心脏毒性的综述。
IF 3.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Current Problems in Cardiology
Pub Date : 2025-12-22 DOI: 10.1016/j.cpcardiol.2025.103257
Yashendra Sethi , Saurabh Singhal , Apoorv Pratap Singh , Akshat Banga , Pratik Agarwal , Oroshay Kaiwan , Inderbir Padda , Aakash Paruthi , Sneha Annie Sebastian , Arsalan Moinuddin , Gurpreet Johal , Nigel H. Greig

Background

Immune checkpoint inhibitors (ICIs) have significantly advanced cancer treatment, especially in improving survival rates for patients with various malignancies such as melanoma, non-small cell lung cancer (NSCLC), and renal cell carcinoma. Despite their therapeutic promise, ICIs carry the risk of immune-related adverse events, with cardiotoxicity emerging as a notable concern. This umbrella review aims to critically evaluate the diverse data from published systematic reviews and meta-analyses, to provide a cohesive overview of ICI-associated cardiotoxicity across different cancer types and treatment regimens.

Methods

This umbrella review analytically evaluates data from systematic reviews and meta-analyses on cardiotoxicity in cancer patients receiving ICI therapy. We conducted a comprehensive search across PubMed, Scopus, and Google Scholar, from inception till Jan 2025. The JBI checklist was employed to assess the quality of included studies.

Results

Our analysis reveals varying cardiotoxicity risks associated with ICIs. The incidence of cardiac immune-related adverse events ranges from 0.8 % to 1.3 %, with myocarditis being the most common (0.5-0.72 % of patients). Combination therapies significantly increase risks: dual ICIs elevate myocarditis risk 3.07-fold compared to monotherapies, whereas PD-1/PD-L1 inhibitors with chemotherapy increase all-grade and severe cardiotoxicity by 53 % and 63%, respectively. NSCLC patients face a 97 % higher risk of all-grade cardiotoxicity with combination treatments. ICI-induced myocarditis carries a high mortality rate of 37.7 %. Notably, some studies report no significant increase in cardiac events, highlighting the need for further investigation to reconcile these disparate findings.

Conclusions

The variability in cardiotoxicity reports highlights the complex risk landscape associated with ICI therapy. Although ICIs continue to enhance cancer care, they require careful cardiovascular monitoring and comprehensive risk management, particularly for combination therapies and patients with existing heart conditions.
背景：免疫检查点抑制剂（ICIs）具有显著的癌症治疗进展，特别是在提高各种恶性肿瘤（如黑色素瘤、非小细胞肺癌（NSCLC）和肾细胞癌）患者的生存率方面。尽管具有治疗前景，但ICIs存在免疫相关不良事件的风险，心脏毒性正在成为一个值得关注的问题。本综述旨在批判性地评估来自已发表的系统综述和荟萃分析的各种数据，以提供不同癌症类型和治疗方案中ici相关心脏毒性的综合概述。方法：本综述对接受ICI治疗的癌症患者心脏毒性的系统评价和荟萃分析数据进行了分析性评价。我们在PubMed， Scopus和b谷歌Scholar上进行了全面的搜索，从创建到2025年1月。采用JBI检查表评估纳入研究的质量。结果：我们的分析揭示了不同的心脏毒性风险与ICIs相关。心脏免疫相关不良事件的发生率从0.8%到1.3%不等，其中最常见的是心肌炎（0.5-0.72%）。联合治疗显著增加风险：与单一治疗相比，双重ICIs使心肌炎风险增加3.07倍，而PD-1/PD-L1抑制剂联合化疗使全级和严重心脏毒性分别增加53%和63%。联合治疗的非小细胞肺癌患者出现全级别心脏毒性的风险高出97%。ici引起的心肌炎死亡率高达37.7%。值得注意的是，一些研究报告心脏事件没有显著增加，强调需要进一步的调查来调和这些不同的发现。结论：心脏毒性报告的可变性突出了与ICI治疗相关的复杂风险景观。尽管ici继续加强癌症治疗，但它们需要仔细的心血管监测和全面的风险管理，特别是对于联合治疗和已有心脏病的患者。
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引用次数: 0
Epitranscriptomic regulation in cardiovascula disease: mechanistic roles and clinical implications of m6A RNA methylation in cardiac pathophysiology 心血管疾病的表转录组调控：m6A RNA甲基化在心脏病理生理中的机制作用和临床意义
IF 3.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Current Problems in Cardiology
Pub Date : 2025-12-19 DOI: 10.1016/j.cpcardiol.2025.103253
Shahid Ullah Khan , Mustafa H. Halawi , Mazen Almehmadi , Essam H. Ibrahim , Ramadan Taha , Ahmed Ezzat Ahmed , Esmael M. Alyami , Nuruliarizki Shinta Pandupuspitasari , Endang Widiastuti , Munir Ullah Khan , Jonathan P. Harrington , Tahir Ullah khan
N6-methyladenosine (m6A) RNA methylation has emerged as a pivotal epitranscriptomic regulator influencing cardiovascular development, homeostasis, and disease progression. As the most abundant internal modification in eukaryotic mRNA, m6A dynamically modulates RNA stability, translation, splicing, and degradation through the coordinated actions of “writers,” “readers,” and “erasers.” Recent advances demonstrate that dysregulated m6A modifications contribute to major cardiovascular disorders, including cardiac hypertrophy, heart failure, arrhythmias, atherosclerosis, ischemia reperfusion injury, and cardiomyopathy. METTL3-mediated hypermethylation promotes pathological hypertrophy, autophagy imbalance, and ischemic injury. In contrast, demethylases such as FTO and ALKBH5 exert cardioprotective effects by preserving contractile function, enhancing angiogenesis, and regulating key transcripts involved in Ca²⁺ cycling, autophagy, and metabolism. m6A-dependent control of noncoding RNAs further amplifies its impact on inflammatory signaling, endothelial dysfunction, and vascular remodeling. The involvement of m6A in glucose metabolism, hypoxia responses, and vascular smooth muscle phenotypic transitions highlights its broad relevance across cardiovascular risk factors. As detection technologies advance, m6A profiling shows promise as a diagnostic biomarker and therapeutic target. Understanding epitranscriptomic regulation may unlock innovative treatment strategies and reshape the future of cardiovascular medicine.
n6 -甲基腺苷（m6A） RNA甲基化已成为影响心血管发育、体内平衡和疾病进展的关键外转录组调控因子。作为真核生物mRNA中最丰富的内部修饰，m6A通过“写者”、“读者”和“擦除者”的协同作用，动态调节RNA的稳定性、翻译、剪接和降解。最近的研究表明，失调的m6A修饰可导致主要的心血管疾病，包括心脏肥厚、心力衰竭、心律失常、动脉粥样硬化、缺血再灌注损伤和心肌病。mettl3介导的高甲基化促进病理性肥大、自噬失衡和缺血性损伤。相比之下，去甲基化酶如FTO和ALKBH5通过保持收缩功能、增强血管生成和调节参与Ca 2 +循环、自噬和代谢的关键转录物来发挥心脏保护作用。m6a依赖性非编码rna的控制进一步放大了其对炎症信号、内皮功能障碍和血管重构的影响。m6A参与葡萄糖代谢、缺氧反应和血管平滑肌表型转变，突出了其在心血管危险因素中的广泛相关性。随着检测技术的进步，m6A谱分析有望成为诊断性生物标志物和治疗靶点。了解表观转录组学调控可能会开启创新的治疗策略，重塑心血管医学的未来。
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引用次数: 0
Challenges in the diagnosis and management of hypertrophic cardiomyopathy and the promise of artificial intelligence 肥厚性心肌病诊断和治疗的挑战以及人工智能的前景。
IF 3.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Current Problems in Cardiology
Pub Date : 2025-12-18 DOI: 10.1016/j.cpcardiol.2025.103249
Isna H. Khaliq MD , Aum Solanki MD , Menhel Kinno MD, MPH , Annabelle Santos Volgman MD , Ahmet Afsin Oktay MD
Hypertrophic cardiomyopathy (HCM), the most prevalent inherited cardiomyopathy, is characterized by left ventricular hypertrophy that typically manifests with asymmetric wall thickening and is not caused by a pressure overload state or systemic disease. Despite its considerable prevalence—estimated to affect up to 1 in 200 individuals based on imaging data—it often goes undiagnosed or misdiagnosed, particularly in general clinical settings. Traditional tools, such as the electrocardiogram, although widely used, frequently yield nonspecific findings that complicate the early identification or screening of HCM. In recent years, artificial intelligence (AI) and machine learning have emerged as powerful tools with the potential to revolutionize HCM diagnosis and management. AI-driven algorithms trained on ECG and imaging data are being developed to improve early detection, risk stratification, and therapeutic monitoring in patients with or at risk for HCM. Additionally, AI has shown utility in biomarker-based prediction models, further enhancing diagnostic precision and clinical decision-making. Harnessing the power of AI may help close critical diagnostic gaps and optimize outcomes for individuals affected by HCM.
肥厚性心肌病（HCM）是最常见的遗传性心肌病，其特征是左心室肥厚，通常表现为不对称的心壁增厚，不是由压力过载状态或全身性疾病引起的。尽管它相当普遍——根据影像学数据估计，每200人中就有1人受到影响——但它经常未被诊断或误诊，特别是在一般临床环境中。传统的工具，如心电图，虽然广泛使用，但经常产生非特异性的结果，使HCM的早期识别或筛查复杂化。近年来，人工智能（AI）和机器学习已经成为强大的工具，有可能彻底改变HCM的诊断和管理。正在开发经心电图和成像数据训练的人工智能驱动算法，以改善HCM患者或有HCM风险患者的早期发现、风险分层和治疗监测。此外，人工智能在基于生物标志物的预测模型中显示出实用性，进一步提高了诊断精度和临床决策。利用人工智能的力量可能有助于缩小关键的诊断差距，并优化HCM患者的治疗结果。
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引用次数: 0
The scope of cardiology research: More than 300 topics covered through bibliometric evaluation 心脏病学研究范围：通过文献计量学评估涵盖的300多个主题。
IF 3.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Current Problems in Cardiology
Pub Date : 2025-12-18 DOI: 10.1016/j.cpcardiol.2025.103256
Saeed Alshahrani , Siddig Ibrahim Abdelwahab , Manal Mohamed Elhassan Taha , Abdullah Farasani , Jobran M Moshi , Ahmad Assiri , Khaled A Sahli , Hussam M. Shubaily , Marwa Qadri , Amani Khardali , Waseem Hassan
This study provides a bibliometric overview of cardiovascular-related bibliometric research identified in the Scopus database using a title–abstract–keyword (TAK) search strategy. A total of 2,069 records were identified, with original articles (n = 1,130) and review papers (n = 596) representing the predominant document types. Restricting the analysis to these two categories yielded 1,726 documents, underscoring their central role in bibliometric reporting. A clear temporal growth was observed, increasing from a single publication in 1991 to 71 in 2025, with notable expansion after 2020. Authorship and institutional analyses revealed a strong concentration of contributions from China. Hu Y. was the most prolific author (13 publications), followed by Shou X. (7), while several others contributed five publications each. The China Academy of Chinese Medical Sciences (44 publications) and Beijing University of Chinese Medicine (41) were the leading institutions. China dominated global output with 229 publications, far exceeding the United States (25) and other contributing countries. Funding was primarily provided by the National Natural Science Foundation of China (84 publications). Frontiers in Cardiovascular Medicine was the leading journal (44 publications), followed by Medicine (United States) (28) and Heliyon (18). Thematically, over 300 cardiological subtopics were identified, spanning clinical areas such as heart failure, atrial fibrillation, and obesity-related cardiovascular disease, as well as emerging domains including artificial intelligence, autophagy, ferroptosis, non-coding RNAs, and digital health. Studies also addressed societal and environmental determinants such as gender disparities, air pollution, and psychosocial stress. Collectively, these findings demonstrate the accelerating adoption of bibliometric approaches in cardiovascular science and the field’s transition toward interdisciplinary, technology-integrated, and data-driven research directions.
本研究使用标题-摘要-关键词（TAK）搜索策略对Scopus数据库中心血管相关文献计量学研究进行了文献计量学综述。共确定了2,069条记录，其中主要的文件类型为原创文章（n = 1,130）和综述论文（n = 596）。将分析限制在这两个类别产生了1 726份文件，强调了它们在文献计量报告中的中心作用。观察到明显的时间增长，从1991年的一份出版物增加到2025年的71份，在2020年之后有显著的扩展。作者身份和机构分析显示，中国的贡献高度集中。胡颖是最多产的作者（13篇），其次是寿旭（7篇），其他几个人每人发表了5篇文章。中国中医科学院（44篇）和北京中医药大学（41篇）是领先的机构。中国以229篇论文占据全球主导地位，远远超过美国（25篇）和其他贡献国。主要由国家自然科学基金资助（84篇）。《心血管医学前沿》（Frontiers in Cardiovascular Medicine）是排名第一的杂志（44篇），其次是《医学》（美国）（28篇）和《Heliyon》（18篇）。在主题上，确定了300多个心脏病亚主题，涵盖心力衰竭、心房颤动和肥胖相关心血管疾病等临床领域，以及人工智能、自噬、铁死亡、非编码rna和数字健康等新兴领域。研究还涉及社会和环境决定因素，如性别差异、空气污染和社会心理压力。总的来说，这些发现表明了文献计量学方法在心血管科学中的加速应用，以及该领域向跨学科、技术集成和数据驱动的研究方向的转变。
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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 : 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
Antiplatelet therapy in patients with chronic coronary syndrome requiring oral anticoagulation: An updated meta-analysis of randomized trials 需要口服抗凝治疗的慢性冠状动脉综合征患者的抗血小板治疗：一项随机试验的最新meta分析。
IF 3.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Current Problems in Cardiology
Pub Date : 2025-12-18 DOI: 10.1016/j.cpcardiol.2025.103250
Fernando Garagoli , Walter Masson , Martin Lobo , Leandro Barbagelata , Guillaume Cayla , Martine Gilard , Gilles Lemesle

Background

Patients with chronic coronary syndrome (CCS) often require long-term oral anticoagulation (OAC), most commonly for atrial fibrillation (AF). Evidence on the optimal antithrombotic strategy in this setting remains inconclusive, prompting this updated meta-analysis of randomized trials comparing OAC plus a single antiplatelet therapy (SAPT) with OAC monotherapy.

Methods

We systematically searched PubMed/MEDLINE, SciELO, Latindex, LILACS, the Cochrane Library, and ClinicalTrials.gov up to November 12, 2025. The primary efficacy endpoint was all-cause death, while secondary efficacy endpoints included cardiovascular death, acute myocardial infarction, ischemic stroke, and systemic embolism, each analyzed individually. Safety endpoints comprised major and clinically relevant non-major bleeding (International Society on Thrombosis and Hemostasis [ISTH] definition).

Results

Six randomized trials including 5,924 participants were analyzed. All-cause death did not differ significantly between OAC plus SAPT and OAC monotherapy (OR 1.31; 95 % CI 0.89–1.92). Dual therapy was associated with an increased risk of cardiovascular death (OR 1.42; 95 % CI 1.05–1.92), whereas rates of myocardial infarction (OR 0.98; 95 % CI 0.60–1.57), ischemic stroke (OR 0.95; 95 % CI 0.64–1.39), and systemic embolism (OR 1.00; 95 % CI 0.20–4.95) were similar between groups. Safety outcomes were markedly worse with dual therapy, which significantly increased the risk of major bleeding (OR 2.20; 95 % CI 1.51–3.22) and major or clinically relevant non-major bleeding (OR 2.30; 95 % CI 1.72–3.06).

Conclusions

In patients with CCS requiring long-term OAC, dual therapy (OAC plus SAPT) did not reduce all-cause death nor ischemic events compared with OAC alone but significantly increased major bleeding and cardiovascular death. PROSPERO Registration No.: CRD420251239917.
背景：慢性冠状动脉综合征（CCS）患者通常需要长期口服抗凝（OAC），最常见的是房颤（AF）。在这种情况下，关于最佳抗血栓策略的证据仍然不确定，这促使我们对比较OAC加单抗血小板治疗（SAPT）与OAC单抗治疗的随机试验进行了更新的荟萃分析。方法：系统检索PubMed/MEDLINE、SciELO、Latindex、LILACS、Cochrane图书馆和ClinicalTrials.gov，检索截止日期为2025年11月12日。主要疗效终点是全因死亡，而次要疗效终点包括心血管死亡、急性心肌梗死、缺血性卒中和全身性栓塞，每个终点都单独分析。安全终点包括大出血和临床相关的非大出血（国际血栓和止血学会[ISTH]定义）。结果：共分析了6项随机试验5924名受试者。OAC + SAPT与OAC单药治疗的全因死亡率无显著差异（OR 1.31; 95%CI 0.89-1.92）。双重治疗与心血管死亡风险增加相关（OR 1.42; 95%CI 1.05-1.92），而心肌梗死（OR 0.98; 95%CI 0.60-1.57）、缺血性卒中（OR 0.95; 95%CI 0.64-1.39）和全身性栓塞（OR 1.00; 95%CI 0.20-4.95）的发生率在两组之间相似。双重治疗的安全性结果明显更差，显著增加了大出血（OR 2.20; 95%CI 1.51-3.22）和大出血或临床相关的非大出血（OR 2.30; 95%CI 1.72-3.06）的风险。结论：在需要长期OAC的CCS患者中，与单独OAC相比，双重治疗（OAC + SAPT）并没有减少全因死亡和缺血性事件，但显著增加了大出血和心血管死亡。普洛斯彼罗注册号: CRD420251239917。
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引用次数: 0
The early initiation of sodium-glucose cotransporter-2 inhibitors in patients with decompensated heart failure: A systematic review and meta-analysis 钠-葡萄糖共转运蛋白-2抑制剂在失代偿性心力衰竭患者中的早期应用：一项系统综述和荟萃分析。
IF 3.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Current Problems in Cardiology
Pub Date : 2025-12-18 DOI: 10.1016/j.cpcardiol.2025.103255
Ahmad Al-Abdouh MD , Ahmad Jabri MD , Mohammed Mhanna MD , Laith Alhuneafat MD , Fares Ghanem MD , Ibrahim Mortada MD , Omar Obeidat MD , Shareef Mansour MD , Wissam Khalife MD

Introduction

Sodium-glucose cotransporter-2 (SGLT2) inhibitors have shown significant reduction in cardiovascular mortality and heart failure hospitalization in patients with chronic heart failure. Despite their benefits in chronic heart failure, their use during episodes of acute decompensation remains under investigation.

Methods

A comprehensive literature search was performed using PubMed, Google Scholar, and ClinicalTrials.gov from database inception through September 3, 2025. The predefined endpoints were all-cause mortality, heart failure hospitalizations, and a composite of cardiovascular mortality or heart failure worsening. Outcomes were pooled using a random effects Mantel-Haenszel model. The DerSimonian and Laird method was used for estimation of τ.2 We reported effect sizes as risk ratios (RR) with 95 % confidence interval (CI).

Results

A total of eight randomized controlled trials, encompassing 4,714 patients, were included in the analysis. Among patients hospitalized with decompensated heart failure, treatment with SGLT2 inhibitors compared with standard care only (control group) was associated with a significant decrease in all-cause mortality (RR 0.72; 95 % CI, 0.58–0.90; P < 0.01; I² = 0 %), and in the composite outcome of cardiovascular mortality or heart failure rehospitalization (RR 0.68; 95 % CI, 0.53–0.86; P < 0.01; I² = 28 %). However, no significant reduction was observed in heart failure rehospitalization as an isolated outcome (RR 0.92; 95 % CI, 0.82–1.03; P = 0.16; I² = 0 %).

Conclusion

SGLT-2 inhibitors during hospitalization for acute decompensated heart failure is effective and led to decrease in all-cause mortality and a composite endpoint of cardiovascular mortality or heart failure hospitalizations.
钠-葡萄糖共转运蛋白-2 （SGLT2）抑制剂在慢性心力衰竭患者心血管死亡率和心力衰竭住院率方面有显著降低。尽管它们对慢性心力衰竭有好处，但在急性失代偿发作时的使用仍在研究中。方法：从数据库建立到2025年9月3日，使用PubMed、谷歌Scholar和ClinicalTrials.gov进行全面的文献检索。预先设定的终点是全因死亡率、心力衰竭住院、心血管死亡率或心力衰竭恶化的复合。使用随机效应Mantel-Haenszel模型汇总结果。用DerSimonian和Laird方法估计τ2。我们以95%置信区间（CI）的风险比（RR）报告效应大小。结果：共有8项随机对照试验，包括4,714例患者被纳入分析。在失代偿性心力衰竭住院患者中，与单纯标准治疗（对照组）相比，SGLT2抑制剂治疗与全因死亡率显著降低（RR 0.72; 95% CI, 0.58-0.90; P < 0.01; I² = 0%）以及心血管死亡率或心力衰竭再住院的综合结局（RR 0.68; 95% CI, 0.53-0.86; P < 0.01; I² = 28%）相关。然而，作为孤立结局的心力衰竭再住院率没有显著降低（RR 0.92; 95% CI, 0.82-1.03; P = 0.16;I² = 0%）。结论：急性失代偿性心力衰竭住院期间使用SGLT-2抑制剂是有效的，可降低全因死亡率和心血管死亡率或心力衰竭住院的综合终点。
{"title":"The early initiation of sodium-glucose cotransporter-2 inhibitors in patients with decompensated heart failure: A systematic review and meta-analysis","authors":"Ahmad Al-Abdouh MD ,&nbsp;Ahmad Jabri MD ,&nbsp;Mohammed Mhanna MD ,&nbsp;Laith Alhuneafat MD ,&nbsp;Fares Ghanem MD ,&nbsp;Ibrahim Mortada MD ,&nbsp;Omar Obeidat MD ,&nbsp;Shareef Mansour MD ,&nbsp;Wissam Khalife MD","doi":"10.1016/j.cpcardiol.2025.103255","DOIUrl":"10.1016/j.cpcardiol.2025.103255","url":null,"abstract":"<div><h3>Introduction</h3><div>Sodium-glucose cotransporter-2 (SGLT2) inhibitors have shown significant reduction in cardiovascular mortality and heart failure hospitalization in patients with chronic heart failure. Despite their benefits in chronic heart failure, their use during episodes of acute decompensation remains under investigation.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was performed using PubMed, Google Scholar, and ClinicalTrials.gov from database inception through September 3, 2025. The predefined endpoints were all-cause mortality, heart failure hospitalizations, and a composite of cardiovascular mortality or heart failure worsening. Outcomes were pooled using a random effects Mantel-Haenszel model. The DerSimonian and Laird method was used for estimation of τ.<sup>2</sup> We reported effect sizes as risk ratios (RR) with 95 % confidence interval (CI).</div></div><div><h3>Results</h3><div>A total of eight randomized controlled trials, encompassing 4,714 patients, were included in the analysis. Among patients hospitalized with decompensated heart failure, treatment with SGLT2 inhibitors compared with standard care only (control group) was associated with a significant decrease in all-cause mortality (RR 0.72; 95 % CI, 0.58–0.90; <em>P</em> &lt; 0.01; I² = 0 %), and in the composite outcome of cardiovascular mortality or heart failure rehospitalization (RR 0.68; 95 % CI, 0.53–0.86; <em>P</em> &lt; 0.01; I² = 28 %). However, no significant reduction was observed in heart failure rehospitalization as an isolated outcome (RR 0.92; 95 % CI, 0.82–1.03; <em>P</em> = 0.16; I² = 0 %).</div></div><div><h3>Conclusion</h3><div>SGLT-2 inhibitors during hospitalization for acute decompensated heart failure is effective and led to decrease in all-cause mortality and a composite endpoint of cardiovascular mortality or heart failure hospitalizations.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"51 3","pages":"Article 103255"},"PeriodicalIF":3.3,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800654","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
Artificial Intelligence in detection of acute coronary occlusion in NSTEMI patients 人工智能在NSTEMI患者急性冠状动脉闭塞诊断中的应用。
IF 3.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Current Problems in Cardiology
Pub Date : 2025-12-18 DOI: 10.1016/j.cpcardiol.2025.103254
Sara Tomovic , Robert Herman , Srdjan Dedic , Nikola Boskovic , Stefan Juricic , Srdjan Aleksandric , Marina Ostojic , Ivana Nedeljkovic , Vojislav Giga , Marko Banovic
The prognosis of patients with MI has improved significantly with the recognition that early reperfusion is critical, particularly since timely percutaneous coronary intervention (PCI) became widely adopted. The invasive reperfusion era also reshaped MI diagnostics, shifting the paradigm from Q-wave vs. Non-Q-wave MI to ST-Elevation Myocardial Infarction (STEMI) vs. Non-ST-Elevation Myocardial Infarction (NSTEMI).
The current ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) paradigm have long been the cornerstone of myocardial infarction (MI) care but fail to identify many patients with acute coronary occlusion (ACO), delaying treatment and worsening outcomes. This limitation is increasingly important, since NSTEMI now represents the majority of presentations accounting for roughly 70% of AMI worldwide and many of these occlusive events are managed with delays contributing to worse outcomes. Adding to this challenge, substantial inter-physician variability in ECG interpretation for ACO has been demonstrated.
In this review, we highlight recent advances using the artificial intelligence in the evaluation of patients presenting with ECG changes suggestive of NSTEMI and evaluate its role in the detection of NSTEMI patients with acute coronary occlusion.
由于认识到早期再灌注至关重要，特别是及时经皮冠状动脉介入治疗（PCI）被广泛采用，心肌梗死患者的预后已显著改善。有创再灌注时代也重塑了心肌梗死的诊断模式，从q波心肌梗死与非q波心肌梗死转变为st段抬高型心肌梗死（STEMI）与非st段抬高型心肌梗死（NSTEMI）。目前的st段抬高型心肌梗死（STEMI）和非st段抬高型心肌梗死（NSTEMI）模式长期以来一直是心肌梗死（MI）护理的基石，但未能识别许多急性冠状动脉闭塞（ACO）患者，导致治疗延迟和预后恶化。这一限制越来越重要，因为NSTEMI现在占AMI的大多数，约占全球AMI的70%，并且许多这些闭塞事件的处理延迟导致结果更差。增加这一挑战的是，已经证明了ACO的ECG解释在医生之间存在很大的差异。在这篇综述中，我们重点介绍了人工智能在评估具有非stemi心电图变化的患者中的最新进展，并评估了其在检测急性冠状动脉闭塞的非stemi患者中的作用。
{"title":"Artificial Intelligence in detection of acute coronary occlusion in NSTEMI patients","authors":"Sara Tomovic ,&nbsp;Robert Herman ,&nbsp;Srdjan Dedic ,&nbsp;Nikola Boskovic ,&nbsp;Stefan Juricic ,&nbsp;Srdjan Aleksandric ,&nbsp;Marina Ostojic ,&nbsp;Ivana Nedeljkovic ,&nbsp;Vojislav Giga ,&nbsp;Marko Banovic","doi":"10.1016/j.cpcardiol.2025.103254","DOIUrl":"10.1016/j.cpcardiol.2025.103254","url":null,"abstract":"<div><div>The prognosis of patients with MI has improved significantly with the recognition that early reperfusion is critical, particularly since timely percutaneous coronary intervention (PCI) became widely adopted. The invasive reperfusion era also reshaped MI diagnostics, shifting the paradigm from Q-wave vs. Non-Q-wave MI to ST-Elevation Myocardial Infarction (STEMI) vs. Non-ST-Elevation Myocardial Infarction (NSTEMI).</div><div>The current ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) paradigm have long been the cornerstone of myocardial infarction (MI) care but fail to identify many patients with acute coronary occlusion (ACO), delaying treatment and worsening outcomes. This limitation is increasingly important, since NSTEMI now represents the majority of presentations accounting for roughly 70% of AMI worldwide and many of these occlusive events are managed with delays contributing to worse outcomes. Adding to this challenge, substantial inter-physician variability in ECG interpretation for ACO has been demonstrated.</div><div>In this review, we highlight recent advances using the artificial intelligence in the evaluation of patients presenting with ECG changes suggestive of NSTEMI and evaluate its role in the detection of NSTEMI patients with acute coronary occlusion.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"51 3","pages":"Article 103254"},"PeriodicalIF":3.3,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800956","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}
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