Current Problems in Cardiology最新文献

英文中文

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。

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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。

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引用次数: 0

Burden of cardiovascular diseases attributable to diet high in sodium in China and the global from 1990 to 2021 1990 - 2021年中国及全球高钠饮食导致的心血管疾病负担

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.2025.103248

Wuyang Wei , Meiyuan Chen , Jiyong Wei , Xiaoyu Zheng

Background

Diet high in sodium is an established major risk factor for cardiovascular diseases (CVDs), yet a comprehensive and updated assessment of its attributable disease burden, particularly comparing China with global patterns over the last three decades, is lacking.

Methods

This study aims to quantify and compare the deaths and disability-adjusted life years (DALYs) of CVDs attributable to diet high in sodium in China and globally from 1990 to 2021. Using data from the Global Burden of Disease (GBD) Study 2021, we applied the comparative risk assessment framework to estimate the sodium-attributable CVD burden. Mortality and DALYs were analyzed as absolute numbers and age-standardized rates (ASRs). Temporal trends were assessed using estimated annual percentage changes (EAPCs), and future burden to 2046 was projected using an age-period-cohort (APC) model.

Results

In 2021, diet high in sodium was responsible for 1.71 million [95 % uncertainty intervals (UI): 0.36-3.81 million] global deaths and 37.77 million (95 % UI: 9.05-80.81 million) DALYs. The global age-standardized death rate (ASDR) and DALY rate (ASDAR) were 20.4 and 437.7 per 100,000, respectively. From 1990 to 2021, while absolute death counts increased by 52 %, the ASDR significantly declined (EAPC: -1.46 %). Pronounced sex and age disparities were observed, with males bearing a consistently higher burden and the elderly experiencing the highest rates but slowest improvements. In China, the 2021 ASDR (40.91/100,000) and ASDAR (837.94/100,000) were approximately double the global averages, despite substantial declines since 1990 (ASDR EAPC: -1.74 %; ASDAR EAPC: -1.85 %). Projections to 2046 indicate rising absolute numbers globally and in China, driven by demographic changes, despite continuing declines in age-standardized rates.

Conclusion

High sodium intake remains a major contributor to the global and Chinese CVD burden, with significant sex and age disparities. Although age-standardized rates have improved, the rising absolute burden underscores the imperative for more effective, targeted salt-reduction public health strategies.

背景：高钠饮食是心血管疾病（cvd）的主要危险因素，但缺乏对其归因疾病负担的全面和最新评估，特别是将中国与过去三十年的全球模式进行比较。方法：本研究旨在量化和比较1990年至2021年中国和全球高钠饮食导致的心血管疾病死亡和残疾调整生命年（DALYs）。使用来自2021年全球疾病负担（GBD）研究的数据，我们应用比较风险评估框架来估计钠导致的心血管疾病负担。死亡率和DALYs以绝对数字和年龄标准化率（ASRs）进行分析。使用估计年百分比变化（EAPCs）评估时间趋势，并使用年龄-时期-队列（APC）模型预测到2046年的未来负担。结果：2021年，高钠饮食导致全球171万例[95%不确定区间（UI）： 0.36- 381万]死亡和3777万例（95% UI: 905 - 8081万）伤残调整生命年。全球年龄标准化死亡率（ASDR）和DALY率（ASDAR）分别为20.4和437.7 / 10万。从1990年到2021年，虽然绝对死亡人数增加了52%，但平均死亡率显著下降（EAPC: -1.46%）。观察到明显的性别和年龄差异，男性承受的负担一直较高，老年人的发病率最高，但改善速度最慢。在中国，尽管自1990年以来大幅下降（ASDR EAPC: -1.74%; ASDAR EAPC: -1.85%），但2021年ASDR（40.91/100,000）和ASDAR（837.94/100,000）约为全球平均水平的两倍。到2046年的预测表明，尽管年龄标准化率持续下降，但受人口结构变化的推动，全球和中国的绝对数字仍将上升。结论：高钠摄入仍然是全球和中国心血管疾病负担的主要因素，存在显著的性别和年龄差异。虽然年龄标准化率有所改善，但不断上升的绝对负担凸显了制定更有效、更有针对性的减盐公共卫生战略的必要性。

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Innate lymphoid cells and trained innate immunity in cardiovascular disease: Mechanistic insights, immunopathology, and emerging translational opportunities 先天淋巴样细胞和先天免疫在心血管疾病中的作用：机制、免疫病理学和新兴的转化机会。

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.2025.103252

Mustafa H. Halawi , Mazen Almehmadi , Essam H. Ibrahim , Ramadan Taha , Ahmed Ezzat Ahmed , Esmael M. Alyami , Theodore Whitmore , Muhammad Sohail , Fazal Rehman , Shahid Ullah Khan

Cardiovascular diseases (CVDs) remain the leading global cause of morbidity and mortality, with growing evidence highlighting the immune system as a central regulator of disease initiation and progression. Recent advances have uncovered pivotal roles for innate lymphoid cells (ILCs) and trained innate immunity (TI) in shaping cardiovascular homeostasis and inflammation. This review synthesizes current knowledge on the development, tissue residency, and functional specialization of ILC subsets, including ILC1/NK cells, ILC2, and ILC3, as well as their divergent contributions to atherosclerosis, myocardial infarction, heart failure, myocarditis, and pericarditis. ILC1 and NK cells promote vascular inflammation and plaque progression, whereas cardiac-resident ILC2s exert reparative, anti-inflammatory, and atheroprotective effects. Parallel evidence shows that TI, driven by metabolic stressors such as hyperglycemia, oxidized LDL, smoking, and a Western diet, induces persistent myeloid reprogramming that amplifies vascular inflammation and accelerates CVD. We further highlight their potential as diagnostic biomarkers and therapeutic targets, including cytokine-directed interventions, modulation of the IL-33/ILC2 axis, and epigenetic therapies. Together, these insights position ILC biology and TI as transformative frameworks for advancing precision immunocardiology.

心血管疾病（cvd）仍然是全球发病率和死亡率的主要原因，越来越多的证据强调免疫系统是疾病发生和进展的主要调节因子。最近的研究进展揭示了先天淋巴样细胞（ILCs）和后天免疫（TI）在形成心血管稳态和炎症中的关键作用。这篇综述综合了目前关于ILC亚群的发育、组织居住和功能特化的知识，包括ILC1/NK细胞、ILC2和ILC3，以及它们在动脉粥样硬化、心肌梗死、心力衰竭、心肌炎和心包炎中的不同作用。ILC1和NK细胞促进血管炎症和斑块进展，而心脏驻留的ILC2s发挥修复、抗炎和动脉粥样硬化保护作用。平行的证据表明，由代谢应激源（如高血糖、氧化低密度脂蛋白、吸烟和西方饮食）驱动的TI诱导了持续的髓细胞重编程，从而放大了血管炎症并加速了心血管疾病。我们进一步强调了它们作为诊断生物标志物和治疗靶点的潜力，包括细胞因子定向干预、IL-33/ILC2轴的调节和表观遗传治疗。总之，这些见解使ILC生物学和TI成为推进精确免疫心脏病学的变革性框架。

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IF 3.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

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IF 3.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

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IF 3.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

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IF 3.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

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IF 3.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

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