Acta cardiologica最新文献

Rare cardiovascular diseases represent a heterogeneous group of conditions that are individually uncommon but collectively significant. They include inherited cardiomyopathies, infiltrative and metabolic disorders, channelopathies, aortopathies, as well as rare vascular syndromes and some congenital heart diseases. Over the last decade, major advances in multimodality imaging, genetic testing, and targeted therapies have substantially improved diagnostic accuracy and clinical outcomes. Patient-tailored management and disease‑modifying treatments, particularly for cardiomyopathies and selected metabolic disorders, illustrate the transition towards precision medicine in the field. Despite these scientific advances, important organisational challenges remain. In Belgium, eight centres are recognised as reference hospitals for rare diseases since 2014, but high‑level expertise and advanced technologies are available in more tertiary centres and care pathways for rare cardiovascular diseases remain fragmented. The recent Plan rare disease 2026-2030 with a development of a Central Rare Disease Registry and the extension of structured rare disease event registration to all medical services represent important steps towards improved epidemiological monitoring and coordination. However, formally organising a national network dedicated to rare cardiovascular diseases is a challenge to offer uniform access to specialised care. The framework for collaboration of the reference centres with the different partners over the lines of care, the establishment and support of multidisciplinary clinics, the development of generic and personalised care pathways and national registries are key steps towards more coordinated, equitable, and efficient management of patients with rare cardiovascular diseases in Belgium.

Background: Lipoprotein(a) (Lp(a)) is a proatherogenic lipoprotein associated with increased cardiovascular risk and is minimally responsive to statins or lifestyle changes. While Lp(a) is linked to adverse cardiovascular events, its role in predicting repeat revascularization after percutaneous coronary intervention (PCI) remains unclear. This review evaluates the relationship between Lp(a) levels and coronary revascularization outcomes.

Methods: A systematic review and meta-analysis of studies from MEDLINE and EMBASE through June 18, 2025, evaluated the association between elevated Lp(a) and revascularization outcomes post-PCI. Random-effects models using the DerSimonian-Laird method were used to pool odds (ORs) and hazard ratios (HRs). Heterogeneity was assessed using the I² statistic and Cochran's Q test, and publication bias was evaluated with Egger's regression test.

Results: Twenty studies were included in the systematic review, of which eighteen were included in the meta-analysis. Elevated Lp(a) levels were associated with a higher risk of any repeat revascularization, with pooled OR 1.33 (95% CI: 1.17-1.52) and HR 1.15 (95% CI: 1.05-1.25). High Lp(a) was also linked to increased risk of target vessel revascularization (TVR) (OR 1.42; 95% CI: 1.12-1.81). A non-significant trend towards increased target lesion revascularization (TLR) was observed (OR 1.25; 95% CI: 0.96-1.64).

Conclusion: Elevated Lp(a) levels were associated with a higher risk of repeat revascularization and TVR, with a non-significant trend towards increased TLR. Further studies are warranted to confirm these findings and explore the potential benefit of Lp(a)-lowering strategies.

Introduction: To compare perioperative outcomes and long‑term effects of 3D printing-guided personalised stent grafting versus conventional Sun procedure in type B aortic dissection (TBAD).

Methods: From January 2018 to October 2024, 150 TBAD patients were enrolled: 84 underwent 3D printing-assisted stent grafting and 66 received the Sun procedure. After 1:1 propensity score matching (PSM), 74 pairs with balanced baseline characteristics were analysed. Surgical metrics, perioperative and follow‑up complications, aortic remodelling, and patient satisfaction were assessed.

Results: Post‑matching, baseline data showed no significant differences (p > 0.05). Compared with the Sun group, the 3D printing group had shorter operative time, reduced blood loss, lower 24‑h drainage, shorter ventilator support, ICU stay, and hospitalisation (all p < 0.05). Complication rates were lower and patient satisfaction higher (*p < 0.05). At 6 and 12 months, the 3D printing group demonstrated greater true lumen expansion and false lumen reduction at the aortic isthmus and pulmonary artery bifurcation (*p < 0.05), with no difference in thrombosis rates (p > 0.05).

Conclusions: 3D printing-assisted individualised stent grafting offers superior perioperative outcomes, fewer complications, enhanced aortic remodelling, and higher patient satisfaction compared with the Sun procedure, supporting its broader clinical application.

Background: Acute coronary syndrome (ACS) is a leading cause of cardiovascular mortality, but early biomarkers for disease prediction remain limited. Circular RNAs (circRNAs) have emerged as potential diagnostic tools due to their stability and disease-specific expression. The aim of this study is to explore the hsa_circ_0005870 as a diagnostic/prognostic biomarker for ACS and its mechanism.

Methods: This study enrolled 98 ACS, 68 stable coronary artery disease (SCHD), and 56 controls. Serum hsa_circ_0005870 and miR-127-3p levels were quantified via RT-qPCR. The diagnostic utility of hsa_circ_0005870 was evaluated by receiver operating characteristic (ROC) analysis. Kaplan-Meier survival analysis and multivariate Cox regression assessed independent prognostic factors. CCK-8/flow cytometry measured cell viability/apoptosis; ELISA quantified endothelial dysfunction (ED) markers. Dual-luciferase assays confirmed hsa_circ_0005870-miR-127-3p and miR-127-3p-CDH1 interactions.

Results: Serum hsa_circ_0005870 levels were significantly reduced in SCHD and ACS compared to controls. The expression level inversely correlated with Gensini scores. ROC analysis revealed high diagnostic accuracy of hsa_circ_0005870 for distinguishing ACS from both healthy and SCHD. Low expression level elevates the risk of major adverse cardiovascular events. Overexpression of hsa_circ_0005870 promotes cell proliferation, inhibits apoptosis, and suppresses endothelial adhesion molecules. miR-127-3p had opposite effects, negatively correlating with hsa_circ_0005870. Mechanistically, hsa_circ_0005870 negatively regulates miR-127-3p, while miR-127-3p directly targets CDH1.

Conclusions: These findings suggest that hsa_circ_0005870 may serve as a potential diagnostic/prognostic biomarker for ACS, modulating cellular viability and apoptosis through miR-127-3p/CDH1 axis-mediated mechanisms while synergistically influencing ACS progression with molecular mediators.