American journal of cardiovascular disease最新文献

Pulmonary arterial hypertension (PAH) is a fatal disease with extremely poor prognosis, primarily driven by persistent pulmonary vascular remodeling. The disease often presents insidiously and progresses rapidly. Although current targeted therapies may slow disease progression, they fall far short of reversing pathological changes, underscoring the urgent need for novel therapeutic breakthroughs and precise diagnostic approaches. Within this context, microRNA (miRNA) regulatory networks - key nodes of epigenetic regulation - have emerged as a potential bridge between basic science and clinical translation. Increasing evidence has shown that specific miRNAs, by targeting signaling pathways such as PI3K/AKT and TGF-β/Smad, orchestrate complex multi-target molecular cascades that critically regulate pathological processes, including endothelial dysfunction, abnormal proliferation and phenotypic switching of smooth muscle cells, inflammatory activation, and metabolic remodeling. These mechanisms ultimately drive irreversible vascular remodeling. Aberrant expression patterns of miRNAs are not only closely associated with disease severity but also hold great promise as non-invasive biomarkers, facilitating early detection, subtype classification, and prognostic assessment of PAH. Importantly, miRNA-targeted nucleic acid therapeutics have demonstrated therapeutic potential in preclinical models, including reversal of vascular remodeling and improvement of hemodynamics, highlighting their potential in future precision medicine strategies. However, clinical translation faces multiple barriers, such as poor targeting efficiency of delivery systems, unpredictable off-target effects, significant inter-individual variability, and lack of standardized efficacy evaluation frameworks. Therefore, systematic breakthroughs are urgently needed. This review aims to comprehensively summarize the role of miRNA regulatory networks in the pathogenesis, diagnosis, and treatment of PAH, with a particular emphasis on their central position in shaping early-stage precision intervention strategies.

Background: Atherosclerosis (AS), the primary cause of cardiovascular morbidity and mortality, involves chronic vascular inflammation and plaque formation. While conventional therapies target systemic risk factors, their limited plaque-specific effects and adverse profiles have driven the exploration of targeted delivery systems. Nanoparticle-mediated delivery of nucleic acid therapies offers a promising strategy to modulate inflammation and promote plaque regression at the molecular level. This study aimed to systematically evaluate recent preclinical evidence on the effectiveness of functionalized nanoparticles for delivering nucleic acid-based therapies to atherosclerotic plaques.

Methods: This systematic review, conducted in accordance with the PRISMA 2020 guidelines, evaluated preclinical studies published between 2018 and 2024 that utilized nanoparticles to deliver siRNA, miRNA inhibitors, or antisense oligonucleotides (ASOs) to atherosclerotic plaques. Data extraction included nanoparticle type, targeting ligands, size, loading efficiency, administration route, and therapeutic outcomes. Comparative figures were generated, including a bar chart of plaque reduction efficacy by nanoparticle type and a qualitative heatmap mapping functionalization strategies to molecular targets.

Results: Fifteen animal studies met the inclusion criteria. Nanoparticles varied in size (5-190 nm), composition (cyclodextrin, gold, polymeric, lipid-based), and targeting mechanisms (e.g., VCAM1, CD36, integrin ligands). High efficacy was reported for functionalized carriers targeting macrophages or inflammatory pathways, with plaque reductions up to 65.8%. Visual analyses highlighted cyclodextrin-integrin and rHDL-based systems as top-performing strategies, while a heatmap revealed preferred pairings of delivery ligands with nucleic acid targets.

Conclusion: Functionalized nanoparticles demonstrate robust preclinical efficacy for delivering nucleic acids to atherosclerotic plaques. These findings support their potential for targeted, multimodal therapy in cardiovascular disease, warranting further clinical investigation into scalable, biocompatible delivery platforms.

Objectives: Preoperative hypoxemia in patients with acute type A aortic dissection (ATAAD) increases the risk of Postoperative pulmonary complications (PPCs). Sivelestat, which is used for acute lung injury has not been extensively studied in ATAAD patients who develop preoperative hypoxemia. This study first aims to evaluate the impact of sivelestat on the duration of postoperative mechanical ventilation and the length of stay in the Intensive Care Unit (ICU) for patients with ATAAD complicated by hypoxemia. Secondly, we investigate the effects of sodium sivelestat on the oxygenation index (OI, PaO₂/FiO₂) and serum inflammatory factors of patients.

Methods: In this retrospective study, 143 patients diagnosed with ATAAD undergoing total aortic arch replacement with stent grafting (Sun's) at our hospital (2021-2024) were grouped into sivelestat and non-sivelestat groups. We obtained and compared patient data including demographics, hospitalization, ventilation, and perioperative biomarkers.

Results: In total, 79 patients (55.2%) experienced preoperative hypoxemia based on the inclusion criteria. Eventually, 65 patients were enrolled in the study after excluding 14 patients. The postoperative PaO₂/FiO₂ decreased in both groups. The postoperative PaO₂/FiO₂ was significantly higher in the sivelestat group than in the non-sivelestat group at 3d (T2), 5d (T3), and 7d (T4). White blood cell count (WBCc) and neutrophil count (NEUTc) at T3 and T4, as well as a neutrophil percentage (NEUT%) at T4 in the sivelesta group were lower than that in the non-sivelestat group. Additionally, the C-reactive protein (CRP) and Interleukin-6(IL-6) levels in the sivelesta group at T3 and T4 were reduced. The mechanical ventilation duration, ICU, and hospital length of stay in the sivelesta group were shortened. Other clinical indices displayed no significant differences.

Conclusion: In summary, patients with ATAAD and preoperative hypoxemia have lower postoperative PaO₂/FiO₂. Besides, sivelestat improves postoperative PaO₂/FiO₂, reduces inflammation, and shortens ventilation as well as ICU/hospital stay in ATAAD patients with preoperative hypoxemia.

Cardiovascular disease (CVD), a leading global health concern and the primary cause of death worldwide, is often associated with atherosclerosis and cardiac events.

Objective: This study evaluated biochemical and hematological parameters as predictors of CVD risk using atherosclerotic CVD and World Health Organization/International Society of Hypertension risk scores (WHO/ISH).

Methodology: 102 volunteer participants representing 69 males (67.6%) and 33 females (32.4%) from the Health and Administrative Staff of University Hospital-General Sir John Kotelawala Defence University, Sri Lanka, were selected. Patient demographics, biometrics, clinical parameters, and behavioral risk factors were collected. Laboratory parameters: complete blood count, lipid profile, aspartate and alanine aminotransferases were performed. The 10-year CVD risk was estimated using the "ASCVD-Risk Estimator-Plus" and WHO/ISH risk score charts; South Asia and Southeast Asia. The data were analyzed using IBM-SPSS-version26.

Results: The study population showed strong to moderate-strong correlations within the hematological, biochemical, and risk estimators, but not between these parameters. Platelets-to-Lymphocytes Ratio (PLR) had a strong, significant positive correlation with the Neutrophils-to-Lymphocyte Ratio (NLR) and a moderately strong, significant positive correlation with Platelets and NLR (r=0.446; P<0.001), indicating the inflammatory response, atherosclerosis with increased CVD risk. In the regression analysis, the HDL-LDL ratio was found to independently predict the TC-HDL ratio and successfully combined the WHO/ISH risk estimators with the collected biochemical, hematological, clinical, biometric, and behavioral risk factors by introducing highly predictive, well-fit equations. The ROC analysis indicated that once the HDL-LDL-ratio reduces below 0.39, ASCVD-10-year-risk (ASCVD_10) and ASCVD-lifetime-risk (ASCVD_LT) increase to 4.95 and 37.5, respectively.

Conclusion: A strong positive correlation was found between NLR, PLR, and CVD risk, with a moderate correlation between PLT and NLR. ASCVD_10 showed a reliable link with ASCVD_OP and ASCVD_LT, marking the first comparison of all three risk types. Predictive equations were developed by integrating WHO/ISH scores and other parameters. The TC-HDL ratio significantly correlated with the HDL-LDL ratio, enabling a cut-off value to predict ASCVD_10 risk and associated hematological and biochemical markers.

Objectives: Permanent pacemaker (PPM) implantation is a standard intervention for bradyarrhythmias, yet the long-term hemodynamic consequences of right ventricular (RV) lead positioning remain underexplored. While apical pacing has traditionally been favored, emerging evidence suggests that septal positioning may offer more physiological activation and better preserve cardiac function. This study aimed to compare the early echocardiographic effects of apical versus septal RV lead placement on right heart structure, function, and tricuspid valve competence in patients undergoing PPM implantation.

Methods: In this prospective observational study, 20 patients were divided equally into two groups: apical and septal pacing. Comprehensive echocardiographic evaluations were performed pre- and one month post-implantation. Parameters included RV and right atrial (RA) size, RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery pressure (PAP), inferior vena cava (IVC) diameter, tissue Doppler indices (E', A'), and tricuspid regurgitation (TR) severity. Statistical analyses included Mann-Whitney U tests and visualizations using radar plots and p-value heatmaps.

Results: Post-implantation, the apical group demonstrated significantly greater RV and RA dilation, elevated PAP, and reduced E' velocities, indicative of impaired diastolic function and increased right-sided load. In contrast, the septal group exhibited more stable dimensions and preserved diastolic function. Although baseline mild TR was more prevalent in the apical group (P<0.024), no significant intergroup differences in TR severity were observed at follow-up. Other clinical risk factors were comparable between groups.

Conclusions: Septal lead positioning is associated with more favorable right heart geometry and hemodynamics than apical pacing in the early post-implantation period. These preliminary findings support septal pacing as a potentially superior strategy for long-term cardiac preservation, but the small sample size limits generalizability and warrants confirmation in larger, randomized trials.

It is well established that video monitoring is effective in promoting self-care among patients with heart failure during the intervention period. However, its long-term impact on sustaining self-care behaviors after discontinuation remains unclear. This article describes a randomized clinical trial protocol designed to assess the effectiveness of a video monitoring strategy in maintaining self-care behaviors in patients with heart failure with reduced ejection fraction (HFrEF). This is a randomized, parallel trial with blinded outcome assessment. During hospitalization, eligible patients will be invited to participate. Data collection will include sociodemographic and clinical variables, laboratory test results, current medications, and cardiovascular physical examination. Validated instruments will measure clinical congestion, self-care (European HF Self-Care), HF knowledge, treatment adherence, quality of life, and cardiorespiratory fitness. The control group (CG) will receive standard care after discharge. In the intervention group (IG), the discharge summary will be shared with primary healthcare providers (nurse and physician) to facilitate transitional care. IG participants will receive structured video monitoring sessions with specialized cardiovascular nursing support at 7, 30, 60, 180, and 365 days post-discharge, focusing on self-care reinforcement. The primary outcome is the self-care score at one year. Secondary outcomes include quality of life, HF knowledge, treatment adherence, cardiorespiratory fitness, mortality, and hospital readmissions. Unlike mobile-based or voice telemonitoring strategies, video monitoring fosters a stronger connection between patients and healthcare professionals, which may enhance self-care maintenance over time. This approach aligns with personalized nursing interventions, reinforcing education and behavioral changes beyond the intervention period. This study highlights the role of video monitoring in sustaining self-care practices in heart failure management. By strengthening the nurse-patient relationship and promoting long-term adherence, it has the potential to reduce readmissions and mortality rates. Video monitoring may enhance global nursing practices, improving outcomes and quality of life for heart failure patients.

Evolocumab is a human monoclonal antibody that effectively reduces low-density lipoprotein (LDL) cholesterol levels by inhibiting proprotein convertase subtilisin-kexin type 9 (PCSK9). Although generally well tolerated, evolocumab may rarely lead to severe hypersensitivity reactions, including angioedema. To the best of our knowledge, severe angioedema requiring airway intervention has not been reported previously in the US population. A 64-year-old woman with hypertension, hypothyroidism, hyperlipidemia, and active tobacco use presented with acute chest pain and was diagnosed with ST-segment elevation myocardial infarction. She underwent percutaneous coronary intervention with two stents placed in the right coronary artery. Despite maximum lipid-lowering therapy, her LDL level remained elevated at 125 mg/dL, prompting the addition of evolocumab (Repatha). Within 24 hours, she experienced progressive tongue and facial swelling, with oropharyngeal edema threatening airway obstruction. Urgent laryngoscopy confirmed early oropharyngeal involvement, which necessitated endotracheal intubation. She received intravenous corticosteroids and antihistamines in the intensive care unit, with symptoms resolving within 48 hours, allowing for extubation and discharge after three days. This case highlights a rare but potentially life-threatening adverse effect of evolocumab.

Rotational atherectomy device entrapment is a rare but challenging complication of peripheral vascular interventions. This case report details a novel dual-access endovascular technique for retrieving an entrapped atherectomy burr from the posterior tibial artery of a 70-year-old man with severe peripheral arterial and chronic kidney disease. When conventional retrieval methods failed, retrograde posterior tibial access was established as an adjunct to the existing femoral access, enabling sequential balloon angioplasty with progressively larger balloons (1.5-2.5 mm) around the entrapped device. This dual-access approach successfully liberated the burr without requiring surgical extraction or arteriotomy. Following device retrieval, definitive treatment with balloon angioplasty and stent placement was completed immediately, achieving excellent restoration of flow. This minimally invasive technique offers several advantages over traditional surgical approaches, including vessel patency preservation, reduced procedural morbidity, avoidance of general anesthesia, and protection of potential future bypass targets. The described methodology expands the endovascular options for managing complex device-related complications and demonstrates particular value in high-risk patients with significant comorbidities.

Coronary angiography and cardiac catheterization using the right radial arterial access have lower complication rates but are associated with unique challenges that can lead to procedural failure. One of the major challenges can be the wire advancement into the ascending aorta with a tortuous subclavian artery, particularly in the case of arteria lusoria. The deep inspiratory maneuver can help navigate the guiding wire into the ascending aorta. However, in extreme tortuosity or the case of arteria lusoria, it can be very difficult to advance the wire in the ascending aorta. In this manuscript, the second successful case of guide wire advancement in the ascending aorta in a very tortuous subclavian artery is described by instructing the patient to move her head to the left. This maneuver will straighten the subclavian artery, thus facilitating wire advancement into the ascending aorta by reducing the tortuosity of the subclavian artery. This can save radial cardiac catheterization and prevent changing the access route. This report describes this easy-to-perform maneuver in a difficult case of severe subclavian tortuosity, enabling us to complete the right radial cardiac catheterization.

Objective: The present study aimed to assess the efficacy and safety of a fixed-dose combination (FDC) of Azelnidipine 16 mg and Telmisartan 40 mg compared to FDC of Amlodipine 5 mg and Telmisartan 40 mg in Indian essential hypertensive patients with a special focus on the impact on micro-albuminuria.

Methods: This prospective, randomized, open-label 12-week study enrolled 225 patients with treatment-naive stage II hypertensive patients or hypertensive patients not controlled on Telmisartan 40 mg monotherapy. The eligible participants were randomized to receive either FDC of Azelnidipine-Telmisartan (Test group; n=115) or FDC of Amlodipine-Telmisartan (Reference group; n=110). Efficacy was assessed via changes in systolic and diastolic blood pressure (SBP/DBP), pulse rate (PR), and urinary albumin-to-creatinine ratio (UACR), a marker of microalbuminuria. Safety parameters were evaluated by documenting the adverse effects.

Results: Both groups showed significant reductions in SBP and DBP from baseline, with no statistical difference among the groups. However, the test group expressed a more favorable effect on pulse rate, displaying a significant reduction compared to the reference group. Additionally, the occurrence of pedal edema was significantly lower in the test group vs. the reference group (1.7% vs. 9.1%). Changes in UACR were nominal and comparable in both groups, indicating limited renoprotective effects.

Conclusion: Collectively, the study confirms that FDC of Azelnidipine-Telmisartan is as effective as the commonly used FDC of Amlodipine-Telmisartan combination for management of hypertension, with additional safety benefits related to heart rate and edema. These findings support the clinical utility of Azelnidipine in hypertensive patients with concerns associated with tachycardia or pedal edema.