BMC Cardiovascular Disorders最新文献

Background: Primary cardiac echinococcosis is rare, and cardiac alveolar echinococcosis is even rarer and more unusual. Reported cases of this disease are extremely limited, and multimodal imaging provides an important guide to treatment and decision-making. We report a case of cardiac alveolar echinococcosis. A 31-year-old male patient with no significant history was diagnosed to have a space-occupying lesion in the mediastinum. Transthoracic echocardiography showed a cystic mass anterior to the right lateral aspect of the right atrium, which did not show enhancement on the enhanced scan. Multidetector computed tomography (MDCT) and cardiac magnetic resonance showed a cystic space-occupying lesion in the right lateral aspect of the right atrium, with mild enhancement of the edges of the lesion and multiple small vesicles on the enhancement scan. Clinicians operated on the patient under suspicion of cardiac echinococcosis and successfully removed the lesion. Ultimately, postoperative histopathologic examination revealed cardiac alveolar echinococcosis. The patient recovered well and was discharged with regular postoperative oral albendazole tablets and regular follow-up reviews.

Conclusion: We report a case of cardiac alveolar echinococcosis with multimodal imaging features and therapeutic strategies, an extremely rare cardiac occupying disease. Multimodal imaging is of great help in the diagnosis of this disease, and surgical resection and histopathological diagnosis are essential. After surgery, treatment and follow-up will be carried out based on the results of the histological examination. This rare case emphasizes the integrated diagnosis of cardiac alveolar echinococcosis with clinical, multimodal imaging and pathologic data.

Background: Excessive prolongation of the PR interval indicates the potential for atrioventricular (AV) asynchrony, resulting in severe impairment of cardiac function.

Case presentation: A 72-year-old man presented to the cardiology department with a history of worsening shortness of breath and chest tightness over the past 3 years. The electrocardiogram (ECG) showed sinus rhythm with a prolonged PR interval of 400 ms. The echocardiogram revealed mild mitral valve regurgitation with mitral E-A fusion during ventricular diastole. The patient received left bundle branch area pacing to shorten the AV conduction time.

Conclusion: In patients with symptomatic AV block, reflected by an excessively prolonged PR interval, prompt decision-making regarding cardiac pacing therapy can help relieve clinical symptoms and enhance the patient's quality of life.

Background: Oral microbiome dysbiosis is an important risk factor affecting the occurrence and progression of coronary artery disease (CAD). However, the dysbiosis on the tongue in patients with CAD is still unclear, and whether the oral alteration caused by these disorders can be identified by other tools for CAD diagnosis needs to be further explored. Hyperspectral imaging (HSI) is characterized as high spectral resolution, broad spectral range, and superior spatial resolution. Hyperspectral images contain high-dimensional data that generally require machine learning algorithms for feature identification and model construction. Therefore, this study aims to investigate the variation of tongue microbiota and the effectiveness of HSI models in CAD diagnosis.

Methods: Between 2023 and 2024, we prospectively approached 276 patients with chest pain and exhibiting risk for CAD who underwent coronary artery angiography (CAG). And 190 patients were enrolled in this study. Tongue dorsum swabs were collected for subsequent 16sRNA sequencing and microbiome analysis. Tongue dorsum features were extracted from hyperspectral images. The HSI analysis incorporated a total of 4750 hyperspectral images from all patients. All images are divided into training set (N = 2555), internal test set (N = 1095) and external test set (N = 1095). A total of 31 models were constructed. 30 single machine learning algorithms were used to construct and test the CAD prediction models. Furthermore, the best performing fusion model was established. The efficacy of the model was evaluated employing several metrics, including area under the curve (AUC), decision curve analysis (DCA), calibration curve, accuracy (ACC), sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and F1 score.

Results: The 16sRNA sequencing results indicated significant dysbiosis in the oral microbiota of patients with CAD, with decreased microbial abundance, network complexity and stability. The fusion model (GP-GB-SVM) demonstrated the highest performance, achieving an AUC of 0.92, ACC of 0.82, SE of 0.70, SP of 0.92, PPV of 0.88 and NPV of 0.79 in the internal test set and AUC of 0.86, ACC of 0.70, SE of 0.90, SP of 0.46, PPV of 0.60 and NPV of 0.90 in the external test set.

Conclusion: These findings not only emphasize the significant alteration of microbiome colonized on the tongue dorsum in CAD patients but also demonstrate the tongue features associated with microbiome dysbiosis can be identified in hyperspectral images. Thereby the integration of HSI and machine learning provides novel insights into non-invasive diagnosis of CAD.

Background: Bone cement embolism is one of major complications of percutaneous kyphoplasty. Although rare, the intracardiac cement embolism is potentially life-threatening, with a documented incidence of 3.9%, and it is even more infrequent if symptomatic (0.3%).

Case presentation: Herein, we reported an extremely rare case of intracardiac bone cement embolism after percutaneous kyphoplasty causing right ventricle perforation. A 70-year-old woman, experiencing sudden left chest pain with radiation to the shoulder for 9 h, was transferred to our emergency department. Two hours before onset of her symptoms, she underwent percutaneous kyphoplasty at the local hospital. The computed tomography angiography revealed that an intracardiac foreign body penetrated her right ventricle. In light of her surgical history, bone cement embolism was suspected and thus, the patient was transferred to our center. Computed tomography and echocardiography confirmed the presence of intracardiac linear-shaped foreign body perforating the right ventricle. Therefore, the patient underwent open-heart surgery and the bone cement was removed successfully.

Conclusions: Symptomatic intracardiac bone cement embolism is potentially fatal, so the rapid diagnosis and prompt treatment measures based on the cement emboli characteristics and the patient's condition are crucial.

Antidromic atrioventricular re-entrant tachycardia (AVRT) is a rare clinically wide-QRS tachycardia that can often be misdiagnosed as ventricular tachycardia (VT). If the accessory pathway (AP) is slower than the normal atrioventricular (AV) junction, evidence of preexcitation will not appear on the surface electrocardiogram (ECG), which increases the difficulty of diagnosis. This report describes a 13-year-old male patient who was diagnosed with VT at a local hospital at the time of onset of palpitation. ECG revealed wide-QRS-complex tachycardia, and the ECG after the termination of palpitations was within the normal range of sinus rhythm. The patient was confirmed to have an AV accessory pathway on the left anterior free wall with Mahaim fiber features by intracardiac electrophysiological study at our hospital. Wide-QRS-complex tachycardia was confirmed to be antidromic AVRT. We treated the patient with catheter radiofrequency ablation, which eliminated tachycardia. By comparing the ECGs before and after the operation, we observed the hidden manifestation of the ventricular preexcitation wave. There was no recurrence after half a year of follow-up.

Background: Creatinine-to-albumin ratio (CAR) has been recognized as a predictive indicator in the postoperative setting. However, its relationship with outcomes in patients receiving cardiac surgery remains elusive. This study aimed to discuss the link between CAR and 28-day mortality in patients admitted to intensive care unit (ICU) following cardiac surgery, hoping to provide some insights for targeted interventions for improvement of patient outcomes.

Methods: MIMIC-IV database was searched to obtain data of patients admitted to ICU following cardiac surgery. Retrieved patients were split into three groups based on CAR levels. The 28-day ICU mortality in each group was evaluated and compared using Kaplan-Meier analysis. Subgroup analysis, multivariate Cox regression and restricted cubic spline (RCS) analysis were used to further examine the relationship between CAR and outcomes. Receiver operating characteristic (ROC) curves were used to assess the predictive ability of CAR. Mediation analysis was conducted to investigate the potential mechanism by which CAR affects 28-day ICU mortality.

Results: A total of 5,670 patients were included and divided into three groups. Patients with high CAR values (CAR ≥ 0.31) had a significantly increased rate of 28-day ICU mortality (11.4%), as compared to those with low CAR levels (CAR < 0.23, 1.83%). In addition, patients with high CAR values (CAR ≥ 0.31) had a lowest survival rate than the other two groups (p < 0.0001). ROC curve analysis showed that CAR exhibited a moderate predictive power (AUC = 0.748). Moreover, CAR was identified as a strong risk factor for 28-day ICU mortality, and a significant dose-response association was presented. Further subgroup analysis revealed pronounced mortality risks in females and patients without chronic conditions such as chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). Mediation analysis indicated that CAR affected 28-day ICU mortality through biomarkers like chloride (39.8%), glucose (11.8%), potassium (24.4%), and sodium (28.3%).

Conclusion: CAR served as a risk factor for 28-day ICU mortality in patients receiving cardiac surgery, and it showed a complex dose-response and subgroup-specific association with 28-day ICU mortality. Additionally, CAR affected 28-day ICU mortality through multiple key biomarkers, providing some insights for targeted interventions.

Background: This study developed and investigated the prognostic significance of a comprehensive biomarker for postoperative type A aortic dissection (TAAD) patients.

Methods: A retrospective cohort of 175 TAAD patients who underwent open surgery at the First Affiliated Hospital of Chongqing Medical University, China, between September 2017 to December 2020, was included in the analysis. The least absolute shrinkage and selection operator (LASSO) method was employed to select indicators, thereby constructing a comprehensive biomarker, termed the comprehensive physiological response indicator (CPRI). The prognostic significance of the CPRI was assessed employing the Kaplan-Meier method and log-rank test. Univariate and multivariate Cox regression model were applied to identify independent prognostic factors for TAAD. A prognostic nomogram was constructed based on the CPRI and other nine blood and clinical indicators. The predictive performance of prognostic models and individual indicators was evaluated by determining the area under the curve (AUC) of the receiver operating characteristic (ROC) analysis.

Results: A comprehensive prognostic biomarker (CPRI) was developed, incorporating cardiac troponin T (cTnT), red blood cell count (RBC), white blood cell count (WBC), absolute neutrophil count (ANC), and absolute lymphocyte count (ALC). In the cohort of type A aortic dissection (TAAD) patients who underwent open surgery, those with lower preoperative CPRI values exhibited significantly poorer overall survival, with a HR of 2.325 (95% CI: 1.126-4.802) in a multivariate Cox regression analysis. The CPRI was identified as an independent prognostic factor for TAAD patients. Additionally, a nomogram constructed based on the CPRI demonstrated superior predictive accuracy compared to other models, with an area under the curve (AUC) of 0.874 versus 0.592, 0.514, and 0.577 for the respective models.

Conclusion: Our study suggested that CPRI may be a useful comprehensive prognostic biomarker for predicting the long-term survival of TAAD patients. The nomogram based on CPRI can be considered a valuable tool to identify high risk TAAD patients with poor prognosis.

Background: Advances in managing non-ST-elevation acute coronary syndrome (NSTE-ACS) have yet to clarify the optimal treatment for elderly patients, whose complex health profiles and underrepresentation in trials add challenges to decision-making.

Methods: We systematically searched PubMed, Embase, Web of Science, and Scopus for randomized controlled trials comparing invasive versus conservative strategies in elderly patients (≥ 70 years) with NSTE-ACS through October 2024. Co-primary outcomes were all-cause and cardiovascular mortalities, with secondary outcomes including myocardial infarction (MI), revascularization, stroke, decompensated heart failure, and bleeding events. Outcomes were analyzed using both risk ratios (RR) and hazard ratios (HR).

Results: Analysis of 11 trials (4,114 patients) showed no significant differences in all-cause mortality (RR: 1.04, 95% CI: 0.98-1.11; HR: 1.10, 95% CI: 0.94-1.29) or cardiovascular mortality (RR: 0.98, 95% CI: 0.85-1.12; HR: 0.94, 95% CI: 0.73-1.20) between strategies. The invasive approach significantly reduced subsequent revascularization (RR: 0.41, 95% CI: 0.27-0.62; HR: 0.30, 95% CI: 0.19- 0.47; p < 0.01 in both analyses) and MI risk (RR: 0.75, 95% CI: 0.57-0.99, p = 0.04; HR: 0.64, 95% CI: 0.49-0.83, p < 0.01), though with some levels of heterogeneity in sensitivity analyses for MI. Stroke and heart failure outcomes were comparable between strategies. However, it significantly increased the risk of both composite major and minor bleeding risk (RR: 1.50, 95% CI: 1.02-2.20, p = 0.04) and major bleeding alone (RR: 1.92, 95% CI: 1.04-3.56, p = 0.04).

Conclusion: In elderly patients with NSTE-ACS, an invasive strategy reduces revascularization needs and, potentially, MI risk without impacting survival, but at the cost of increased bleeding risk. This supports individualized treatment decisions based on patient-specific characteristics, particularly bleeding risk and geriatric factors.

Background: Stress phase bandwidth (SPBW), assessed using single-photon emission computed tomography (SPECT), is considered to be a useful indicator of left ventricular dyssynchrony. However, few reports have examined whether it can be used as an indicator for improvement of left ventricular ejection fraction (LVEF) in new-onset heart failure with reduced ejection fraction (HFrEF).

Methods and results: A total of 64 patients (mean age 56 years, 39 male) who were admitted to our hospital with new-onset non-ischemic HFrEF (median LVEF 24.7%) from January 2018 to December 2022 in the SAKURA-HF registry and underwent SPECT were enrolled. The relationship between SPBW in the acute phase and LVEF improvement in the chronic phase was retrospectively investigated in the present study. LVEF improved significantly in the 36 patients (from 27.1 to 62.8%, p < 0.001). Guideline-directed medical therapy in both groups was comparable. SPBW was significantly lower in the group with improved LVEF (median 55.5° vs. 79.0°, p = 0.010). Logistic regression analysis revealed that SPBW was an independent predictor for LVEF improvement. Moreover, an SPBW of 71.0° was suggested as a possible cut-off value.

Conclusions: SPBW may predict the improvement of LVEF in new-onset non-ischemic HFrEF, suggesting its potential utility in heart failure management.

Background: Ascending aortic perforation is a rare complication of the transseptal puncture procedure that often requires emergency management.

Case presentation: We report the case of a 53-year-old woman with severe mitral stenosis (MS) who underwent percutaneous balloon mitral valvuloplasty (PBMV). After the transseptal puncture procedure, a right atrium-iatrogenic ascending aortic perforation was observed. An 8-mm muscular ventricular septal defect (VSD) occluder was then successfully used for emergency closure.

Conclusion: Percutaneous closure of ascending aortic perforations via a muscular VSD occluder is a feasible treatment approach.