Cardiology最新文献

Introduction: This study aims to assess left ventricular (LV) function and exercise endurance in patients with hypertrophic cardiomyopathy (HCM) using a combination of left ventricular pressure-strain loop (LV-PSL) and cardiopulmonary exercise testing (CPET), and to explore the correlation of the maximum left ventricular wall thickness (MWT) with clinical, echocardiographic, and CPET parameters.

Methods: A total of 55 patients with non-obstructive HCM, diagnosed between January 2022 and March 2023 at Longyan First Affiliated Hospital of Fujian Medical University, were included, along with 55 healthy volunteers as a control group. Two-dimensional ultrasound speckle tracking technology was used to obtain global longitudinal strain (GLS), longitudinal strain peak time dispersion (PSD), as well as the myocardial global work index (GWI), myocardial global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). The differences in these parameters were compared between the two groups before and after CPET. CPET was used to measure peak oxygen consumption (Peak VO2), anaerobic threshold (AT), ventilation equivalent for carbon dioxide slope (VE/VCO2 slope), oxygen pulse (VO2/HR), and metabolic equivalents (METs), and the differences between the two groups were also compared.

Results: Compared to the control group, the HCM group showed significant reductions in GLS, GWI, GCW, and GWE, while GWW and PSD were significantly increased, with statistical significance (P < 0.05). Peak VO2, AT, VO2/HR, and METs were significantly lower in the HCM group compared to the control group, while VE/VCO2 slope did not show a significant increase (P > 0.05). After CPET, GWI and GCW did not increase significantly in the HCM group (P > 0.05), whereas GWW and PSD showed significant increases (P < 0.05). In contrast, in the control group, GWI and GCW increased significantly after CPET (P < 0.05), and no significant changes were observed in GWW and PSD (P > 0.05). Univariable linear regression analysis showed that MWT was correlated with NYHA classification, GLS, PSD, GCW, GWW, Peak VO2, and AT (P < 0.05). Multivariate linear regression analysis confirmed the independent associations of MWT with PSD, GCW, and GWW (P < 0.05).

Conclusion: LV-PSL combined with CPET is effective in early detection of left ventricular function and exercise endurance impairment in HCM patients, providing valuable information for clinical decision-making.

Introduction Current heart failure (HF) guidelines recommend hemodynamic assessment based on four clinical profiles: dry-warm, wet-warm, dry-cold, and wet-cold. While physical examination for signs of congestion, e.g., jugular venous distention, is commonly performed, evaluation of perfusion status is often neglected due to the lack of simple and reliable physical indicators. This study aims to evaluate the perfusion index (PI), a noninvasive parameter derived from the ratio of pulsatile to non-pulsatile blood flow components, as a useful tool for assessing perfusion status in patients with HF. Methods This prospective study included 257 patients hospitalized for the management of acute HF. Peripheral PI was measured on the index finger before discharge. The presence or absence of a cold perfusion profile was determined using standard clinical criteria. All patients were followed after discharge. The primary outcome was a composite of all-cause mortality and hospitalization for worsening HF. Results During a mean follow-up of 446 ± 280 days, 109 patients experienced a primary outcome event. Patients with a cold perfusion profile, as defined by standard criteria, had a higher incidence of the primary outcome (hazard ratio 1.98, 95% confidence interval 1.28-2.91, p <0.01), as did those with a peripheral PI <1.1 (hazard ratio 2.27, 95% confidence interval 1.55-3.32, p <0.01). These associations remained consistent across subgroup analyses. Conclusions Assessing perfusion status using peripheral PI before discharge may provide a simple and practical method for risk stratification in patients with HF, offering prognostic value comparable to that of a cold perfusion profile determined by standard clinical criteria.

Background: Growing evidence shows that the relationship between cancer and cardiovascular disease is not unidirectional. The recognized impact of cardiovascular risk factors and cardiovascular disease on cancer risk has led to the coining of the term reverse cardio-oncology Summary: Cardiovascular risk factors such as smoking, hypertension, diabetes, dyslipidemia, and obesity are involved in several pathophysiologic mechanisms which also underlie cancer development and progression. These mechanisms include inflammation, oxidative stress, and DNA damage. In addition, cardiovascular diseases such as atrial fibrillation, atherosclerotic cardiovascular disease, and heart failure by causing an imbalance in the autonomic nervous system and neurohormonal system function, through the activation of tumorigenesis processes may facilitate cancer development. Epidemiological studies, which show an increased incidence and a faster progression of cancer in patients with concurrent cardiovascular disease, support the existence of an association between these two sets of diseases.

Key messages: Several biological pathways underlying cardiovascular risk factors and cardiovascular diseases are also involved in cancer development and progression. Reverse cardio-oncology has the potential to become the foundation for integrated healthcare strategies aimed at reducing global disease burden.

Introduction: This study aimed to assess the prognostic value of Aortic valve calcification (AVC) score and CT angiography-derived fractional flow reserve (CT-FFR) for major adverse cardiovascular events (MACE) after transcatheter aortic valve replacement (TAVR).

Materials: In this retrospective observational cohort study, we included patients with severe aortic valve diseases undergoing TAVR between February 2016 and April 2022. Patients were followed, and univariable and multivariate Cox regression were applied for outcome analysis using a composite endpoint including all-cause mortality, nonfatal myocardial infarction, unstable angina, heart failure rehospitalization. The incremental prognostic value of CT-FFR was also analyzed.

Results: A total of 251 patients were enrolled (mean age, 67 ± 10 years; 176 men). During a mean follow-up period of 36 months, 60 patients (23.9%) experienced MACE. AVC score ≥ 2000 (HR = 1.714, 95%CI: 1.020, 2.882, P = 0.042) and CT-FFR ≤ 0.8 (HR = 3.248, 95% CI: 1.760,5.996, P < 0.001) were independent predictors of MACE. The C statistics revealed that adding CT-FFR to the clinical risk factors alone or combined with AVC score provided incremental prognostic value for MACE after TAVR (C-index: 0.710 vs 0.645 [P = 0.012]; and 0.710 vs 0.672 [P = 0.030]).

Conclusion: AVC score and CT-FFR were associated with MACE in patients after TAVR, and CT-FFR presented incremental prognostic value for MACE beyond clinical risk factors alone or combined with AVC score. Therefore, CT-FFR should be incorporated into routine clinical decision-making and risk management for TAVR patients.

: Introduction: Cervical cancer ranks first for cancer-related deaths among women. Having metastasis to the heart from the cervical cancer holds a poor prognosis with average survival being under six months. This metastasis is an understudied phenomenon. For this crossroad of gynecological oncology and cardio-oncology, this scoping review maps the available evidence on cervical cancer with cardiac metastasis to better understand how, when, where cervical cancer spreads in the heart and what can be done with current diagnostic and treatment modalities.

Methods: A scoping review was conducted in accordance with PRISMA- ScR guidelines with 41 case reports published between 1965-2025 globally were included through systematic search using pubmed and google scholar. Data on histologic subtype, time of metastasis, clinical symptoms, echocardiogram findings and treatment modalities and outcomes were extracted and studied.

Results: The women aged between 40-60 years. Squamous cell carcinoma was the most common subtype of cervical cancer. Cardiac metastasis primarily involved right ventricle followed by right atrium, interventricular septum and pericardium. Asymptomatic presentations delayed clinical recognition of metastasis while symptomatic findings led to a misdiagnosis. Echocardiography, MRI, and PET-CT played important diagnostic roles. Treatments included chemotherapy, radiotherapy, immunotherapy, and surgical excision; however, after intervention, prognosis remained poor with death in most cases within 6-9 months.

Conclusion: This review emphasizes the need for heightened clinical suspicious of cardiac metastasis in patients with advanced or recurrent cervical cancer presenting with cardiac symptoms. Timely detection and treatment may improve clinical outcomes in patients.

Introduction Janus kinase inhibitors (JAK-Is), as novel medications, are utilized in treating immune-mediated inflammatory diseases such as rheumatoid arthritis. However, concerns about their cardiovascular safety associated with the use of JAK inhibitors have been increasing in recent years. This study aimed to compare the risk of cardiovascular events (CVEs) in patients taking JAK-Is and tumor necrosis factor alpha inhibitors (TNF-Is) using the Korea Adverse Event Reporting System (KAERS) database. Methods Adverse event (AE) reports between January 1, 2015 and December 31, 2020 of JAK-Is (tofacitinib or baricitinib) or TNF-Is (adalimumab, etanercept, or golimumab) were included. CVEs were categorized into major cardiovascular events (MACEs), thrombosis, and other CVEs. The reporting odds ratios (RORs) for outcomes with 95% confidence interval (CIs) were calculated using 2x2 contingency tables. Results A total of 625 AE reports were identified for JAK-I and 4,777 for TNF-Is, resulting in 876 and 7,999 drug-AE pairs, respectively. Disproportionality analysis showed reporting signals suggesting possible associations between JAK-Is and CVEs compared with TNF-Is (ROR: 4.90, 95% CI: 2.80-8.59), with particularly pronounced for thrombosis (ROR: 12.70, 95% CI: 5.10-31.66). These trends were particularly notable in women (CVEs: ROR: 7.52, 95% CI: 3.06-18.47) and in patients over 50 years old (CVEs: ROR: 5.01, 95% CI: 2.02-12.43). Conclusion This disproportionality analysis using a national pharmacovigilance database identified reporting signals for total CVEs with JAK-Is compared to TNF-Is; in particular, a significant signal for thrombosis was observed.

Introduction: Acute and critical cardiac illnesses have attracted considerable attention because of their high mortality rates. Various innovative treatment methods including extracorporeal life support have been used to save the lives of patients with critical cardiac illnesses. This study aimed to evaluate the clinical efficacy of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in treating critical cardiac illnesses.

Methods: We retrospectively analyzed data from an observational study conducted in China. The study population included adult patients with acute and critical cardiac illnesses admitted to the intensive care unit between January 1, 2021, and December 31, 2023. The primary endpoints were the successful reversal of cardiogenic shock and other related outcomes.

Results: A total of 57 patients with acute and critical cardiac illnesses underwent VA-ECMO for refractory cardiogenic shock. These patients included 31 with acute coronary syndrome, 14 with fulminant myocarditis, 4 with stress-induced cardiomyopathy, and 8 with sepsis-induced myocardial depression. The median duration of VA-ECMO support was 120 h. Among the 31 patients with acute coronary syndrome, 17 (54.8%) had successfully reversed cardiogenic shock. In the group of 14 patients with fulminant myocarditis, cardiogenic shock was successfully reversed in 7 patients (50%). All four patients with stress-induced cardiomyopathy achieved successful reversal of cardiogenic shock (100%). Among the eight patients with sepsis-induced myocardial depression, five (62.5%) showed successful recovery of cardiac function. The overall cardiogenic shock reversal, 30-day survival, and 1-year overall survival rates were 54.4% (31/57), 45.6% (26/57), and 43.9% (25/57), respectively. Multivariate logistic regression analysis demonstrated that requiring additional continuous renal replacement therapy following VA-ECMO initiation was independently associated with in-hospital mortality.

Conclusions: For refractory cardiogenic shock caused by acute and critical cardiac illnesses, VA-ECMO can effectively improve cardiac function, but it does not significantly increase the survival rate.

Background:  Radiofrequency catheter ablation (RFCA) is an established therapy for pediatric supraventricular tachycardia (SVT). However, data on long-term outcomes and predictors of success from sizable contemporary cohorts are limited. This study aimed to evaluate the long-term clinical success rate of RFCA in a pediatric cohort and to identify independent predictors of arrhythmia-free survival.

Methods:  We conducted a retrospective analysis of 219 consecutive pediatric patients (age ≤18 years) who underwent their first RFCA for SVT (including atrioventricular reentrant tachycardia, atrioventricular nodal reentrant tachycardia, and atrial tachycardia) at a single tertiary center over a 6-year period. The primary outcome was long-term clinical success, defined as acute procedural success without clinical recurrence during follow-up. Univariable and multivariable logistic regression analyses were performed to identify factors associated with long-term success.

Results:  The overall acute procedural success rate was 96.3% (211/219, excluding 3 with non-inducible SVT and 5 acute failures from the denominator). The long-term clinical success rate was 91.3% (based on 200/219 patients). Multivariable analysis identified older age as a significant independent predictor of long-term success (p=0.016). Furthermore, atrial tachycardia was associated with a lower odd of success compared to atrioventricular nodal reentrant tachycardia, although the difference was not statistical significance.

Conclusion:  RFCA is highly effective for treating pediatric SVT, with excellent long-term durability. Older age at procedure is a strong independent predictor of success, while patients with AT may have a higher risk of recurrence. These findings are valuable for pre-procedural counseling and patient selection.

Background: Sex disparities in the clinical presentation, management, and outcomes of infective endocarditis (IE) remain inconsistent throughout the literature.

Objectives: We aimed to investigate the prognostic impact of sex-associated disparities in all-cause mortality and baseline clinical characteristics among patients with IE.

Methods: We comprehensively searched PubMed, Scopus, Embase, and Web of Science till July 2025 for studies reporting sex-specific data on clinical presentation, mortality, and management patterns in IE. We reconstructed individual patient data (IPD) from published Kaplan-Meier (KM) plots for all-cause mortality and estimated HR with 95% CI using a Cox regression model. Data regarding clinical presentation, microbiological profile, and management were pooled using random-effects meta-analysis.

Results: Eighteen studies comprising 12,594 female and 24,365 male patients were included. Female sex was associated with a higher risk of mortality (HR: 1.338, 95% CI: 1.272 to 1.407, p < 0.001). Women more often had mitral valve endocarditis and valve vegetations, but less frequently aortic valve endocarditis and intracardiac abscesses. Rates of surgical indication were similar between sexes, yet women underwent surgery less often, coinciding with higher baseline EuroScore II. Enterococcal infections were less common in women, with no significant sex differences for other microbiological etiologies.

Conclusion: Women with IE experience higher mortality than men despite similar surgical indications, alongside distinctive valve involvement patterns, higher baseline surgical risk, and lower surgical intervention rates. Earlier recognition, timely intervention, and optimized surgical decision-making in women may help reduce this disparity.

Introduction: Residual congestion is associated with a high rehospitalization rate in acute heart failure (HF) patients. This study aims to evaluate the role of adrenomedullin (MR-pro ADM and bio-ADM) as a prognostic marker of tissue congestion with clinical outcomes in acute heart failure patients.

Methods: Three databases were systematically searched until November 2024 to include both observational and post hoc clinical trial studies that suit the research question. Outcomes assessed are clinical outcomes of in-hospital mortality, composite outcome of all-cause mortality and major adverse cardiovascular events (MACEs), and heart failure rehospitalization. Statistical analyses conducted are pooled hazard ratio, correlation coefficient, and area under the curve (AUC) with a random effect model.

Results: Twenty-one studies of 18,110 patients with low to medium risk of bias are included of which 20 of them are prospective cohort studies. Both MR-pro ADM and bio-ADM measured at admission or discharge are associated with a statistically significant increasing risk of composite outcome, MACE outcome, and all-cause mortality (HR 1.17 - 2.72,). MR-pro ADM is also associated with a statistically significant increasing risk of in-hospital mortality and HF rehospitalization (HR 1.72 - 2.20). Bio-ADM measured at discharge is found to have a better prognostic value for all-cause mortality outcome than bio-ADM measured at admission (HR 1.90 and 1.17, respectively, p 0.007). MR-pro ADM showed a strong and moderate linear correlation with bio-ADM and NT-pro BNP (R 0.784, 0.461, respectively).

Conclusion: MR-pro ADM and bio-ADM are both reliable prognostic markers in acute heart failure patients.