Cardiology最新文献

Introduction: Evidence on dual- and triple-targeted therapy in patients with left-to-right shunt congenital heart disease-associated pulmonary arterial hypertension (CHD-PAH) remains limited. We compared the efficacy of triple- versus dual-targeted drug therapy in patients with CHD-PAH and evaluated treatment outcomes and prognosis.

Methods: In all, 67 patients with CHD-PAH received targeted drug therapy and were evaluated for potential defect closure. Patients were categorized into closure and non-closure groups and further subdivided into dual- or triple-targeted therapy groups. Follow-up assessments, including echocardiography, were conducted every 3-6 months over 12-35 months (mean: 2 years).

Results: The mean patient age was 42.4 ± 17.7 years. Twenty-five patients (37.3%) successfully underwent CHD closure. At the last follow-up, the mean pulmonary artery systolic pressure (PASP) significantly decreased from 78.8 ± 21.3 mm Hg to 45.6 ± 15.4 mm Hg (p < 0.001). At the 3-month follow-up, the reduction in PASP did not differ significantly between the triple- and dual-targeted therapy groups (13.8 ± 13.0 mm Hg vs. 10.5 ± 4.0 mm Hg, p = 0.53). The 6-min walk distance (6MWD) improved from 183.6 ± 29.7 m to 251.4 ± 89.9 m (p < 0.001). In the non-closure group, PASP decreased from 92.9 ± 29.0 mm Hg to 83.5 ± 13.9 mm Hg at the last follow-up (p = 0.005). At the 3-month follow-up, PASP reduction was significantly greater in the triple-targeted therapy group than that in the dual-targeted therapy group (9.2 ± 7.4 mm Hg vs. 3.5 ± 2.7 mm Hg, p = 0.004). The 6MWD also improved, from 164.9 ± 29.3 m to 202.7 ± 32.2 m, though the difference was not statistically significant (p = 0.64).

Conclusion: Combination targeted therapy is effective for patients with left-to-right shunt CHD-PAH, regardless of closure status. Among patients not eligible for closure, triple-targeted therapy demonstrated superior efficacy compared to dual-targeted therapy.

Introduction: Hypertrophic cardiomyopathy (HCM) is a common inherited heart condition. Traditional genetic testing is typically conducted on the proband only, with family members undergoing Sanger sequencing, which may overlook other pathogenic variants. This study explores the gene sequencing strategy in a three-generation family based on genetic carrier status and examines the relationship between phenotypic characteristics and genotype.

Methods: High-throughput second-generation sequencing was performed on the proband to analyze HCM-related pathogenic genes. Subsequently, the identified pathogenic variants were validated by Sanger sequencing in the proband and family members. Clinical, electrocardiographic, and echocardiographic assessments were conducted for family members.

Results: Second-generation sequencing of the proband (III7) revealed a pathogenic variant MYBPC3-P453Lfs. Initially, no HCM-related pathogenic variants were detected in another patient (III11), prompting additional sequencing of III11, which identified the MYH7-G823E pathogenic variant. Both patients had severe left ventricular outflow tract obstruction. Sanger sequencing showed that five family members carried both mutations. Among them, three died suddenly before age 40, one required an implantable cardioverter defibrillator for arrhythmias, and one developed HCM before adulthood. Cardiac magnetic resonance imaging (MRI) of patients carrying both mutations showed myocardial fibrosis of 32.75%, significantly higher than the 6.98% observed in patients carrying only one mutation.

Conclusion: In families with varying HCM phenotypes, second-generation sequencing should be considered for all members. In this family, carrying one variant led to outflow tract obstruction, while carrying both variants resulted in severe disease, including sudden death and early onset. Cardiac MRI is crucial for assessing the severity of the disease within the family.

Introduction: Extracorporeal membrane oxygenation (ECMO) is a vital therapy for cardiopulmonary failure, yet its use in patients with cancer remains controversial due to immunosuppression and coagulopathy. Advances in oncology necessitate re-evaluating ECMO's role in this population. This study investigates survival outcomes and prognostic factors in ECMO patients with and without cancer.

Methods: We analyzed a retrospective cohort of 342 adult ECMO patients treated at National Taiwan University Hospital Hsin-Chu Branch between January 2017 to December 2023. Patient demographics, medical history, and pre-ECMO laboratory parameters were assessed. Kaplan-Meier curves and Cox proportional hazards models were used to identify survival predictors.

Results: Among the 342 patients, 40 had cancer, with solid tumors constituting 92.5% of cases. The 90-day mortality was 56.8% for non-cancer patients and 70.0% for cancer patients, with no significant difference (p = 0.087). Hyperlactatemia (>10 mmol/L, hazard ratio [HR]: 2.74, p < 0.001) and hypoalbuminemia (<2.4 g/dL, HR: 1.76, p = 0.018) were significantly associated with worse survival outcomes in the multivariable analysis. Cancer status was not statistically significant (HR: 1.41, p = 0.114). Subgroup analyses in cancer patients confirmed elevated lactate (>10 mmol/L, HR: 8.85, p < 0.001) and low albumin (<3.4 g/dL, HR: 3.62, p = 0.018) as significant prognostic factors.

Conclusions: ECMO may be an option in highly selected patients with solid tumors and without significant metabolic derangements. Elevated lactate and low albumin predict poor outcomes, highlighting the need for early metabolic optimization. ECMO is a potential bridge therapy for critically ill cancer patients, warranting further validation and assessment of the impact of modern oncologic therapies on outcomes. Only 3 patients in this study had hematologic malignancies. Therefore, the findings primarily reflect outcomes in patients with solid tumors and should not be generalized to those with hematologic cancers.

Objective To investigate the risk factors of acute lung injury (ALI) after type A aortic dissection and establish a predictive model to evaluate the risk of ALI. Methods The clinical data of patients who underwent type A aortic dissection in the First Affiliated Hospital of Nanchang University from January 2022 to June 2024 were retrospectively analyzed. According to whether acute lung injury occurred after surgery, ALI group and non-ALI group were divided into two groups. Univariate and multivariate analysis were performed on the factors that may cause acute lung injury, and multivariate Logistic regression prediction model was constructed. Results A total of 187 patients were included in the study, including 94 patients in the non-ALI group and 93 patients in the ALI group. The incidence of ALI after type A aortic dissection was 49.7%. Multivariate analysis showed that BMI, smoking history, D-dimer, interleukin-6, and cardiopulmonary bypass time were independent risk factors for ALI after type A aortic dissection. The prediction model based on these risk factors has good prediction efficiency. Conclusion BMI, smoking history, D-dimer, interleukin-6 and cardiopulmonary bypass time are independent risk factors for ALI after type A aortic dissection. The predictive model established based on these risk factors has good predictive efficacy, which helps to identify high-risk patients early, take appropriate preventive measures, improve surgical safety and improve patient prognosis.

Objective: The objective was to analyze the risk factors for frailty syndrome in elderly patients with acute coronary syndrome (ACS) and establish a nomogram prediction model.

Methods: A total of 256 elderly ACS patients admitted to our hospital from September 2022 to March 2025 were retrospectively selected and randomly assigned into a modeling group and a validation group in a 7:3 ratio. The modeling group was further divided into a frailty group and a non-frailty group based on the presence or absence of frailty syndrome. Clinical data were collected, and logistic regression analysis was performed to identify influencing factors for frailty syndrome in elderly ACS patients. R software was performed to construct nomogram prediction models. The ROC curve and calibration curve were used to evaluate the discrimination and calibration of the model. Decision curve analysis (DCA) was employed to assess its clinical application value.

Results: Out of 179 patients, 70 developed frailty syndrome, with an incidence rate of 39.11%. The logistic analysis results showed that age, Charlson Comorbidity Index (CCI), living alone, anxiety, history of falls, sarcopenia, and NT-proBNP were risk factors for frailty syndrome in elderly ACS patients (p < 0.05). The AUC of the modeling group was 0.877, and the H-L test showed χ2 = 8.567 (p = 0.785). The AUC of the validation group was 0.890, and the H-L test showed χ2 = 7.231 (p = 0.705). DCA curve showed that when the threshold probability was between 0.06 and 0.95, the nomogram prediction model for evaluating elderly ACS with frailty syndrome had high clinical application value.

Conclusion: Age, CCI, living alone, anxiety, history of falls, sarcopenia, and NT-proBNP are the influencing factors of frailty syndrome in elderly ACS patients. The predictive model constructed based on these factors demonstrates good predictive performance.

Introduction: Vascular complications following transcatheter aortic valve replacement (TAVR) significantly contribute to morbidity and mortality. Conventional suture-based closure technique has been widely utilized for large-bore arterial access closure. Recent findings on hybrid strategy combining plug and suture-based devices has been on spotlight as it may improve the hemostatic efficacy and lower the access-site related complications and clinical outcomes.

Methods: We performed a systematic review and meta-analysis of studies comparing a suture-based approach with a hybrid closure strategy (suture+plug) in aortic stenosis patients undergoing TAVR. Included studies were appraised following the Cochrane Risk of Bias and Newcastle-Ottawa Scale tools. Forest plots were extracted in Review Manager with a main outcome of pooled-risk ratio (RR). The primary endpoint was the composite of access-site related vascular complications as defined by Valve Academic Research Consortium criteria whilst secondary end-points were in-hospital bleeding, closure device failure, mortality, and unplanned endovascular or surgical intervention.

Results: Six eligible studies encompassing 2,064 patients were analyzed. Compared with suture-based closure, hybrid closure exhibited a lower rate of vascular complications (pooled-RR 0.46; 95% confidence interval [CI], 0.38-0.57; p < 0.001), closure device failure (pooled-RR 0.35; 95% CI, 0.13-0.96; p = 0.04), in-hospital bleeding events (pooled-RR 0.38; 95% CI, 0.26-0.55; p < 0.001), and mortality (pooled-RR 0.51; 95% CI, 0.26-0.99; p = 0.049). Unplanned endovascular or surgical intervention was no different among two groups (pooled-RR 0.42; 95% CI, 0.17-1.06; p = 0.07).

Conclusion: Hybrid vascular closure strategy offers better efficacy with fewer complications amongst patients undergoing TAVR, directing the clinical adoption of hybrid techniques, although further large-scale multicenter studies are warranted to confirm the benefit and optimize patient selection.

Introduction: Arterial thrombosis is a multifaceted process characterized by platelet aggregation and fibrin deposition, leading to the occlusion of blood vessels. It plays a central role in cardiovascular conditions such as myocardial infarction and ischemic stroke. Gaining insight into the mechanisms underlying arterial thrombosis is essential for developing effective treatments aimed at preventing thrombotic events and reducing associated health burdens. In vitro and ex vivo models serve as critical tools for investigating the pathophysiology of arterial thrombosis by providing controlled environments to study thrombus formation and characteristics. This systematic review provides a comprehensive overview of in vitro and ex vivo flow-based models used to study arterial thrombosis, classifying them by scale (macro vs. micro) and evaluating their design principles, physiological relevance, and experimental utility.

Methods: A systematic search of Medline, Embase, and Web of Science was conducted using broad and specific terms related to arterial thrombosis models incorporating flow or shear stress. Articles were screened by two independent reviewers. Studies were included if they described in vitro or ex vivo models with dynamic flow; models limited to static or venous conditions or in vivo studies were excluded. In total, 82 studies met the inclusion criteria.

Results: Macro-scale models can mimic complex flow patterns in larger arterial conditions and enable the formation of thrombi comparable in size to clinical specimens. Microfluidic models allow precise control over shear conditions and geometry with minimal blood volumes and are suitable for high-resolution imaging and customization, including endothelialization and patient-specific designs. While, both model types present limitations in replicating complex in vivo hemodynamics, standardization, and scalability, they offer valuable, controllable platforms for mechanistic studies and drug testing in arterial thrombosis.

Conclusions: While no single model fully recapitulates the in vivo environment, ongoing innovations, particularly in microfabrication and model standardization, continue to improve physiological relevance and clinical translatability.