Cardiology最新文献

Introduction: Brain tumors may disrupt cardiac autonomic regulation, leading to arrhythmias that complicate patient management. This review aims to synthesize evidence on the relationship between brain tumor characteristics, treatments, and cardiac arrhythmias.

Methods: A systematic literature search was performed with independent screening and data extraction by two reviewers. Due to heterogeneity in study designs, tumor types, and arrhythmia outcomes, quantitative meta-analysis was not feasible; results were synthesized qualitatively.

Results: Supratentorial tumors, especially in limbic and insular regions, were frequently associated with atrial arrhythmias and ECG abnormalities. High-grade tumors showed diverse arrhythmias, including bradycardia and ventricular events, often linked to tumor progression or seizures. Surgical resection improved arrhythmias but posed perioperative risks, notably with right insular involvement. Chemotherapy effects were variable; radiation-induced arrhythmias were infrequent and dose-dependent. Arrhythmia patterns varied across pre-, peri-, and post-treatment phases, reflecting complex neurocardiac interactions.

Conclusion: Cardiac arrhythmias in brain tumor patients arise from multifactorial mechanisms influenced by tumor biology and treatment effects. Prospective, standardized studies are required to clarify underlying mechanisms and optimize arrhythmia management in neuro-oncology.

Introduction: Early myocardial injury during chemotherapy may precede declines in left ventricular ejection fraction. We assessed the diagnostic accuracy of cardiac troponin I (cTnI) for early detection of cancer therapy-related cardiac dysfunction (CTRCD).

Methods: We conducted a diagnostic test accuracy (DTA) meta-analysis of prospective cohorts measuring cTnI within 3 months after chemotherapy initiation following PRISMA-DTA. Searches were conducted across PubMed, Embase, Cochrane Library, CNKI, and Wanfang databases through August 2025. A bivariate random-effects hierarchical summary receiver operating characteristic (HSROC) model estimated pooled sensitivity and specificity with confidence/prediction regions; risk of bias was appraised using QUADAS-2. Clinical implications were illustrated with Fagan nomograms at prespecified pretest probabilities (10% and 20%).

Results: A total of 5 prospective cohort studies were included. The HSROC summary operating point yielded pooled sensitivity 0.669 (95% CI 0.444-0.836) and specificity 0.839 (95% CI 0.634-0.940). The corresponding positive likelihood ratio was 4.15, and negative was 0.39. At a 10% pretest probability, posttest probabilities were 32% after a positive result and 4% after a negative result; at a 20% pretest probability, they were 51% and 9%, respectively. Leave-one-out analyses indicated stable estimates.

Conclusions: Within the first 3 months of chemotherapy, cTnI shows moderate sensitivity and high specificity for early CTRCD detection. These performance characteristics support cTnI as a confirmatory biomarker to inform risk-stratified surveillance alongside imaging under standardized assay procedures.

Introduction: Guideline-directed medical therapy (GDMT) optimization and effective de-congestion are known to improve outcomes in admitted heart failure (HF) patients, yet their implementation is suboptimal. Using an HF decision aid and point-of-care ultrasound (POCUS) at admission, this resident-led quality improvement (QI) initiative aimed to improve GDMT use and reduce HF readmissions.

Methods: This prospective, single-center QI initiative compared resident-performed POCUS and HF decision-aid use (the QI arm) with routine hospital care in admitted HF patients. Assignment to the QI arm was based on the availability of residents trained to perform POCUS on admission.

Primary outcome: 30-day hospital readmission; secondary outcomes: GDMT utilization using a standard score, adverse outcome occurrence, and 30-day mortality.

Results: The study was terminated early due to funding constraints. We enrolled 103 (42 in the QI arm) out of the planned 254 patients. At discharge, the QI arm had a trend towards improvement in GDMT scores (+21 ± 23% vs. +12 ± 24% in controls, p = 0.106). In particular, a numerically higher proportion of patients in the QI arm were discharged on renin-angiotensin-aldosterone blockers (70.4% vs. 51.4% of controls, p = 0.126). Adverse effect occurrence and 30-day outcomes (readmissions and mortality) were not significantly different between groups. Significantly more people in the QI arm had a transthoracic echocardiogram in the hospital (26 [65.0%] vs. control: 21 [38.9%], p = 0.012).

Conclusion: This study showed that a resident-led QI initiative was feasible and resulted in modest improvement in GDMT use and echocardiography utilization, but without effectively altering 30-day outcomes.

Introduction: Vericiguat has been shown to improve clinical outcomes in patients with heart failure (HF) with reduced ejection fraction in several randomized controlled trials. However, there is limited real-world evidence regarding its effectiveness in clinical practice outside of the controlled research setting.

Methods: Patients hospitalized due to symptomatic HF between January 1 and December 30, 2023, were consecutively enrolled and divided into the vericiguat group and the control group. A total of 207 patients with left ventricular ejection fraction <45% were enrolled.

Results: Patients in the control group had a higher incidence of clinical endpoints than the vericiguat group: cardiac mortality and hospitalization for symptomatic HF during the median follow-up duration of 11.25 months. Patients in the vericiguat group demonstrated a higher event-free survival rate for both cardiac mortality and hospitalization for HF. In the univariable Cox regression analysis, vericiguat was found to be associated with a reduced risk of cardiac mortality (hazard ratio [HR]: 0.299, 95% confidence interval [CI]: 0.104-0.863, p = 0.026) and hospitalization for HF (HR: 0.586, 95% CI: 0.348-0.988, p = 0.045). After propensity score matching for age and sex, we observed that vericiguat's benefit on cardiac mortality was maintained.

Conclusion: This prospective study is the first to report, using real-world data from a Chinese population with ventricular ejection fraction <45%, that vericiguat is associated with a lower incidence of clinical endpoints, including cardiac mortality and hospitalization for HF. These findings align with the results of previous clinical trials.

Introduction: Conventional echocardiography does not identify abnormal cardiac function for heart failure with preserved ejection fraction (HFpEF) in patients with uremia. This study aimed to investigate the diagnostic value of three-dimensional speckle-tracking imaging (3D-STI) for HFpEF in uremia patients.

Methods: A total of 108 participants were divided into the non-HFpEF group (n = 54) and the HFpEF group (n = 54) based on whether they met the diagnostic criteria for HFpEF as specified in the 2021 European Society of Cardiology Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure. The study compared various parameters between two groups, including global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), global area strain (GAS), left ventricular global peak twist angle (twist), and torsion. Multivariate logistic regression analysis was used to analyze the factors influencing HFpEF. Receiver operating characteristic (ROC) curve analysis was employed to evaluate the area under the curve (AUC) of GLS, GCS, GRS, GAS, twist, and torsion parameters in predicting the occurrence of HFpEF in uremia patients. Cox regression analysis was used to analyze the prognostic value of GLS for recurrent adverse cardiovascular events.

Results: Compared to the non-HFpEF group, the HFpEF group showed lower values for GLS, GCS, GRS, GAS, twist, and torsion (p < 0.05). Multivariate logistic regression showed that GLS was an independent risk factor for HFpEF in patients with uremia (Exp(B) = 1.586, p < 0.001). ROC curve analysis showed that GLS had an AUC value of 0.794, with a sensitivity of 90.7% and a specificity of 55.6%. The GAS, with an AUC value of 0.793, had a sensitivity of 88.9% and a specificity of 53.8%. The GRS, with an AUC value of 0.803, had a sensitivity of 88.9% and a specificity of 57.4%. Cox regression analysis showed that GLS was a risk factor for recurrent adverse cardiovascular events (p < 0.05).

Conclusions: 3D-STI is effective in identifying altered cardiac function indicative of HFpEF in uremic patients, demonstrating potential predictive value.

Introduction: Transcatheter aortic valve implantation (TAVI) may be complicated by postoperative bleeding due to heparin use. Heparin antagonists, such as protamine, have shown potential in reducing bleeding risks. This meta-analysis assesses the efficacy and safety of protamine in reducing bleeding complications after TAVI.

Methods: A systematic search was conducted up to March 2025. Inclusion criteria encompassed studies reporting the use of protamine post-TAVI with a control group. Primary outcomes included major bleeding events as the efficacy endpoint, 30-day mortality, and ischemic events (stroke and transient ischemic attack, or TIA) as safety endpoints. Secondary outcomes included life-threatening bleeding events and the need for blood transfusion. A random-effects model was used to calculate odds ratios (ORs).

Results: Four studies involving 1,569 patients were included. As compared to the control group, protamine was not associated with a statistically significant difference in major bleeding events (OR = 0.59, 95% CI = 0.26-1.34, p = 0.21), life-threatening bleeding events (OR = 0.3, 95% CI = 0.06-1.62, p = 0.16), need for blood transfusions (OR = 0.75, 95% CI = 0.46-1.24, p = 0.27), 30-day mortality (OR = 1.07, 95% CI = 0.54-2.11, p = 0.85), or rate of stroke and TIA (OR = 0.86, 95% CI = 0.05-13.58, p = 0.91).

Conclusion: Protamine use after TAVI appeared to be safe with no increase in 30-day mortality or stroke and TIA rates, but there was no observed statistically significant benefit in the reduction of major or life-threatening bleeding events and the need for blood transfusions. These findings are based on a limited number of studies, and larger randomized controlled trials are warranted to confirm them.

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.