Cardiology最新文献

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.

Introduction: At present, existing risk scores together with traditional biomarkers such as troponin and brain natriuretic peptide are still unable to accurately predict cancer therapy-related cardiac dysfunction (CTRCD). MicroRNAs (miRNAs) have emerged as promising biomarkers for improved identification of high-risk patients; however, limited studies have been performed in patients with HER2-positive breast cancer. This study aimed to investigate the predictive potential of six serum-derived circulating miRNAs for CTRCD occurrence in patients with early-stage HER2-positive breast cancer receiving trastuzumab (TTZ).

Methods: A prospective cohort study was conducted involving consecutive female patients aged 18 years or older with HER2-positive early breast cancer, who attended the breast oncology outpatient clinic of the institution between March 2019 and March 2022. Blood samples were obtained prior to the initiation of TTZ therapy. CTRCD was defined as a reduction in left ventricular ejection fraction >10 percentage points, resulting in a value <53%. Quantification of miRNAs - including let-7f-5p, miR-1-3p, miR-20a-5p, miR-126-3p, miR-130-3p, and miR-210a-3p - was performed using quantitative real-time polymerase chain reaction. The optimal miRNA cutoff points were determined using the Youden index. CTRCD-free survival was analyzed using Kaplan-Meier curves, with group comparisons conducted via the log-rank test.

Results: A total of 47 patients (mean age 53.1 ± 13.2 years) were included and followed for a median of 14.2 months (IQR 10.9-24.5), corresponding to 71.5 patient-years of follow-up. Doxorubicin was administered as part of the treatment regimen in 22 patients (46.8%). Six patients (12.8%) developed CTRCD. Patients exhibiting high baseline expression levels of miR-20a-5p, miR-126-3p, miR-130-3p, and miR-210-3p prior to TTZ treatment demonstrated significantly reduced CTRCD-free survival (all p < 0.05). Elevated levels of miR-126-3p and miR-130-3p showed 100% sensitivity and specificities of 53.7% and 48.8%, respectively, for predicting the development of CTRCD.

Conclusion: This pilot study suggests that elevated expression of some miRNA prior to TTZ treatment may be associated with lower CTRCD-free survival, but these findings require confirmation in larger, prospective studies. While high levels of miR-126-3p and miR-130a-3p were observed in all patients who developed CTRCD, their potential role as biomarkers of cardiotoxicity risk should be further explored in future research with broader patient cohorts.

Background: Space exploration has progressed significantly with increased human presence in orbit, the development of space stations, and the planning of increasingly prolonged missions. However, the space environment poses substantial physiological challenges, particularly for the cardiovascular system. According to NASA's Human Research Program, the five primary risks associated with human spaceflight are (1) microgravity, (2) ionizing cosmic radiation, (3) isolation and confinement, (4) closed environmental systems, and (5) great distance from Earth.

Summary: The cardiovascular system is among the most extensively studied systems in aerospace medicine because of its adaptive responses to microgravity. Documented changes include altered blood-flow dynamics, disturbances in electrical conduction, and structural effects on the myocardium. These may result in variations in the heart rate (e.g., increased resting heart rate in microgravity), blood volume (e.g., central fluid shift and subsequent plasma volume reduction), and endothelial function (e.g., leading to increased vascular stiffness), as well as a potential predisposition to long-term cardiovascular events (e.g., orthostatic intolerance or arrhythmias). Review Methodology: We conducted a literature review (August 2024 - March 2025) using targeted searches with terms like "astronaut," "spaceflight," "microgravity," "cardiovascular system" to identify peer-reviewed studies on cardiovascular adaptation to spaceflight.

Key messages: Evidence from studies involving astronauts, animal models, and ground-based simulations has enhanced our understanding of these mechanisms, thereby enabling the development of preventive strategies. These findings not only contribute to the safety and success of future space missions but also provide valuable insights into cardiovascular diseases on Earth, potentially informing novel therapeutic approaches.

Introduction: This study explored the differences in circulating cytokines between sexes and age and their association with the pathogenesis of coronary artery disease (CAD) in order to identify populations suitable for anti-inflammatory treatment.

Methods: This retrospective study included hospitalized patients who underwent coronary angiography between October 2022 and November 2024. The selected participants were grouped by age and sex to compare differences in circulating inflammatory cytokine levels and CAD occurrence. Univariate logistic regression analysis was used to assess the association of cytokines with the incidence of CAD, which was significantly different between age and sex groups. Results are presented as odds ratios (ORs) with 95% confidence intervals (CIs). Variables included in the multivariate adjustment model were selected based on their significance as traditional risk factors in the univariate analysis.

Results: A total of 2,208 participants (931 women and 1,277 men; 1,270 participants ≥aged 65 years and 938 participants aged <65 years) were included. Circulating interleukin (IL)-1β, IL-2, IL-5, IL-10, and tumor necrosis factor-α levels were significantly different between sexes. Circulating IL-6, IL-8, and IL-12 levels were significantly different between the ≥65-year and <65-year age groups. The fully adjusted model yielded an OR of 1.157 and 95% CI of 1.004-1.334 for CAD occurrence per unit increase in IL-5 in women and an OR of 1.023 and 95% CI of 1.003-1.043 for CAD occurrence per unit increase in IL-6 in older men.

Conclusion: The independent risk factors for the onset of CAD in women and older men were IL-5 and IL-6, respectively. This finding provides important clues for selecting the appropriate population for anti-inflammatory treatment of CAD. However, due to the retrospective design of this study, there may be unmeasured confounding factors, and future prospective studies are still needed to further verify these associations.

Introduction: Patients with atrial fibrillation (AF) and history of cancer face unique bleeding risks, complicating the applicability of standard bleeding risk scores like HAS-BLED. This meta-analysis aimed to evaluate the performance of HAS-BLED in predicting bleeding events in this high-risk population.

Methods: The MEDLINE, PubMed, and EMBASE databases were searched from 1st of January 2010 to 30th of November 2024 for relevant studies using keywords, such as "AF" "cancer" "bleeding," and "HAS-BLED." Data on C-statistics were extracted to assess the predictive performance of HAS-BLED score.

Results: Our analysis included seven retrospective cohort studies, recruiting a total of 436,102 patients. The quality of the included studies was deemed acceptable for analysis. The reported C-statistics for HAS-BLED score varied widely across studies, ranging from 0.45 to 0.77. Subgroup analyses demonstrated moderate discrimination in patients with breast cancer (0.56-0.80), prostate cancer (0.58-0.72), and lung cancer (0.59-0.80), while poorer performance was observed in hematological malignancies (0.45-0.70) and in anticoagulated patients (pooled C-statistic = 0.55; 95% confidence interval: 0.54-0.56). Significant heterogeneity was observed in the overall analysis and most subgroups (I2 > 90%), except for the anticoagulated subgroup. A sensitivity analysis excluding the largest study reduced heterogeneity and improved funnel plot symmetry, indicating that study size contributed to variability in HAS-BLED performance.

Conclusion: The HAS-BLED score has shown variable predictive abilities in AF patients with cancer ranging from poor to good, with notable heterogeneity across studies secondary to various contributing factors. This emphasizes the need for individualized risk assessment tailored to the unique characteristics of cancer patients to effectively guide clinical decision-making.

Introduction: The prognostic value of cardiac troponins in revascularized patients with myocardial infarction (MI) is uncertain. This study examined the relationship between peak troponin levels and adverse outcomes in a revascularized cohort from the Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS).

Methods: MENZACS enrolled patients with a first-time acute coronary syndrome from 2015 to 2019. Peak high sensitivity troponin was standardized by dividing the observed peak troponin by the upper limit of normal. The primary outcome was a composite of all-cause death or cardiovascular readmission, determined through national datasets. Troponin's relationship with outcomes was analysed using penalized spline Cox regression.

Results: Among 1,645 revascularized patients (81% male, mean age 61, 74% European, 14% Māori, 5% Pacific, 5% Indian, 3% Other; 46% ST-elevation MI (STEMI), 54% non-STEMI), higher peak troponin was associated with male sex, STEMI, current smoking, and elevated N-terminal pro-B-type natriuretic peptide levels. Over a median of 4.9 years, 402 (24%) people experienced the primary outcome. Peak troponin levels were not significantly associated with this outcome.

Conclusion: In this revascularized cohort surviving a first-time MI, the magnitude of peak troponin elevation was not associated with all-cause death or cardiovascular readmission.