Progress in cardiovascular diseases最新文献

Heart failure (HF) due to left ventricular systolic dysfunction (LVSD) remains a major clinical challenge, particularly among patients with chronic total occlusions (CTO). CTO are present in up to 30% of patients with LVSD undergoing coronary angiography and are independently associated with worse outcomes. Although advances in interventional techniques have increased success rates of CTO percutaneous coronary intervention (CTO-PCI), high-quality evidence supporting this procedure in patients with LVSD remains limited. Observational studies report potential benefits, including improved survival, alleviation of HF symptoms, and recovery of left ventricular ejection fraction (LVEF). However, randomized controlled trials (RCTs) have largely excluded patients with LVEF <35% and those with advanced, complex coronary artery disease (CAD), including CTO, thereby restricting generalizability. Assessment of myocardial viability remains central to patient select for CTO-PCI, its prognostic value for hard clinical endpoints has not been definitively established. The use of mechanical circulatory support (MCS) during high-risk CTO-PCI is increasing, particularly in patients with reduced LVEF and complex coronary anatomy; available data provides inconsistent evidence regarding its impact on clinical outcomes and appears to be largely influenced by individual patient characteristics. Finally, in the setting of acute coronary syndromes (ACS), the effect of CTO revascularization on clinical endpoints and arrhythmic risk is unclear, with conflicting observational data. Future research should prioritize this underrepresented high-risk cohort and be conducted in experienced centers within an integrated multidisciplinary care framework.

Sleep is increasingly recognized as a modifiable factor for cardiovascular diseases (CVDs), yet the roles of specific sleep stages, particularly rapid eye movement (REM) sleep, and the utility of wearable-derived sleep parameters for CVD prediction remain unknown. Therefore, we aimed to investigate the associations of sleep with CVD risk and to develop multimodal prediction models for incident CVD. Using data from the All of Us Research Program, 23,413 adults who consented to share both Fitbit and electronic health record data between May 2018 and October 2023 were included in the analysis. Sleep data were obtained from Fitbit wearable devices, including sleep duration and stage-specific information such as REM sleep. Incident CVD was defined as occurring at least six months after the initiation of Fitbit monitoring. Cox proportional hazards models were applied to estimate adjusted hazard ratios (aHR) with 95% confidence intervals (CIs) for sleep duration and REM sleep in association with CVD. For the prediction of CVD within six years, two modeling strategies were implemented, including a non-invasive multimodal model using demographic, self-reported, and wearable-derived data and an invasive multimodal model that additionally incorporated laboratory measures. To compare real-world model performance, we applied and compared several conventional risk prediction models, including SCORE2, the Framingham Risk Score, AutoPrognosis 2.0, and the Pooled Cohort Equations. Among 23,413 participants (mean [standard deviation] age, 56.7 [15.5] years; 70.9% female), both short (<7 h) and long (≥9 h) sleep durations were associated with higher risk of CVDs compared with 7 to 9 h of sleep (short sleep: aHR, 1.16 [95% CI, 1.07 to 1.27]; long sleep: aHR, 1.32 [95% CI, 1.10 to 1.58]), with U-shaped relationship. Individuals with less than 20% REM sleep had a greater risk of CVDs (aHR, 1.31 [95% CI, 1.18 to 1.45]) compared with those with 20% to 25% REM sleep. These associations were consistent across CVD subtypes. In prediction analyses, soft-voting ensemble models with LightGBM and XGBoost integrating wearable, clinical, and laboratory data achieved high performance (AUROC of non-invasive models, 0.748; AUROC of invasive models, 0.782), outperforming conventional risk scores (SCORE2, the Framingham Risk Score, AutoPrognosis 2.0, and the Pooled Cohort Equations: AUROC range, 0.649 to 0.685). Short and long sleep durations, as well as reduced REM sleep, were associated with increased risk of CVD. We also derived and validated a multimodal model to predict the incidence of CVD within six years. These findings support the potential value of integrating objective sleep-stage measures and multimodal digital health data into future cardiovascular prevention strategies and guideline development.

Background: Management of valvular heart disease (VHD) has shifted from predominantly surgical approaches to widespread use of transcatheter interventions, including transcatheter aortic valve replacement (TAVR), mitral transcatheter edge-to-edge repair (M-TEER), transcatheter mitral valve replacement (TMVR), and emerging tricuspid transcatheter valve intervention (TTVI). Although ESC/EACTS and ACC/AHA guidelines recognize frailty as a major determinant of mortality, complications, and recovery, they offer limited guidance on how to modify frailty before intervention.

Content: Frailty is highly prevalent in VHD, particularly among transcatheter candidates, and represents a dynamic, potentially reversible syndrome driven by sarcopenia, deconditioning, malnutrition, inflammation, and psychological vulnerability. It influences symptoms, procedural selection, and recovery, exerting prognostic effects beyond valve anatomy. Prehabilitation offers a strategy to convert the preprocedural interval from passive waiting into a therapeutic opportunity. Evidence from cardiac surgery and hemodynamic interventions shows that multimodal prehabilitation (including aerobic and resistance exercise, respiratory training, nutritional optimization and psychological support) can improve functional capacity, reduce pulmonary complications, and shorten hospitalization. In TAVR candidates, early data suggest that even short programs may enhance functional performance, mitigate frailty and reduce major adverse cardiovascular events. In contrast, dedicated trials for M-TEER, TMVR and TTVI remain limited, and current practice depends on evidence from other procedural settings. Ongoing studies are testing exercise-based, nutritional, and psychological interventions, including telemedicine-supported and home-based models, while incorporating objective measures of frailty reversal.

Summary: As procedural risk declines, patients' physiological reserve becomes the principal barrier to long-term benefit. Prehabilitation may provide a scalable strategy to bridge anatomical correction with meaningful functional recovery.

Background: Preoperative cardiac risk assessment is critical in patients undergoing intermediate- to high-risk non-cardiac surgery. While both treadmill testing (TMT) and coronary computed tomography angiography (CTA) are widely used, the incremental prognostic value of combining these modalities remains unclear.

Objectives: To evaluate the additive predictive value of coronary CTA when performed after TMT in patients scheduled for non-cardiac surgery.

Methods: In this prospective multicenter cohort study conducted at two tertiary hospitals (Changwon Gyeongsang National University Hospital and Gyeongsang National University Hospital), 447 patients undergoing non-cardiac surgery were enrolled between January 2018 and April 2025. All patients underwent both TMT and coronary CTA prior to surgery. The primary endpoint was 30-day major adverse cardiac events (MACE), defined as a composite of cardiac death, nonfatal myocardial infarction, myocardial injury after noncardiac surgery, pulmonary edema with heart failure, clinically significant arrhythmias requiring urgent intervention, and prophylactic coronary revascularization. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC), and incremental prognostic value was evaluated using net reclassification improvement (NRI) and integrated discrimination improvement (IDI).

Results: Forty-five patients (10.1%) experienced MACE. Significant coronary stenosis (≥50%) and a high coronary artery calcium score (CACS ≥203) on CTA were strong independent predictors of perioperative events. Among patients with positive TMT results, the addition of CTA significantly improved risk prediction. Importantly, even among TMT-negative patients, CTA findings provided meaningful discriminatory value. Conversely, TMT contributed modest incremental prognostic information in patients with significant coronary stenosis identified on CTA. Overall, models integrating both anatomic and functional assessments demonstrated the best predictive performance.

Conclusions: Coronary CTA provides incremental prognostic value beyond TMT for predicting 30-day perioperative MACE in patients undergoing non-cardiac surgery. A combined strategy incorporating both anatomic and functional testing may enhance perioperative risk stratification and support more informed clinical decision-making.

Atherosclerotic cardiovascular disease remains the leading cause of death and disability worldwide. Its major clinical outcomes, myocardial infarction, stroke, vascular dementia, and cognitive decline, reflect a shared vascular foundation. Recognizing subclinical atherosclerosis early is essential to preventing these interrelated cardiovascular and neurological consequences. Coronary artery calcium (CAC), quantified by non-contrast CT, is a well-validated and reproducible marker of total atherosclerotic burden. Although primarily applied to the heart, CAC also reflected systemic vascular injury. Findings from large prospective cohorts, including the Rotterdam Study and AGES-Reykjavik Study, demonstrate that higher CAC scores independently predict ischemic stroke, dementia, and accelerated cognitive decline. Individuals with CAC ≥100 Agatston units have roughly three times the risk of ischemic stroke and cognitive decline compared with those with CAC = 0, even after adjusting for shared vascular risk factors. Extra-coronary arterial calcification, involving the aorta and intra- and extra-cranial arteries, has been associated with cerebral small-vessel disease, white-matter hyperintensities, and cortical atrophy, highlighting the systemic nature of vascular atherosclerosis. Detecting both coronary and extra-coronary calcification enables earlier, targeted intervention through lipid-lowering, blood pressure, and glycemic control, and lifestyle modifications. Integrating arterial calcification imaging across vascular beds into clinical risk assessment may therefore enhance the prevention of both cardiovascular and neurovascular events. Imaging of arterial calcification provides a practical and scalable assessment of systemic atherosclerosis. Its predictive value extends beyond coronary outcomes to encompass stroke, dementia, and cognitive decline, highlighting the common vascular pathways that link cardiovascular disease with vascular cognitive impairment.

Background: Gout and cardiovascular disease (CVD) are globally widespread diseases, yet evidence on their association in the Chinese population remains limited. We aimed to investigate the association between gout and the incident risk of CVD in a Chinese population.

Methods: A register-based cohort study was conducted based on a city-wide health information platform in Shenzhen, China (2016-2022). We included individuals diagnosed with gout and free of CVD at baseline, and used the propensity score to select a 5-fold number of matched controls without gout. Electronic medical records and death registration were used to identify gout patients and CVD events. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) between gout and the incident risk of CVD, including ischemic heart disease (IHD), stroke, and heart failure (HF).

Results: We included 230,339 CVD-free gout patients and matched 1,055,509 controls. During a maximum follow-up of 5.7 years, a total of 5108 and 16,621 incident CVD in gout patients and the controls were recorded, with incidence rates of 9.82 and 6.24 per 1000 person-years, respectively. Compared with the controls, gout patients had a higher risk (HR: 1.27, 95% CI: 1.24 to 1.29) for the total CVD incidence. Subgroup analyses showed that women and younger patients (aged 18 to 44 years) with gout had higher relative risks of CVD than their counterparts (P for interaction ≤ 0.001).

Conclusion: We provide evidence that gout is associated with incident CVD risk, emphasizing the need for effective prevention and management strategies to mitigate CVD burden.