Progress in cardiovascular diseases最新文献

Cardioneuroablation (CNA) is an emerging therapy for patients with vasovagal syncope with predominant cardioinhibitory responses. The procedure targets the neuromyocardial connections localized in specific regions of the right and left atrium as well as the adjacent ganglionated plexi (GP) providing parasympathetic innervation to the sinus and atrioventricular nodes. The target regions for CNA can be determined with various techniques, which result in heterogenous procedural approaches and endpoints in different centers specialized in this procedure. In this review we summarize the rationale and details of the procedural approach for three different techniques for CNA, namely: CNA controlled by extra-cardiac vagal stimulation, CNA guided by analysis of fractionated electrograms, and an anatomical approach to CNA.

Ischemic heart disease (IHD) is the leading global cause of death, affecting millions and leading to significant morbidity and mortality. Ischemic cardiomyopathy (ICM), a manifestation of IHD, results in severe left ventricular dysfunction due to coronary artery disease and poses a significant challenge due to the complex pathophysiology, variable clinical presentation, and overall poor prognosis. Recent advances in medical therapy, device interventions, and revascularization techniques offer newfound hope in improving ICM patient outcomes. This article reviews the state-of-the-art management approaches for ICM, emphasizing the importance of personalized treatment plans that integrate the various contemporary therapies to address the multiple mechanisms of disease development and progression. A meticulously tailored treatment approach for each individual patient offers the hope of prolonged survival through the synergy of therapies designed to address the different and complex mechanisms that contribute to their disease process.

Background: Right ventricular (RV) performance impacts clinical outcomes across pulmonary hypertension (pH), yet noninvasive tools for early detection and risk stratification are limited. Cardiac MRI (CMR) derived RV to left ventricular (LV) volume ratio (RV/LV_vol ratio) provides a relative assessment of RV size by normalizing chamber size to the LV. However, its prognostic utility remains underexplored. In the present study, we investigate the association between the RV/LV_vol ratio and outcomes in patients with PH.

Methods: This prospective study included patients with PH (pulmonary arterial systolic pressure > 35 mmHg by echocardiography or mean pulmonary artery pressure > 20 mmHg on invasive right heart catheterization), who underwent CMR. Abnormal RV/LV_vol ratio cutoff (≥1.27) was applied and further tested using established gradation thresholds. The primary outcome was a composite of all-cause mortality and heart failure hospitalizations.

Results: Of 135 patients, 56 (41.5 %) had an abnormal RV/LV_vol ratio. After a mean follow-up of 1.9 ± 1.3 years, 75 patients experienced the primary outcome. Patients with an abnormal RV/LV_vol ratio had higher rates of the primary outcome (64.3 % vs 50.0 %, p = 0.02). After multivariable analysis adjusting for age and CMR indices, abnormal RV/LV_vol ratio was associated with a higher risk of the primary outcome (HR 1.81 [95 % CI 1.06-2.97]; p = 0.003). RV/LV_vol ratio added incremental prognostic value over age and traditional RV indices (global χ2 value increasing from 6.7 to 17.4, p = 0.006).

Conclusions: The RV/LV_vol ratio is a simple clinical tool associated with an increased risk of adverse outcomes in PH patients, offering prognostic information beyond traditional RV parameters.

Cardiovascular disease (CVD) represents a significant health crisis, leading to premature morbidity and mortality, that is largely preventable. A decade ago, the World Health Organization formally acknowledged the powerful role culture plays in health and well-being, a key factor in preventing CVD, prompting increased attention on how shared values, norms, symbols, ethics and life practices effect the decisions and behaviors of patients, populations and practitioners alike. Cultural contexts affect human behaviors and health outcomes, and the United States (U.S.) is divided between dominant regional cultures. The American Nations model, informed by the work of cultural geographers, historians, and anthropologists, provides an analytical framework for understanding regional cultural contexts within the U.S. This model has been used to demonstrate significant regional differences in health outcomes, wellbeing, lifestyle behaviors, lifespan, and social vulnerability, with communitarian cultures consistently outperforming individualistic cultures across a broad range of phenomena. This model has significant implications for how a nation approaches health and health care, shifting from the traditional, national level one-size-fits-all paradigm to one that considers distinct regional differences based on historical settlement patterns. In this context, the American Nations model can help improve the effectiveness of health interventions by supporting a better understanding of cultural differences and the dominant U.S. cultural landscapes.

What defines a group of individuals as part of a community is broadly interpreted and depends on the context of the group being categorized. For this review, community may be defined as "as a group of people with diverse characteristics who are linked by social ties, share common perspectives, and engage in joint action in geographical locations or settings". A given community will possess unique cultural attributes, defined by the American Psychological Association as "the values, beliefs, language, rituals, traditions, and other behaviors that are passed from one generation to another within any social group". Unhealthy lifestyle behaviors drive the unacceptably high incidence and prevalence of chronic disease in the United States. Despite well intentioned efforts, society appears to be failing at altering the trajectory of unhealthy lifestyle behaviors, from an individual to population level. Perhaps our oftentimes one size fits all approach to health behavior messaging and counseling is a critical shortcoming. The fact that being more physically active, not smoking and consuming a healthier diet is of great benefit to human physiology and therefore human health outcomes is clear. However, human health behaviors or decisions to make a change in behavior are not driven by physiology but rather a complexly interacting milieu of factors - cultural drivers unique to a community amongst them. Herein, we discuss several community settings where there are opportunities to promote a culture of health living. This review will focus on settings that embody the definitions of community and culture described previously.

Social structures have become focal points in considering how to address the circumstances and conditions under which people live their lives. Yet, the many interactions among multiple factors that make up social and structural determinants are complex, interdependent, interactive, dynamic, and multilevel. This paper introduces an evidence-informed ecological framework that organizes drivers and feedback mechanisms collectively representing a generative force towards population health and well-being. The proposed ecological framework supports explanatory and exploratory considerations for prevention and management of population health and well-being issues. The framework explicitly includes a recognition that successful health and well-being outcomes are often dependent on the presence of social capital and healthy power dynamics. Dominant cultural norm is positioned as an overarching driver in this framework because it shapes the political realities and power dynamics responsible for infrastructure as well as the habits and behaviors of people at both the individual and social levels.