Cardiology Research and Practice最新文献

Objectives: This study systematically reviewed and meta-analyzed randomized controlled trials (RCTs) evaluating the efficacy and safety of acupuncture in myocardial ischemia/reperfusion (I/R) injury. Methods: A comprehensive literature search was conducted in PubMed, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang from database inception to November 3, 2024. Eligible RCTs assessing acupuncture for myocardial I/R injury were included. Statistical analyses were performed using Review Manager 5.3 and Stata 16. Results: A total of 26 RCTs of moderate methodological quality were included. Acupuncture significantly reduced myocardial enzyme levels compared to controls. Inflammatory markers (hs-CRP, TNF-α, IL-6, IL-8, and IL-1) were suppressed, while anti-inflammatory and immunoregulatory factors (IL-10 and IL-2) increased. Oxidative stress parameters showed improvements, with reductions in MDA and SOD levels. Echocardiographic findings demonstrated enhanced cardiac function, reflected by increased LVEF and LVESV, along with reductions in LVFS, LVEDD, LVEDV, and LVESD. Additionally, acupuncture alleviated TCM chest pain symptoms, shortened ICU stays, lowered MACE incidence, and improved 6MWT and SAQ indicators. No adverse reactions were reported. Conclusion: Acupuncture attenuates myocardial injury, inflammation, and oxidative stress while activating anti-inflammatory and immune responses, enhancing cardiac function, and mitigating ventricular remodeling. Furthermore, it alleviates chest pain, shortens ICU stays, reduces adverse cardiovascular events, and improves 6MWT and SAQ indicators.

Background: Recognizing the natural progression of the remaining valve disease following the intervention of a single valve is crucial in multiple rheumatic valvular diseases as often encountered in clinical practice. We aimed to investigate whether performing mitral valve (MV) intervention alone for multiple rheumatic MV and aortic valve (AV) disease is safe. Hypothesis: Rheumatic AV disease progresses slowly and severity does not differ significantly after MV intervention. Methods: We retrospectively investigated the progression of AV disease with rheumatic changes following MV intervention in a single tertiary center. Among 890 patients initially screened, 76 patients met the criteria for assessment. Results: Six patients fell under severe aortic stenosis (AS) definition-wisely and four of them were classified as low-flow low-gradient severe AS despite normal ejection fraction. Eventually, four patients were found to have true-severe AS at a median follow-up period of four years (mean 5.8 years) and only one of them underwent AV surgery for severe AS per se. None of the patients with aortic regurgitation deteriorated to severe. Conclusions: Only a small portion of rheumatic AV involvement progresses to severe AS after MV intervention, and performing MV intervention for severe mitral stenosis or mitral regurgitation in patients with concurrent mild or moderate AS or aortic regurgitation due to rheumatic changes is reasonable.

Background: Visual angiographic assessment of left main (LM) bifurcation lesions is fraught with major limitations. Bifurcation-dedicated quantitative coronary angiography (Bif-QCA) assessment provides higher accuracy than standard QCA in bifurcation lesions. Fractal laws (e.g., Finet's and Murray's laws) can enhance the accuracy of reference diameter calculation when applied to angiography-derived algorithms and may serve as a surrogate for pressure-based assessment. Aims: To investigate the correlation between Bif-QCA, Finet's law derived Bif-QCA (Finet-QCA) and pressure-wire functional assessment for LM bifurcation stenosis. Methods: Using instantaneous wave-free ratio (iFR) as a reference standard (≤ 0.89), we compared the value of Bif-QCA and Finet-QCA (diameter stenosis ≥ 50%). Moreover, the differences in MEDINA classification according to site-reported visual assessment vs Bif-QCA or Finet-QCA were investigated. Results: Eighty-four patients were included in the analysis, of which 72 (85.7%) presented an abnormal iFR. Bif-QCA derived %DS was moderately correlated with iFR values; however, implementing Finet's law in the correlation resulted weak. Site-reported MEDINA (visual assessment) resulted in significant higher rate of 1,1,1 and lower rate of 1,0,0 patterns compared to Bif-QCA MEDINA (9.5% vs. 1.2%, p < 0.001 and 33.3% vs. 46.4%, p < 0.001, respectively) and to Finet-QCA MEDINA (9.5% vs. 2.4%, p < 0.001 and 33.3% vs. 40%, p < 0.001, respectively). Conclusions: The present study suggested that LM MEDINA bifurcation pattern should be based on QCA analysis rather than visual assessment, both in the context of clinical practice and clinical studies. Compared to conventional Bif-QCA, the implementation of fractal laws (Finet-QCA) did not appear to improve the determination of the reference diameters of the LM shaft.

Background: The most important pathological basis of coronary heart disease is atheroma formation. If atheromatous plaque occurs and is not treated promptly and effectively, the plaque will gradually grow, causing the lumen of the coronary arteries to gradually narrow until it is completely occluded, causing angina pectoris and even myocardial infarction, but its cellular heterogeneity is not fully understood. Methods: We utilized various techniques including single-cell RNA sequencing, CytoTRACE, monocle, slingshot, CellChat, and SCENIC to investigate the significant subgroup of NK cells in 15 specimens from individuals in order to understand their contributions to the development of coronary plaque. Results: The analysis revealed that studying the subgroup C1 RACK1+ NK cells was crucial for this paper. We investigated its effect on coronary plaque and then analyzed C1 RACK1+ NK cells to explore the expression of this subgroup in pseudotime trajectories, cell interactions, and transcription factors. Conclusion: Single-cell RNA sequencing could provide a deeper understanding of the factors that have an important impact on the development of coronary plaque, improved the understanding of the microenvironment of coronary plaque, provided enlightenment for the treatment of coronary plaque in the future, and helped to improve the diagnosis of coronary plaque and design the best treatment strategy.

Purpose: This study aimed to analyze the epidemiological, clinical, and therapeutic characteristics of patients with pulmonary arterial hypertension (PAH) treated at a major reference center in Bulgaria and to assess treatment patterns, patient compliance, and overall survival. Principal Results: The epidemiological data revealed that 69.5% of the patients were female, with a mean age of 52 years. The majority of patients were diagnosed at advanced stages of PAH, with 92.1% classified as World Health Organization Functional Class III. Monotherapy was the most common treatment regimen, used by 61.4% of patients, despite advanced disease. Patients who adhered to treatment demonstrated significantly longer overall survival (78.9 months) compared to those lost to follow-up (50.8 months). The study also identified a 31% rate of noncompliance, with patients missing follow-up visits and becoming ineligible for further therapy. Major Conclusions: The findings highlight the need for earlier diagnosis and more aggressive treatment strategies, as monotherapy appears insufficient for optimal outcomes in advanced PAH. Establishing a national PAH registry and increasing disease awareness could facilitate earlier interventions and improve patient outcomes in Bulgaria.

Objectives: The head-up tilt test (HUTT) is a well-established diagnostic procedure used to differentiate between the types of syncope. Since its introduction in 1986, the protocol has undergone several refinements aimed at increasing diagnostic accuracy. Despite growing interest in advanced autonomic ECG parameters and beat-to-beat blood pressure monitoring, their integration into routine HUTT protocols remains limited. Methods: In this study, we compared the conventional HUTT protocol using two-minute interval monitoring with an advanced protocol incorporating autonomic ECG parameters-periodic repolarization dynamics (PRD) and deceleration capacity (DC)-as well as continuous beat-to-beat hemodynamic monitoring. Results: The extended protocol improves diagnostic resolution by detecting more pronounced hemodynamic fluctuations, enabling real-time trend analysis, and allowing earlier recognition of impending syncope. The tilt phase was characterized by a significant initial increase in PRD, and patients with syncope showed significantly higher PRD values during the tilt phase (8.14 vs. 3.91 deg², p=0.043). Conclusions: Continuous hemodynamic monitoring during HUTT improves the diagnostic quality by detecting changes at an early stage, thus allowing to anticipate syncope and to clearly identify its etiology. While beat-to-beat blood pressure monitoring is already recommended by current syncope guidelines, we propose the additional evaluation of autonomic ECG parameters as a valuable extension to standard protocols.

Background: Ischemic heart disease and stroke kill 25% of people worldwide. Vitamin K antagonist (warfarin) is the most widely used oral anticoagulant. Although affordable and effective, its usage is limited in many patients due to anticoagulation level variability and other factors, its alternatives include new nonvitamin K antagonist oral anticoagulants (NOACs). The study aims to investigate NOAC usage barriers. Methods: This is an observational, cross-sectional study, involved 144 doctors from different specialties and different medical degrees in Khartoum state, the data were collected by an author designed close-ended questionnaire. Data were entered, cleared and analyzed using Statistical Package for Social Sciences (SPSS) V25.0 software. Results: Medicine was most common (45.8%) among 144 medical department participants. The most prevalent medical degrees were registrars (25%) and doctors (25%). Specialists (22.9%), then house officers (15.3%). Over half (51.4%) had worked less than 5 years. 50% did not know about the 2021 DOACs guideline. 60.4% claimed DOACs' unavailability inhibits prescription. The lack of a multidisciplinary team approach hinders DOACs prescription, said 70.2%. Conclusion: Sudanese clinicians' hurdles to using NOAC for thromboembolic episodes were explored. Lack of a reversal agent and multidisciplinary team approach hinder DOAC prescription. Lack of information about international guidelines, since most participant's preferred specialized advice or personal experience, and high DOAC costs and inaccessibility and unavailability are other important barriers. Medical practitioners should update guidelines and government insurance plans should include DOACs. Each department should start studies separately.

Introduction: There is no information on the potential of machine learning (ML)-based techniques to improve cardiovascular risk estimation in the Colombian population. This article presents innovative models using five artificial intelligence techniques: neural networks, decision trees, support vector machines, random forests, and Gaussian Bayesian networks. Methods: The research is based on a cohort of 847 patients free of cardiovascular disease at baseline and followed for cardiovascular disease events over 10 years at the Central Military Hospital in Bogotá, Colombia. To enhance the robustness and reduce the risk of overfitting, model evaluation was conducted using a 5-fold cross-validation on the entire dataset. Discriminatory ability was evaluated with the area under a ROC curve (AUC-ROC) for each ML-based model and the Framingham model. Results: Experimental results showed that the neural network technique had the best discriminative ability to predict cardiovascular events, with an AUC-ROC of 0.69 (CI 95% 0.622-0.759) for unbalanced data and 0.67 (CI 95% 0.601-0.754) for balanced data. Other ML techniques also showed good discriminatory ability with AUC-ROC values between 0.56 and 0.65, superior to that observed for the Framingham model (0.53; CI 95% 0.468-0.607). Conclusion: Our study supports the flexible ML approaches to cardiovascular risk prediction as a way forward for cardiovascular risk assessment in Colombia. Our data even suggest that risk prediction using these techniques could be even more discriminative than widely used risk-stimulation models such as Framingham, adapted to the Colombian population. However, new prospective studies need to validate our data before general implementation.

Background: Micro-oxygen therapy can reduce the effects of doxorubicin (DOX) on left ventricular function, cardiac fibrosis, inflammation, and oxidative stress in SD rats. These results suggest the potential of DOX for clinical use. Method: 8-week-old SPF-grade SD male rats were randomly divided into four groups: control group (Ctrl) (n = 10), doxorubicin group (DOX) (n = 10), doxorubicin + conventional oxygen intervention group (DOX+CO) (n = 10), doxorubicin + micropressed oxygen group (DOX+MO)) (n = 10). Left ventricular function was assessed by echocardiography 3 weeks after the end of treatment, and histopathological analysis was conducted utilizing Masson and hematoxylin-eosin (HE) staining. The mRNA expression levels of TGF-β1 and Collagen I were quantified by quantitative real-time PCR (qRT-PCR). Additionally, inflammatory markers, including the concentrations of IL-1β, IL-6, and TNF-α, as well as the activities of SOD and GSH-Px, were measured using enzyme-linked immunosorbent assay (ELISA). Results: The DOX + MO group significantly improved the symptoms of heart failure caused by DOX. The specific results are as follows: The EF significantly increased to 78.037 ± 1.283 (63.259 ± 8.855 in the DOX, p ≤ 0.0001); the IVSs increased from 0.243 ± 0.036 to 0.324 ± 0.038 (p ≤ 0.001); the LVPWs increased from 0.263 ± 0.028 to 0.323 ± 0.036 (p ≤ 0.01); the IVSd and the LVPWd increased from 0.171 ± 0.019 to 0.2 ± 0.015 (p ≤ 0.05) and from 0.181 ± 0.032 to 0.234 ± 0.026 (p ≤ 0.01). Among cardiac function indexes, NT-proBNP in DOX + MO group was significantly different from that in DOX group (p ≤ 0.0001). Compared with DOX group, the degree of myocardial fibrosis in DOX + MO group was decreased, and qRT-PCR showed that MO oxygen effectively reduced the mRNA expression of TGF-β1 and collagen1 induced by DOX. In terms of inflammatory indicators, TNF-α (p ≤ 0.0001), IL-1β (p ≤ 0.0001), and IL-6 (p ≤ 0.0001) in DOX + MO group were significantly lower than those in DOX group. In terms of oxidative stress, serum levels of SOD and GSH-PX were decreased in the DOX group, and MO oxygen therapy effectively prevented the reduction of these indexes. On the other hand, the experimental results also showed that DOX + MO group was significantly better than DOX + CO group in terms of cardiac function, inflammation, and oxidative stress. Conclusion: Microbaric oxygen therapy can reduce the effects of DOX on left ventricular function, cardiac fibrosis, inflammation, and oxidative stress in SD rats. These results provide support for clinical studies to evaluate the potential of DOX in clinical applications.