Cardiology in Review最新文献

Cardiovascular disease remains a leading cause of morbidity and mortality worldwide, with South Asians carrying a disproportionate burden. Compared to other ethnic groups, South Asians experience a decade earlier onset of atherosclerotic cardiovascular disease, often before age 60, and have higher rates of ischemic heart disease and stroke. This elevated risk reflects a complex interaction of biological, environmental, and sociocultural factors that are not fully accounted for by existing research models. This review summarizes current evidence on the epidemiology, pathophysiology, and risk factors contributing to the atherosclerotic cardiovascular disease risk in South Asians. Key risk factors include hypertension, diabetes, dyslipidemia, central obesity, and dietary patterns high in refined carbohydrates and saturated fats. Nontraditional factors-such as elevated pro-inflammatory biomarkers and epigenetic programming-may further accelerate atherosclerosis in this population. Despite progress in reducing mortality, underrepresentation in cardiovascular research and limited access to preventive care continue to hinder effective management. Culturally tailored prevention programs and earlier screening, combined with advancements in research, are critical to improving outcomes. Collaborative efforts across research and clinical practice are needed to reduce the burden and create effective interventions.

Idiopathic cardiomyopathy in children is a rare but severe condition that demonstrates high morbidity and mortality. Pediatric cardiomyopathy is etiologically multifaceted, with many presentations involving de novo genetic mutations or undiagnosed metabolic conditions, but these are not definitive, which complicates diagnosis and treatment. This review explores the limitations in identifying the etiology of pediatric idiopathic cardiomyopathy and examines the impact of these challenges on the development of targeted, pediatric therapies to improve current outcomes. A literature review was conducted, analyzing current information from clinical trials, cohort studies, and specialist consensus statements focused on pediatric cardiomyopathy etiology, treatment, and outcomes. The majority of treatments are adapted from adult studies, which show limited effectiveness in children. The absence of a standardized classification system, insufficient pharmacologic evidence, and scarce pediatric-specific trials contribute to poor prognosis and generalized treatment practices. Advancing pediatric cardiomyopathy care requires precision medicine frameworks, substantial databases on genotype-phenotype, and clinical trials developed specifically for pediatric patients. Increasing attention to pediatric research and targeted treatment strategies is crucial to improving survival and outcomes from current strategies.

Patients with a small aortic annulus (SAA) undergoing transcatheter aortic valve replacement (TAVR) face a high risk of prosthesis-patient mismatch and adverse outcomes. The 2 most studied valve types, balloon-expandable valves (BEVs) and self-expanding valves (SEVs), differ in structure and deployment, potentially impacting outcomes in this subgroup. To compare the hemodynamic and clinical outcomes of BEVs versus SEVs in SAA patients undergoing TAVR. A systematic search of major databases through March 2025 identified randomized controlled trials and propensity score matching studies comparing BEVs and SEVs. Pooled analyses were conducted using a random-effects model to derive mean differences (MDs) and odds ratios (ORs) with 95% confidence intervals (CIs) in R (version 4.4.1). Thirteen studies (n = 4582; BEV: 2290; SEV: 2292) were included. BEVs were associated with smaller indexed effective orifice area (iEOA) (MD: -0.15 cm²/m²), higher mean (MD: 4.92 mm Hg) and peak (MD: 4.78 mm Hg) transvalvular gradients, and higher overall (OR: 2.64) and severe (OR: 2.72) prosthesis-patient mismatch rates. However, BEVs had a significantly lower risk of permanent pacemaker implantation (OR: 0.62). No significant differences were found in mortality, stroke, bleeding, acute kidney injury, paravalvular leak, myocardial infarction, vascular complications, or heart failure hospitalization. BEVs and SEVs demonstrate comparable mortality in SAA patients undergoing TAVR. SEVs offer superior hemodynamic outcomes, while BEVs reduce pacemaker need. Prosthetic valve selection should be individualized based on anatomy, clinical profile, and procedural factors. Future randomized trials with long-term follow-up are warranted to inform optimal device selection in this population.

Heart failure (HF) in patients with chronic obstructive pulmonary disease (COPD) is associated with increased morbidity and mortality. This study delineates national trends and predicts HF-related mortality among COPD patients utilizing US death certificate data from 1999 to 2024, with projections extending to 2030. We extracted mortality data from the CDC WONDER database (1999-2024) for adults aged ≥25 years with HF and COPD listed on death certificates. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 population and stratified by sex, race/ethnicity, region, and urbanization. Trends were analyzed using Joinpoint regression, and forecasts were generated using autoregressive integrated moving average models. Between 1999 and 2024, 1,445,877 COPD-related HF deaths occurred. Overall, AAMR declined from 1999-2012 [annual percent change (APC) = -0.80%, 95% confidence interval (CI): -1.21 to -0.44], then increased from 2012-2021 (APC = +3.12%, 95% CI: 2.59-4.42), followed by a post-2021 decline (APC = -1.46%, 95% CI: -4.46 to -0.59). Projections indicate AAMR will increase from 21.29 in 2025 to 22.25 in 2030. Regional variation was notable, with the Midwest having the highest AAMR (27.9) and the Northeast having the lowest (19.5). Rural areas exhibited markedly higher mortality (AAMR = 32.7) compared to urban areas (AAMR = 21.9). The mortality rate associated with HF among US adults diagnosed with COPD experienced a significant increase after 2012, reaching its peak around 2021. Projections indicate that AAMRs are likely to either escalate or stabilize through 2030, especially within vulnerable subpopulations.

The protocol for the management of hypotension in the setting of septic shock has been long debated. Septic shock is a type of distributive shock where disseminated infection causes widespread vasodilation in the vascular network, leading to inefficient perfusion of organs and ultimately multiorgan failure, which can cause death if not compensated for. In the setting of severe sepsis, acute kidney injury may occur, leading to electrolyte and acid-base abnormalities, which can further contribute to mortality. Traditionally, fluid resuscitation and vasopressor administration have been utilized in order to help minimize end-organ damage secondary to malperfusion. The discussion of fluid resuscitation has been contentious, with the focus being on whether fluids should be given to patients in edematous states to begin with, and also on what type of crystalloid fluid should be given. This paper aims to review current protocol concerning whether normal saline (0.9% NaCl) or lactated Ringer's solution is more optimal for maintaining electrolyte and acid-base status in septic patients.

Out-of-hospital cardiac arrest stands as a prominent global public health challenge. The effect of cardiopulmonary resuscitation (CPR) duration on neurological outcomes is inconclusive. Therefore, this study seeks to systematically review the link between CPR duration and neurological outcomes following out-of-hospital cardiac arrest. Web of Science, Cochrane Library, PubMed, and Embase were searched up to October 15, 2024. The quality of the included studies was appraised via the Newcastle-Ottawa Scale. StataMP/15.1 was employed to analyze heterogeneity, sensitivity, and the dose-response relationship. Eight studies involving 369,897 patients were selected. This study unraveled that compared to the shortest CPR duration, prolonged CPR duration was correlated with a lower probability of good neurological outcomes [odds ratio = 0.05, 95% confidence interval: (0.02, 0.16), P < 0.001]. Moreover, prolonged CPR duration was related to a notably reduced 1-month survival rate [odds ratio = 0.06, 95% confidence interval: (0.03, 0.14), P < 0.001]. Dose-response analysis indicated nonlinear correlations between CPR duration and both favorable neurological prognosis and 1-month survival rate (P < 0.001). However, generally, the correlations between them were negative. In conclusion, prolonged CPR duration can substantially reduce the probability of favorable neurological prognosis and 1-month survival rate. Since the number of selected studies was small, high-quality studies are needed to validate the results.

Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide and remains a leading cause of stroke, heart failure, and mortality. Catheter-based ablation, primarily pulmonary vein isolation, has become a cornerstone of rhythm control, but conventional thermal approaches carry risks of collateral injury and variable long-term efficacy. Pulsed-field ablation (PFA), a nonthermal modality that employs irreversible electroporation to selectively ablate myocardial tissue while sparing adjacent structures, has emerged as a promising alternative. This review synthesizes evidence from preclinical studies, pivotal randomized trials, and real-world registries, highlighting PFA's consistent procedural efficiency, high acute success, and favorable safety profile compared with radiofrequency and cryoablation. Catheter innovations-including balloon, circular, and lattice platforms-along with integration into electroanatomical mapping systems, have streamlined workflows and shortened procedure times. Expanding applications in heart failure, redo ablation, atrial flutter, and early ventricular tachycardia ablation underscore its versatility, while integration with artificial intelligence, high-resolution mapping, and multimodality imaging positions PFA within the future of precision electrophysiology. Nonetheless, challenges remain regarding mechanistic understanding, lesion durability, device heterogeneity, and long-term outcomes. As ongoing trials and registries mature, PFA is poised to redefine the ablation landscape and inform future guideline recommendations.

Cardiac arrest causes circulatory collapse, stress-related adrenal insufficiency, and a strong inflammatory response, creating a plausible rationale for corticosteroid therapy. Glucocorticoids can restore adrenergic responsiveness, raise vascular tone and blood pressure, correct inadequate cortisol activity during critical stress, and attenuate ischemia-reperfusion inflammation. Across randomized trials, the most consistent finding is a higher rate of return of spontaneous circulation (ROSC) with steroid-containing regimens, particularly in in-hospital cardiac arrest and when steroids are combined with vasopressin. Results for survival to discharge and favorable neurological recovery are mixed, and benefits in out-of-hospital cardiac arrest are less consistent. Meta-analyses generally confirm an ROSC advantage and suggest a potential dose-response, with higher intra-arrest methylprednisolone doses associated with improved survival to discharge. Safety findings are reassuring overall, with no clear increase in hyperglycemia, infection, or bleeding, although most trials were not powered for rare adverse effects. Major guideline bodies acknowledge physiologic plausibility and ROSC gains but do not recommend steroids as standard therapy during resuscitation. Priorities for future work include adequately powered multicenter trials that use survival with favorable neurological recovery as primary outcomes, prospectively test dose and timing (intra-arrest and post-ROSC), separate the effect of steroids from coadministered vasopressin, standardize postresuscitation care targets, and incorporate early endocrine and inflammatory biomarkers to focus enrollment on patients most likely to benefit.

Cardiovascular disease remains the leading global cause of mortality, with projections indicating a steep rise in prevalence and deaths by 2050. Elevated low-density lipoprotein cholesterol (LDL-C) is a central driver of atherosclerotic cardiovascular disease, and lowering LDL-C consistently reduces major adverse cardiovascular events without an apparent threshold. Recent guidelines underscore both early and durable LDL-C reduction through sequential and combination therapies. Bempedoic acid, an oral first-in-class adenosine triphosphate-citrate lyase inhibitor, offers hepatoselective LDL-C lowering with reduced risk of myotoxicity. Randomized controlled trials demonstrate LDL-C reductions of 15-20% with monotherapy and up to 40% with ezetimibe combination, alongside cardiovascular event reduction in statin-intolerant patients. Regulatory approvals in the United States, European Union, and United Kingdom converge on its role in patients unable to tolerate statins or inadequately controlled on standard therapy. This review synthesizes current evidence and guideline positioning, situating bempedoic acid within contemporary lipid management strategies that emphasize earlier combination therapy, achievement of lower LDL-C thresholds, and long-term maintenance of treatment goals.

The field of interventional cardiology has rapidly progressed, given recent advances in the management of complex, high-risk indicated percutaneous coronary intervention. These procedures are becoming increasingly necessary due to the aging population and increasing comorbidity burden. Expanded procedural capabilities have been made possible through innovations in mechanical circulatory support (MCS) devices, drug-coated balloons, and intravascular lithotripsy, which have enhanced procedural safety and enabled revascularization in patients previously considered inoperable. This critical review synthesizes emerging evidence from randomized trials, observational studies, and current guidelines to examine the role of support strategies in complex, high-risk indicated percutaneous coronary intervention. We explore clinical definitions, risk stratification tools, comparative efficacy of MCS devices, drug-coated balloons, and intravascular lithotripsy, as well as ongoing trials and future technologies like PulseCath and TandemHeart. These studies emphasize the importance of personalized, multidisciplinary strategies that integrate MCS, advanced lesion preparation, and imaging-guided decision-making. As the field evolves toward safer, more individualized care, further research is necessary to determine optimal device selection and long-term outcomes.