Background: Congenital right ventricular aneurysm (CVA) and diverticulum (CVD) are rare heart diseases that can be diagnosed prenatally. Data on the natural progression of ventricular aneurysms or diverticula identified during fetal life remains scarce, with insights primarily derived from a limited number of case reports and case series. This case report aims to highlight the diagnosis, management, and outcomes of a rare right ventricular free wall aneurysm progressing to hypoplastic right heart syndrome (HRHS), utilizing advanced fetal imaging and prenatal therapy. These findings provide valuable perspective on the underlying cause, diagnostic approaches, and treatment strategy for rare cardiac anomaly.
Case description: The aneurysm of the right ventricular free wall was diagnosed 13 weeks of gestation during prenatal ultrasound of the fetus in the first trimester. At the time of diagnosis, severe tricuspid valve stenosis with severe tricuspid regurgitation, critical pulmonary stenosis, pericardial effusion, ascites, and secondary flow reversal in the ductus venosus was found. Genetic testing using microarray-based comparative genomic hybridization (aCGH) on amniotic fluid samples showed no genomic imbalance. Digoxin treatment was initiated at 13 weeks of gestation, starting with a loading dose of 1,200 micrograms, followed by a maintenance dose of 375 micrograms daily, to address signs of fetal heart failure. The fetalHQ® software was utilized to assess the size and contractility of both the right and left ventricles, focusing on global and segmental strain measurements. The gradual reduction in right ventricular cardiac output led to the progression of HRHS with pulmonary atresia. At 39 weeks of gestation, a female newborn weighing 2,480 g was delivered in good condition, with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. Prostaglandin E1 treatment was initiated postnatally to maintain ductal patency. Postnatal echocardiography and angio-computed tomography (CT) confirmed the prenatal diagnosis, revealing a right ventricle-to-right coronary artery (RCA) fistula and interruption of RCA perfusion continuity. The newborn underwent successful first-stage palliation with a Blalock-Taussig shunt to establish systemic-pulmonary circulation. Follow-up during the interstage period showed the child remained in good clinical condition, with no significant complications reported.
Conclusions: CVAs are rare but significant anomalies with potential for severe hemodynamic consequences. Multidisciplinary approaches integrating advanced imaging techniques, prenatal counseling, and tailored postnatal management are essential for optimizing outcomes.
Background: In-stent neoatherosclerosis (ISNA) is an important cause of in-stent restenosis (ISR) with drug-eluting stent (DES) implants. High-density lipoprotein cholesterol (HDL-C) is associated with ISNA. However, few studies have focused on the functionalities of HDL-C composition, and till date, optical coherence tomography (OCT) has not been used to analyze the relationship between ISNA incidence and HDL-C-to-apolipoprotein A-I ratio (HAR) in patients with DES implants and ISR (DES-ISR). This study aimed to clarify the association between HAR and ISNA.
Methods: This single-center, retrospective study included patients admitted to the Affiliated Hospital of Zunyi Medical University. A total of 216 patients with 220 ISR lesions who underwent OCT for the culprit stent were included between July 2018 and November 2022. Based on HAR at admission, 33rd and 66th percentiles were identified as the cut-off points, and all eligible patients were divided into three groups: Tertile 1 (HAR ≤0.836; n=71), Tertile 2 (0.836< HAR <0.932; n=73), and Tertile 3 (HAR ≥0.932; n=72). Baseline characteristics and angiographic and OCT features were compared between the different groups. In addition, univariate and multivariate logistic regression models were used to assess the association of HAR with ISNA and in-stent thin-cap fibroatheroma (TCFA).
Results: Angiographic characteristics and quantitative OCT assessment values did not differ significantly among the groups. The incidences of ISNA (62.0% vs. 52.1% vs. 37.5%, P=0.01) and in-stent TCFA (35.2% vs. 27.4% vs. 15.3%, P=0.02) were significantly lower in the third tertile of the HAR group than in the first or second tertiles. The multifactor logistic regression model revealed that the highest tertile group had a reduced risk of ISNA [hazard ratio (HR) =0.185, 95% confidence interval (CI): 0.081-0.421; P<0.001] and TCFA (HR =0.197, 95% CI: 0.075-0.517; P<0.001) compared with the lowest tertile group.
Conclusions: OCT revealed high HAR levels to be negatively correlated with the incidences of ISNA and TCFA in patients with ISR. HAR is a better indicator of ISNA and plaque fragility than HDL-C itself, thus providing a marker and pathway for better prevention of ISNA.
This paper presents case studies of adult patients with congenital heart disease (CHD) who developed cancer and also discusses relevant epidemiological studies, risk factors, and reports on early detection. Herein, we describe three cases: a 63-year-old man with an atrial septal defect and multiple myeloma; a 48-year-old man with tetralogy of Fallot and colorectal cancer; and a 25-year-old man with Fontan circulation and hepatocellular carcinoma (HCC). Previous studies have found that the incidence of cancer in adult patients with CHD is higher than that in the general population. The management of adult patients with CHD complicated by cancer requires careful attention because cancer treatment alone can affect the survival prognosis and quality of life, as well as the pathophysiology and treatment of underlying heart disease. Apart from known risk factors in the non-CHD population, specific risk factors have been reported, such as genetic abnormalities, low-dose ionizing radiation exposure, early thymectomy, Fontan-associated liver disease, and hypoxia. Encouraging patients to participate in cancer screening and avoid known risk factors is essential in daily practice for the early diagnosis and prevention of cancer. It is also important to be vigilant for initial signs that are indicative of cancer as well as avoidable risk factors.
Background: Coronary artery bypass grafting (CABG) is an effective and durable treatment for coronary artery atherosclerotic heart disease. However, stenosis or occlusion of vein grafts frequently occurs after CABG, posing a significant challenge in postoperative management. This study aims to evaluate the clinical efficacy of saphenous vein graft (SVG) harvesting using the no-touch technique during off-pump CABG (OPCABG).
Methods: In this prospective study, a comparative analysis of 1-year postoperative graft patency rates between left internal mammary artery (LIMA) grafts and SVGs harvested using the no-touch technique was conducted. The recruiting and data collection period was between June 2018 and December 2020. The study included 140 patients who underwent OPCABG at the Heart Center of The Second Hospital of Hebei Medical University. The primary outcomes assessed were the occurrence of major adverse cardiovascular and cerebrovascular events (MACCEs), which encompassed all-cause mortality, sudden cardiac death, acute myocardial infarction, recurrent angina, coronary revascularization, cerebral infarction, and cerebral hemorrhage, as well as the 1-year graft patency rate.
Results: No MACCEs occurred during the perioperative period, and all patients survived to discharge. During follow-up, two patients died, and 10 were lost to follow-up. Of the 128 patients who underwent coronary computed tomography angiography at the 1-year follow-up, there were no statistically significant differences in patency rates between SVGs and LIMA grafts (94.5% vs. 97.7%, P=0.15). Similarly, for end-to-side anastomosis, SVG and LIMA graft patency rates were comparable (93.9% vs. 97.7%, P=0.11). Among these patients, three cases (2.3%) of recurrent angina were reported, predominantly in those with occluded LIMA grafts, while one case of dyspnea was observed in a patient with an occluded SVG.
Conclusions: The 1-year patency rate of SVGs harvested using the no-touch technique was similar to that of LIMA grafts. Further research is warranted to explore the long-term effects of the no-touch technique on SVG patency.
Background and objective: The urgent need to identify pathways that can mitigate myocardial ischemia-reperfusion injury (MIRI) has become a central focus in cardiovascular treatment. Chinese herbal medicine (CHM), renowned for its multi-component, multi-channel, and multi-target therapeutic properties, holds significant promise in the management of MIRI. Mitochondria, as pivotal players in MIRI, have been shown to be effectively modulated by CHM through various mechanisms. The objective of this narrative review is to underscore the critical role of mitochondria in MIRI and to provide an up-to-date overview of the latest research advancements in utilizing CHM to treat MIRI by targeting mitochondrial morphology and function.
Methods: The PubMed and the China National Knowledge Infrastructure (CNKI) databases were searched using keywords related to MIRI. Relevant English-language articles published from January 2019 to July 2024 were included in this narrative review.
Key content and findings: Mitochondria are intimately linked to MIRI. The mechanisms involve the regulation of mitochondrial biogenesis and energy metabolism, the functionality of the mitochondrial respiratory chain, resistance to oxidative stress-induced damage, the maintenance of mitochondrial homeostasis, the modulation of calcium ion homeostasis, the preservation of mitochondrial membrane potential, the opening of adenosine triphosphate (ATP)-sensitive potassium channels, and the effective control over the opening of the mitochondrial permeability transition pore, all of which contribute to the balance between autophagy and apoptosis in cardiomyocytes. Various effective monomers of CHM, extracts of CHM, compounds, and proprietary Chinese medicine have demonstrated promising therapeutic potential in basic research, among them, tonic and blood-activating CHMs account for the largest proportion.
Conclusions: The prospect of CHM targeting mitochondria for the treatment of MIRI is promising, yet it necessitates overcoming challenges such as low bioavailability and inadequate mechanistic research. By integrating traditional Chinese medicine theories with modern scientific technologies, it is imperative to delve deeper into and optimize the pharmacodynamics, pharmacokinetics, and clinical applications of these herbs.
Background: Lipoprotein(a) [Lp(a)] levels and diabetic status have been recognized as risk factors for atherosclerosis. However, no studies on atherosclerosis have integrated these two indicators. This study aimed to evaluate the relationship between Lp(a) levels, diabetic status, and their combined effects on subclinical atherosclerosis.
Methods: This cross-sectional study included patients presenting with a first episode of chest pain at the First Affiliated Hospital of Chongqing Medical University from June 2018 to February 2022. All participants underwent coronary computed tomography angiography (CCTA) and carotid ultrasound to evaluate subclinical atherosclerosis. Logistic regression analysis was used to examine the associations of Lp(a) levels and diabetic status-both individually and in combination-with coronary artery calcium (CAC) and carotid arteriopathy.
Results: Among 912 patients, 473 (51.9%) had CAC and 637 (69.8%) had carotid arteriopathy. After adjusting the confounding variables, elevated Lp(a) levels associated with CAC [odds ratio (OR) 1.51, 95% confidence interval (CI): 1.02-2.24, P=0.040] and carotid arteriopathy (OR 1.77, 95% CI: 1.10-2.86, P=0.02) were statistically significant. After combining diabetic status, almost all Lp(a) levels were significantly associated with CAC and CAC score categories (CAC scores: 0.1-99.9, 100-399.9, ≥400) in the diabetes mellitus (DM) group. In this group, the highest risk for CAC and the most severe CAC score categories were observed in patients with Lp(a) levels of >300 mg/L. Among patients with DM, in the lower Lp(a) level group, the prevalence and severity of CAC were more pronounced than those in the medium Lp(a) level group. Additionally, in patients with DM only, elevated Lp(a) levels were associated with carotid arteriopathy (OR 3.38, 95% CI: 1.24-9.20; P=0.02), increased carotid intima-media thickness (cIMT; OR 3.67, 95% CI: 1.10-12.30; P=0.04), and stable/vulnerable carotid plaque (OR 3.39, 95% CI: 1.09-10.55; P=0.04; OR 3.21, 95% CI: 1.07-9.65; P=0.04). However, there were no significant differences between prediabetes and CAC or carotid arteriopathy.
Conclusions: In patients with chest pain and DM without cardiovascular disease (CVD), Lp(a) level was significantly associated with subclinical atherosclerosis and had a synergistic effect with DM. Notably, lower Lp(a) levels in patients with DM may lead to an additional subclinical atherosclerosis risk, whereas prediabetes does not show the same association. Therefore, these findings highlight the importance of formulating early preventive strategies for subclinical atherosclerosis based on Lp(a) levels and diabetic status.
Background: Both acute myocarditis patients and normal cohort usually present with normal coronary computed tomography angiography (CCTA) performance, and the performance of CCTA radiomics on the prediction for myocarditis is still unclear. This study aims to build a clinical prediction model for acute myocarditis using CCTA-based radiomics.
Methods: A total of 215 consecutive patients from the Affiliated Jinhua Hospital, Zhejiang University School of Medicine (Center 1) and Sir Run Run Shaw Hospital, Zhejiang University School of Medicine (Center 2) who underwent CCTA and were diagnosed as normal or acute myocarditis were enrolled. All CCTA images of myocardium were automatically segmented to extract radiomics features. Pearson correlation analysis was used to identify features that were highly correlated with others. The application of the 5-fold cross-validation test reduced reliance on a single training set and provided more robust performance estimation. The best radiomics prediction model was chosen and combined with the clinical labels to construct a clinical-radiomics model for the classification of patients as with or without myocarditis.
Results: Pearson's correlation and least absolute shrinkage and selection operator (LASSO) regression analyses identified 10 radiomics features and 7 clinical features which demonstrated the best correlation. The receiver operating characteristic curves of the three models that used the support vector machine (SVM) demonstrated the best performance. The area under the curves (AUCs) of Model 1 (Rad-score model) using training and test datasets were 0.970 (0.949-0.991) and 0.912 (0.832-0.992), respectively. The AUCs of Model 2 (clinical factors model) for the training and test datasets were 0.992 (0.983-1.000) and 0.943 (0.875-1.000), respectively. Model 3 (clinical factors and Rad-score model) demonstrated the best results, with AUCs of 1.000 (0.999-1.000) and 0.951 (0.880-1.000) in the training and test datasets, respectively.
Conclusions: The CCTA-based radiomics model constructed using machine learning demonstrated good performance for predicting myocarditis.
Background: Elevated levels of lipoprotein(a) [Lp(a)] and diabetes have been identified as potential risk factors for coronary artery disease (CAD). This study investigates various Lp(a) levels' impact on atherosclerotic cardiovascular disease (ASCVD) events in pre-diabetics and diabetics.
Methods: We included retrospective studies in English until May 2023, exploring the link between high Lp(a) levels and cardiovascular outcomes in humans with diabetes, prediabetes, or normal glucose levels. Studies were sourced from PubMed, Scopus, and Google Scholar, emphasizing detailed population and outcome data. We excluded studies with major methodological issues, low-quality data, missing key information, duplicates, and non-human subjects. We included high-quality retrospective studies on Lp(a) and cardiovascular outcomes, using risk of bias tools like Newcastle-Ottawa Scale (NOS) to ensure data integrity, and resolved discrepancies through discussion. Binary random-effects models were employed to estimate pooled hazard ratios (HRs) and 95% confidence intervals (CIs). Leave one out sensitivity analysis was performed. Heterogeneity was assessed using I2 statistics. For outcomes showing moderate or high heterogeneity, subgroup analyses were performed for follow-up duration or type of study.
Results: A total of 20,271 patients with diabetes, prediabetes, and non-diabetics were included from three studies. In our analysis, compared to non-diabetics with Lp(a) <10 mg/dL, the risk of ASCVD increased with an increase in Lp(a) levels among pre-diabetics [Lp(a) <10 mg/dL (HR: 1.40, 95% CI: 1.17-1.67), Lp(a) 10-30 mg/dL (HR: 1.60, 95% CI: 1.30-1.96), Lp(a) >30 mg/dL (HR: 2.08, 95% CI: 1.49-2.90)] and diabetics [Lp(a) <10 mg/dL (HR: 2.42, 95% CI: 1.97-2.98), Lp(a) 10-30 mg/dL (HR: 2.26, 95% CI: 1.64-3.12), Lp(a) >30 mg/dL (HR: 4.17, 95% CI: 3.24-5.37)] with statistical significance (P<0.01).
Conclusions: High Lp(a) (>30 mg/dL) is associated with more ASCVD events in diabetics and pre-diabetics vs. Lp(a) <30 mg/dL, underscoring Lp(a)'s clinical importance in risk stratification and intervention.
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