Cardiovascular diagnosis and therapy最新文献

Background and objective: Calcific aortic valve disease (CAVD) is a prevalent and progressive cardiovascular condition, particularly found in the elderly population, characterized by the thickening, calcification, and increased stiffness of the aortic valve leaflets. These structural changes lead to impaired valve function and ultimately contribute to heart failure and increased cardiovascular mortality. Surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) remain the only effective treatments but are associated with significant risks, high costs, and limited suitability for early-stage or asymptomatic patients. Therefore, the development of non-invasive, disease-modifying therapies is of critical importance. This review aims to summarize current evidence on the role of endothelial-mesenchymal transition (EndMT) in the pathogenesis of CAVD and to explore its potential as a therapeutic target for future non-surgical interventions.

Methods: A comprehensive literature search was performed in PubMed, Web of Science, and Embase. Studies related to aortic valve stenosis published between January 1, 2019 and December 20, 2024, as well as all available reports on EndMT published prior to the search date, were included. Only English-language publications were considered, and relevant findings were synthesized to support this review.

Key content and findings: Recent studies have highlighted the pivotal role of EndMT in the pathogenesis of CAVD. EndMT contributes to valvular fibrosis, inflammation, and osteogenic differentiation, all of which drive disease progression. Targeting key EndMT-related pathways-such as transforming growth factor-β (TGF-β), Notch, and Wnt-offers promising therapeutic potential. Moreover, combining EndMT-targeted strategies with anti-inflammatory and anti-calcification interventions may enable early-stage intervention, thereby slowing disease progression and reducing reliance on surgical treatments. This review summarizes current understanding of EndMT mechanisms in CAVD and explores emerging therapeutic strategies beyond current surgical options.

Conclusions: CAVD progresses through complex mechanisms involving inflammation, lipid deposition, and osteoblastic differentiation. EndMT has emerged as a key driver of fibrosis and osteogenesis in valve mesenchymal cells, thereby accelerating calcification. However, its regulatory networks and pathway interactions remain incompletely understood. Further research is needed to clarify these mechanisms and develop EndMT-targeted interventions, which may offer new avenues for early diagnosis and treatment of CAVD.

Background: The micro-axial intravascular flow pump (mAFP) may potentially improve the prognosis of cardiogenic shock (CS). Despite its advanced hemodynamic profile, efficacy remains undetermined. Safety and mid-term outcomes were compared between the mAFP and intra-aortic balloon pump (IABP).

Methods: This single-center, cross-sectional study retrospectively evaluated 205 consecutive patients treated using the IABP or mAFP at Osaka Medical and Pharmaceutical University from January 2017 to June 2023. After exclusion of those with CS who were treated with only extracorporeal membrane oxygenation (ECMO), patients who required IABP or mAFP were enrolled in the current study. The primary outcome was 180-day mortality. Secondary outcomes were major [major bleeding (Bleeding Academic Research Consortium criteria 3-5), limb ischemia and stroke] and other complications (hemolysis, thrombocytopenia, acute kidney impairment and requirement of renal replacement therapy). Those outcomes were compared between IABP and mAFP.

Results: Of all patients, 62 (30.2%) received the mAFP and 143 (69.8%) the IABP. There were no significant differences in 180-day mortality between the devices (P=0.86). Further investigation according to the Society for Cardiovascular Angiography and Intervention (SCAI) shock stage classification demonstrated that the mortality rate for SCAI C was significantly lower in the mAFP group (P=0.02), while mortality was not significantly different for SCAI D/E (P=0.71). The major and other complications were more frequent in the mAFP group (61.3% vs. 46.0%, P=0.02 and 90.3% vs. 68.8%, P<0.001, respectively). In multivariate analysis, age ≥75 years [hazard ratio (HR): 2.37, 95% confidence interval (CI): 1.42-3.97], out-of-hospital cardiopulmonary arrest (OHCPA) (HR: 2.05, 95% CI: 1.04-4.08), ECMO use (HR: 5.05, 95% CI: 2.85-8.95) and major complications (HR: 2.11, 95% CI: 1.07-4.17) were independently associated with mortality. Moreover, age ≥75 years (HR: 2.06, 95% CI: 1.08-3.92) and ECMO use (HR: 6.67, 95% CI: 3.32-13.42) were independent predictors of major complications, whereas mAFP (vs. IABP) (HR: 5.27, 95% CI: 1.71-16.30), age ≥75 years (HR: 2.80, 95% CI: 1.28-6.11) and ECMO use (HR: 8.34, 95% CI: 2.33-29.9) were independent predictors of other complications.

Conclusions: Classical CS attained benefit from the mAFP, whereas it is still challenging for patients with severe CS, particularly OHCPA and requirement for ECMO. The use of mAFP was associated with more complications and its true impact on clinical outcomes remains to be determined.

Background: The application of ultrahigh-field cardiac magnetic resonance imaging (MRI), such as 9.4 T imaging, in mouse models remains challenging, especially under rapid heart rates (500-600 beats per minute), and its feasibility and reproducibility have yet to be thoroughly studied. Therefore, this study aimed to evaluate the feasibility and reproducibility of combining cardiac magnetic resonance feature tracking (CMR-FT)-derived strain parameters and conventional cardiac MRI parameters to image an acute experimental autoimmune myocarditis (EAM) mouse model under a 9.4 T ultrahigh field system and to assess its potential for the early diagnosis of acute EAM.

Methods: This retrospective study (conducted from December 2023 to December 2024) included 45 male BALB/c mice (30 EAM mice and 15 controls). EAM mice were injected with Complete Freund's Adjuvant (CFA; Sigma-Aldrich) to induce myocarditis. The control mice were treated with equal amounts of normal saline at the same time and position as those in experimental mice. CMR was performed with a 9.4 T scanner (Biospec 94/30; Bruker BioSpin) at 7 days, which included precontrast T1, postcontrast T1 and T2, and extracellular volume fraction (ECV) mapping. Left ventricular (LV) strain was evaluated via feature tracking. The diagnostic performance of CMR was evaluated through receiver operating characteristic (ROC) analysis.

Results: A total of 45 mice (30 EAM mice and 15 controls) were included. All parameters were feasible in the mice that underwent CMR, and there was excellent reliability, as indicated by intraclass correlation coefficients greater than 0.9 for both intra- and interobserver agreement across all parameters. Intra- and interobserver agreement was analyzed by intraclass correlation coefficients (ICC). EAM mice demonstrated significantly impaired strain parameters compared to healthy controls [global radial strain (GRS): 34.07%±2.49% vs. 38.20%±2.76%, P<0.001; global circumferential strain: -19.44%±1.40% vs. -21.4%±2.37%, P=0.001; global longitudinal strain: -17.03%±1.64% vs. -19.04%±2.03%; P=0.001]. In ROC analyses, combining GRS with T2 generated the best parameter for identifying acute myocarditis (area under the curve, 0.882; sensitivity, 88.7%; specificity, 82.0%) and provided incremental diagnostic value.

Conclusions: The feasibility of LV strain parameters combined with CMR conventional sequences in identifying EAM in mice at 9.4 T CMR has good reproducibility. For mice with preserved LV ejection fraction, the combination of T2 and GRS can significantly increase the ability to predict EAM within 7 days and provides incremental value as compared to conventional CMR parameters.

Background: Carbohydrate antigen 125 (CA125) has been associated with a higher risk of mortality and readmission after an acute heart failure (HF) episode. However, the utility of CA125 in evaluating prognosis in chronic and stable HF is not yet established. The aim of this prospective study was to assess whether there is prognostic value of plasma CA125 in chronic HF population with reduced ejection fraction (HFrEF) after a long period of clinical stability.

Methods: Prospective cohort study that included consecutive patients with stable HFrEF who were followed in the outpatient HF clinic of the General University Hospital of Elche (Alicante, Spain) between July 2018 and January 2019. Stability was defined as the absence of hospital admissions due to HF symptoms or use of intravenous diuretics for at least six months before the inclusion date. The primary outcome was all-cause mortality related to CA125. The secondary endpoints were HF admissions and total cardiovascular (CV) admissions. The association between CA125 and recurrent hospitalizations was evaluated by the Famoye bivariate Poisson regression model.

Results: The study included 116 patients [69±12 years, 71.6% males, left ventricular ejection fraction 33.4%±7.1%; 52.6% in New York Heart Association class I (indicating long-term stability)]. The median CA125 value was 9.15 U/mL [interquartile range (IQR), 6.15-14.08 U/mL]. During a median follow-up of 18 months (IQR, 13-19 months), there were 13 deaths, 47 HF admissions, and 60 CV admissions. After multivariate adjustment, patients with CA125 >9.15 U/mL had higher rates of HF admissions [incidence rate ratio (IRR) 2.49; 95% confidence interval (CI): 1.14-5.44; P=0.02] and CV admissions (IRR 1.88; 95% CI: 1.01-3.52; P=0.04) compared with those with lower levels. Higher CA125 values were also associated with an increased risk of mortality in a non-linear fashion (P=0.02). Additionally, CA125 levels correlated with serum sodium (P<0.001), inferior vena cava diameter (P=0.03), and inflammatory status (P=0.01).

Conclusions: In patients with stable chronic HFrEF, higher plasma CA125 was associated with an increase in the burden of mid-term morbidity and mortality. CA125 could be a surrogate marker of residual congestion and inflammatory activity in this particular scenario.

Background: Artificial intelligence-assisted quantitative coronary angiography (AI-QCA) has been developed to enable the automated, objective assessment of coronary artery stenosis without human intervention. Previous studies have shown its accuracy compared with manual QCA and intravascular ultrasound. In this study, we aimed to evaluate cardiologists' experience of analyzing coronary lesions with AI-QCA.

Methods: Ten board-certified cardiologists from multiple centers specializing in coronary intervention, with varying periods of experience, participated in this study. They analyzed angiograms from 180 patients with marked coronary stenosis requiring coronary revascularization. Correlations between manual QCA and AI-QCA were measured by using Pearson's or Spearman's correlation coefficients.

Results: The average System Usability Scale (SUS) score was 66.7, indicating marginal high acceptability. The angiographic frame selected by the cardiologists with AI-QCA assistance was within five frames of that elected by the QCA analyst in 64.2% of cases. Furthermore, the time taken by cardiologists to analyze angiograms with AI-QCA assistance was 1.5±0.9 s, significantly lower than that required by an expert analyst to perform manual QCA (88.1±35.5 s, P<0.001). Key angiographic variables, such as reference vessel diameter (RD), minimal lumen diameter (MLD), diameter stenosis (DS), and lesional length (LL), showed moderate-to-strong correlations between AI-QCA and manual QCA (e.g., distal reference diameter, R=0.74).

Conclusions: This prospective study showed that automated analysis with AI-QCA can be performed with an acceptable user experience as well as minimal human intervention and little additional time. Therefore, the application of AI-QCA in the Cath lab is feasible and potentially helpful during coronary angiography (CAG) and intervention.

Background: Acute coronary syndrome (ACS) remains one of the leading causes of mortality worldwide. This study investigates the diagnostic and prognostic value of circulating exosomal miR-20b-5p and miR-1273g-3p in ACS.

Methods: This retrospective study randomly included 138 patients diagnosed with ACS according to the 2020 European Society of Cardiology (ESC) Guidelines for managing ACSs and 129 controls with normal coronary arteries (NCA) between October 2020 and November 2023 in Meizhou People's Hospital. Plasma-derived exosomes were isolated from patients with ACS and NCA controls. The expression of miR-20b-5p and miR-1273g-3p was measured using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Major adverse cardiovascular events (MACEs) within 1 year after percutaneous coronary intervention (PCI) were recorded. Receiver operating characteristic (ROC) curve analysis was carried out to assess diagnostic performance, and Kaplan-Meier survival analysis with Cox regression was applied to examine association of exosomal miR-20b-5p with MACEs.

Results: Both exosomal miR-20b-5p and miR-1273g-3p were markedly elevated in patients compared with NCA controls. The ROC analysis yielded an area under the curve (AUC) of 0.705 [95% confidence interval (CI): 0.639-0.771] for miR-20b-5p and 0.720 (95% CI: 0.657-0.783) for miR-1273g-3p, both slightly lower than that of cardiac troponin I (cTnI) (AUC =0.761; 95% CI: 0.693-0.829). Combined detection of cTnI with miR-20b-5p and miR-1273g-3p achieved AUCs of 0.818 (95% CI: 0.764-0.871) and 0.794 (95% CI: 0.737-0.850), respectively. During follow-up, patients with elevated miR-20b-5p levels exhibited a significantly higher incidence of MACEs. Multivariable Cox regression confirmed an independent association between miR-20b-5p expression and MACEs, with a hazard ratio of 3.107 (95% CI: 1.157-8.340, P=0.02).

Conclusions: Exosomal miR-20b-5p and miR-1273g-3p represent potential diagnostic biomarkers for ACS, and miR-20b-5p also provides prognostic value for predicting MACEs.

[This corrects the article DOI: 10.21037/cdt-2024-692.].

Background: Stroke is the second-leading cause of death and the third-leading cause of disability, with acute ischemic stroke (AIS) being the most serious subtype. Systematic reviews of randomized controlled trials (RCTs) for AIS play a crucial role in formulating clinical guidelines and health policies. However, potential outcome reporting bias (ORB) in RCTs may skew the analytical results of systematic reviews and ultimately lead to suboptimal medical decisions. This study was conducted to investigate the prevalence and possible influencing factors of ORB in RCTs included in systematic reviews of AIS and to correct ORB at the level of systematic reviews.

Methods: A systematic literature search was conducted across three databases to retrieve subject headings and text terms related to AIS, RCTs, and systematic reviews, with the aim of identifying AIS-related systematic reviews published in 2022. ORB in trials was employed to assess the risk of ORB in RCTs, and multivariate logistic regression was used to identify the possible ORB-related factors, including registration, country, quality of journal, funding, sample size, and type of control. The correcting for ORB model was used to correct ORB evidence synthesis results.

Results: A total of 33 systematic reviews and 287 nonduplicate RCTs were included in this study. ORB was suspected in 138 (48.08%) of these RCTs. Statistically significant outcomes were more likely to be reported than were nonsignificant ones [relative risk (RR) =3.18; 95% confidence interval (CI): 2.77-3.64]. The potential factors associated with ORB were unregistered status [odds ratio (OR) =4.87; 95% CI: 1.93-12.28] and sample sizes smaller than 100 (OR =2.57; 95% CI: 1.30-5.10). The corrected results indicated that 31.58% of the therapeutic effects were overestimated due to reversal and that 16.67% of adverse reactions were underestimated due to reversal. Among outcomes without reversal, 56.52% of the effect sizes and 60.87% of the P values exceeded the clinically acceptable range.

Conclusions: The presence of ORB within the field of AIS poses a serious threat to the reliability of evidence synthesized in systematic reviews. In the future, healthcare practitioners and decision-makers should adopt a critical perspective when applying seemingly favorable results in clinical practice.

Background: Hypereosinophilic syndrome (HES) is a rare disease characterized by persistent eosinophilia associated with organ damage, and may be complicated by eosinophilic myocarditis (EM). However, the utility of strain imaging in these conditions remains unclear. We aimed to evaluate the value of strain imaging in HES.

Methods: We performed a cross-sectional study of all patients aged >18 years diagnosed with HES at Cleveland Clinic between September 1986 and January 2023. Left ventricular global longitudinal strain (LVGLS), left atrial (LA) strain, and right ventricular (RV) free wall strain were measured. The primary endpoint was a composite of stroke at diagnosis and major adverse cardiovascular events during the follow-up period. Outcomes were compared using chi-square tests.

Results: Of 1,664 patients with eosinophilia, 34 patients with confirmed HES were included in the final cohort. The mean age was 57±16 years, and 58.8% were female. The median follow-up duration was 85 months. Among them, ten patients (29.4%) were diagnosed with EM and twelve patients (35.3%) developed the primary endpoint. EM patients had significantly worse LVGLS (-9.7% vs. -15.5%, P<0.001), LA reservoir strain (21.0% vs. 32.1%, P=0.02) and LA contraction strain (-9.7% vs. -19.2%, P<0.001) compared to non-EM patients, but there was no significant difference in RV free wall strain (-17.5% vs. -23.4%, P=0.08). All EM patients and half of non-EM patients had LVGLS worse than -16%. Patients with worse LVGLS had significantly higher incidence of primary endpoint compared to patients with normal LVGLS (47.6% vs. 9.1%, P=0.03).

Conclusions: LVGLS is frequently impaired in patients with EM, and is associated with increased risk of stroke and major cardiovascular events. These findings suggest its potential as a marker of cardiac involvement and prognosis in HES.

Interval cross-sectional imaging plays an important role in aortopathy surveillance. Often, cardiac magnetic resonance imaging (MRI) is used over computed tomography (CT) due to the lack of radiation in repeated surveillance and the option of additional hemodynamic assessment. Primarily, assessment includes the orthogonal measurement of aortic dimensions in a three-dimensional (3D) structure. Lately, four-dimensional (4D) flow MRI is becoming more widespread as it can be acquired within 1-5 minutes using advanced techniques. In addition to standard flow quantification, 4D flow MRI offers advanced hemodynamic quantification. This review discusses important advanced imaging biomarkers, including helical flow pattern, wall shear stress (WSS), flow displacement and systolic flow reversal ratio (sFRR). It focuses on those parameters that can be analyzed using commercially available post-processing platforms and are accessible for clinical centers without the need for research setup and collaboration. WSS plays a role in the assessment of bicuspid aortic valve disease. Here it is elevated even without the presence of stenosis. Flow displacement is also of value in bicuspid aortic valve disease and is abnormal in heart failure with preserved ejection fraction (HFpEF) as well as chronic aortic dissection. 4D flow MRI is also useful in understanding and assessing flow changes in aortic valve replacement.